"The Reckoning," a National Journal article by James Kitfield

8/4/2019 "The Reckoning," a National Journal article by James Kitfield

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september 10, 2011 national journal22


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The odyssey begins: Soldiers in Aghanistan

evacuate a comrade who stepped on a land mine.

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The troops come home rom

war much the way they let,largely invisible to a dis-tracted nation. Returningunits are typically met at anaireld by buses that shut-tle them to a gated military

base. On a parade ground, a commander re-minds the assembled, some o the more than2.3 million service members deployed duringthe past decade o war, o all that they accom-plished. He recalls the brothers in arms whodidnt make it back and the memories that

unite those who did. The shared hardships,the moments o terror and elation, the con-stant joking that held the awulness at bay.The unbearable melancholy that descends atthe playing o Taps.

The commander dismisses the orma-tion, and the troops realize that the ties that

bound their lives together are breaking. Themarried service members run into the openarms o their amilies, husbands holding ba-

bies theyve never met, uniormed womenhugging young children they can hardly rec-ognize. Even beore the smiles and tears sub-side, spouses sense the vast gul that now lies

between them and wonder how to get across.Single troopers head or the barracks, crack-ing wise but oten wishing that they, too, hadamily to welcome them home. And, inevita-

bly, there are the stragglersyoung soldiersshuing and chain-smoking, unsure o whereto go or what to do next. Having come o ageon distant battleelds, they are suddenly lostin America.

Even Col. David Sutherland, a decoratedcommander who served in Iraq, was shocked

by the dizzying sense o alienation he elt onreentry. Never in the history o our Repub-lic have so ew been asked to do so much orso long. And yet, when soldiers return home,they eel acutely this disconnect between themilitary and a civilian society that doesnteven seem to be at war, says Sutherland, theJoint Stas special assistant in charge o the

Warrior and Family Support program. Weall into the same trap o our athers rom

World War II or Vietnam, which is to keep thememories o those sacred moments on the

battleeld to ourselves. Thats how they be-come secrets, and secrets are not healthy.

Tens o thousands o other troops returnhome on the aeromedical-evacuation ightsthat land routinely at Andrews Air Force Base

in Maryland or Travis Air Force Base in Cali-ornia, where the buses waiting to meet them

bear large red crosses. The critically wound-ed emerge rom the massive C-17 transportsrst, nearly invisible beneath bandages, a

jungle o medical equipment strapped totheir gurneys. Next out are the less-dire cas-es, carried on stretchers. Finally, the am-

bulatory patients shue single le to thewaiting buses. In the past decade, Air Mobil-ity Command has own more than 35,600aeromedical-evacuation sorties, transport-ing more than 177,000 wounded or ill service

members home.Sta Sgt. Dan Nevins was one o those pa-

tients who landed on the tarmac at Andrewsin 2005 clinging to lie. Having already lostone leg, he ought through 18 months and 30surgeries at Walter Reed Army Medical Cen-ter trying in vain to save the other. In retro-spect, nally letting go o my other leg andgetting on with my lie was the best decisionI ever made, says Nevins, who now works orthe nonprot Wounded Warrior Project help-ing other injured veterans try to get on withtheir lives.

Thousands o other troopers have re-

turned home in ag-draped cofns at Do-ver Air Force Base in Delaware. Last month,President Obama and other senior ofcialstraveled to Dover to honor the 30 Americantroops killed in Aghanistan on Aug. 6 atertheir helicopter was shot down, the worstsingle-day loss o the long Aghan war. Their

names joined the honor roll o more than6,000 allen service members rom Iraq and

Aghanistan. The deaening silence o thedead continues to send shock waves througha landscape o grie inhabited by their ami-lies and comradesthe collateral wounded othese wars.

A death in the military is unlike any oth-er loss in our society, because there are somany complicating actors, says Bonnie Car-roll, ounder and president o the Tragedy

Assistance Program or Survivors, or TAPS,which reaches out to grieving military ami-

lies with peer proessionals who have socialwork degrees and have also lost loved ones inthe military. Because deaths oten happen onlong combat deployments, Carroll says, griev-ing spouses sometimes trick themselves intothinking that a missing service member willstill walk through the ront door someday.Other times, the manner o death is so trau-matic that amilies receive multiple sets oremains. When a death is so horric in na-ture, and the spouse hears about it repeatedlyin the media or third-party accounts, they cancreate a memory that leads to their own post-traumatic stress disorder.

