Problems seen in VA, military handling of disorder.
When he closes his eyes, Edmond Rivera can smell the burning flesh of his fellow soldier. He can see the man — his friend — clawing on the driver’s-side window of his Humvee, trapped by flames after a bomb set his vehicle afire on an Iraqi roadside.
Though Rivera struggled to save his friend, he couldn’t get get into the vehicle. All he could do was stand in the road and listen to the screams.
“You’re two feet away from someone, watching the flesh melt off his bones, and there’s nothing you can do about it,” Rivera, 43, said of an experience now seared into his memory. “You can’t forget.”
Though he returned from Iraq more than two years ago, Rivera said his dreams — and indeed, his waking life — still are haunted by that image, and by memories of his own vehicle being twice damaged by explosions while he served as a squad leader in a military police platoon.
Now, the career military man fears driving on Louisville’s highways. On the Fourth of July, he goes from window to window to make sure fireworks and firecrackers aren’t bombs or gunshots.. And he tries to stay in his Louisville home as much as possible because it’s the only place he feels safe.
Like nearly one out of every five Americans who have served in Iraq and Afghanistan, Rivera has post-traumatic stress disorder. And like many others, he experienced delays getting it diagnosed and now faces the possibility of redeployment that doctors say could worsen his condition.
As the number of Iraq and Afghanistan veterans with the disorder grows — some expect it eventually will exceed the 19 percent rate among Vietnam veterans — military and veterans hospitals across the nation say they have placed greater emphasis on screening for and treating PTSD.
“No military in the history of the world has done more to identify, evaluate, prevent and treat the mental-health needs and concerns of its personnel,” said Department of Defense spokeswoman Cynthia O. Smith.
Yet there is evidence that screening has had spotty results, and many veterans still aren’t getting the early care that experts say can greatly improve their chances of living a normal life.
A Defense Department task force report released this month calls for a greater focus on prevention and screening for the disorder but acknowledges that the military’s mental health system doesn’t have enough money or staff to meet future needs. Smith could not say how much is being spent on PTSD, saying officials are analyzing that now.
And the Government Accountability Office reports that only 22 percent of military members screened and found at risk for PTSD were referred for further evaluations.
Some, like Rivera, say they didn’t receive any PTSD screening from the military. Rivera was diagnosed only after his girlfriend insisted he go to the Veterans Affairs Medical Center in Louisville almost two years after returning to the United States.
A couple of weeks ago, Rivera, an Army reservist, got orders to spend 179 days in Honduras, training local fighters. He figures the Army doesn’t know about his disorder, since it was diagnosed by the VA hospital, not military doctors.
But PTSD doesn’t automatically disqualify someone from being redeployed, even though many psychologists, including some within the military, liken it to reinfecting a psychological wound.
Rivera is fighting his potential deployment, saying he just wants to stay home and heal.
“I feel like I’ve served my time,” he said. “Peace is all I want.”
Flashback to attack
As Rivera was driving down the Watterson Expressway with his girlfriend two months ago, an empty box flew up from the road and hit his windshield. He doesn’t remember the rest of the drive, only that it was fast, and that he walked around a Harley-Davidson dealership for 3 ½ hours afterward, decompressing.
His girlfriend, Gail Bratcher, took the wheel on the way home, while he reclined the passenger seat so he wouldn’t have to look out the window.
Mentally, he said, hitting the box took him back to an incident in Iraq three years earlier, when he was an Army staff sergeant, sitting in the passenger seat of a vehicle traveling with a convoy of fuel trucks. The road was nicknamed “IED Alley,” referring to the improvised explosive devices used by insurgents in Iraq.
An explosion threw a piece of asphalt onto the vehicle’s hood, he said, bringing him “from calm to 1,000 degrees in a split second.” Rivera, an amateur photographer and videographer, captured the blast on video.
The camera also was rolling a month later, when the hastily repaired vehicle — with the words “Ed’s Ouchy” scribbled on the front — drove near another IED. That one cracked the windshield and sent a 30-foot plume of smoke into the air. It also damaged the hearing in Rivera’s right ear, he said, and left shrapnel in the face of another soldier.
After returning to the United States in December 2004, Rivera said, he found himself instinctively searching roadsides for discolorations or strange objects that could be explosives. He looked for phantom shooters on overpasses. His girlfriend took over most of the driving.
As the months passed, Bratcher said, she watched her once fun-loving boyfriend — a man who traveled the globe during his 23 years in the Army and as an active reservist — retreat.
Six months after getting back from Iraq, he reluctantly returned to his human resources job with the Army Reserve, but commuting proved harrowing, and when he got home, he usually stayed there.
He lost interest in chess, golf, even photography. At night, he often woke up in a cold sweat, and Bratcher would sometimes catch him looking out windows, “checking the perimeter.”
When she tried to comfort him or cuddle, he wouldn’t let her get too close.
“He was the same person,” Bratcher said, “but yet he wasn’t.”
