Wounds of Iraq war: US struggles with surge of returning veterans

In the spring of 2005, Marine Lt. Col. Mike Zacchea returned from the Iraq war to his Long Island, N.Y., home both a hero and a shattered man.

Zacchea excelled in battle. During Operation Phantom Fury, the all-out assault against Sunni insurgents in Fallujah in late 2004, he earned a Bronze Star for valor. He received a Purple Heart for injuries sustained when a rocket-propelled grenade exploded just feet from him, piercing his shoulder with shrapnel. Doctors said his injuries were aggravated when he refused to be airlifted out – he didn't want to leave the Iraqi Army soldiers whom he trained and fought alongside in the country's infamous Sunni Triangle.

But while Zacchea, a third-generation marine, survived combat with honors, civilian life nearly killed him. For the first six months he was home, he didn't talk to anyone. He was irritable, angry, and aggressive. The most routine encounters turned violent. He assaulted a flower store clerk after they got in an argument and she threw change at him. "I grabbed her neck and almost choked her unconscious," he says. He erupted into rages at home, too, at one point setting the bathroom door on fire after his wife locked herself inside. He thought she was an insurgent.

Eventually, he began to heal. A Yale School of Medicine doctor working at the West Haven, Conn., Veterans Affairs hospital told him he probably had suffered a traumatic brain injury in Iraq. Zacchea felt he finally had some clarity about why he couldn't cope with New York City traffic or even lead a normal life.

Today, he's earning an MBA and helping run an entrepreneurial "boot camp" for other disabled veterans at the University of Connecticut in Hartford. "It's a long journey [going] from a guy who set his house on fire because he thought his wife was an insurgent to helping other disabled veterans make their own transition," he says.

Zacchea's journey from calamity to cautious hope may be a parable for the United States as it prepares to cope with one of the largest influxes of returning war veterans since Vietnam four decades ago. With combat missions set to end in Iraq by Aug. 31, thousands of troops are poised to come home, joining those who have already returned after multiple tours of duty over the course of the seven-year war. The roughly 65,000 troops in Iraq will soon drop to 50,000. Some of them will be redeployed to Afghanistan. But many will be resettling in big cities and small towns from Long Island to Los Angeles in what could be called the great surge home.

If one gauge of a nation's humanity is how it treats its returning soldiers, then the US is about to face a significant test. Experts say the country is woefully unprepared to handle it.

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Every war presents its own set of challenges in handling returning soldiers. After World War II, the men who came home from Europe and Asia were greeted with parades, but the young men who suffered psychological traumas often had few places to seek help. A generation later, after Vietnam, vets became the symbol of an unpopular conflict during an era of national tumult. Soldiers were often outcast and ridiculed. Homelessness and drug addition among vets climbed. Vietnam also gave us the misunderstood and long-ignored effects of Agent Orange.

Today's soldiers are again being embraced as heroes. They went to war in the shadow of 9/11 with the image of the crumbling twin towers seared into the American consciousness. A sense of national indebtedness followed the men and women deployed to Afghanistan and Iraq.

Yet the nation, the military services, the Department of Veterans Affairs, and the soldiers themselves were unprepared for the wars' length and severity. Now, the marks of these two wars are presenting their own unique problems, both physically and psychologically.

As Afghanistan grinds into its ninth year, it has become the longest war in US history, surpassing Vietnam. Iraq ranks as the third-longest conflict, lasting nearly twice as long as US involvement in World War II. Many soldiers, as a result, have cycled through several deployments and even fought in both wars. Since 2001, about 2 million servicemen and servicewomen from an all-volunteer force have served in Iraq and Afghanistan, and more than 1 million veterans from those two wars have returned to civilian life. Most came home unharmed – but not unchanged.

Unlike in earlier wars, soldiers in Iraq and Afghanistan have faced insurgents whose use of unconventional weapons – roadside bombs, suicide attackers, and improvised explosive devises (IEDs) – have wreaked havoc on the military as well as on veterans' psyches. IEDs alone have been responsible for 40 percent of the US troop deaths in Iraq.

While body armor and improved equipment have helped keep the death toll down in the two wars – just over 4,400 US soldiers have been killed in Iraq and 1,200 in Afghanistan – an unusually large number of soldiers have returned home missing arms and legs. Many more have suffered traumatic brain injury (TBI) or post-traumatic stress disorder (PTSD) – the signature wounds of the wars.

