Scars and StripesScars & Stripes: Reading behind the lines

1/18/2008

In Wake of Afghanistan and Iraq, a New Generation of Homeless Veterans Emerges

Erin McClam, Associated Press

The Ledger Dispatch
Jan 17, 2008

January 15, 2008 - Leeds, Mass. - Peter Mohan traces the path from the Iraqi battlefield to this lifeless conference room, where he sits in a kilt and a Camp Kill Yourself T-shirt and calmly describes how he became a sad cliche: a homeless veteran.

There was a happy homecoming, but then an accident - car crash, broken collarbone. And then a move east, close to his wife’s new job but away from his best friends.

And then self-destruction: He would gun his motorcycle to 100 mph and try to stand on the seat. He would wait for his wife to leave the morning, draw the blinds and open up whatever bottle of booze was closest.

He would pull out his gun, a .45-caliber, semiautomatic pistol. He would lovingly clean it, or just look at it and put it away. Sometimes place it in his mouth.

“I don’t know what to do anymore,” his wife, Anna, told him one day. “You can’t be here anymore.”

Peter Mohan never did find a steady job after he left Iraq. He lost his wife - a judge granted their divorce this fall - and he lost his friends and he lost his home, and now he is here, in a shelter.

He is 28 years old. “People come back from war different,” he offers by way of a summary.

This is not a new story in America: A young veteran back from war whose struggle to rejoin society has failed, at least for the moment, fighting demons and left homeless.

But it is happening to a new generation. As the war in Afghanistan plods on in its seventh year, and the war in Iraq in its fifth, a new cadre of homeless veterans is taking shape.

And with it come the questions: How is it that a nation that became so familiar with the archetypal homeless, combat-addled Vietnam veteran is now watching as more homeless veterans turn up from new wars?

What lessons have we not learned? Who is failing these people? Or is homelessness an unavoidable byproduct of war, of young men and women who devote themselves to serving their country and then see things no man or woman should?

The 1,500

For as long as the United States has sent its young men - and later its young women - off to war, it has watched as a segment of them come home and lose the battle with their own memories, their own scars, and wind up without homes.

The Civil War produced thousands of wandering veterans. Frequently addicted to morphine, they were known as “tramps,” searching for jobs and, in many cases, literally still tending their wounds.

More than a decade after the end of World War I, the “Bonus Army” descended on Washington - demanding immediate payment on benefits that had been promised to them, but payable years later - and were routed by the U.S. military.

And, most publicly and perhaps most painfully, there was Vietnam: Tens of thousands of war-weary veterans, infamously rejected or forgotten by many of their own fellow citizens.

Now it is happening again, in small but growing numbers.

For now, about 1,500 veterans from Iraq and Afghanistan have been identified by the Department of Veterans Affairs. About 400 of them have taken part in VA programs designed to target homelessness.

The 1,500 are a small, young segment of an estimated 336,000 veterans in the United States who were homeless at some point in 2006, the most recent year for which statistics are available, according to the National Alliance to End Homelessness.

Still, advocates for homeless veterans use words like “surge” and “onslaught” and even “tsunami” to describe what could happen in the coming years, as both wars continue and thousands of veterans struggle with post-traumatic stress.

People who have studied postwar trauma say there is always a lengthy gap between coming home - the time of parades and backslaps and “The Boys Are Back in Town” on the local FM station - and the moments of utter darkness that leave some of them homeless.

In that time, usually a period of years, some veterans focus on the horrors they saw on the battlefield, or the friends they lost, or why on earth they themselves deserved to come home at all. They self-medicate, develop addictions, spiral down.

How - or perhaps the better question is why - is this happening again?

“I really wish I could answer that question,” says Anthony Belcher, an outreach supervisor at New Directions, which conducts monthly sweeps of Skid Row in Los Angeles, identifying homeless veterans and trying to help them get over addictions.

“It’s the same question I’ve been asking myself and everyone around me. I’m like, wait, wait, hold it, we did this before. I don’t know how our society can allow this to happen again.”

A history of violence

Mental illness, financial troubles and difficulty in finding affordable housing are generally accepted as the three primary causes of homelessness among veterans, and in the case of Iraq and Afghanistan, the first has raised particular concern.

Iraq veterans are less likely to have substance abuse problems but more likely to suffer mental illness, particularly post-traumatic stress, according to the Veterans Administration. And that stress by itself can trigger substance abuse.

Some advocates say there are also some factors particular to the Iraq war, like multiple deployments and the proliferation of improvised explosive devices, that could be pulling an early trigger on stress disorders that can lead to homelessness.

While many Vietnam veterans began showing manifestations of stress disorders roughly 10 years after returning from the front, Iraq and Afghanistan veterans have shown the signs much earlier.

That could also be because stress disorders are much better understood now than they were a generation ago, advocates say.

“There’s something about going back, and a third and a fourth time, that really aggravates that level of stress,” said Michael Blecker, executive director of Swords to Plowshares,” a San Francisco homeless-vet outreach program.

“And being in a situation where you have these IEDs, everywhere’s a combat zone. There’s no really safe zone there. I think that all is just a stew for post-traumatic stress disorder.”

Others point to something more difficult to define, something about American culture that - while celebrating and honoring troops in a very real way upon their homecoming - ultimately forgets them.

This is not necessarily due to deliberate negligence. Perhaps because of the lingering memory of Vietnam, when troops returned from an unpopular war to face open hostility, many Americans have taken care to express support for the troops even as they solidly disapprove of the war in Iraq.

But it remains easy for veterans home from Iraq for several years, and teetering on the edge of losing a job or home, to slip into the shadows. And as their troubles mount, they often feel increasingly alienated from friends and family members.

“War changes people,” says John Driscoll, vice president for operations and programs at the National Coalition for Homeless Veterans. “Your trust in people is strained. You’ve been separated from loved ones and friends. The camaraderie between troops is very extreme, and now you feel vulnerable.”

The VA spends about $265 million annually on programs targeting homeless veterans. And as Iraq and Afghanistan veterans face problems, the VA will not simply “wait for 10 years until they show up,” Pete Dougherty, the VA’s director of homeless programs, said when the new figures were released.

“We’re out there now trying to get everybody we can to get those kinds of services today, so we avoid this kind of problem in the future,” he said.

Unloading the dead

These are all problems defined in broad strokes, but they cascade in very real and acute ways in the lives of individual veterans.

Take Mike Lally. He thinks back now to the long stretches in the stifling Iraq heat, nothing to do but play Spades and count flies, and about the day insurgents killed the friendly shop owner who sold his battalion Pringles and candy bars.

He thinks about crouching in the back of a Humvee watching bullets crash into fuel tanks during his first firefight, and about waiting back at base for the vodka his mother sent him, dyed blue and concealed in bottles of Scope mouthwash.

It was a little maddening, he supposes, every piece of it, but Lally is fairly sure that what finally cracked him was the bodies. Unloading the dead from ambulances and loading them onto helicopters. That was his job.

“I guess I loaded at least 20,” he says. “Always a couple at a time. And you knew who it was. You always knew who it was.”

It was in 2004, when he came back from his second tour in Iraq with the Marine Corps, that his own bumpy ride down began.

He would wake up at night, sweating and screaming, and during the days he imagined people in the shadows - a state the professionals call hypervigilence and Mike Lally calls “being on high alert, all the time.”

His father-in-law tossed him a job installing vinyl siding, but the stress overcame him, and Lally began to drink. A little rum in his morning coffee at first, and before he knew it he was drunk on the job, and then had no job at all.

