Veterans for Common Sense

Spc. Josh Sanders, then a psychiatric outpatient at Walter Reed, in July 2004.

Behind the walls of Ward 54

They’re overmedicated, forced to talk about their mothers instead of Iraq, and have to fight for disability pay. Traumatized combat vets say the Army is failing them, and after a year following more than a dozen soldiers at Walter Reed Hospital, and reporter Mark Benjamin says he believes the soldiers.

Feb. 18, 2005  |  WASHINGTON — Before he hanged himself with his bathrobe sash in the psychiatric ward at Walter Reed Army Medical Center, Spc. Alexis Soto-Ramirez complained to friends about his medical treatment. Soto-Ramirez, 43, had been flown out of Iraq five months before then because of chronic back pain that became excruciating during the war. But doctors were really worried about his mind. They thought he suffered from post-traumatic stress disorder after serving with the 544th Military Police Company, a unit of the Puerto Rico National Guard, the kind of unit that saw dirty, face-to-face combat in Iraq.

A copy of Soto-Ramirez’s medical records, reviewed by Salon, show that a doctor who treated him in Puerto Rico upon his return from Iraq believed his mental problems were probably caused by the war and that his future was in the Army’s hands. “Clearly, the psychiatric symptoms are combat related,” a clinical psychologist at Roosevelt Roads Naval Hospital wrote on Nov. 24, 2003. The entry says, “Outcome will depend on adequacy and appropriateness of treatment.” Doctors in Puerto Rico sent Soto-Ramirez to Walter Reed in Washington, D.C., to get the best care the Army had to offer. There, he was put in Ward 54, Walter Reed’s “lockdown,” or inpatient psychiatric ward, where the most troubled patients are supposed to have constant supervision.

But less than a month after leaving Puerto Rico, on Jan. 12, 2004, Soto-Ramirez was found dead, hanging in Ward 54. Army buddies who visited him in the days before his death said Soto-Ramirez was increasingly angry and despondent. “He was real upset with the treatment he was getting,” said René Negron, a former Walter Reed psychiatric patient and a friend of Soto-Ramirez’s. “He said: ‘These people are giving me the runaround … These people think I’m crazy, and I’m not crazy, Negron. I’m getting more crazy being up here.’

“Those people in Ward 54 were responsible for him. Their responsibility was to have a 24-hour watch on him,” Negron said in a telephone interview from his home in Puerto Rico. While Soto-Ramirez’s death was by his own hand, Negron and other soldiers say the hospital shares the blame.

In fact, repeated interviews over the course of one year with 14 soldiers who have been treated in Walter Reed’s inpatient and outpatient psychiatric wards, and a review of medical records and Army documents, suggest that the Army’s top hospital is failing to properly care for many soldiers traumatized by the Iraq war. As the Soto-Ramirez case suggests, inadequate suicide watch is one concern. But the problems run deeper. Psychiatric techniques employed at Walter Reed appear outmoded and ineffective compared with state-of-the-art care as described by civilian doctors. For example, Walter Reed favors group therapy over one-on-one counseling; and the group therapy is mostly administered by a rotating cast of medical students and residents, not full-fledged doctors or veterans. The troops also complain that the Army relies too much on pills; few of the soldiers took all the medication given to them by the hospital.

Perhaps most troubling, the Army seems bent on denying that the stress of war has caused the soldiers’ mental trauma in the first place. (There is an economic reason for doing so: Mental problems from combat stress can require the Army to pay disability for years.) Soto-Ramirez’s medical records reveal the economical mindset of an Army doctor who evaluated him. “Adequate care and treatment may prevent a claim against the government for PTSD,” wrote a psychologist in Puerto Rico before sending him to Walter Reed.

“The Army does not want to get into the mental-health game in a real way to really help people,” said Col. Travis Beeson, who was flown to Walter Reed for psychiatric help during a second tour with one of the Army’s special operations units in Iraq. “They want to Band-Aid it. They want you out of there as fast as possible, and they don’t want to pay for it.” Indeed, some psychiatric patients at Walter Reed are given the option of signing a form releasing them from the hospital as long as they give up any future disability payments from the Army. One soldier from Pennsylvania, who was shot five times in the chest and saved by body armor, told me he would do anything to get out of Walter Reed, even relinquish disability pay. “I’ll sign anything as soon as I can get my hands on it,” he told me several days before being released from the hospital. “I loved the Army. I was obsessed with it. The Army was my life. Fuck them now.”

The conditions for traumatized vets at the Army’s flagship hospital are particularly disturbing because Walter Reed is supposed to be the best. But leading veterans’ advocate and retired Army ranger Steve Robinson, executive director of the National Gulf War Resource Center, agrees that when it comes to psychiatric care, Walter Reed doesn’t make the grade. “I think that Walter Reed is doing a great job of taking care of those suffering acute battlefield injuries — the amputees, the burn victims, and those hurt by bullets and bombs,” said Robinson, who has spent many hours visiting psychiatric patients at Walter Reed. “But they are failing the psychological needs of the returning veterans.”

