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In October 2003, Sgt. Walter Padilla, Charlie Company, 1st Battalion, 12th Infantry Division, was commanding a Bradley Fighting Vehicle near the city of Kirkuk, rounding up insurgents and fending off mortar attacks.
On a break one day, Padilla’s company headed to a deserted area a few miles from base to practice their marksmanship. When gunfire rang out from a nearby village, Padilla wheeled his Bradley around to investigate. He saw two groups of armed men arguing over a pile of wood. The Bradley rumbled closer and the men began shooting.

“Everything slowed down. I lost sense of time. I saw nothing, felt nothing,” he says. “Then I opened up with the machine gun.”

After Padilla gripped the trigger long enough, he moved in for a closer look.

“You’re walking up on something you’ve done with your hands. You see the back of brains blown out. You know it’s either him or you! But I’d never seen anybody dying.”

When Padilla’s unit was shipped back to Fort Carson, Colo., in late February 2004, his life unraveled.

While he was gone, his wife had filed for divorce. He began having terrible dreams about Iraq. He grew paranoid anytime he left home.

One morning, on his way to work at Fort Carson, Padilla glimpsed the lights of an Air Force jet. He swerved his car off the highway and grabbed his cell phone to call his commanding officer. “I thought it was a tube flash from a mortar,” he says.

A December 2003 U.S. Army study, published in The New England Journal of Medicine, found that approximately 16 percent of soldiers returning from Iraq were suffering from Post Traumatic Stress Disorder [“Back From the Wasteland,” Jan. 20], a psychologically debilitating condition causing intense nightmares, paranoia and anxiety. But that study is, already, out of date.

Now, after a particularly bloody summer and fall, many military and mental health experts predict the rate of PTSD will actually run nearly twice what the Army study found, approximately the same level suffered by Vietnam veterans. Others think it could spike even higher and note that rarely has such a dramatic rate of PTSD manifested itself so early.

At the same time, there is mounting concern over the system designed to help: the Department of Veterans Affairs. Numerous reports show the VA does not have many of the essential services veterans desperately need.

“I don’t know how many people are going to be seeking treatment, or whether the demand is going to be met by available resources,” acknowledges Matthew Friedman, executive director of the VA’s National Center for PTSD. “What I am confident is that people who come for treatment will get good treatment.”

Yet the VA chronically has underfunded mental-health programs and currently projects a $1.65 billion shortfall in those programs by the end of 2007.

“If we don’t give the VA what it needs immediately, the consequences will be lifelong and devastating,” says Steve Robinson, executive director of the National Gulf War Resource Center.

The emerging scenario is that of a generation of new veterans whose psyches are in tatters, their families scarred by the strangers their loved ones have become—and of an exhausted health-care system holding its breath.

While Padilla grasped at his ghosts, Washington bureaucrats were hearing about another nightmare. On March 25, 2004, Dr. James Scully, medical director of the American Psychiatric Association, testified to the House Appropriations Subcommittee on VA, HUD and Independent Agencies.

Scully, a Navy veteran, reported a 42-percent explosion in VA patients with severe PTSD, with only a 22-percent increase in money spent on PTSD services. The discrepancy was particularly “startling,” he said, because there were more vets using the VA for psychological help than ever—nearly half a million.

It was the latest blow for an institution that has struggled for decades to fulfill its mission.

A mammoth, federally funded agency, the VA began treating veterans in 1930, charging a sliding fee based on a variety of factors. But in the wake of the first Gulf War, the system swelled out of control. The soaring cost of civilian health insurance, combined with aging World War II, Korea and Vietnam vets, pushed droves of servicepeople toward the VA where everything was cheaper.

In 1995, the VA began realigning its health care system and opening hundreds of outpatient clinics. Yet by 2001, only half provided mental-health services, according to the National Mental Health Association.

Again, funding was a factor. By 2003, the previous decade had seen a 134 percent jump in vets seeking care, with only a 44 percent increase in the budget.