THE PATHOLOGY OF WAR

Every war leaves its imprint on those whoght it and on the national psyche. At the 10-

year mark, the wounds and mental scar tissuerom Aghanistan and Iraq have amassed intosomething like a pathology unique to theseconictsone that will aict this countryor a generation.

Due largely to advances in combat medi-cine, rapid aeromedical evacuation, and bodyarmor, the wars have proven to be the leastlethal in modern U.S. history. According toDr. Ronald Glasser, a Vietnam-era Army sur-geon and the author o the recent book, Bro-ken Bodies, Shattered Minds: A Medical Odysseyrom Vietnam to Aghanistan, or every battle-eld death, 16 service members survived their

wounds. The ratio in Vietnam, he said, was2.4 wounded or every death. In the Civil War,the ratio was less than 1-to-1, with ew soldierssurviving battleeld wounds.

In his book, Glasser warns that the na-tion will ace a moral and economic reckon-ing in caring or so many wounded veterans.Because o body armor there have been rela-tively ew o the penetrating chest wounds orabdominal injuries that caused so many battle

Marching Home

Veterans of Iraq and Afghanistan leaving

active duty (estimated)

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

Source: Veterans Affairs

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same risk. When a lot o us Vietnam veterans returnerom war, it took us a decadeor even two beore we wouldeven talk about what happened, and we bottled up alot o anger and hurt, saysTom Mitchell, a state directoror U.S. Vets, a nonprot tha

works to get homeless veterans o the streets. A lot o usare determined not to let thathappen with this new genera

tion o combat veterans romIraq and Aghanistan.

THE VOLUNTEERS

Todays wars are the rst extended conicts to be oughtnot by dratees but by a rela-tively small cohort o volunteers. That partly explains

why the pathologies specic to this wahave been so hard to predict. Like previousgenerations, however, todays veterans generally keep the toxic atereects o war tothemselves; they are simply too painul to ad

mit or conront.The small size o the all-volunteer orceor instance, has necessitated multiple com

bat deployments with inadequate breaks in between, which mental-health experts believe greatly increases the propensity orPTSD and its eects: depression, drug abuseailed marriages, and emotional distress. TheDeense Departments Task Force on MentaHealth ound in 2007 that 38 percent o allactive-duty service members have reportedpsychological symptoms ater their tours. Insome months this year, the suicide rate oractive-duty service members has exceededcombat deaths, and in April, the VAs suicideprevention hotline received more than 14 ,000callsthe most ever recorded in a singlemonth. Dr. Robert Petzel, the VA undersecretary o health, says that doctors have becomeexpert at recognizing and treating PTSD. Itprobably true that multiple combat deployments increase the likelihood o PTSD, he

warns, though we dont have adequate research to prove that yet.

Todays all-volunteer orce is also older than its drat-era counterpart, with moremarried service members and a larger num

ber o uniormed women (14.6 percent o

deaths in past wars, he tells National Journal.But no one was really prepared or the num-

ber o seriously wounded survivors. Accord-ing to the Pentagon, 168,000 service mem-

bers wounded or injured in these wars are

graded 60 percent disabled or higher, andthe VA aces a 492,000-case backlog o dis-ability claims. More than 508,000 veterans otodays wars have already been treated at VAhospitals and clinics. The Congressional Bud-get Ofce estimates that the medical costs as-sociated with todays veterans could come to$40 billion to $55 billion over the next decade.

Just as the current wars have dragged on,with tactics and geography shiting over theyears, the pathology o these wounds has alsomutated over time. Early on in Aghanistan,or instance, small arms caused many inju-ries. A ew years into the ghting in Iraqasinsurgent bombs got bigger and the armoron U.S. military vehicles got thickertroopsabsorbed blast waves through their seats,causing a spike in spinal-cord injuries, con-cussions, and brain trauma. Over the last18 months in Aghanistan, the prole haschanged again.