Walter Reed officials declined requests for interviews, although two spoke to me on the condition of anonymity. In written statements to Salon, Walter Reed said the mental and physical health of patients is the hospital’s top priority and described its PTSD treatment regimen as being in line with modern medical standards. The hospital said patients see both “board certified” and “board eligible” psychiatrists, including medical students and residents who “participate in the clinical activities on the ward as part of their training, and as is appropriate for their level of training and needs of the soldiers.”

The hospital also cited a recent survey in which 42 out of 45 psychiatric inpatients surveyed, or 94 percent, felt that their care was either outstanding or good. “We are satisfied that there is a very high level of patient satisfaction with their treatment,” the statement read. The hospital gave few details about the inpatient survey, such as whether it was anonymous, or whether the patients surveyed were even soldiers who recently fought in Iraq. (Inpatients can include military dependents or soldiers who fought in wars decades ago.)

The high level of satisfaction among inpatients as reported by Walter Reed is completely opposite what I saw and heard while tracking soldiers there over the last year. The soldiers I interviewed invited me to their bedsides in the lockdown ward. They handed over their private medical records. They allowed me to call their buddies, their girlfriends, their mothers. All professed to loving the Army, though some said their trust in the institution had been irrevocably shattered. All said their symptoms either stayed the same or worsened while at Walter Reed; two said they made suicide attempts. While it’s true that patients’ self-reports about treatment are not always objectively based, the repeated, bitter complaints I heard over the course of more than a year, in combination with conversations with civilian experts, cast serious doubts on Walter Reed’s approach to treating PTSD sufferers. It all convinced me that something is seriously amiss at the Army’s top hospital.

Politicians and celebrities — like Dale Earnhardt Jr., ZZ Top and President Bush — routinely visit the wounded at Walter Reed; but dignitaries don’t come to Ward 54. When I first visited the lockdown unit in February 2004, it held around 35 patients, who slept as many as six patients to a room. Most patients stay in lockdown for just a few days, then are moved to rooms in hotel-like facilities to get treatment at the Walter Reed outpatient clinic, known as Ward 53. Within the lockdown unit, doors were kept open so that the patients who padded around the linoleum floors in Army-issued slippers, pajamas and robes could be observed at all times. Patients in various states of consciousness, from alert to near catatonic, sat around a television in a communal room. Some wore bandages from what other soldiers said were self-inflicted wounds. Patients were not allowed near the twin electric doors to Ward 54; these open by a buzzer from the nurses’ station, staffed 24 hours a day.

Soldiers who have stayed in the lockdown unit say they were heavily medicated the entire time. Some remember hearing screaming, or patients being subdued on stretchers after shock therapy. “Inpatient can be a traumatic experience for anyone,” said Lt. Julian P. Goodrum, 34, who was in Ward 54 last February after serving in Iraq. Records show Goodrum was held in the ward 13 days longer than needed while the Army decided whether to charge him as absent without leave when, after getting back from Iraq, he was earlier hospitalized by a civilian psychiatrist. He is fighting those charges.

The soldiers told me about their textbook symptoms of PTSD: sudden, ferocious bouts of rage, utter detachment, anxiety attacks accompanied by shortness of breath, and increased perspiration and rapid eye movement. They complained of relentless insomnia, racing thoughts, self-loathing, blackouts, hallucinations and the constant reliving of war through flashbacks by day and nightmares at night. Some described vivid fantasies of violence toward the Army brass in charge of patients there — slicing their throats, throwing them out windows or shooting them. One psychiatric outpatient, who watched as his best friend was blown up by a roadside bomb in Iraq, said: “It does not matter how hardcore you are. Once you go to that war and you start to see dead bodies — you see an arm over here, you see guts over there. There is no way you are ever going to erase that.”

When it is done right, PTSD treatment is a delicate task. Trust is crucial, and medications are carefully administered and monitored. Most critical is getting patients to control the powerful and destructive emotions that can follow a traumatic event like fighting a war. What bewildered the soldiers at Walter Reed, though, was that the Army seemed determined to downplay their war trauma and search for other causes for their mental health problems. In group therapy, sessions often focused more on family relationships and childhood experiences than war, the soldiers said. One outpatient soldier was so angered about this avoidance of the topic of war, he threw a chair during group therapy. Doctors promptly sent him to lockdown.

“When you get [to Walter Reed], they analyze you, break you down, and try to find anything wrong with you before you got in” the Army, said Spc. Josh Sanders, in a telephone conversation from his home in Lovington, Ill. “They started asking me questions about my mom and my dad getting divorced. That was the last thing on my mind when I’m thinking about people getting fragged and burned bodies being pulled out of vehicles,” said Sanders. “They asked me if I missed my wife. Well, shit yeah, I missed my wife. That is not the fucking problem here. Did you ever put your foot through a 5-year-old’s skull?”

Sanders, 25, served in Iraq with the 1st Brigade, 1st Armored Division, from May until December 2003. I met him in the summer of 2004 while he was getting treatment at Walter Reed in the outpatient clinic. Sanders had been evacuated from Baghdad because of the toll the war had taken on his mind. His complaints about Walter Reed were sadly typical. “Nobody hears about this. Nobody hears about what really happens when you are there getting the ‘premier’ medical treatment,” Sanders said.