And now Mike Lally, still only 26 years old, is here, booted out of his house by his wife, padding around in an old T-shirt and sweats at a Leeds shelter called Soldier On, trying to get sober and perhaps, on a day he can envision but not yet grasp, get his home and family and life back.

“I was trying to live every day in a fog,” he says, reflecting between spits of tobacco juice. “I’d think I was back in there, see people popping out of windows. Any loud noise would set me off. It still does.”

Soldier on

Soldier On is staffed entirely by homeless veterans. A handful who fought in Iraq or Afghanistan, usually six or seven at a time, mix with dozens from Vietnam. Its president, Jack Downing, has spent nearly four decades working with addicts, the homeless and the mentally ill.

Next spring, he plans to open a limited-equity cooperative in the western Massachusetts city of Pittsfield. Formerly homeless veterans will live there, with half their rents going into individual deposit accounts.

Downing is convinced that ushering homeless veterans back into homeownership is the best way out of the pattern of homelessness that has repeated itself in an endless loop, war after war.

“It’s a disgrace,” Downing says. “You have served your country, you get damaged, and you come back and we don’t take care of you. And we make you prove that you need our services.”

“And how do you prove it?” he continues, voice rising in anger. “You prove it by regularly failing until you end up in a system where you’re identified as a person in crisis. That has shocked me.”

Even as the nation gains a much better understanding of the types of post-traumatic stress disorders suffered by so many thousands of veterans - even as it learns the lessons of Vietnam and tries to learn the lessons of Iraq - it is probably impossible to foretell a day when young American men and women come home from wars unscarred.

At least as long as there are wars.

But Driscoll, at least, sees an opportunity to do much better.

He notes that the VA now has more than 200 veteran adjustment centers to help ease the transition back into society, and the existence of more than 900 VA-connected community clinics nationwide.

“We’re hopeful that five years down the road, you’re not going to see the same problems you saw after the Vietnam War,” he says. “If we as a nation do the right thing by these guys.”

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8/27/2007

Cancer in Iraq Vets Raises Possibility of Toxic Exposure

Go to Original
By Carla McClain
The Arizona Daily Star

Sunday 26 August 2007

After serving in Vietnam nearly 40 years ago - and receiving the Bronze Star for it - the Tucson soldier was called back to active duty in Iraq.

While there, he awoke one morning with a sore throat. Eighteen months later, Army Sgt. James Lauderdale was dead, of a bizarrely aggressive cancer rarely seen by the doctors who tried to treat it.

As a result, his stunned and heartbroken family has joined growing ranks of sickened and dying Iraq war vets and their families who believe exposures to toxic poisons in the war zone are behind their illnesses - mostly cancers, striking the young, taking them down with alarming speed.

The number of these cancers remains undisclosed, with military officials citing patient privacy issues, as well as lack of evidence the cases are linked to conditions in the war zone. The U.S. Congress has ordered a probe of suspect toxins and may soon begin widespread testing of our armed forces.

“He Got So Sick, So Fast”

Jim Lauderdale was 58 when his National Guard unit was deployed to the Iraq-Kuwait border, where he helped transport arriving soldiers and Marines into combat areas.

He was a strong man, say relatives, who can’t remember him ever missing a day of work for illness. And he developed a cancer of the mouth, which overwhelmingly strikes smokers, drinkers and tobacco chewers. He was none of those.

“Jim’s doctors didn’t know why he would get this kind of cancer - they had no answers for us,” said his wife, Dixie.

“He got so sick, so fast. We really think it had to be something he was exposed to over there. So many of the soldiers we met with cancer at Walter Reed (Army Medical Center) complained about the polluted air they lived in, the brown water they had to use, the dust they breathed from exploded munitions. It was very toxic.”

As a mining engineer, Lauderdale knew exactly what it meant when he saw the thick black smoke pouring nonstop out of the smokestacks that line the Iraq/Kuwait border area where he was stationed for three months in 2005.

“He wrote to me that everyone was complaining about their stinging eyes and sore throats and headaches,” Dixie said. “For Jim to say something like that, to complain, was very unusual.”

“One of the mothers on the cancer ward had pictures of her son bathing in the brown water,” she said. “He died of kidney cancer.”

Stationed in roughly the same area as Lauderdale, yet another soldier - now fighting terminal colon cancer - described the scene there, of oil refineries, a cement factory, a chlorine factory and a sulfuric acid factory, all spewing unfiltered and uncontrolled substances into the air.

“One day, we were walking toward the port and they had sulfuric acid exploding out of the stacks. We were covered with it, everything was burning on us, and we had to turn around and get to the medics,” said Army Staff Sgt. Frank Valentin, 35.

Not long after, he developed intense rectal pain, which doctors told him for months was hemorrhoids. Finally diagnosed with aggressive colorectal cancer - requiring extensive surgery, resulting in a colostomy bag - he was given fewer than two years to live by his Walter Reed physicians.

He is now a couple of months past that death sentence, but his chemo drugs are starting to fail, and the cancer is eating into his liver and lungs. He spends his days with his wife and three children at their Florida home.

“I don’t know how much time I have,” he said.

Suspect: Depleted Uranium

None of these soldiers know for sure what’s killing them. But they suspect it’s a cascade of multiple toxic exposures, coupled with the intense stress of daily life in a war zone weakening their immune systems.

“There’s so much pollution from so many sources, your body can’t fight what’s coming at it,” Valentin said. “And you don’t eat well or sleep well, ever. That weakens you, too. There’s no chance to gather your strength. These are kids 19, 20 and 21 getting all kinds of cancers. The Walter Reed cancer ward is packed full with them.”

The prime suspect in all this, in the minds of many victims - and some scientists - is what’s known as depleted uranium - the radioactive chemical prized by the military for its ability to penetrate armored vehicles. When munitions explode, the substance hits the air as fine dust, easily inhaled.

Last month, the Iraqi environment minister blamed the tons of the chemical dropped during the war’s “shock and awe” campaign for a surge of cancer cases across the country.

However, the Pentagon and U.S. State Department strongly deny this, citing four studies, including one by the World Health Organization, that found levels in war zones not harmful to civilians or soldiers. A U.N. Environmental Program study concurs, but only if spent munitions are cleared away.

Returning solders have said that isn’t happening.

“When tanks exploded, I would handle those tanks, and there was DU everywhere,” said Valentin. “This is a big issue.”

The fierce Iraq winds carry desert sand and dust for miles, said Dixie Lauderdale, who suspects her husband was exposed to at least some depleted uranium. Many vets from the Gulf War blame the chemical used in that conflict for their Gulf War syndrome illnesses.

Congress Orders Study

As the controversy rages, Congress has ordered a comprehensive independent study, due in October, of the health effects of depleted uranium exposure on U.S. soldiers and their children. And a “DU bill” - ordering all members of the U.S. military exposed to it be identified and tested - is working its way through Congress.

“Basically, we want to get ahead of this curve, and not go through the years of painful denial we went through with Agent Orange that was the legacy of Vietnam,” said Rep. Raúl Grijalva, D-Ariz., a co-sponsor of the bill.

“We want an independent agency to do independent testing of our soldiers, and find out what’s really going on. These incidents of cancer and illness that all of us are hearing about back in our districts are not just anecdotal - there is a pattern here. And yes, I do suspect DU may be at the bottom of it.”

What’s happening today - growing numbers of sickened soldiers who say they were exposed to it amid firm denials of harm from military brass - almost mirrors the early stages of the Agent Orange aftermath. It took the U.S. military almost two decades to admit the powerful chemical defoliant killed and disabled U.S. troops in the jungles of Vietnam, and to begin compensating them for it.