As Aghanistan has turned primarily intoa war o dismounted inantry, our polytrauma

wards have seen a huge inux o troopers withreally massive injuries rom absorbing blasts

while on oot patrol, including multiple am-putations, really severe brain injury, and theemotional wounds that go with all o that,

says Dr. Shane McNamee, the chie o physicalmedicine and rehabilitation at the VAs Poly-trauma Rehabilitation Center in Richmond,

Va. In the past ve years, I cant tell you howmany times we have regeared to tailor our

care delivery to subsequent waves o servicemembers with dierent kinds o wounds.But improvised explosive devices, the en-

emy weapon o choice in both conicts, havecaused their signature wounds, creating morethan 1,300 amputees, numerous burn victims,and unknown numbers who suer rom trau-matic brain injury. According to the advoca-cy group Veterans or Common Sense, morethan 190,000 troops have suered a con-cussion or brain injury. There is also grow-ing evidence o links between TBI and post-traumatic stress disorder. They both injuresimilar areas o the brain and exhibit simi-lar symptoms, says McNamee. The lines

between them are pretty gray. Accordingto a 2008 Rand survey, one in ve veteranso these warssome 300,000 peoplearesuering either rom major depression orPTSD, while 320,000 have suered concus-sions or TBI.

Those growing numbers are signicant. Byallowing the Vietnam Warand the physicaland emotional trauma it causedto recederom our national consciousness, Americainherited an epidemic o veterans sueringrom the attendant ills o PTSD. Today, thepost-9/11 generation o volunteers aces the

A deep bench:As a share o soldiers injured, more

wounded soldiers survive now than ever beore.


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26 september 10, 2011 national journal

the active-duty total). More than 220,000 women have served in Iraq and Aghani-stan, meaning that theyve borne a highershare o the burden than in past wars. Ater9/11, the military divorce rate climbed rom2.6 percent per year in 2001 to 3.6 percentin 2010. And 7.8 percent o women in the mili-tary divorced in 2010. (Because the military

does not track overall divorce rates, count asdivorced those service members who remarryin a given year, or ollow up on the divorce rateo military personnel a year or two ater theyleave service, many experts believe the Penta-gon underestimates the actual rate o militarydivorce.) Overall divorce rates in the militarycould climb to as high as 80 percent or rstmarriages, which would mean that service inthe military is becoming a precursor or di-

vorce, says Leticia Dreiling, a Houston VetsCenter marriage and amily therapist.

According to the VA, about one in ve e-male veterans, or 20 percent, have also test-

ed positive or posttraumatic stress related tomilitary sexual trauma, a catch-all categorythat includes everything rom sexual harass-ment to rape. I actually think the militarysexual trauma among women is much higherthan the ofcial gures, because we nd thata lot o women service members eel guiltyeven talking about it, says Judith Broder, aclinical psychologist who started The SoldiersProject, which oers ree mental-health coun-seling to returning veterans. Women veter-ans oten eel like its a betrayal o their unitto speak about sexual trauma, so they tend tocarry that wound a long time in silence, which

increases the likelihood that it will developinto combat-stress disorder. Women are alsothe astest growing subset o the homeless-

veteran population in America, accordingto Broder. Some land on the streets withtheir children.

As a percentage o the overall deployedorce, the National Guard and Reserves havealso shouldered more o the burden in A-ghanistan and Iraq than in wars past. Yet ascitizen-soldiers, reservists are less preparedor the stresses o a long combat tour. Indeed,the Task Force on Mental Health ound that49 percent o National Guardsmen report-ed experiencing psychological troubles atertheir deployments.

With the wars now winding down, thePentagon estimates that as many as 1 mil-lion service members are likely to leave activeduty in the next ve years. They will enter astruggling economy where the jobless rate or

young (ages 18 to 24) male veterans o Iraqand Aghanistan was 21.9 percent last year,and where veterans make up an estimated 20percent o the homeless population. Many ex-perts believe that the nation is simply unpre-pared or that approaching army o suering.

There are combat wounds you can see,

and others that are invisible until symptomsdevelop long ater service members returnhome, and were seeing an increase in virtu-ally all o the metrics that track them, saysclinical psychologist Barbara Van Dahlen, theounder and president o the nonprot Givean Hour, which connects veterans to a net-

work o 6,000 mental-health proessionals orree treatment.

Despite improvements in the military andVA health care systemsand the cooperationo nearly 5,000 nonprots that serve militarypersonnelVan Dahlen sees a population atsevere risk. We should have learned rom

Vietnam, because all you have to do is studythe homeless population today to understandthat an awul lot o those veterans never re-ally made it all the way home, she says. I wedont get ahead o the challenge, we will risklosing this generation o veterans.