The demographics of the fighting force have contributed to the complexity of dealing with returning warriors. Female service members make up 15 percent of the active duty force. Although women do not serve in official combat roles, thousands have returned from Iraq with mental-health issues and, according to a report from the Veterans' group Swords to Plowshares, women warriors experience PTSD at rates twice that of men. But many returning women, say advocates, feel alienated or even unable to find the care they need at VA hospitals that have been treating mainly men for generations.

At the same time, reservists and National Guard units were deployed to Baghdad in great numbers, at one point making up almost half of the troops deployed in Iraq. Soldiers were often in their 40s and left behind families, businesses, and mortgages. As the Iraq war lurched forward, the economy at home worsened. Some returning soldiers lost their jobs or struggled when back in their cubicles. Others volunteered to return to war because of dimming job prospects stateside.

"We expected to go [into Iraq] quickly and have everyone happy we were there and be ... down to 30,000 troops within a year," says John Allen Williams, a political scientist at Loyola University Chicago and a retired Naval Reserve captain. "Nobody was completely prepared for the problems during the war and after. And, to be fair, nobody could be."

Before 9/11, the VA medical system was in the midst of downsizing. World War II veterans, its main clients, were dying off. When soldiers began coming home from Iraq with missing limbs and coping with brain injuries, the system was simply not equipped to handle them.

"We were not only caught with our pants down, but we were dropping them farther," says David Segal, director of the Center for Research on Military Organization at the University of Maryland in College Park. But, he says, "under the best of situations you can't ramp up a military structure to meet the needs as fast as you need."

Critics say the military services and the VA didn't move fast enough to meet the growing needs of wounded warriors and disabled veterans. In fact, the VA underestimated by 77,000 the number of returning vets who would seek its services, according a 2006 Government Accountability Office report. Today, it faces a backlog of about 1 million benefit claims. Many wounded veterans complain that the system is cumbersome and antiquated. Even though it has made efforts to address the issues of today's vets, the VA is still struggling to adapt to the demand created by fighting in Iraq and Afghanistan – as Brian Fuqua knows all too well.

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In september 2006, Mr. Fuqua, an Army paratrooper with the 82nd Airborne Division, was in Iraq battling an increasingly deadly insurgency. The war was grinding into its fourth year. The fighting was intense and frantic.

At one point in the hostilities, Fuqua found himself too close to a detonation set off by US forces to disarm an unexploded bomb. He lost consciousness and, like many others who suffer possible brain injuries on the battlefield, didn't seek immediate help.

"There really wasn't time to sit there and analyze that," he says. "It was more like, I had a job to do and I had to be on point – people are getting killed."

When he got back home to Roanoke, Va., however, Fuqua did have time to think about the experience. Maybe too much time. Doctors had diagnosed Fuqua with both PTSD and probable TBI.

At first, he sought help from the VA. But he soon became frustrated with the agency's slow pace and burdensome bureaucracy. Fuqua, a big man with tight-cropped hair and a quiet demeanor, says many of his fellow service members refuse even to go to a VA hospital.

"I had better luck Googling how to deal with PTSD than going to a specialist," he says over a cup of coffee at his apartment in Roanoke. "When you have this government you just fought for, and all of a sudden you have to fight them, it makes people go rogue."

Fuqua finally decided to handle the problem on his own, through self-medication and finding other ways to deal with daily life. For him, that means working out or keeping his mind focused on anything other than his time in Iraq.

Fuqua's travails are far from unique. According to a landmark 2008 RAND Corporation study ("Invisible Wounds of War"), as many as 26 percent of Iraq and Afghanistan vets suffer from mental-health issues related to combat. It found that some 300,000 were dealing with PTSD, which can arise from the intensity and severity of fighting, and 320,000 with TBI, often the result, as in Fuqua's case, of being too close to an IED or other explosion.

The capacity of the VA to recognize and deal with mental-health issues among Iraq vets has certainly improved over the past several years. The US government has invested billions to expand its treatment programs and established rehabilitation centers around the country designed to treat vets with multiple injuries suffered in the two wars. But more needs to be done.

"Really, it's going to take a national, coordinated effort" to meet the needs of vets coming home with mental-health issues, says Terri Tanielian of the Rand Center for Military Health Policy Research who co-wrote the "Invisible Wounds of War" study. "We are going to continue to find that there are other related consequences."

In July, President Obama said the VA would begin making it easier for vets to receive health benefits for problems related to PTSD and TBI. Until recently, they were asked to give specific dates for an event that may have triggered PTSD. "Well, I don't think our troops on the battlefield should have to take notes to keep for a claims application," the president said in a radio address.