Doctors Flabbergasted

Whatever it was that struck Jim Lauderdale did a terrifying job of it.

Sent to Walter Reed with oral cancer in April 2005, he underwent his first extensive and disfiguring surgery, removing half his tongue to get to tumors in the mouth and throat. A second surgery followed a month later to clear out more of those areas.

Five months later, another surgery removed a new neck tumor. Then came heavy chemotherapy and radiation.

Shortly after, he had a massive heart attack, undergoing another surgery to place stents in his arteries. Two weeks later, the cancer was back and growing rapidly, forcing a fourth surgery in January 2006.

By this time, much of his neck and shoulder tissue was gone, and doctors tried to reconstruct a tongue, using tissue from his wrist. He couldn’t swallow, so was fed through a tube into his stomach.

Just weeks later, four external tumors appeared on his neck - “literally overnight,” his wife said. Suffering severe complications from the chemo drugs, Lauderdale endured 39 radiation treatments, waking up one night bleeding profusely through his burned skin. The day after his radiation ended, new external tumors erupted at the edge of the radiation field, flabbergasting his doctors.

“As this aggressive disease grew though chemoradiation, it was determined at this point there was no chance for cure,” his oncologist wrote then.

By then, the cancer had spread to his lungs and spine and, most frightening of all, “hundreds and thousands” of tumors were erupting all over his upper body, his wife said.

“The doctors said they’d never seen anything like it - that this happens in only 1 percent of cases,” she said. Efforts to contact his doctors at Walter Reed were unsuccessful, but a leading head-and-neck cancer specialist at the Arizona Cancer Center reviewed the course of Lauderdale’s disease. “This a a very wrenching case,” said Dr. Harinder Garewal. “This is unusually aggressive behavior for an oral cancer. I would agree it happens in only 1 percent of cases.”

When oral cancer occurs in nonsmokers and non-drinkers, it tends to be more aggressive, he said. “My feeling is the immune system for some reason can’t handle the cancer,” he said.

Jim Lauderdale died on July 14, 2006, and was buried in Arlington National Cemetery.

Dixie and their two grown children still feel the raw grief of loss, but not anger, she said.

“But I am convinced something very wrong is happening over there. Is anyone paying attention to this? Is the cancer ward still full?” she asked. “I would hate to see another whole generation affected like this, but I’m very afraid it will be.”

——–

Contact reporter Carla McClain at 806-7754 or at cmcclain@azstarnet.com.

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5/25/2007

Memorial Day

Big three day weekend!

On my small island, it means the tourists are coming, in droves. The ferry dumps them off every three hours. Memorial Day. The beginning of the season. It also means a Pet Parade. Kids dress their pets in ridiculous costumes and proudly strut them down North Beach Road.

For a few residents of our island, and for a few residents in our country, it means memories. They remember fallen comrades. They re-experience the sting of battle, quietly, in the safety of their homes. A few will wander to a nearby cemetery, place flags, pay tribute, attempt to honor in the only way they know how.

For the majority of our citizenry, however, they barely remember that we are currently at war. They will grumble a bit at the high cost of gas, but it’s the dollar value that upsets them, not the number of lives that are currently being spewed in the desert.

They drive their SUVs to a beautiful green island for a three-day weekend, maybe watch the kids in the Pet Parade and spend a few dollars that contribute to the overall island economy.

At the end of the weekend, they will cram themselves onto the ferry, and drive bumper to bumper back to their sanctuary of denial.

If they have enough time, they may stop off to catch the last few minutes of a big three-day Memorial Day Sale. Those bargains are so important!

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5/4/2007

Symptomatic Persian Gulf War Vets Show Brain-Volume Deficits



Soldiers returning from Iraq in the early 1990s with several health issues display difficulty in learning and memory, new study says

According to preliminary results from a study probing the possible effects of chemical exposure during the Persian Gulf War, soldiers displaying multiple health-related symptoms upon their return from combat have decreased volume in two brain regions intimately linked to learning and memory.This morning at the American Academy of Neurology’s 59th Annual Meeting in Boston the study’s senior investigator, Roberta White, chair of the department of environmental health at the Boston University School of Public Health, revealed early findings based on brain scans and memory tasks administered to 36 veterans. “This study came out of a bunch of prior studies,” says White, who has published multiple evaluations of both the health and cognitive state of Gulf War vets since the early 1990s. In one study, she noted significant cognitive deficiencies in soldiers exposed to the plume resulting from the destruction of a suspected chemical weapons depot at Khamisiyah in southeastern Iraq in March 1991. Overall, 100,000 soldiers were informed that they might have encountered the nerve agent sarin in the blast. Exposure to the poison can result in loss of control of bodily functions as well as death. In the current study, White separated Gulf War veterans into two groups—low symptom and high symptom—based on the results of a health evaluation given to them upon return from Iraq at Ft. Devens, in Massachusetts. The average soldier reported five symptoms out of a possible 20, which included forgetfulness, headaches, fatigue, nausea, skin rash and joint pain. Half of the soldiers in the report White presented today returned from the war with more than five of these symptoms; the other half had less than five. Using magnetic resonance imaging (MRI), White’s team determined that soldiers in the high-symptom group consistently evidenced a pair of discrepancies in brain volume: Two regions, their cortex and rostral anterior cingulate gyrus were, on average, 5 percent and 6 percent smaller, respectively. (Both the cortex, the outermost layer of the brain, and the cingulate gyrus, located in the midbrain, are believed to associated with learning and memory.) In addition, the researchers also administered a memory evaluation called the California Verbal Learning Test—wherein subjects must memorize a list of 16 words and then recall them after time has passed or other lists have been committed to memory. This test registered the vets’ ability to acquire and retain information. In behavioral findings that matched the physical deficits that White had observed in the soldiers brains, the high-symptom group showed some cognitive deficiency, performing, on average, 12 to 15 percent worse on the test than their low-symptom counterparts. White says that the results revealed a statistically significant correlation between lower brain volume and poor performance on the learning test, adding that these preliminary findings suggest the physical brain discrepancies are likely “a marker for some kind of underlying central nervous system difference between high- and low-symptom groups.” Going forward, she plans to factor in the kind and amount of potentially harmful substances the soldiers were exposed to—chemicals ranging from pesticides to nerve agents, like sarin. Adding exposure into the equation, she says, “gets us much … closer to some kind of change or an effect of some kind of exposure in the Gulf.” As to whether these symptoms are part of a pathology known as “Gulf War syndrome,” an illness that has been linked to immune system disruptions in troops who had served in the Gulf War, White says she cannot be sure. “I have never been able, in 16 years of research, to identify a common core group of symptoms that could be characterized as Gulf War syndrome.”

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4/20/2007

PTSD Care at Fort Carson at Issue

The Gazette

Tom Roeder

Apr 20, 2007

Veterans for Common Sense

A group of senators Thursday called for an investigation of Fort Carson’s mental-health programs in a letter that alleges soldiers with PTSD have faced discrimination and have been unfairly discharged.

At issue is whether war-driven mental illness such a post-traumatic stress disorder in some soldier led to misconduct that got them kicked out of the service, said Steve Robinson, an advocate with Veterans for America who has lobbied for months for an investigation.

Robinson is particularly irked that Fort Carson has publicly told its officers that mental illness does not excuse bad behavior.

“When you teach a class that says PTSD is not an excuse for drinking and drugs, then you are reinforcing bad information,” said Robinson, who contends that soldiers use drugs and alcohol to treat their own symptoms.