THE ODYSSEY

The odyssey begins on a day like any other,

logging duty in a araway and unamiliar land.Dan Nevins began in Iraq in a Humvee that

was bouncing down a dusty road outside theSunni-insurgent stronghold o Falluja. With-out warning, his vehicle struck a roadside

bomb. In an instant, Nov. 10, 2004, becamethe day that changed his lie orever. By thetime Nevin arrived at the U.S. military hos-pital in Landstuhl, Germany, 12 hours later,he had already lost one leg. Eventually, he lostthe other to a bone inection.

In 2004 and 2005, the insurgencies thatwould eventually drive Iraq to the brink o civ-il war grew; correspondingly, the number ocritically wounded service members pouringinto the military medical system spiked. Nev-in had to wait a week to get space on one o thecrowded medical ights rom Germany, and

when he arrived at Walter Reed Army Medi-cal Center, the sta was nearly overwhelmed.The care was absolutely world-class, hesays. But the caregivers just couldnt handleall o the wounded. Those guys worked day

Faster than ever: A medevac team

in Kandahar (above); in Marja (below).


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soldiers rom the paralyzing ears that haunted young troopers at Walter Reedthe notion that the military was abandoning them atheir moment o greatest need.

Lt. Col. Danny Dudek, who now works othe Warrior Transition Command, realizedhow precarious he elt when his own odys-sey began in 2007. While traveling north o

Baghdad just three months earlier, a penetrat-ing explosive hit his armored Stryker ghting vehicle. The blast killed the soldier next tohim and caused a spinal-cord injury in Dudekthat let him paralyzed below the knee. Within days, he had been through surgery at Walter Reed; within a ew months, he was sentto the VA hospital in Seattle to recover nearhis amily. The care was excellent, but Dudekelt beret o the camaraderie and supportstructures that he had come to depend on inhis unit and somewhat lost in the VA bureaucracy. We overlooked all the other stu thatgoes into being a soldier, like being able to rely

and night, but it was a constant battle to getappointments i you needed a modication to

your prosthetic leg. And when you did get anappointment, you could wait hours.

Leaders o the military health care systemwere also beginning to realize the complex-ity o providing lie-saving and rehabilitativecare or so many severely wounded troops.

Nevins Reserve activation had orced him totake a major pay cut rom his job selling phar-maceuticals in Caliornia. Because his wiecouldnt aord to leave her own job, he couldonly see her one weekend every six weeks orso, putting more strain on their marriage. Yetcompared to some o the younger active-dutypatients who were told they were too injuredto continue servingmeaning orced separa-tion rom the only job and culture they hadknown as adultshe elt lucky. As a reserv-ist, I had a college degree, a good job, and asupportive amily to go home to, Nevin says.Some o those young kids joined the mili-

tary right out o high school, however, andthey didnt have any o that to all back on.So they ound every excuse imaginable not to

be released rom Walter Reed. I thought theywere crazy at the time, but later I realized thatthose young guys barely into their 20s wereparalyzed with ear about what came next.

By 2007, the problems at Walter Reed ex-

ploded into a ull-blown scandal when TheWashington Postpublished a series o articlesdetailing neglect, overworked case managers,and shoddy inrastructure. The commandero Walter Reed and the secretary o the Armyresigned. But the scandal helped show thePentagon and VA that their understaed andstovepiped medical acilities were still unpre-pared or the wounded and maimed patientsoten transitioning back and orth betweentheir systems. For the Army, the result was thecreation o the Warrior Transition Command.From the beginning, its mission was to pro-tect subsequent waves o returning wounded

The care was excellent, but Dudek felt bereft of thecamaraderie and support structures that he had come todepend onand somewhat lost in the VA bureaucracy.

Injurious: Soldiers who survive IED attacks

sufer a particular set o medical problems.


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on strong leadership, showing up or orma-tion, knowing that our amilies are taken careo, Dudek says. I think the Army realizedthat we cant just treat wounded soldiers likepatients. We need to continue to treat themlike soldiers, too.

That epiphany led to the establishment in2007 o 29 community-based Warrior Tran-

sition Units or all soldiers whose care re-quires at least six months o complex medi-cal treatment. The units blend the eorts oa primary-care doctor, a nurse case manager,and a squad leader. Soldiers help shape theirown comprehensive transition plans, whichinclude career and employment goals; Soldierand Family Assistance Centers aid their am-ily members.

Still, the challenges are so complex thateven this well-intentioned program initially

went awry in some places. Media investiga-tions o various units showed conicts be-tween the medical and military sta, over-

crowding, and an overreliance on medication. An Army Inspector Generals report issuedin January estimated that up to a third o allsoldiers in Warrior Transition Units last year

were overmedicated, hooked on drugs, orabusing illegal substances.