As U.S. troops pushed toward Baghdad, Dr. Joseph T English, chairman of psychiatry at St. Vincent’s Catholic Medical Centers of New York, told the House Appropriations Subcommittee on VA, HUD and Independent Agencies that veterans were waiting an average of 47 days to get into PTSD inpatient programs and up to a year at some outpatient facilities.

VA Secretary Anthony Principi (who resigned on Dec. 8 as part of the Bush administration’s cabinet shuffle and will leave office when his successor is confirmed by the Senate—the nominee is Jim Nicholson, U.S. ambassador to the Vatican) had commanded a Navy gunboat during Vietnam and understood PTSD. He also knew that with combat-dazed vets beginning to trickle home from Iraq, he needed to move. So he commissioned a task force to cobble together the VA’ s mental-health services on short notice.

In a revealing June 3, 2004, memo to VA Undersecretary for Health Dr. Jonathan Perlin, Principi wrote that the task force had discovered four major deficiencies: Mental-health services were scattered;
substance-abuse programs had been reduced; the VA’s mental-health leadership hadn’t been diligent in overseeing the situation; and, there was no coherent mental-health strategy. Principi ordered VA brass to begin plugging the holes immediately.

While the VA worked on a long-term mental-health plan to implement the reforms, the agency’s Special Committee on PTSD delivered an October report to Congress, warning that with more soldiers with PTSD arriving home, services needed beefing up. During the 1980s, the VA had recommended there be teams of PTSD counselors at all VA medical centers. Two decades later, the report noted, barely half of the 163 facilities had them.

The VA plan estimated it would take $1.65 billion by 2008 to fix things.

Similarly, the PTSD Committee conceded that the VA couldn’t be expected to treat psychologically troubled vets from Iraq and Afghanistan while still caring for those already in the system. “If the human cost of PTSD and its related disorders is staggering, so are the long-term medical costs to the VA associated with chronic PTSD,” the report stated.

The House Veterans Affairs Committee urged Congress to pump an additional $2.5 billion into the Bush administration’s VA health-care budget for 2005. But that seemed unlikely, despite the warnings from veterans groups and VA doctors who sat on the PTSD Committee.

These same doctors knew they could treat the disorder better than anyone. They have been on the cutting edge of PTSD since its diagnosis was born from a war whose lessons now seemed distant.

Sergeant Dave Durman did a tour in the Mekong Delta back in 1969. He was 18, and had joined the Navy the minute he got his draft notice, even though some of his buddies had already gone and died there. “I think it was because I just really loved the water,” Durman says.

Durman also loved working on the supply ship where he was stationed and the pulsing adrenaline whenever his unit supported the Marines on missions around the South Vietnamese coast. He loved it all so much that he stayed in the Navy for nine years and, in 1995, joined the Virginia National Guard’s 1032nd Transportation Company, 10 miles from his home in Kingsport, Tennessee.

In February, 2003, Durman’s unit was sent to Kuwait. He was 52 years old.

Two months later, the 1032nd crossed into Iraq, charged with shipping supplies from the southern city of Talil, 300 miles north to Balad. Other convoys had been attacked on the same route, so Durman and the 19-year-old soldier who rode with him slung their flak jackets protectively over the outside of both truck doors because, Durman says, “you could stab a hole through those doors with a knife.”

During one August haul, Durman came upon a group of Iraqi police who had just shot two children for stripping a car on the side of the road. He drove right by their bodies. “We’re told not to interfere with domestic affairs,” Durman says quietly.

“I didn’t want to get personally close to the Iraqis, because I knew we might have to shoot them,” he continues. “I’d look into their eyes and they all looked like Gooks.”

In September, Durman’s unit shipped back to Virginia. It was then the nightmares started, about Iraq, but also things he’d buried—his abusive childhood, Vietnam.

His girlfriend, Teresa A. McKay, noticed that Durman, once confident and kind, now broke into random sweats and angered easily. He drank too much whiskey and bought a .357 pistol. Their sex life, McKay said, went “190 degrees different.”

To McKay, a former nurse who’d worked with homeless Vietnam veterans, Durman’s behavior looked disquietingly familiar.