Dr. Herbert Hendin, medical director of the American Foundation for Suicide Prevention spent many years studying and treating veterans with PTSD after the Vietnam War. In discussing their treatment, Hendin said, “What veterans need is not simply to be able to talk about their combat experiences but to be able to talk about them with someone who understands the context.” Hendin said a combat veteran “needs to feel an empathic connection with the treating professional.” But to the soldiers, the atmosphere in the Walter Reed psychiatric units wasn’t conducive to feeling understood, or getting better.

In Ward 54, recent combat veterans are mixed with other soldiers and even civilians suffering a wide range of mental problems. For them, coming back from Iraq and being treated alongside soldiers with schizophrenia, for example, or maybe even soldiers’ dependents with schizophrenia, makes them feel “crazy,” as opposed to having a natural reaction to combat stress. “If you are a hard-charging person, or somebody who tries to do things right, you are already taking a huge hit to your ego by being put in there,” Beeson, the Army colonel, told me. One of the two Walter Reed officials who spoke on condition of anonymity agreed that recent combat vets shouldn’t be lumped in with other psychiatric patients. Those soldiers “need to have a specialized unit,” the official said. “They are labeled goofy and crazy, and they are not crazy.”

Beeson served in Iraq with the Army’s Civil Affairs Command, part of the Army’s special-operations units. He is a 47-year-old reservist with 26 years of service under his belt, a wiry man grizzled by war. Beeson says his PTSD manifested during his second tour in Iraq. He was flown to Walter Reed. When I first met him in August 2004, heavy medication made him speak in slow, halting sentences like a drunk with a stutter. “A lot of the therapy was counterproductive to me,” Beeson said in a telephone interview from his home in Arkansas, after getting out of Walter Reed. “It was a very paranoia-inducing place. If I was not paranoid when I got there, I was paranoid when I left … To me, they need to figure out if they are going to treat people for war or be a regular hospital.”

Josh Sanders, like the other soldiers I spent time with, also believes he is worse off because of his treatment at Walter Reed. “I don’t trust anybody now … I wish people could understand,” he said. Sanders made two suicide attempts while under outpatient care at Ward 53. Hospital officials would not answer questions about the prevalence of suicide attempts at Walter Reed, but said two incidents that occurred there in January, one apparent fatal overdose and another suicide attempt, are under investigation. Two years ago, the case of Army Master Sgt. James Curtis Coons, also an outpatient, raised serious questions about how Walter Reed handles suicidal patients — questions that persist today.

Coons was evacuated to Walter Reed from Kuwait on June 29, 2003, after swallowing sleeping pills in an apparent suicide attempt several days earlier. When he arrived at Walter Reed, he wasn’t sent to the lockdown unit but to a room in one of the hotel-like facilities on campus. Coons, 36, promptly hanged himself. And although he had a doctor’s appointment the next day, Walter Reed officials failed to look for Coons until July 4, so his body hung and decomposed until then. “A soldier coming in from a war zone does not show up for a doctor’s appointment and they did not even check on him?” his mother, Carol Coons, said in a telephone interview from her home in Texas. “Until this is taken seriously, this is going to continue on. A psychiatric problem among those coming home from these war zones is just as deadly as a bullet.” In a statement, the hospital said it has recently “enacted more stringent policies and procedures to strengthen outpatient soldier accountability”; for example, a Walter Reed staff member is now sent to check on patients who don’t show up for appointments, the hospital said.

It’s unclear how many combat vets are in need of PTSD treatment. But data from the Department of Veterans Affairs and a published Army study show at least one out of every six soldiers coming back from Iraq may have PTSD. (Many Army bases have psychiatric clinics, but some of the most serious cases go to Walter Reed.) Congress is responding with a flurry of bills that might help keep track of and treat the mental toll Operation Iraqi Freedom is taking on U.S. troops. Illinois Democrat Rep. Lane Evans’ bill calls on the military to use state-of-the-art methods to treat psychological injuries. Sen. Russ Feingold, D-Wis., would require the Pentagon to send reports to Congress on PTSD among troops because there is so little information on psychological injury rates.

Normally, soldiers discharged from the Army seek medical treatment from the Department of Veterans Affairs, which is widely understood to do a superior job at treating soldiers with PTSD. Because of the V.A.’s good track record, Steve Robinson of the National Gulf War Resource Center is asking Congress to put the V.A. in charge of treating soldiers with PTSD even before they leave the Army. Four of the soldiers I interviewed who left Walter Reed and later got treatment at the V.A. all praised the care they received there. They finally got a chance to talk one-on-one with other veterans about war, they said. Their medications were pared down, and their disability pay has been increased.

Indeed, the Army’s system for allocating disability pay to traumatized vets is another source of their frustration and anger. An Army panel at Walter Reed, called the Physical Evaluation Board, decides what percentage of income each soldier should get from the military to compensate him if he is too ill to serve any longer. The doctors decide whether wounds are combat related, and then the board decides how much disability the Army will pay. The board’s decision is critical for soldiers trying to make a living after leaving the Army with what can be a debilitating mental condition. Fighting with the hospital about disability pay is a source of considerable stress just as these soldiers are trying to heal their minds.