Eight Democrats, including presidential hopeful Barack Obama of Illinois, signed the letter along with one Republican, Sen. Kit Bond of Missouri. It asks for the Government Accountability Office, Congress’ research arm, to report on mental-health care throughout the Defense Department and on specific allegations at Fort Carson, including whether soldiers have been improperly discharged or have been discouraged from seeking care.The letter says Obama and others want GAO to investigate because they haven’t received an adequate response from the Defense Department on mental-health questions.The Department of Defense has an investigation of mentalhealth treatment at Fort Carson and other installations, but that report is not expected to be released until mid-May.

Alex Glass, a spokeswoman for Sen. Patty Murray, D-Wash., said the GAO letter reflects national concerns and is not aimed only at Fort Carson officials. She said Murray has been hearing about problems with mental-health care at Fort Lewis, near Tacoma, Wash.

Mental health has been a major health issue for Fort Carson soldiers returning from war. Nearly 600 Fort Carson soldiers were diagnosed with PTSD last year, up from 102 cases in 2003, when soldiers started returning from their first tours in Iraq and Afghanistan.

Fort Carson spokesman Lt. Col. David Johnson said commanders at the post welcome scrutiny.

After allegations were raised last year, commanders at the post admitted mishandling a handful of cases and implemented a training program for officers and sergeants on how to care for soldiers with mental-health issues.

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4/15/2007

Broken Warrior

One soldier’s struggle

First it was the horrors of Iraq. Now, Rob Withrow is locked in a fight with his own Army superiors. He wants mental health treatment — they want him to face a court-martial

By CAROL SMITH

SEATTLE POST-INTELLIGENCER

Rob Withrow was a good soldier until he got back from combat duty in Iraq.

Now by his own admission, he is no longer anyone’s idea of a model fighting man. He screwed up, and he’s screwed up — an assessment the Army would agree with.

U.S. Army soldier Rob Withrow, photographed among the yellow ribbons tied to the Freedom Bridge across Interstate 5 near Fort Lewis. Since his problems began, Withrow has been reduced in rank from sergeant to private.

But that’s where their agreement ends.

Withrow wants mental health treatment. He has tried to commit suicide four times since returning from Iraq. He has been hospitalized in Madigan Army Medical Center’s inpatient psychiatric unit on multiple occasions and is currently on a cocktail of antidepressants and psychoactive drugs. He is a month out of treatment for an addiction to narcotic pain pills that he began taking to “numb out” the month he returned from Iraq and he does not fit the Army’s new criteria for deployment.

But now the Army wants to redeploy him to Iraq, and court- martial him over there. The charges stem from his pattern of not showing up on time, or sometimes at all.

Withrow’s case raises questions about how the Army handles soldiers with psychiatric illnesses, particularly PTSD and depression and whether discipline, or the threat of it, interferes with treatment.

Since his return from Iraq in November 2004, Withrow has received multiple Article 15s — the Army’s form of non-judicial punishment — for disciplinary issues related to “patterns of minor misconduct.” He’s been reduced in rank from sergeant to private.

If he is discharged for misconduct, he will lose benefits for his family, which is already facing a financial crisis related to his demotions.

“I’m not going to candy coat it,” Withrow said. “I’ll take responsibility for my part. I have purposefully not gone to work.”

At the time, medical records show he was struggling with depression, anxiety and post-traumatic stress disorder. He repeatedly informed doctors that he was late or absent to work because he was having difficulty waking up, in part because of powerful sedatives prescribed for sleep disturbances.

Still, prosecutors have indicated their intent to court-martial him in Iraq, said Capt. Geoff Deweese, Withrow’s defense attorney.

“I think it would be absurd for them to do that,” Deweese said. “You don’t bring someone with this kind of instability to a combat zone and risk harm to himself or others.”

Culture clash?

The military’s handling of mental health problems has come under intense scrutiny after an increase in the number of soldier suicides in Iraq in 2005. According to the Army’s most recent Mental Health Advisory Team Findings, the suicide rate was 19.9 per 100,000 soldiers in 2005, up from the year before. That review led to new mental health screening policies and more stringent criteria for sending soldiers to war with pre-existing mental health diagnoses.

“Severe mental disorders, such as schizophrenia, bipolar disorder and severe depression, preclude deployment,” Col. Elspeth Ritchie, the Army Surgeon General’s Consultant on Psychiatry, said in an e-mail. “Soldiers may not deploy on a variety of types of medication, to include lithium, antipsychotic agents, and anticonvulsant agents.”

But for soldiers such as Withrow, the reality after they return from deployment is that behavior stemming from mental health problems can result in disciplinary action rather than treatment.

The Army does offer several ways to provide psychological help for soldiers and is in the midst of testing a number of new programs to improve resiliency. Soldiers go through an extensive evaluation two to three months after their return to gauge adjustment back to life on the base and to spot any emerging health issues — physical or mental — said Fort Lewis spokesman Joe Piek. The Army also offers confidential help lines and other mental health counseling.

But the military culture, and sometimes the symptoms of depression itself — fatigue and despair — can still make it difficult for soldiers to find and benefit from treatment, said Dr. Jonathan Shay, Boston-based author and psychiatrist who specializes in combat stress injuries.

“What you have is a military that’s not set up to care for these soldiers,” said Tod Ensign, attorney and director of Citizen Soldier, a non-profit veterans advocacy group that has represented a number of soldiers with mental health histories who are being charged with misconduct. The Army, under pressure to keep its troops eligible for re-enlistment, discourages treatment that would deem them undeployable, he said.

If a soldier does seek treatment, often in tandem with discipline issues that stem from PTSD or other disorders, the Army’s preference is to discharge them for misconduct or for having pre-existing mental conditions, either of which would reduce the burden on the Veterans Affairs medical care system, Ensign said.

Withrow said when he first tried to get help, he felt like he was getting the runaround. So he gave up.

When his symptoms were bad enough for him to go to the emergency room, he did receive help. But his symptoms persisted, despite treatment. At the same time, he began having trouble in his unit with a commander he perceived as unsympathetic.

Withrow and his lawyer contend that if he had gotten the right help at the appropriate time, his situation never would have escalated.

Withrow says he wanted to stay in the Army. In the midst of all his turmoil, he pleaded to be reassigned to his original battalion in the 3rd Brigade, 2d Infantry Division, which he knew would be going to Iraq again. (It deployed last July.)

“They said they would welcome me back, even knowing everything that was going on,” said Withrow.

Now he wants a discharge on the best terms possible for himself and his family. Instead, he is facing a court-martial.

Born on the Fourth of July

Withrow, 27, was born in Gettysburg, Pa., on the Fourth of July. He enlisted in the Army and headed to boot camp 20 days after graduating high school in June 1997. A field artillery sergeant, he planned to make the military his life’s work.

In November 2003, he went to Iraq with the 1st Battalion, 35th Field Artillery Regiment. When he returned a year later, he received an Army Commendation Medal for “Exceptionally meritorious service as an air guard during operation Iraqi Freedom.”

Prior to returning from Iraq, he had no disciplinary record and consistently received good-conduct medals, his attorney confirmed. A memorandum from his first sergeant with his old brigade noted, “I would gladly serve with SPC Withrow in combat again because I believe him to be a true Warrior.”

Tall and lean with trimmed dark hair, Withrow is personable and straightforward while relaying his story, but bluish circles under his brown eyes betray fatigue. In addition to his legal and health problems, he is facing bankruptcy and loss of his base housing. He worries frequently out loud about what will become of his wife and three children if he goes back to Iraq. “I don’t want them to wind up on the street,” he said.