“I didn’t know how to feel,” Rivera said.
Rivera was suffering classic symptoms of PTSD — flashbacks, sleep problems, emotional numbness, jumpiness and hyper-vigilance. Some experts say it’s not surprising so many Iraq veterans suffer from the disorder, given the constant stress of close combat and a largely hidden enemy.
Experts also say doctors are better at recognizing the disorder than they were years ago, which may account partly for the high numbers of affected Iraq veterans.
In Rivera’s case, Bratcher wasn’t sure what was wrong, only that he needed to be checked. In November of last year, VA hospital doctors diagnosed him with PTSD and depression.
Psychologists say delays in diagnosing PTSD increase the possibility of serious problems, such as depression, substance abuse and even suicide. Ideally, anyone experiencing symptoms for three to four months should seek treatment, say those who work with PTSD patients at the Louisville VA hospital.
But that often doesn’t happen, for a number of reasons.
For one thing, veterans who returned from Iraq or Afghanistan before the end of 2003 didn’t necessarily get screened. After that, the Department of Defense went national with a post-deployment health assessment that includes four PTSD questions.
Bob Wolz of Rineyville, Ky., for example, said he got no screening when he returned from Iraq in September 2003 to Fort Hood in Texas.
But even some soldiers who returned after that didn’t get screened. Officials at Fort Knox’s Ireland Army Community Hospital said they started offering the screening in October 2004. And Rivera said he got no screening when he returned from Iraq to North Carolina in December 2004.
Carl Mumpower, a North Carolina psychologist and national expert in PTSD, said the military recently has gotten better at ensuring that all returning soldiers are screened.
In addition to offering mental health care in Iraq, defense officials said, screenings are now offered within a week of a soldier’s return, and then reviewed with a medical provider. A second screening, added nationally last year, is given about three to six months later.
Screening, however, doesn’t always lead to treatment, according to the federal GAO.
Agency reports from this year and last showed that a relatively small percentage of military members found to be at risk for PTSD were referred for further evaluations: 23 percent in the Army and Air Force, 18 percent in the Navy and 15 percent in the Marines.
Officials could not provide comparable local figures, but Rogers, at Fort Knox, said medical professionals virtually always refer soldiers for further care if they suspect a problem.
One additional problem is that soldiers sometimes choose not to follow up. The defense task force’s preliminary report noted a stigma surrounding mental health problems, which military officials are trying to address.
“They’re concerned it will hurt their military career,” Michael Hollifield, an associate professor of psychiatry and family medicine at the University of Louisville, said of soldiers. “And there’s this thought that people fake it.”
New tour possible
According to a November memo from the assistant secretary of defense, psychotic and bipolar disorders automatically disqualify someone from being redeployed by the military — but PTSD does not.
The memo calls the disorder treatable, although it says the potential for effective treatment is considered on a case-by-case basis that takes into account the soldier’s vulnerabilities and demands of the job.
If soldiers are diagnosed outside the military health system, such as at a VA hospital or a family doctor’s office, it’s up to them to raise the issue — although officials say they are working to share medical records more easily between the military and Veterans Affairs.
At Fort Knox, Army reservists treated elsewhere and ordered to redeploy must let their commanders know of their diagnosis, said Col. Susan Rogers, a psychologist and behavioral health chief at Ireland Hospital. Even if they don’t initially, it should come up during the pre-deployment process, when soldiers are asked whether they got mental health care during the previous year. And those with mental health concerns or a history of receiving care are evaluated for their fitness to redeploy.
Army officials did not respond to repeated requests for the number of soldiers with PTSD who are now deployed. But several psychologists, including Rogers, said they think that number should be zero.
“I would never recommend that,” Rogers said, adding that soldiers shouldn’t be drummed out of the military for having the condition, but should be directed to appropriate military jobs in the United States.
Redeploying those with PTSD ” absolutely makes no sense. It’s asking for disaster,” said Lebanon, Ky., psychiatrist James Bland, who has treated recently returned soldiers with PTSD. “It’s like sending someone who had a heart attack back to dig ditches. They might last a while, but they may die.”
Irv Mattingly, a Vietnam veteran diagnosed with PTSD who now works with the Kentucky Disabled Veterans Outreach Program, said deploying troops with the disorder could also endanger others.
“Would you like to be in that foxhole with someone who has PTSD?” he asked.
Rivera, for his part, said he has informed Army officials he doesn’t want to go to Honduras and is awaiting a response. He said he dreads the idea of driving around the country and the even remote possibility of facing combat. “I just don’t want to get shot at,” he said, adding that he wants to find a civilian job and retire from the military.
In the meantime, he said, he continues to work to exorcise the demons of war with therapy at the VA hospital, weekly support groups and the anti-depressant Zoloft.
“I live minute by minute, day by day and just hope nothing goes ‘boom,’ ” he said. “When you see the things I’ve seen and had to do the things I’ve done, you don’t forget.”
Reporter Laura Ungar can be reached at (502) 582-7190