Some of the soldiers are fighting decisions by the board at Walter Reed. Out of the 14 soldiers interviewed, five have left Walter Reed. Three ended up getting zero percent of their income as disability pay, despite what they said was serious mental stress that made it more difficult or impossible to work. Even those who got a third of their pay still had trouble making ends meet. (In every case I followed, the Department of Veterans Affairs made a later determination that the soldiers deserved more. The soldiers can choose to take the higher percentage of pay from the V.A., but in some cases if they do so, they must pay back what they have received so far from the Army.)

 

After 26 years of service, the Army gave Col. Beeson, from the Army’s Civil Affairs Command, zero percent of his income as disability pay for his mental wounds. Luckily, he still gets some retirement pay because of his many years of service, but he says he struggles with his injuries every day. He is appealing Walter Reed’s decision.

 

Josh Sanders, from the 1st Armored Division, got 30 percent from the Army, but the Army also said his problems did not come from the war. “When I was over there [at Walter Reed] the PEB [Physical Evaluation Board] process was degrading. It is like pulling money from an insurance company. All my paperwork says ‘non-service connected.’ If it is non-service connected, then why am I getting 30 percent?” he asked. The V.A. recently decided to give him 70 percent disability.

 

One Army reservist I spent time with tried to return to his day job as a policeman after the war, but his mental state prohibited him from carrying a gun. The reservist cannot go back to policing, but since the Army decided his mental problems did not come from the war, the small percentage of disability pay he got is not enough to make ends meet, he said. He’s hoping the V.A. will give him more.

 

René Negron, the former soldier who visited Soto-Ramirez before the suicide, was given 30 percent of his pay until February 2006, when he’ll be reevaluated. Negron was a psychiatric patient at Walter Reed after 11 months in Iraq. At one point he checked himself into the emergency room there because he thought he might kill himself. But the Physical Evaluation Board determined that “the soldier’s retirement is not based on disability from injury or disease received in the line of duty,” according to a copy of Negron’s evaluation board proceedings. “This disability did not result from a combat-related injury.”

Negron, 48, taught hair care and cosmetology before serving in Iraq as an Army specialist with the Puerto Rico National Guard. Now, he says his debilitated mental state after the war has left him unable to work. He drives two hours each way for mental health treatment at a V.A. medical center. “You think I can live on $700 a month?” Negron asked. “I can’t work. My wife is suffering. She can’t leave me alone. Sometimes I feel suicidal. Sometimes I hear voices. Sometimes I see lights. I feel like I’m being shot at. They sent me home like that. I’ve been dealing with this since I got back,” Negron said. “I left here in good condition. If I have a mental condition, they have to deal with it … I did my part. Why can’t they do their part?”

 

Rumsfeld May Face Contempt for Continuing with Experimental, Illegal Anthrax Shots

Washington, DC, Feb. 15 (UPI) — A judge in Washington has warned Defense Secretary Donald Rumsfeld he could face contempt for ignoring a ruling on Pentagon anthrax vaccinations.

In October, U.S. District Judge Emmet Sullivan largely struck down the U.S. military’s involuntary vaccinations for weaponized anthrax.

The judge said the program could not be administered unless individual service members give “informed consent” to the vaccinations, President Bush issues a specific waiver or the Food And Drug Administration properly classifies a drug for use in the program.

A 1999 executive order by then President Bill Clinton required “informed consent” before administering the vaccine.

Monday, Sullivan ordered “Donald H. Rumsfeld” to “show cause by Feb. 28” why “he/or the government should not be held in contempt” for failing to follow the earlier ruling.

Sullivan also ordered Pentagon employees and soldiers challenging the program to respond to an emergency motion by the Pentagon asking that the earlier injunction be modified.

Disabled veterans must keep waiting in Illinois

Illinois’ wounded veterans will have to wait several months before learning why they’ve received among the lowest disability pay in the country for the past seven decades.

“We don’t know how long it’s going to take, and that really is the truth,” said Veterans Affairs Deputy Inspector General Jon Wooditch. “Before the full report is on the street, it would probably be months.”

Sen. Barack Obama (D-Ill.) called the delay “troubling and disappointing.”

“Our veterans have served their country and have already waited long enough for the answers they deserve,” Obama said in a statement Tuesday evening. On Monday, Obama said he wanted the investigation to last weeks, not months, and expected answers soon.

‘A massive job’

Wooditch defended the length of his agency’s investigation — already two months old — saying that teams of analysts are combing through millions of records, some dating as far back as 1985.

“If we rush to judgment here and make a hasty conclusion and it turns out there were other factors involved that we’ve missed, then the report really isn’t that valuable to anybody,” Wooditch said.

At least one veterans representative called the delay reasonable. Randy Bunting, Chicago supervisor for the Disabled American Veterans office, which helps veterans file their disability claims, characterized the IG’s probe as “a gigantic undertaking.”

“They have thousands upon thousands of records to sift through. That’s a massive job,” Bunting said. “The inspector general’s study could possibly do some good, but it will be up to the VA whether they act on its findings.”