“When he got back, I could tell he was just different,” said Jenny Withrow, his wife of six years.

Like many of his comrades, he said he had images from Iraq burned into his brain — a mass grave with still decomposing men’s bodies layered over women’s and children’s, fresh bullet holes in his Humvee.

“I would lay in bed at night and wonder if this is the night I get blown up,” he said.

Adjusting to life back home wasn’t what he expected. He had left when his baby girl was 4 months old.

“When I got back, my daughter — it’s like she didn’t know me,” he said.

Other guys gravitated to alcohol, he said. “I gravitated to opioids. All I wanted to do is be numb.”

In May 2005, short on non-commissioned officers, the Army transferred Withrow to a different unit. But he didn’t click with his new command and missed the soldiers he had deployed with. “We were like family,” he said. His depression worsened and he started having difficulty waking. He began showing up at the ER with problems breathing from panic attacks. In August 2005, he was diagnosed with PTSD as well as depression and anxiety.

He was also late reporting to work on a number of occasions.

Instead of recommending him for mental health treatment, however, he was threatened with an Article 15 — a demotion. “They said fix your issues, or we’ll take your stripes,” Withrow said.

At his request, the Army did switch him to a different battery for a fresh start in September 2005. But the second day with that unit, he woke late again. He said that the night before, he laid in bed and contemplated killing himself.

Distraught, he first tried to cut his wrists. He then tried to drive straight into a tree at full speed with his seat belt off. He swerved at the last possible moment, he said.

“I drove myself straight to the ER instead,” he said.

He was admitted to the psychiatric ward and stayed four days before being discharged to full duty, with the understanding he would go through a two-week outpatient behavioral health program.

His commander picked him up from the hospital and offered him a chapter discharge “nice and quiet,” but Withrow, who had put in nearly nine years, wasn’t ready to give up the Army.

The scope of the problem

Estimates of the number of soldiers who suffer from PTSD and mental problems vary, but most experts agree that the nature of the fighting in Iraq sets up soldiers for psychological trauma.

According to Ritchie of the Surgeon General’s Office, an estimated 15 to 17 percent of deployed soldiers experience PTSD and 23 percent experience other behavioral health problems. Others put the numbers higher.

According to a study published last month in the Archives of Internal Medicine, nearly one-third (31 percent) of 103,788 veterans who had served in Iraq and Afghanistan were diagnosed with mental health or psychosocial problems upon their return.

The Surgeon General’s Office indicated about 11 percent of soldiers who have returned receive mental health diagnoses.

For Withrow, as his mental anguish grew, his problems with his commanders intensified.

“If I were his commander, I’d be frustrated with him as well,” said Deweese, who has also worked as a prosecutor.

At the end of March, Withrow was informed he would deploy this week with the 4th Brigade, 2nd Infantry Division back to Iraq.

As part of predeployment screening, an Army psychiatrist specified his “symptoms are not stable” and indicated he should have “no access to weapons or ammunition, no exposure to combat situations, no exposure to casualties, and was not recommended for deployment.”

The issue of whether to send him to Iraq for a court-martial is still pending.

P-I reporter Carol Smith can be reached at 206-448-8070 or carolsmith@seattlepi.com.© 1998-2007 Seattle Post-Intelligencer

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3/22/2007

A Perfect Storm: PTSD

“They fly the flag when you attack;
when you come home they turn their back.”
–(Iraq Veterans Against the War cadence)

Stacy Bannerman | March 12, 2007

The sole aspect of the Iraq War upon which Americans are united is the need to provide post-deployment mental health care for our soldiers. The good news is that no one wants to abandon the veterans coming back from Iraq as happened with far too many of the veterans of Vietnam. The bad news is that we already have. Nowhere is that more apparent than within the National Guard and Reserves, who typically go from combat to cul-de-sac in forty-eight hours.

Active-duty troops are required to participate in post-combat mental health care sessions for the first three months of their re-entry, but the Department of Defense has a 90-day “hands-off” policy pertaining to National Guard and Reservists. After serving some of the longest tours in Iraq, they undergo a few days of out-processing, which includes a brief mental health screening. Desperate to get home, Guard and Reservists will say anything that will enable them to leave. When they are released–without support or services –they scatter across states, and generally don’t report at their first post-deployment training drill for three months or more.

The separation from other soldiers creates a feeling of isolation at a time when support and connection with others who are going through the same emotional adjustments is critical.

Like most National Guard soldiers, my husband didn’t receive a comprehensive mental health evaluation until eight months after he returned from a year-long tour at the most-attacked base in Iraq. Nearly a year after his exam, in August of 2006, he was notified of the outcome: Post-traumatic Stress Disorder (PTSD). The Department of Veterans Affairs (VA) provides free health care services to veterans for a period of two years beginning on the date of their separation from active military service. By the time my husband was informed of his diagnosis and advised to get treatment, he had approximately six months remaining to access care. But the waiting list is long, and time is running out for him and for tens of thousands just like him.

The clock has already stopped for hundreds of Guard and Reservists who returned from Iraq suffering from PTSD that was either undiagnosed by the military, or the VA refused/delayed treatment. Pentagon statistics reveal that the suicide rate for U.S. troops who have served in Iraq is double what it was in peacetime.

Soldiers who have served–or are serving–in Iraq are killing themselves at higher percentages than in any other war where such figures have been tracked. According to a report recently released by the Defense Manpower Data Center, suicide accounted for over 25 percent of all non-combat Army deaths in Iraq in 2006. One of the reasons for “the higher suicide rate in Iraq [is] the higher percentage of reserve troops,” said military analyst James F. Dunnigan.

Despite the high risk factor, many soldiers who seek treatment are not receiving urgent care. “When he went to the VA, they didn’t have room to treat him that day,” said the mother of Jason Cooper, an Army Reservist in the Iraq War. Jason hung himself four months after coming back to Iowa. He was 23, a year older than Army Reservist Josh Omvig, and Marine Reservist Jeffrey Lucey, who also committed suicide after the VA’s failure to care. As did National Guardsmen Doug Barber, Tim Bowman, Staff Sgt. Jeffrey Jerome Sloss, and far too many others who have ended their lives rather than live them with the psychological equivalent of a sucking chest wound.

A “Perfect Storm” for PTSD
Post-traumatic Stress Disorder is the result of subtle biological changes in the brain chemistry as a response to severe stress, which alters the way the brain stores memories. During a particularly intense episode, the body releases massive amounts of adrenaline, and the physiological alterations associated with the intense emotional reaction create memories that disrupt normal life.

The markers of post-traumatic stress include nightmares; avoiding reminders of the traumatic event; hyper arousal, a physiological response to stress that can lead to irritability and restlessness; and drug use and alcohol abuse. “Veterans screening positive for PTSD reported significantly more physical health symptoms and medical conditions than did veterans without PTSD. They were also more likely to rate their health status as fair or poor and to report lower levels of health-related quality of life.”

Among soldiers who develop PTSD, “There was a strong reported relation between combat experiences, such as being shot at, handling dead bodies, knowing someone who was killed, or killing enemy combatants.”

More than any previous war, the Iraq War is likely to produce the highest number of soldiers suffering from PTSD There is considerable psychological distress associated with going into a country under the auspices of liberating a people, only to have them rise up against you, and it lingers long after the war has ended. Adding to the pressure is that many mental health officials believe that the nature of urban street fighting and insurgent warfare, coupled with heavy reliance on Guard and Reserve troops, will result in higher rates of PTSD amongst this group of veterans than those in previous conflicts.