The Army has investigated the charges buthasnt backed away rom the concept. Wedid have some inexperienced leaders in War-rior Transition Units who didnt ully under-stand the complexity o tailoring a treatmentregime to each soldier, and some soldiers doeel that military drills get in the way o theirrecovery, says Dudek, who commanded a

transition unit in Seattle. There were alsosome conicts between nurse case manag-ers and squad leaders. But with good leader-ship, that organizational riction usually getsquickly resolved. He adds that the last thing

we need to do is come back wounded and justtake a knee. What I told my soldiers is that

you have to ght to overcome the pain, the ap-athy, and the ear o an uncertain uture. Andor me and a lot o them, it is the hardest ghto our lives.

FALLING THROUGH THE CRACKS

When Lance Cpl. Nancy Schiliro was medi-cally discharged rom the Marine Corps in2005 ater losing an eye in a mortar attack inIraq, there was no long counseling session ortransition unit. They hadnt been created yet.One day she was living in the 24/7 bubble olie as a Marinebeing told what to do, whereto go, when to eat, and who to hang out withand the next day she was home and that bub-

ble had burst. The whole experience wasso disorienting that, or six months, Schil-iro didnt even realize that she was sueringrom PTSD. I wasnt sleeping. I jumped atloud noises. I basically stayed to mysel andstopped interacting with people. I just wasnt

me, she says. Finally, her brothers ather-in-law, himsel a ormer Marine, called a riend ata local veterans center, who reached out. Itstaken me awhile to learn how to manage mydisease, and its gotten better, she says. ButI dont think Ill ever be totally cured.

Cases like Schiliroveterans who needcare but all into the gap between military

medical treatment and VA ollow-on carehave driven reorms designed to make thetransition more seamless. The Pentagon andthe VA established a Joint Executive Councilthat issued 26 initiatives to standardize treat-ment and evaluation systems. For instance,military treatment acilities today typicallydont release a wounded service member un-til he or she has scheduled appointments inthe Veterans Health Administration system.I requested, one o a hundred VA transi-tion patient advocates will even travel withservice members as they move rom ma-

jor military hospitals to VA hospitals closer

to home. Anticipating demand, the VA alsohired 7,000 mental-health ofcials in re-cent years, expanded suicide-prevention ho-tlines, and established caregiver programs

that provide stipends and travel allowancesor amily members who care or seriously

wounded veterans. The departments o De-ense and Veterans Aairs have gone rom arelatively low-level o interaction in 2001 toa degree o cooperation that is historicallyunprecedented, says Petzel, the VA healthundersecretary.

For all o those advances, however, major problems persist. Despite the move to ajoint disability evaluation process designed tostreamline claims procedures, some veteransare still waiting up to 400 days or a decisionon whether they will receive payments and at

what levels, and a backlog o nearly 500,000late claims have gone beyond the 125-daystandard at the VA. Until disability payments

begin, easing some o their nancial burdens, wounded veterans are susceptible to alcoholor drug abuseor worseto alleviate theirsuering. I know that VA and DOD have bigchallenges, Senate Veterans Aairs Com-

mittee Chairwoman Patty Murray, D-Wash.,said at a hearing earlier this year. But servicemembers and veterans continue to take theirown lives at an alarming rate. Wait times or

benets continue to drag on or anaverage o a year or ar more.

Another sign o trouble: Despiteaggressive outreach, only about halo the Iraq and Aghanistan vetshave even registered with the VA,meaning there is a vast at-risk pop-ulation. A chie lesson o Vietnam

was that we need to get new veter-ans help as early as possible, beore

their lives spiral into crisis, saysFern Taylor, supervisor o a clinicor returning veterans at a VA hos-pital in Houston. Too oten, ourrst contact with a veteran is in theemergency room, through the crim-inal-justice system, or on our sui-cide-prevention hotline.

Kathy Molitor, the suicide-prevention coordinator at a VA post-deployment clinic in Houston, hasno doubt that many vets need help.In 2007, the VAs suicide hotline re-ceived 9, 400 calls, she says, and thenext year, it jumped to 67,400. In2009, it reached 119,000, and last

year it was up to 135,000. Just listen-ing to the calls or help can inducesecondary traumatic stress: I eel likean animal, unft or civilized society. My husband only wants to hang outand drink and do drugs with his bud-dies. I cant talk to my wie becauseshe might be inected with my disease.My husband barks orders at our chil-dren like they were soldiers. Aterwatching my buddy blown to bits, Imangry all the time. Why does Daddy

The road back:A Marine

exercises at Walter Reed

Army Medical Center in 2007.