The VA inspector general was asked to investigate the disability disparity in mid-December after a Sun-Times series revealed veterans here have been shortchanged by as much as $5,000 per veteran per year compared to veterans in other states and Puerto Rico. The disparity dates back to 1934.

Illinois’ congressional delegation initially gave the VA a deadline of Jan. 5 to answer why there was such a gap in pay. The inspector general’s office said it couldn’t meet that deadline but never said when it might be done.

“We know everybody out there is waiting for results,” Wooditch said. “We’re doing it as quickly as we can.”

Although the inspector general’s office has never investigated disparity in disability nationwide, it has learned that over the past 30 years other entities, including the VA, have examined the problem, Wooditch said. His office is trying to track down these reports.

“To this day, they (the VA) still haven’t been able to fully explain the disparity,” said Wooditch, “or come up with any remedies to fix it, if in fact, it even is a problem.”

VA Web Site, E-Mail Address, and Phone Numbers for Iraq and Afghanistan War Veterans

The Department of Veterans Affairs (VA) and the Department of Defense should learn a lesson that might benefit the one million recently deployed OEF and OIF war veterans.  VA and DoD should determine quickly how the following veterans could have possibly been better served with thorough medical screenings, including face-to-face mental health evaluations: Rigoberto Nieves, William Wright, Brandon Floyd, Cedric Griffin, David Shannon, Robert Stewart Flores, John Allen Muhammed, Paul Delaney, Frank Ronghi, Jeffrey Glenn Hutchinson, Joseph Ludlam, Matthew Denni, James Gregg, and Richard Corcoran. 

VA OEF and OIF Web Site:

http://www.vba.va.gov/EFIF/

VA Compensation and Pension benefit E-Mail Addres:

freedom@vba.va.gov

VA Toll Free Numbers:

VA Benefits: 1-800-827-1000

• Education
• Home Loan Guaranty
• Disability Compensation
• Disability pension
• Dependency Indemnity Compensation
• Death Pension
• Vocational Rehabilitation and Employment
• Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA)
• Medical Care
• Burial
• Life Insurance

Life Insurance: 1-800-669-8477

Education (GI Bill): 1-888-442-4551

Health Care Benefits: 1-877-222-8387

Income Verification and Means Testing: 1-800-929-8387

Mammography Helpline: 1-888-492-7844

Gulf War/Agent Orange Helpline: 1-800-749-8387

Status of Headstones and Markers: 1-800-697-6947

Telecommunications Device for the Deaf (TDD): 1-800-829-4833

Veterans for Common Sense Resource Guide:

http://www.veteransforcommonsense.org/files/vcs/guide.cfm

‘Over my dead body’

Sgt. Curtis Greene loved the military; the structure, the stability. But eight months in Iraq changed him. And the thought of returning led him to a stark proclamation.

By MARY SPICUZZA
Published February 13, 2005

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[Times photo: Kathleen Flynn ]Lisset Greene her son Anthony Rivera, 6, and her daughter 19-month-old Laila Greene visit the grave of their husband and father Curtis Greene who committed suicide in December after returning from serving in Iraq.

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Photo of Curtis Greene taken in his barracks in Kosovo about 5 years ago. [Family photo]

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Nineteen month old Laila and her half brother Anthony Rivera, 6, hold the flag presented to their mother Lisset Greene after her husband Curtis Greene committed suicide in December. He had recently returned from serving overseas in Iraq. Lisset said she grieves for her children’s loss more than anything. “He looks up in the sky and says my daddy’s up in heaven and he’s looking down on me,” Lisset said of Anthony.

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SPRING HILL – The words haunt Lisset Greene as she struggles to understand what happened to the man she loved. Home from fighting in Iraq, he had grown depressed and distant as he witnessed thousands of his fellow soldiers head off to war.

Curtis Greene was angry about the war and frustrated with Lisset for not understanding what it had been like there. They argued, so fiercely that twice the police had to break it up.

Gone was the man smiling with her and the kids in family photos. “He was not the person I knew when he came back from Iraq.”

One night he disappeared from their home outside Fort Riley, Kan. Lisset and the kids went to stay at her father’s house in Hernando County. When he called her to apologize for running out, he promised he would come home to Fort Riley. But he wasn’t about to return to Iraq.

“Over my dead body are they going to make me go back.”

“I knew he was having dreams, nightmares,” Lisset said. “He would wake up at night really sweaty.”

On Dec. 6, he showed up for work, his uniform pressed, his boots polished. He sang cadence.

That night, he was found hanging in his barracks. Sgt. Curtis Greene, 331st Signal Company, was 25.

 

During the war in Iraq, the military has made unprecedented attempts to understand the psychological toll of combat.

For the first time, the Army sent a team of mental health experts to assess the military’s behavioral health system in an active combat campaign. The team was sent after a dramatic spike in soldier suicides – with five soldiers taking their own lives in Iraq in a single month.

Military leaders say they are expanding psychological services for soldiers, including mental health screenings, post-traumatic stress disorder support and new suicide prevention initiatives.

“The Army is more concerned than ever at looking at and taking care of the needs of the total soldier,” Army spokeswoman Martha Rudd said.