Indeed, Vietnam provides the clinical and historical framework for PTSD and Iraq. Before Vietnam, treatment of a soldier for the psychological effects of battle was not really treatment at all, even though PTSD had long been acknowledged under a variety of names. It took until 1979, and much pressure from Vietnam veterans’ groups, for the diagnosis to become official and for the VA to open its network of storefront Vet Centers.

By 1988, when the National Vietnam Veterans Readjustment Study concluded that 30 percent of Vietnam vets suffered from PTSD, not many were surprised. The condition had been pushed into psychiatric and public consciousness.

Through group and individual therapy, and sometimes medication, the VA was helping veterans heal, though the process could take years.

Michael McCafferty, a readjustment counselor at Albany’s Vet Center, says the process in place now is much better than it was during the Vietnam war. “When vets come back into this country now they go through a process of debriefing, and they’re asked if they’d like to be contacted by a Vet Center in their area. We’re starting to get a lot of cards back that are filled out. We’ll contact those people, just to let them know we’re here, so there’s a connection. So these people come home and aren’t just lost. This is a tough time for them, because it’s still an active war. In some ways it’s like Vietnam, but the support at home is much better.”

But by the time U.S. soldiers touched Iraqi soil, because of the enormous growth in the number of vets seeking mental-health services and the VA’s failure to adequately respond, the advancements in PTSD treatment were being compromised.

As Crystal Luker tells it, May 5, 2004, was the day her husband’s platoon ran into trouble.

As usual, on that afternoon, Specialist Ron Luker was patrolling a section of Baghdad with his 1st Cavalry Division platoon.

“There was a lieutenant in the first Humvee, Ron was in the second and his platoon sergeant was in the third with a group of privates,” Crystal says.

A 19-year-old specialist from Tulsa named James Marshall, whom Ron had been looking after, also rode in the third Humvee. As the convoy snaked through a teeming Baghdad street market, there was an explosion.

“The lieutenant was yelling over the radio for all of them to haul ass back to the base because they were coming under fire,” Crystal says.

When Luker looked behind him, he was horrified. The third Humvee was gone. He flipped his vehicle around and hurtled back down the street.

Crystal says Luker told her when they found the Humvee, the force of the blast had blown the flesh from two of the privates all over the seats. When Luker looked in the back, he saw Marshall, wrapped around the vehicle’s 50 caliber gun.

“When Ron tried pulling James’ body out, his hands just went right inside of him. He pulled James’ flak jacket back and his chest was gone.”

Before that day, Luker called and wrote home religiously, unburdening himself to the woman he’d fallen in love with at a Mariposa, Calif., restaurant four years earlier. But when he came home to Fort Hood, Texas, for a week in August, things changed dramatically.

That first night, at a welcome-home barbeque, Luker cornered his wife in the kitchen.

“He asked why I’d been avoiding him and said that I didn’t want to be around him,” Crystal says. When Luker started cursing, some Army friends pulled him away. “You didn’t come all the way home to fight with your wife,” they told him.

As the week went on, there was more arguing. Crystal says her husband accused her of cheating while he was gone. He rifled through her purse, the bedroom drawers, and repeatedly listened to old phone messages, searching for proof.

“I told him, ‘You’re scaring me! You’re not acting right, Ron!’” Crystal says.

Luker also seemed bothered around his three daughters. In an emotional revelation, he told his wife why.

“He said he’d turned into a monster in Iraq. How he couldn’t bounce his kids on his knee when he’d shoved guns in women’s faces and busted into houses and pushed kids on the floor. He kept saying ‘I’m just trying to remember who I was before.’”

Ron Luker’s problems fit into those of the growing numbers of PTSD soldiers. They also signal another trend–soldiers experiencing PTSD early.

VA psychologist Scott Murray says many vets won’t feel symptoms of PTSD until 15 months from now.

“This early on, PTSD is much higher than anything we’ve seen in previous conflicts,” Murray says. “We anticipate the numbers are only going to keep getting higher.”

Psychologist Kaye Baron currently treats some 70 active soldiers and their families in a private practice in Colorado Springs, near Fort Carson. From clinical discussions she’s had with soldiers, Baron thinks the PTSD rate could spike as high as 75 percent.