Another reason for the escalating mental health challenges is that while soldiers typically spent one tour-of-duty in Vietnam, troops are serving two, three, and occasionally four rotations in Iraq. An additional challenge is the moral ambiguity of fighting a war without front lines, where the combatants are, or are dressed as, civilians. Many veterans are finding it difficult, if not impossible, to reconcile experiences such as shooting at civilians because they had failed to stop at a checkpoint.

“At least 30 percent of Iraq or Afghanistan [veterans] are diagnosed with PTSD, up from 16 percent to 18 percent in 2004,” said Charlie Kennedy, PTSD program director and lead psychologist at the Stratton VA Medical Center. The number of Iraq and Afghanistan veterans getting treatment for PTSD at VA hospitals and counseling centers increased 87 percent from September 2005 to June 2006, and they have a backlog of 400,000 cases, including veterans from previous wars. The most conservative estimates project that roughly 250,000 Iraq War veterans will struggle with PTSD.

These figures are particularly significant for citizen soldiers when considering that: A 2004 analysis of Operation Iraqi Freedom veterans who received VA health care revealed that 58 percent of the veterans seeking treatment were members of the Reserve/National Guard and 71 percent of Operation Enduring Freedom vets who utilized VA services were citizen soldiers.5 A 2006 report detailing VA health care utilization by Operation Iraqi Freedom veterans revealed that, of those who sought care for PTSD, 18 percent were formerly active duty personnel, and 30 percent were National Guard and Reservists.6 Even at their highest rates of deployment, Guard and Reservists represented no more than 44 percent of deployed forces; and, many studies conducted at Walter Reed Military Hospital don’t include Guard and Reserve soldiers.

National Guard and Reserve soldiers have less training and preparation for deployment, less cohesive units, and most never expected to see combat, factors that put them at significantly higher risk for stress-related disorders than active-duty military.

The Department of Defense has known this for at least a decade. They commissioned the Comprehensive Clinical Evaluation Program, which conducted post-deployment studies of Gulf War veterans. Rates of PTSD and attendant mental health issues were found in approximately 20 percent of regular enlisted, but upwards of 90 percent of Reservists who fought in the first Gulf War reported one or more PTSD-specific symptoms six months [post-deployment].

A 1996 study on the impact of long-term overseas deployments of Guard and Reserve troops found that “Reservists were more vulnerable than regular service soldiers…for psychiatric breakdown. [And] being a Reservist, having low enlisted rank, and belonging to a support unit increased the risk for psychiatric breakdown…Many such personnel entertained little expectation that they would ever be called to active duty.”

The same study found that almost 100 percent of Reserve personnel reported some symptoms of PTSD after overseas deployment in combat zones. Yet, according to an investigation by McClatchy Newspapers:

Even by its own measures, the VA isn’t prepared to give returning veterans the care that could best help them…The lack of adequate psychiatric care strikes hard in the states that have supplied a disproportionate share of the soldiers in the wars in Iraq and Afghanistan - often because of their large contingents of National Guard and Army Reserve troops…mental health services in those states rank near the bottom.

My husband, whom I once called Sergeant Sweet Bear, is not the man I married. He retreats to the dark corners in his mind filled with images of war: loading coffins onto planes, seeing family members gunned down because radio communication between checkpoints went on the fritz. The box on top of the vehicle held the remains of their uncle, killed in the crossfire of an earlier skirmish. They were on their way to the funeral.
Abandoning the Troops

The Government Accountability Office (GAO) recently released a report examining the Veterans Administration’s failure to give honest information for budget needs. Among other things, the study exposed that the VA used faulty information when planning for health care needs and (under) estimated treatment expenses for service members returning from Iraq and Afghanistan. It also showed that the VA used faulty information on when they would see real dollars from projected cost saving measures.

Yet, the Bush administration’s newly proposed budget for hospital and medical care for veterans faces a cut to $38.8 billion in 2009 and would hover around that level through 2012.

President Bush, who claims to support the troops, contends that the cuts to veterans care will ensure a balanced budget within five years. But what will restore balance for those of us whose lives are forever undone by the war and the disregard for our loved ones when they come home?

I appreciate the professed commitment to “getting it right this time,” and thank God folks are starting to call for an immediate exit from Iraq. But what the 99.4 percent of Americans who don’t have loved ones in uniform and have no family members who have EVER seen combat in Iraq don’t seem to fathom is that we get any do-overs. Our lives are at stake, and we really can’t afford this county’s flat learning curve.

“We have heard so much about what this military has learned in Vietnam [about Post-Traumatic Stress Disorder], and how they’re doing it differently now. We don’t see that at all,” said Nancy Lessin of Military Families Speak Out. For us, as we care for our wounded by ourselves, struggle alone with the phantoms of war, and watch our families fall apart, it is already far too late to “get it right this time.”

Stacy Bannerman is the author of When the War Came Home: The Inside Story of Reservists and the Families They Leave Behind, (Continuum Publishing, 2006) and an analyst for Foreign Policy In Focus. She is the director of Operation Occupation and can be contacted at: www.stacybannerman.com.

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3/19/2007

When Warriors Come Limping Home

Shameful details continue to emerge on the neglectful care extended to soldiers wounded in Iraq and Afghanistan. The Army’s inspector general reports that more than nine out of 10 disabled veterans have been kept waiting for benefit evaluations beyond the 40-day limit set by the Pentagon. Some have waited up to a year and a half for benefits.

A study of 650 soldiers at 32 Army bases portrayed a system overwhelmed by the dual wars. And the number of cases needing evaluation have leapt to 15,000 in 2005 from 9,000 in 2001. The system is stymied by a lack of trained personnel, modern computer systems and even wheelchair access for some of the returning wounded.

The story isn’t much better at the Veterans Affairs Department, responsible for shepherding wounded soldiers after service. With a backlog of 600,000 claims, the agency took four to six months to process a veteran’s initial paperwork and more than 20 months for appealed decisions, according to a survey by Congress’s Government Accountability Office. That study predicts that the veterans department will be swamped by 638,000 new claims in the next five years, adding up to $150 billion in costs.

Congressional critics are properly calling for the hiring of hundreds more workers to process the claims. Others urge a new policy that would automatically accept a veteran’s claim for disability benefits, with spot-checks to weed out weak claims. This seems both sensible and humane because more than four out of five claims are eventually approved under the currently overwhelmed system.

It seems like every day another member of the Army brass is out because of this scandal. That’s not nearly enough. President Bush has a clear responsibility to fix this shamefully broken system.

Veterans for America

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2/14/2007

A Valentine to Newlyweds Separated by Their Country

by Susan Van Haitsma
Published on Wednesday, February 14, 2007
by CommonDreams.org

The young woman and I talked into the night as we headed south on a Greyhound bus. Each minute of conversation carried us physically farther from but perhaps emotionally closer to the enlisted man she had married just three days prior. The wedding she had arranged and paid for in their home town had to be cancelled because his leave was revoked at the last minute, so she had traveled across the country for a visit with him that included a quick civil ceremony at the courthouse nearest his base. She described in almost comical terms their attempt at a honeymoon, braving subzero temperatures with bodies unused to a northern climate, with his close-shaven head and light sailor hat and her thin jeans, to walk downtown to see the sights. When she couldn’t feel her legs anymore, she told him, “Baby, I’m sure this is a nice place. Send me some pictures. But, for now, get me out of here!”