It’s not enough, some veterans advocacy groups say. And with the protracted ground war, they say, we haven’t seen anything yet. Studies indicate soldiers are suffering from post-traumatic stress disorder on a scale not seen since Vietnam.

Steve Robinson, executive director of the National Gulf War Resource Center, said countless soldiers return from Iraq struggling with emotional scars. He questions whether the military is truly prepared to treat them.

“If we send soldiers off to war and they come back broken, we owe them the best the nation can muster to send them back into health, emotionally, spiritually, physically,” Robinson said. “They’re doing something, but I don’t think it’s enough.”

Lisset wonders: Is that my husband’s story?

“All I know is that I don’t have a husband anymore, and my children don’t have a father.”

Greene grew up in a military home. His stepfather, Donald Greene, served in the Navy from 1968 to 1976; he remembers little Curtis helping him spit shine his shoes.

“We never had a problem out of him,” Mr. Greene said. “I never knew him to have an enemy.”

He asked about joining the military right out of high school in Siler City, N.C.

“I told him that if you want to sow a few oats and you want to see the world, my suggestion is to go into the service,” Mr. Greene said.

But Mr. Greene, who served in Vietnam, also warned that he still struggled with memories of the horrors of war.

Sgt. Greene enlisted in the Army in the fall of 1997 and met Lisset Rivera the following year. Both were stationed in Germany, she working supply, he in communications.

Friends teased her about dating a younger man – she was five years older. But she said the other soldiers all liked him.

“Everybody said he was the coolest white boy,” Lisset, a Puerto Rican who grew up in New Jersey, said with a shy smile.

They were married in a small civil ceremony in Germany early in 2000. Back in the states, Sgt. Greene took to Anthony, Lisset’s son from a previous relationship. It was long absences from Anthony, who lived with Lisset’s parents when she was stationed abroad, that convinced her to leave the military.

Sgt. Greene stayed in. He told Lisset the Army provided him with structure and stability. “He loved the military,” she said. “He would praise it.”

The family moved to Fort Hood, Texas, where as a member of the 16th Signal Battalion, Sgt. Greene earned a reputation as a strict taskmaster.

Staff Sgt. Daniel Boggs remembers Sgt. Greene clashing with a new soldier over his attitude. “Curtis didn’t like it,” Boggs said. “It wasn’t a big deal, but he made it a big deal.”

Boggs and Sgt. Greene didn’t get along at first, but by April 2003, when they were deployed to Iraq, they were close friends.

The Army team of mental health experts was sent to Iraq in July 2003, after five soldiers committed suicide that month.

The resulting study, published in the New England Journal of Medicine, found that as many as 17 percent of soldiers serving in Iraq showed signs of major depression, generalized anxiety or post-traumatic stress disorder.

Most soldiers suffering from psychological problems told researchers they had not sought counseling because of the stigma or fear that it would ruin their careers.

The study found that 72 percent of soldiers reported their unit’s morale was low; it found that mental health workers there felt untrained to treat combat stress.

Because of these barriers to getting care, many experts believe the number of soldiers in Iraq suffering from combat-related psychological problems is far greater than one out of six.

“One of the major impacts of war are mental health problems,” said Dr. Charles W. Hoge, the chief of the division of psychiatry and neuroscience at the Walter Reed Army Institute of Research.

Hoge, a principal author of the study, said he hadn’t met Sgt. Greene and could not comment specifically on his case.

But he said the general “hallmarks” of post-traumatic stress include re-experiencing a traumatic event in some way, such as nightmares; avoiding anything that might remind you of the traumatic event; and hyperarousal, a physiological response to stress that can lead to irritability and restlessness.

Among soldiers who develop PTSD, the study said, “There was a strong reported relation between combat experiences, such as being shot at, handling dead bodies, knowing someone who was killed, or killing enemy combatants.”

The details of what Sgt. Greene experienced during his eight months in Iraq are unclear.

Boggs said he was stationed in Fallujah and Ramadi, while Sgt. Greene built communications networks near the Jordanian border. They talked often, but Boggs said his friend never went into detail about what he witnessed, just that he hated it there.

Sgt. Greene told his stepfather that he had to kill a few people, and that the guilt was weighing on him. “Curtis seems to think that he was a murderer,” his stepfather said. “Curtis was raised to respect life; in the military you’re taught to take it. I think he struggled with that.”

The Army does not provide detailed information about where specific soldiers were stationed or incidents they witnessed, said Rudd, the Army spokeswoman.

Lisset said her husband shared his worst experience: A soldier next to him was shot in the face and died instantly. He told her he screamed until he got to his destination, then watched as the man was placed in a body bag.

He felt guilty because they had switched seats in the car shortly before the shooting.

“He said they treated the body like a bag of trash,” she said. “He said that he was supposed to be in the passenger seat, and the bullet was for him.”

In World War I, it was known as shell shock, in World War II, combat fatigue. The psychological effects of war on soldiers have always been a struggle.

But the rigorous evaluation of war-related mental health problems is relatively new, according to Matthew Friedman, executive director of the Department of Veterans Affairs National Center for PTSD.

In the mid-1980s, the National Vietnam Veterans Readjustment Study found that about 30 percent of male Vietnam veterans suffered from lifetime problems with PTSD. Friedman and other experts believe a flood of soldiers with psychiatric problems will return from Iraq.