Such a rate, psychiatrist Robert Jay Lifton says, is inexorably tied to the war itself.

“This is a counterinsurgency being fought against an enemy which is hard to identify, and that leads to extraordinary stress,” he says.

According to Jonathan Shay, the issue with the most potential for psychological torment is whether soldiers feel they’ve been led into battle for a noble cause.

Shay, who compared the Vietnam veteran’s battle experience to that of Achilles in his book, Achilles in Vietnam: Combat Trauma and the Undoing of Character, wrote how the Greek hero felt betrayed by his arrogant general, Agamemnon, whose disrespect of a priest of Apollo brought down a plague on the Greeks.

“If a soldier has experienced a betrayal of what’s right by those in charge, their capacity for social trust can be impaired for the rest of their lives,” Shay says.

Families of military personnel who are currently in Iraq are told not to send their families any antiwar or “antigovernment” materials. Alison, a Capital Region resident whose longtime partner arrived in a Iraq last week, received an e-mail message on Friday from her partner saying, “warning. please do not mention over the internet or phone of anything going on here. strictly just hi, how is it going, cats are good yadda yadda. eyes and ears are on us.” Her partner has served proudly in the National Guard for two decades, she says, and is “prepared to do what he signed up to do, but he does not agree with us being there. . . . It’s catch-22 many servicemen deal with.”

For others a sense of disillusionment came more gradually. Dave Durman says he first began feeling uncomfortable in Iraq when it became clear there were no WMDs. He says his unit was furious when General Tommy Franks retired midwar, while the rest of National Guard and Reservists were subject to the Army’s “stop-loss” policy, which extends soldiers’ deployments.

Walter Padilla and Ron Luker were outraged when they saw Iraqi children playing in human sewage gurgling through the streets while the Army did nothing. “I thought we were here to help these people,” Padilla says.

That sense of betrayal can translate into what Shay calls “complex PTSD”: nightmares, paranoia, violence, self-hate and a crippling distrust.

“I’ve had a couple of people from Iraq and a couple of people from Afghanistan,” as clients, says McCafferty of the Albany Vet Center. “And if I close my eyes when they’re talking to me, it’s Vietnam.”

Politics is not generally on the top of their minds however, says McCafferty. “I’m a Vietnam vet, and I understand for myself what kind of disillusionment I went though. I understand for these new vets it may be there in the future. It’s not there now. Combat is a great reducer. You’re not thinking about [political] parties, or any person by name, politics. You’re thinking about survival. The here and now. Those issues come up later.”

Even where the support is available, having questions about the cause of the war can isolate both soldiers and their families from that support. Alison says that she doesn’t feel comfortable in the family support groups because they all “seem pretty gung-ho” about the war itself. “You remain somewhat isolated,” she says. “You don’t feel your opinions are welcome. I’ve avoided it all together.” They did request ideas for speakers a few months ago, says Alison, and she sent a suggestion for “someone in conflict resolution or maybe a pastor” to help people talk and work through political differences. She never got any response.

But it’s these family readiness groups through which the vet centers are doing much of their outreach, letting families know what services they have available, and how to recognize signs of PTSD in their loved ones when they return.

“We’ve never had to dip into the VA system,” says Alison. “I’m probably not as aware as I should be. . . . I’m really not too familiar with what the VA offers.”

Since reporting on this story began in October, Dave Durman has started therapy at the VA. He’s likely getting some of the most advanced care in the world. He’s also lucky; he was already enrolled, thanks to his time in the Navy.

Meanwhile, Walter Padilla is trying to leave the military and says he’ll get help once out. Ron Luker is still in Iraq, and Crystal Luker says she’ll drag her husband to the VA if she has to.

These soldiers won’t be alone. So far, more than 10,000 veterans from Iraq and Afghanistan have sought psychological help from the VA, and there’s every indication the numbers will jump significantly.

Despite the challenges these numbers predict, Harold Kudler, co-chair of the VA’s PTSD Committee, says: “We’ve never been so prepared,” and points to unprecedented cooperation with the Department of Defense, intensified PTSD outreach and the 206 vet centers.