She said that they ate at the McDonald’s on base, “where their logo has a little anchor hanging on it - it’s kind of cute.” She didn’t expect the food prices to be so high there, nor had she or her husband counted on other expenses of military life when they had decided jointly on his enlistment several months ago. This hadn’t been her first trip to see him, and she hoped that she could go again by train in the coming weeks, bringing along her two children. But, she wondered if she could afford the travel, or even the purchase of winter clothing for her children. There were also the added costs of keeping up two households, as she put it - “his and ours.” She said that they had decided he should enlist in order to help support their family, but now she realized that the support they really needed was his presence at home.

Although I was a stranger, my seatmate expressed her concerns with a frankness that had not yet been altered by the ‘culture of silence’ that often engulfs military family members. With surprise rather than self-pity, she noted the ways her husband had already changed since basic training. She described his new obsession with order, his habit of lining up his shoes and even his toothbrush and toothpaste in precise, parallel fashion. She said that he suggested she do the same. He was more acutely aware of the time, of the number of minutes necessary to accomplish daily tasks. He walked in front of her instead of by her side. In his sleep, he called out as though he was responding to orders. She explained that he used to show his affection for her liberally in public and private ways, but now he was aloof, turning away from her in bed even during their honeymoon weekend.

Another unexpected consequence of being a military spouse was the paper work she had been required to sign in the case of her husband’s death. She described feeling physically sick as she and her husband listened to an official explain the necessary procedures: the personal effects that would be sent to her, the body, the funeral. Because he was in the Navy rather than the Army, she hadn’t foreseen such a discussion taking place in the first hours of their marriage. The death talk compounded her worry because he told her rumors had been circulating that his unit might soon be shipped to the Middle East.

I asked my seatmate what reasons, beyond the financial security they had hoped for but that so far had proven illusory, had guided their decision about her husband’s enlistment. She said that he “had a problem with authority” and had been fired from a series of jobs, so he felt that the military would help him achieve the discipline he needed.

I confided to my seatmate that the “I need more discipline” motivation is one of the most perplexing reasons for enlistment that I hear, and I hear it frequently. Self-discipline and coercion are opposites. But, I didn’t really need to explain that paradox to my seatmate, who already had described how the brand of discipline her husband was learning was leading to family separation rather than the family protection they were promised.

My heart aches when I think of the significant challenges this young couple faces, but I also am heartened by the fact that they are asking questions and discussing the discrepancies between what they know and what they are told. My valentine to them reads, “Question authority always.”

That jealous lover, Uncle Sam, pointed his long finger and shot an arrow into the joined hearts of this couple and said, “I want you to be mine.” But, they had pledged their hearts to one another, not to him.

Susan Van Haitsma is active with Nonmilitary Options for Youth in Austin, Texas and can be reached at jeffjweb@sbcglobal.net

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2/12/2007

Told to Wait, a Marine Dies

By Charles M. Sennott,
The Boston Globe

Sunday 11 February 2007

VA care in spotlight after Iraq war veteran’s suicide.

Stewart, Minnesota - It took two years of hell to convince him, but finally Jonathan Schulze was ready.

On the morning of Jan. 11, Jonathan, an Iraq war veteran with two Purple Hearts, neatly packed his US Marine Corps duffel bag with his sharply creased clothes, a framed photo of his new baby girl, and a leather-bound Bible and headed out from the family farm for a 75-mile drive to the Veterans Affairs Medical Center in St. Cloud, Minn.

Family and friends had convinced him at last that the devastating mental wounds he brought home from war, wounds that triggered severe depression, violent outbursts, and eventually an uncontrollable desire to kill himself, could not be drowned in alcohol or treated with the array of antianxiety drugs he’d been prescribed.

And so, with his father and stepmother at his side, he confessed to an intake counselor that he was suicidal. He wanted to be admitted to a psychiatric ward.

But, instead, he was told that the clinician who prescreened cases like his was unavailable. Go home and wait for a phone call tomorrow, the counselor said, as Marianne Schulze, his stepmother, describes it.

When a clinical social worker called the next day, Jonathan, 25, told again of his suicidal thoughts and other symptoms. And then, with his stepmother listening in, he learned that he was 26th on the waiting list for one of the 12 beds in the center’s ward for post-traumatic stress disorder sufferers.

Four days later, on Jan. 16, he wrapped a household extension cord around his neck, tied it to a beam in the basement, and hanged himself.

In life, Jonathan Schulze didn’t get nearly what he needed. But in death, this tough and troubled Marine may help get something critical done.

The apparent failure of the Department of Veterans Affairs to offer him timely and necessary care has electrified the debate on the blogs and websites that connect an increasingly networked and angry veterans community. It has triggered an internal investigation by the VA into how a serviceman with such obvious symptoms faced a wait for hospital care.

And it is being cited by veterans’ advocates and their allies in Congress as a searing symbol of a system that they say is vastly unprepared and under funded to handle the onslaught of 1.5 million veterans of the wars in Iraq and Afghanistan who are returning home, an estimated one in five of them with post-traumatic stress disorder, or PTSD. One in three Iraq war veterans is seeking mental health services, according to a report by an Army panel of experts last year.

The death of Jonathan also raises questions, among veterans and in Washington, about how far the military culture still has to go in dealing with the stigma often attached to cases of mental illness. Marines, especially, just aren’t supposed to cry out for help.

“My feeling is no veteran should be turned away, and definitely not a veteran who is openly saying he needs help and that he feels like taking his life,” said Jonathan ’s father, James, who is a Vietnam War veteran and comes from a family with a long tradition of military service.

“My son did his duty, he risked his life for his country, and he came home a broken person. And then the VA failed in its duty to care for him,” he said, sitting in the family home in front of a coffee table transformed into a shrine for his son, with framed photos and, folded in a neat triangle, the flag that draped his coffin.

Across the country, there are stories of veterans suffering with combat stress and PTSD, who are struggling to find help at VA facilities to deal with the problems they face, according to Steve Robinson, director of veterans affairs for the Washington-based Veterans for America, an advocacy group.

“Sadly, there are a lot of Jonathan Schulzes out there,” said Robinson, a veteran of the Gulf War who investigates cases all over the country of service members suffering from mental illness and other injuries who are struggling to get the care they deserve.

A Plea for Help

Jonathan’s case has prompted the US Department of Veterans Affairs , with 235,000 employees at a network of medical centers for servicemen and women, to launch an ongoing internal investigation into the details surrounding Jonathan’s death, according to Phil Budahn , a VA spokesman in Washington.

But beyond that, Budahn could say little. All patient files are confidential, he said, declining comment on any of the specifics of Jonathan’s case.

But VA officials have released 400 pages of documents on the case to the Schulze family. One document from that file showed that the VA clinical social worker, Daniel Ludderman, with whom Jonathan spoke by phone on Jan. 12 did not indicate in his notes that Jonathan had expressed suicidal thoughts.

A VA spokesman told local news organizations that there were emergency beds available in a psychiatric hold unit throughout January. But the VA has not responded to questions about why, if that was the case, Jonathan was not placed in one. Another looming question in the VA investigation is why there are only 12 beds for in-patient PTSD treatment in Minnesota. That number has remained unchanged for a decade, former state VA officials say, even as the nation has engaged in two wars, in Afghanistan and Iraq, in the past five years.

James and Marianne insist they both heard Jonathan clearly state that he was suicidal on Jan. 11. Marianne says she heard it again when Jonathan was speaking with the VA’s Ludderman on the phone the next day.

