Combat Stress Cases May Soar

November 20th, 2006  
Team Infidel

Topic: Combat Stress Cases May Soar

Atlanta Journal-Constitution
November 19, 2006
Pg. 7

By Anne Usher, Cox Washington Bureau
Washington -- Multiple and extended tours of duty in Iraq and Afghanistan are resulting in rates of post-traumatic stress disorder among soldiers that will likely match or exceed the rate among Vietnam War veterans, government officials and veterans groups say.
The unique circumstances in Iraq, where soldiers face an insurgency and no front line, have left many particularly vulnerable to combat stress and are driving the abuse of drugs and alcohol, military health experts say.
Yet many veterans and on-duty troops are not getting the treatment they need.
About one in six of the more than 184,500 returning veterans who have sought care through the Department of Veterans Affairs have been diagnosed with post-traumatic stress disorder, a rate expected to climb higher since it can take months and sometimes years for the condition to manifest. Symptoms include anxiety, sleeplessness, flashbacks and extreme wariness, a recipe that can strain personal relationships and make it hard for those suffering to get or keep jobs.
Jesus Bocanegra, a 24-year-old former Army sergeant from McAllen, Texas, says he is haunted by countless shots he fired at Iraqis while serving as an infantry scout in Tikrit, Iraq, in 2003-04. Bocanegra says he lost track of how many innocent civilians he killed.
"How the hell was I capable of that?" he says now.
Back home and plagued with anxiety attacks, he said he tried to close himself off from the world by drinking to the point of passing out. He progressed to marijuana use and then cocaine.
"The only way to sustain yourself day-to-day is to keep yourself drugged up," he said. But "it made it worse."
Eventually, he stopped taking drugs. But he said it took nearly two years for him to get an appointment at the closest veterans hospital, a four-hour drive away, because it was overbooked. He was diagnosed with PTSD and given pills, but with no VA therapists in the area he sought help from a group called Vets for Vets.
"It's good to have someone to talk to," he said. "It's the only thing that keeps me going."
Longer deployments
Up to 29 percent of soldiers returning from Iraq and Afghanistan will suffer from PTSD, predicts Col. Charles Engel, a clinician at the Walter Reed Army Medical Center. As of August 2006, 63,767 discharged soldiers had been diagnosed by the VA with a mental disorder and 34,380 with PTSD, data shows.
Experts say the PTSD rate among Iraq veterans could well eclipse the 30 percent lifetime rate found in a 1990 national study of Vietnam veterans because soldiers still on active duty are being deployed longer and more often to Iraq and more doctors are aware of the disorder and will diagnose it.
But a study released in May by the Government Accountability Office, the investigative arm of Congress, found that nearly four in five service members returning from Iraq and Afghanistan who may have been at risk for PTSD were not referred for further mental health evaluation. The Pentagon was unable to explain to the GAO why some were not referred for care.
Medical experts say mental health and substance abuse problems are intertwined. And drugs ranging from marijuana to prescription anti-depressants are easily accessible in Iraq, according to interviews with more than a dozen soldiers who served there.
Soldiers said they used banned substances as a way to mentally escape the violence around them. Others said pills were handed out by medics in the field.
John Crawford, a 28-year-old former Florida Army National Guardsman with the 101st Airborne Division, said soldiers in his unit drank alcohol, some took steroids, "pretty much everyone took Valium" and "some did all three."
Crawford said he bought 200-300 pills of Valium on the street in Baghdad for $2 as a way to catch some sleep between patrols. After eight months, he built up a tolerance and was taking seven or eight at a time.
The extent of alcohol and drug abuse among combat veterans is difficult to quantify. Announced drug tests are usually done just once a year.
Army Maj. James Weeden, who directed a team of 200 specialists dealing with combat stress in Iraq until he left the country in September, says senior officers recognize the strain their troops are under and have begun assigning some specialists to remote forward operating bases.
'Baggage' mounts up
But seeking treatment in a combat environment is difficult since any travel risks exposure to enemy attacks and roadside bombs. And asking for help is still seen as a sign of weakness.
Weeden and other medical specialists say they can only treat the symptoms of combat stress -- with anti-depressant drugs and rest, for example -- and that soldiers are sent out of Iraq only when they have clearly disabling cases of PTSD. Commanders naturally want to keep soldiers in the field, and most soldiers say that they don't want to abandon their units.
Joyce Raezer, director of government relations at the National Military Family Association, says soldiers -- some now on their fourth or fifth tour -- are bringing "all the baggage from the last deployment into the next."
"The stress is cumulative," she said. Families are alarmed by military statistics showing that 80 percent of soldiers who have been flagged with "mild" symptoms of post-traumatic stress disorder have been sent back to Iraq and Afghanistan, many with anti-depressant pills aimed at ensuring they can still fight.
When the roughly 160,000 soldiers currently serving in Iraq and Afghanistan eventually return home, the Department of Veterans Affairs has the resources to offer all of them treatment for PTSD and substance abuse, said Dr. Ira R. Katz, deputy chief patient care officer for mental health for the VA. He noted that there are 200 veterans "readjustment" centers nationwide and "telemental" health counseling available over the Internet.
But many soldiers seeking treatment for combat stress when they return say they face steep hurdles getting help from the government.
The GAO said the Veterans Administration has not spent millions of dollars at its disposal to treat returning soldiers, many of whom say their problems were also ignored after being flagged in post-deployment tests aimed at catching early signs of PTSD.
Maj. Gen. Paul Mock, commander of the 63rd Regional Readiness Command for the Army Reserve, told an Army convention last month that he doesn't think the infrastructure is in place to treat all returning troops who need mental health care, especially in rural areas.
"When they don't get the kind of mental health screening -- or physical -- history tells us they will turn to coping mechanisms," said Steve Robinson, director of government relations for Veterans for America, a 35,000-member veterans organization.
He says many of the hundreds of soldiers he has interviewed are addicted to medications given to them in the field, such as painkillers and sleeping pills. But the soldiers are not getting the therapy that normally goes with such medications, Robinson said.
Adam Reuter, a 23-year-old former Army specialist from Atlanta who was stationed near the Syrian border with the 3rd Squadron of the 3rd Armored Company, said a medic simply handed him a plastic bag filled will pills with no instructions after he was tossed out of a Humvee in an accident. The bag contained the narcotics Percocet and Vicodin, Tylenol with codeine, a muscle relaxant, and pain relievers Motrin and Naproxen.
He said he went back for more and developed a dependency that he is still trying to shake.
The military maintains a zero-tolerance policy for drug use on all but prescription medications. Some soldiers have lost their military benefits -- regardless of their combat citations -- after they have been found to have used banned substances. But many commanders offer leeway in such cases, choosing nonjudicial punishments such as demotions in order to keep soldiers on duty, said Army Col. Bill Buckner, a public affairs officer at Fort Bragg in North Carolina.

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