But some say that preparation is not enough. “You can only provide the services for which you have the resources,” says VA psychologist Scott Murray. “There has to be significant improvement in an allocation of funds to make that occur.”

Michael McCafferty, a readjustment counselor at the Albany Vet Center, says that the Capital Region is not likely to have as much trouble accommodating the need as many other areas of the country, because the military participation rate isn’t that high in this area. “A lot of other vet centers are overwhelmed,” he said, but “I don’t think we’re going to be hit with numbers all at once.”

On Nov. 20, Congress added $1 billion to the Bush administration’s $27.1 billion VA health-care budget for 2005. The amount fell $1.5 billion short of what was recommended by the House Veterans Affairs Committee. And while Congress earmarked an additional $15 million for PTSD, few think that money will make much difference.

“The heads of the VA health care networks are all trying to figure out how the hell they’re going to manage,” says Rick Weidman, director of government relations for Vietnam Veterans of America. As for the VA’s mental-health plan, which estimated that an extra $1.65 billion was needed to fix things fully, VA spokesperson Laurie Tranter says: “We cannot comment on this now. The plan is still being finalized.”

Dan Frosch is a freelance reporter for the Santa Fe Reporter. Barbara Solow with the Durham, N.C., Independent Weekly and Miriam Axel-Lute, Metroland’s news editor, contributed reporting to this story.

On the Home Front

Just coping with having a loved one away from home and in harm’s way for more than a year is a challenge all its own, before you ever get to thinking about readjustment to home and the resources that are or aren’t available from the VA.

Since her husband Rodney was sent to training with the National Guard Rainbow Division at Fort Drum last May, and then deployed to Iraq in December, Dolly Livolsi of North Greenbush has learned to add things like changing light bulbs and taking out the garbage to her daily routine, which is now mostly focused on keeping their two daughters busy so they don’t think too much about their dad’s absence. But the bigger lesson, she says, is that dealing with having your spouse deployed is “an unexplained loss” of sorts, and needs to be treated as such.

When Livolsi made the connection between how she was feeling about Rodney’s absence and how she felt when she lost her mother two years ago, a number of things clicked into place. “You have to let your body feel what you feel,” she says. “Do what you have to do to get you through, as long as you’re not hurting yourself or others.” For her, a lot of that has involved being able to laugh at herself when she has found herself overwhelmed, whether it’s the worry “sneaking in” or the first time she tried to buy furnace filters at Home Depot. If people judge a military spouse for acting a little crazy these days, she says, then “they’re not very American.”

She’s grateful that her husband has access to e-mail and phones, and he calls every three or four days. Rodney, who is sergeant first class and assigned to guard the general of his base and therefore isn’t on the front lines, doesn’t call more often in order not to get anyone’s hopes up or create worry if he’s not able to call on a particular day. But when he does call, “his voice is like gold,” says Dolly. “He never tells me anything negative. He says ‘Everything’s fine, everything’s fine.’ But I can tell he just wants to come home.”

Last summer, Rodney, a 39-year-old state trooper, told Metroland he was focused on the mission in front of him and there wasn’t much discussion of politics. He was measuredly upbeat, even though for periods of the training, which was “a young man’s school,” he was “really hating life.” There was a little bit of fear on the base, he said, “which can be good, because it makes people become serious and focused.”

These days, Dolly doesn’t watch the news (except for the Iraqi elections, briefly). “He was a trooper for 10 years, and I never worried,” says Dolly. “I’m not worried now. It’s partly luck, and he’s smart and been trained well. I tell myself I don’t worry, I don’t worry. But it sneaks in, it sneaks in a lot more if I turn CNN on.”

And as for what it will be like when Rodney returns—they’re hoping for November—“We’re not there yet,” she says. “They do give out pamphlets about returning soldiers at deployment—I was like, ‘I don’t need any help with that, I need help with the deployment!’ But in the back of my head I know that it’s not going be as easy as it sounds . . . even though you think, ‘No way, that’s going to be the best day.’ I know there must be some reason they put together those packages.”

—Miriam Axel-Lute

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