But having the capacity to treat PTSD or TBI isn't the only difficulty. Increased mental-health screening is also key, as is breaking the stigma attached with admitting to war-related stress or other mental-health problems tied to combat.

"[For] a generation of young men and women trained to do extraordinary things with very few resources ... to admit there's a problem they can't handle is very difficult," says Tom Tarantino, who served as an Army captain in Iraq and now works for Iraq and Afghanistan Veterans of America (IAVA). He says that vets eager to get home will just check "no" in all the boxes asking about mental conditions. But recently passed legislation has increased face-to-face evaluations between returning soldiers and mental-health professionals.

"When you come home, you're going to get screened whether you like it or not," Mr. Tarantino says. "Now you're not the guy asking for help. It becomes a lot easier to talk about things."

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Zacchea finally found a way to talk about things – and make the system work for him. On a hot Friday in downtown Hartford, he wears aviator sunglasses and a black mock turtleneck underneath a dark suit. He dons UConn and US Marines lapel pins.

At an upscale restaurant a few blocks from the business school's campus, he talks openly about the emotional trauma that followed him home from Fallujah, an experience that seems almost like fiction as he recounts it amid the polite lunchtime chatter of Connecticut office workers. "I thought I was just going to pick up my life where I left off," he says. "That was a mistake. A lot of people who think that just wind up getting into trouble."

After nearly burning down his house when he became convinced his wife was an insurgent, Zacchea didn't end up in jail. Instead, it led him to get some specific and salutary mental-health counseling – in this case through the VA. He began working on his issues related to PTSD and TBI. He left a brokerage firm where he had landed a job after coming home and became involved with veterans' causes. He started working with groups like IAVA and Veterans for Common Sense.

It wasn't long after Zacchea entered the University of Connecticut's School of Business that he became involved with the Entrepreneurial Bootcamp for Veterans with Disabilities (EBV), a program in which UConn and five other business schools offer training, business classes, and mentoring for injured post-9/11 vets looking to start their own businesses. Some 200 vets have completed the program since it was founded in 2007. Its graduates have become independent film producers and private investigators, Web designers and property managers.

"For me, coming to UConn and being involved in this is sort of an intervention," he says. "I was in a negative spiral."

His efforts highlight one of the positive aspects of a nation struggling to cope with the surge home – a sort of shadow VA.

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In Gardner, Mass., a small town an hour west of Boston, Leslie Lightfoot walks past a construction worker and into the cool air-conditioned embrace of a newly built two-bedroom apartment. It feels as clean and fresh as a honeydew melon.

In the coming months, the apartment will be occupied by a disabled veteran from Iraq or Afghanistan. Ms. Lightfoot, a former Army medic and founder of Veteran Homestead, has been working with disabled and terminally ill veterans for more than 30 years and, in October, opened the first all-inclusive rehabilitation center focused on issues facing vets from this generation.

The Northeast Veteran Training and Rehabilitation Center sits on a leafy 12-acre site donated by nearby Mount Wachusett Community College. The remote 20-unit facility will give vets with disabilities the opportunity to recover in a comfortable home while attending classes at the college.

"I knew what was coming," says Lightfoot of the huge number of returning vets in need. "You send people to war six times and what do you expect?"

While the military and VA hospitals are struggling to cope with the problems facing warriors coming home, a growing network of nonprofit groups is forming to fill the gaps in service offered by the government.

"The biggest thing I see right now are vets coming back, and they can't find a job," says Tracy Handschuh, chapter president of the New York/New Jersey branch of Operation Homefront, a group that helps service members cope with emergency financial needs. Ms. Handschuh notes, for instance, that while companies are legally obligated to hold a reservist's job when he or she is deployed overseas, that isn't going to help if the company has folded during the recession. "When a service member comes back from deployment, there may not be a job to save," she says.

The nonprofits dedicated to the postwar recovery of men and women who served in Iraq or Afghanistan run the gamut: from groups that provide free airfare for former soldiers who need to travel for health reasons (Air Compassion for Veterans) to one that builds houses for severely injured veterans, many of whom lost arms and legs (Homes for Our Troops).

In some cases, the organizations are providing services that the government either won't or can't. When Homes for Our Troops goes about building a specially adapted house for a double amputee or some other survivor of an IED attack, it tries to get the entire community involved in the process.

"The feeling and appreciation that these guys get when they see hundreds of people from a community come out to do this for them ... they are being shown direct support of the American people," says John Gonsalves, president and founder of Homes for Our Troops. "It's critical for them to experience that."

• Staff writer Christa Case Bryant contributed to this report.