Rick Weidman, a spokesman for Vietnam Veterans of America, says of the more than 1-million soldiers who have served in Iraq, the number with psychological problems is probably at least 1 in 3.

“Iraq is Vietnam without water,” he said. “We will see a great deal more of this.”

Sgt. Greene’s family said he never talked to them about depression while he was deployed. But one thing is certain: He wanted out of Iraq.

He got out of his Texas-based battalion after about eight months by re-enlisting in the Army, Lisset said. He was able to return to the United States by signing up for another three years with the 331st Signal Company, 1st Brigade, 1st Infantry Division, stationed at Fort Riley, she said.

He seemed “normal” when he returned from Iraq in December 2003, she said. He finally met his newborn daughter, Laila, and couldn’t stop gushing about her.

But after they moved to Fort Riley . . .

“He changed; he changed,” Donald Greene said. “He was just in the ozone, so to speak. He was detached, in turmoil inwardly.”

Lisset said he had nightmares and couldn’t sleep. He cried easily, but avoided talking about Iraq.

“He just said it was ugly, and that you don’t know what it’s like until you’re there,” she said. “He always said he wouldn’t wish it on his worst enemy.”

When the evening news reported deaths in Iraq, he would weep and ask her to turn off the TV.

“He really cried, like it was someone he knew,” she said. “He’d say that we shouldn’t be there. He always wanted to know why we were there.”

He was terrified that his company would be deployed to Iraq. That company remains at Fort Riley.

The Department of Defense recently announced that it is expanding its assessment of soldiers coming home. It will require all soldiers to fill out a health questionnaire within three to six months of their return.

Rudd said the Army also offers a deployment psycho-support program and an extensive suicide-prevention program.

“I think there are still gaps,” Steve Robinson said. His group wants mandatory face-to-face sessions with a qualified mental health care provider.

Military mental health programs are stretched too thin, he said, and should be proactive, not simply react after suicides and other incidents.

In the meantime, many VA hospitals are working to expand psychological services, despite talk of subsidy cuts and possible enrollment fees for some veterans.

Dr. Glenn Smith, a psychologist with the post-traumatic stress disorder clinic at the James A. Haley VA Medical Center in Tampa, is organizing workshops about PTSD for veterans and their spouses.

He is working to erase the stigma around mental health issues that can develop in a combat zone. “PTSD is a normal reaction to abnormal stress,” he said.

The VA recently was authorized to add 50 outreach personnel to the 940 it has nationwide to assist with its readjustment counseling service.

Sgt. Greene did reach out for help after he returned from Iraq. He began seeing a psychiatrist – though he hid it from his wife.

Lisset discovered prescription bottles of antidepressants and sleeping pills in their home. He told her he had started getting therapy and had been diagnosed with post-traumatic stress disorder.

She said he wanted out of the Army, but finances were tight. They would argue, and Lisset said she saw a look in his eye that scared her. “He didn’t punch or hit me, but he threatened to kill me,” and she didn’t know what he might do.

He took off in the middle of the night, leaving Lisset and the kids in Kansas. He drove to Virginia and told his family there that he had “gotten out of the military.”

By the time he called Lisset, she had taken the kids to stay with her father in Spring Hill. She begged him to return to the base, worried he would be arrested for going AWOL.

He did go back, and told her his punishment would be working extra duty.

He called the next day, Dec. 6, and asked about their future together. Lisset said she loved him but thought he needed counseling. He agreed, but said he believed she would be better off without him.

He hung up. She tried repeatedly to call him back, but there was no answer.

Four hours later, fellow soldiers found him dead, hanging in his barracks.

With so many mental health programs available, Sgt. Greene’s stepfather wonders why nobody in the Army noticed the warning signs.

“It seems to me like somebody somewhere would have spotted this,” Mr. Greene said. “He was seeing a psychiatrist.”

He fears the questions around his son’s death will never be answered. “I’m just a grieving daddy who raised a boy and lost him.”

Lisset doesn’t know what to believe. Did her husband have psychological problems before he was deployed? Did Iraq trigger something in him? Could the Army have done more to help him?

“I know it could have been prevented,” she said.

She feels the Army has not provided her with any answers. She has not seen his suicide letter, which she was told is being held as evidence in an ongoing investigation.

“You can’t expect a soldier to go and be expected to take people’s lives – women, children, anyone – then expect them to come back and be fine,” she said.

Lisset and the kids are staying with her father in Spring Hill. She is trying to explain to Anthony what happened to his stepdad. Most days, Anthony insists that she help him put on the gold star pin “for Daddy” that the Army gave him.

Sgt. Curtis Greene is buried at Florida National Cemetery near Bushnell.

“He was a good, honest person,” Lisset said, looking out over the rows of tombstones. “He was willing to die for his country. But when he came home, I thought he’d be safe.”

Researchers Carolyn Edds and Caryn Baird contributed to this report. Mary Spicuzza can be reached at mspicuzza@sptimes.com or 352 848-1432.

How dare some say, ‘Support our troops’?