James believes the VA response thus far indicates that officials are worried more about protecting the VA’s image than in meeting the overwhelming need for more and better PTSD counseling for veterans returning from Iraq and Afghanistan.

“I heard what Jon said. They can doctor the records all they want; it is not going to change what I heard,” he said.

Major Cynthia Rasmussen, who worked for 18 years as a psychiatric nurse at the VA and who now runs the Army Reserve Combat Operational Stress Control Program at Minnesota’s Fort Snelling, said, “Jonathan’s case is classic and classically tragic.”

Rasmussen said that there are many excellent programs and treatment centers within the VA, but that effective delivery of service is spotty and inconsistent and that problems of poor communication between the military and the VA are thwarting attempts by service providers to treat those veterans who need help.

“That is what happened to Jonathan, and there are just hundreds of cases like this across the country. We are seeing them every day,” she added.

Descent into Mental Illness

Behind the stark details of the case is a more complex and nuanced picture of Jonathan’s descent into mental illness.

He arrived home last fall after a hellish tour of duty with Second Battalion, Fourth Marines in the Ramadi/Fallujah area of Iraq, where fighting was particularly intense in the spring of 2004. In letters home, Jonathan had described the combat deaths of 16 men he called friends. He himself was wounded by shrapnel twice.

In his neat grammar-school cursive, Jonathan described the death and danger that confronted his unit daily. He made it very clear: He was terrified.

“My heart is filled with sadness. And I ask God why,” he wrote on May 13, 2004, the day after two close friends were killed. “I pray so much and ask God to keep me out of harm’s way and get me back in one piece.”

One of his fellow Marines in the Fallujah area was 25-year-old Eric Satersmoen, who knew Jonathan from local bars in the Minneapolis area where Jonathan had worked as a bouncer. They traded news about mutual friends and the Vikings and the Minnesota Wild hockey team, and they vowed to stay in touch when they got back home.

When they did return, in the winter of 2005, they found they shared some other things: persistent nightmares, sleeplessness, anxiety, anger, and a tendency to use alcohol to numb themselves to all that.

But their experiences diverged in a critical way that underscores how the VA system sometimes succeeds and why it so often falls devastatingly short - right from the moment demobilized troops get ready to go home.

Returning Marines and soldiers are routinely asked to fill out a form in which they are told to self-evaluate their own mental health on a questionnaire about nightmares, anxiety, aggression, and suicidal thoughts.

The military says the forms are a way to highlight problems early. But veterans advocates say that all too often servicemen, eager to reunite with family and friends, give the forms short shrift. They simply check “no” to every question because they do not want to be delayed at the base with mental health appointments.

That’s what Jonathan told friends and family he did. And that’s also what his close friend Eric had done after his first tour, but was determined not to repeat this second time around.

This time he knew he had a problem. He checked “yes” to the boxes that asked about nightmares, anxiety, and violent outbursts. He was given a schedule of appointments and began to enter a long process of counseling that has allowed him to slowly heal and eventually to have in-patient treatment at the Minneapolis VA where he was given a bed in the PTSD ward.

Jonathan, meanwhile, returned home for 30 days’ leave. His family immediately saw that he was depressed and anxious. They heard him thrashing and yelling in his sleep. He was not the big, fun-loving young man he was before he went off to war, they said.

The family doctor, William Phillips, saw him and wrote a report that Jonathan appeared to be suffering classic symptoms of PTS D. He prescribed Valium and encouraged Jonathan to seek help when he returned to Camp Pendleton.

“I told him that when I came home from Vietnam, I just closed up and hardened my shell. It hurt me in life. I was a pole cat to live with, and I wanted to be sure he didn’t make the same mistake,” said his father.

After his 30 days’ home leave, Jonathan returned to Pendleton for 90 days before his final discharge notice would be given. That was when he really went off the rails. He was drinking heavily and getting in violent confrontations at local bars off the base and even with his own Marines. He had nightmares of firefights in which comrades died and civilians were caught in the crossfire. He refused to admit he suffered mental problems

“Marines don’t do weakness,” said his older brother Travis, 27, a Marine who also joined up straight out of high school. Travis served in Afghanistan in the fall of 2001 during the US-led military response to the attacks of Sept. 11, 2001. “That’s the attitude, and Jon was caught up in that world,” said Travis.

Jonathan was completely out of control. In the fall of 2004, he brutally beat a fellow Marine. He also threw a 200-pound potted tree through a plate glass window during a bar fight. He ended up spending one month in the brig. Military Police searched his locker and found steroids - he was an obsessive body builder. He was busted in rank from lance corporal to private and given a “general” rather than an “honorable” discharge.

Drinking and Self-Loathing

These kinds of discharges are on the rise among returning veterans, particularly among those suffering from mental trauma who veer into violence and substance abuse, according to Lieutenant Colonel Colby Vokey, who supervises the legal defense of Marines at Camp Pendleton.

For Jonathan, the “general” discharge status meant that he was ineligible for GI Bill benefits, including assistance for college tuition, and it was technically up to the discretion of the VA whether he would receive medical treatment.

The VA did accept Jonathan for treatment of his shrapnel wounds and back pain. Eric, his Marine buddy, tried to help him get assistance for his mental health issues as well. They sometimes waited the entire day for appointments and group counseling.

Through it all, Jonathan never stopped drinking. Friends and family say that every night he drank his trusted Wild Turkey by the shot glass and one beer after another to chase it down. When he was tired, he drank “Jager-bombs,” a mix of the potent German liqueur Jagermeister mixed with the energy drink Red Bull.

His friend Eric drank with him. It was not easy for either one of them when they talked about the war. Eric lost control sometimes, but nothing compared with the bouts of anger and depression and violence that he watched Jonathan go through. “Crazy Jonny,” as he called him, was on a different path.

Jonathan was wracked with feelings of self-loathing about his demotion in rank, his tainted discharge, and what he felt was a failure on his part to save his friends, several of whom were killed right by his side in Iraq. The obsession with lifting and steroids, Eric believes, were an expression of low self-esteem.

“He just never could be big enough and bad enough … It was like he was going to drink and lift his way through the mess,” Eric said.

Then at 8:35 p.m. on Jan. 16, Eric, who was in Florida on business, received a phone call from Jonathan, who was staying in an apartment in New Prague, Minn., that Eric owned and where he gave Jonathan a room.

Jonathan told Eric he was in the basement standing on a stool and tying a noose around his neck with an extension cord. A bottle of Captain Morgan rum, three-quarters’ full, was at his side, and he was slurring.

“I tried to stall him by being nice, and then I tried getting mad at him, telling him he was taking the easy way out. I told him, ‘What about your faith?’ I was doing everything I could,” said Eric.

“He said: ‘The hell with it all, the Marines, the VA, the hell with religion. The hell with it all. I am doing it,’” said Eric.

Then, Eric said, he heard the phone fall to the floor.

A Family Mourns

Last week, it was 10 below zero with the windchill factor in the farming town of Stewart. Before his shift at a nearby dairy plant, Jonathan’s father crunched through dry, drifting snow toward the St. Paul’s Lutheran Church cemetery to visit his son’s grave.

Dead flowers from the funeral and a small American flag that marked the grave were disappearing beneath the drifting snow.

“This never should have happened,” said James, tears welling behind a pair of sunglasses.

“This country should have taken better care of one of its sons. They owed that to Jon.”

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	U.S. Army soldier Rob Withrow, photographed among the yellow ribbons tied to the Freedom Bridge across Interstate 5 near Fort Lewis. Since his problems began, Withrow has been reduced in rank from sergeant to private.