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29national journal september 10, 2011

ngers and disappear onto the streets again

As a ormer Marine who served in IraqGonzalez-Yetzirah himsel has also struggled with PTSD and readjustment issues. Inhis rst job backwaiting tableshe almostclocked his boss, a pimply 18-year-old, or ordering him around. That might have landedhim in the Harris County Jail, where he runsgroup-therapy sessions or the 400 to 600

jailed vets being held there on any given dayHe now sees a new wave o vets approachingthe precipice, just one similar outburst awayrom joining their brothers in jail or under the

bridge. I run into a lot o [recently returned] veterans in my work who are not homeles

yet, but they are at the stage o running romplace to place, sleeping on a buddys couchliving paycheck to paycheck and barely making ends meet, Gonzalez-Yetzirah says.

Many are married to young wives who havelittle education and are caring or babies, evenas the veterans struggle against their PTSD tohold down jobs. They tend to ollow a patternhe says: Soon, their amilies will break apartand the vets will end up on the streets. Iveseen that enough times to understand how ithappens. I just dont understand how we as acountry can allow those people who oughor our reedoms to stay homeless.

Like previous generations o veterans beore them, the post-9/11 volunteers are coming home rom war burdened by wounds andsorrows. Only this time its not too late to helpthem carry that weight.

The soldiers sent to ght on our behal arenot victims; they dont want our pity, and theyhave much to contribute and even to teach usBut combat veterans struggling to regain asense o normalcy in everyday lie need anddeserve the same assurances at home thattheir buddies gave them on araway battleelds: They need to know that someone hastheir back. n

want to go back to war? Our son is constantlycleaning his gun in his room alone, and we cant get him to stop. Im not/shes not/hes not thesame person anymore

The essential message that Molitor and theother hotline therapists try to convey to call-ers is simple: War is hazardous to your men-tal health. Its really no surprise that these

veterans have posttraumatic stress, becausethese are hard issues or humans to deal withon top o all o lies other stresses and dif-culties, she says. On the phone, we try andlet them know that these are normal reactionsto what are really abnormal experiences.

BROTHERS UNDER THE BRIDGE

On a recent sweltering day, Oskar Gonzalez- Yetzirah o the nonprot U.S. Vets trolledbeneath one o Houstons countless highwayoverpasses, oering bottles o water to theragged men and women gathered there. Hehad a simple question or any takers.

You a vet?U.S. Vets is one o roughly 5,000 non-

prots nationwide that aid military person-nel and veterans. In a sense, they are Ameri-cas catchers in the ryethe last line o helpor veterans poised on the precipice o a cli.The veterans whom Gonzalez-Yetzirah ndsunder the overpass have already hit rock bot-tom, joining some 3,500 homeless veteransin Houston and 150,000 nationwide. Almostall are jobless; many are substance abusersor mentally ill.

He tries to coax the vets into government

or nonprot assistance systems. U.S. Vetshas a 72-bed acility in downtown Houston,

but it is overbooked by 30 spaces. Gonzalez-Yetzirah and his boss would have to work thephones to nd an open slot at another shel-ter. He knows that many veterans who suerrom PTSD would rather sleep outside thansubject their rayed nerves to the chaos o ahomeless shelter. He also knows rom experi-ence that i red tape keeps him rom loggingthe veterans into the system beore night-all, they will almost surely slip through his

/

The haunting: A homeless

veteran in Massachusetts.

Iraq and Afghanistan wounded in action bycause, Oct. 2001-Aug. 2011

Iraq and Afghanistan veterans treated eachyear by Veterans Health Administration

Sources: Armed Forces Health Surveillance Center; Defense Manpower Data Center; CBO

Battle-ScarredVeterans of the wars in Iraq and Afghanistan survived wounds that in earlier wars would have been fatal.But the physical and psychological injuries wreaked by roadside bombsthe wars signature weaponsaregrowing and not yet fully understood.

Rocketpropelledgrenade Other

Artillery

Gunshot

Notreported

Explosivedevice

Annual new cases of posttraumatic stress disorder (all services)

Deployed to Iraq

or Afghanistan

Not deployed

TOTAL

"The Reckoning," a National Journal article by James Kitfield

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