Someone recently informed me that they didn’t know that my son was being deployed to Iraq and asked why I hadn’t told them. I really didn’t have an answer. That is when I began to be annoyed by those ever-present, good-intentioned but mindless ribbons stuck on the back of cars and SUVs exhorting, “Support Our Troops.”

I find those magnetic messages to be offensive when I think of parents and friends of National Guard soldiers who purchased expensive Kevlar armor for their soldiers while Donald Rumsfeld said they didn’t have any in stock.

Those marketing messages seem so empty when soldiers are told to “up-armor” their Humvees because the Department of Defense had not asked the manufacturers if more could be done.

I am saddened when veterans wait over a year for appointments at veterans’ hospitals and soldiers in Iraq, Afghanistan and places like Walter Reed Hospital are required to pay for phone calls and emails home. I bet Rumsfeld doesn’t have to pay for calls and e-mails back home, and I find it unbelievable and unacceptable that Rumsfeld has not been fired while the troops have been treated so poorly. Support our troops?

I accept that there are justifications for going to war. However, I cannot find anyone who can give me a solid reason to justify our going to and continuing the war in Iraq.

SEEKING REASONS

There seems to be no question in America more avoided, particularly by elected officials, than a discussion of the war in Iraq. I asked Maine’s members of Congress those questions.

U.S. Rep. Tom Allen said the war was not justified, but to abandon Iraq and its people now would be a mistake. Sen. Susan Collins said that going to war in Iraq was a problem of faulty intelligence, but the chaos in Iraq required us to stay.

Sen. Olympia Snowe blamed Saddam Hussein as the revised apparent rationale for invading Iraq, and she focused on the need for global support for the U.S efforts in Iraq. U.S. Rep. Michael Michaud agreed with Snowe.

Those answers translate that we got there by mistake, and we are staying there by mistake. There is no plan, there is no discussion and there is no leadership. Didn’t we go into Iraq to protect ourselves from weapons of mass destruction and because of Iraq’s connections with the terrorists, reasons that have been found to be utterly in error? Support our troops?

The pointless death and maiming of this war is pure insanity and probably even criminal. In this war, many times those who died in the World Trade Center have been wounded or killed. Over 1,400 American soldiers are dead, over 10,000 soldiers are physically wounded while uncounted others are psychologically wounded, and, by some estimates, over 100,000 Iraqis have been killed and maimed.

How can the killing be justified? Are we going to destroy a nation and kill its people to save it? We tried that once before. Support our troops?

I am afraid for my son. I certainly worry about his being killed, but I am also worried about his being placed in the position of killing, too. Most of all, I am angry that we are sending our soldiers to a war that nobody can justify.

Most Americans, especially members of Congress, do not have to worry about a loved one in the middle of this war, and they duck the tough questions.

Why do we permit a defacto back-door draft of the National Guard and recycle them, too? We were lied to once before, and we must avoid being lied to again. Will President Bush be this generation’s Robert McNamara? I hope not. Will the Congress have the courage to ask the relevant questions? I hope so. Support our troops?

PLEASE DON’T ASK

Now you know why I didn’t go out of my way to tell people that my son is being deployed to Iraq, and please don’t ask about him if you really don’t want to know.

Instead, please know that you will be in my shoes or his shoes unless you ask questions and demand answers of those in power. In the meantime, please excuse me if I have a painful lump in my throat or tears brimming in my eyes and that I am so angry with this damned war and the people who declared it.

Support our troops. Ask tough questions. Bring them home now.

J. Kamilewicz dexkam@aol.com

The Rise of the Far Right: New Ads Amplify the Voices of Fear, Hate, and Violence

White supremacists are using mainstream media to gain new followers, and legitimacy. Watchdogs fear violence if such groups grow.

ST. LOUIS — White supremacist groups around the country are moving aggressively to recruit new members by promoting their violent, racist ideologies on billboards, in radio commercials and in leaflets tossed on suburban driveways.

Watching with mounting alarm, civil rights monitors say these tactics stake out a much bolder, more public role for many hate groups, which are trying to shed their image as shadowy extremists and claim more mainstream support.

Watchdog groups fear increased violence from these organizations if they grow. But perhaps an even greater fear is that the new public relations strategy will let neo-Nazis recast themselves as just another voice in the political spectrum — even when that voice may be advocating genocide.

“The concern is that this will bring them new members and money, and that they will get some real traction in mainstream politics,” said Mark Potok, who tracks hate groups for the Southern Poverty Law Center. “We are completely in favor of the 1st Amendment. [But] they poison the public discourse with ideas like ‘Jews are behind it all and need killing.’ ”

The National Alliance, which calls for ridding the U.S. of minorities, has led the drive to raise the profile of white supremacists.

The local chapter spent $1,500 on MetroLink ads here in St. Louis last month, plastering nearly every commuter train car in the city with a blue-and-white placard that declares “The Future belongs to us!” and lists the group’s website and phone number. The same chapter bought airtime on local talk radio last fall, urging whites to unite and fight for the survival of “white America.” One member of the chapter, Frank Weltner, has long hosted a radio show that advocates a white supremacist viewpoint.

“We want to use mainstream advertising to say to the public: We’re not a shadowy group. This is what we believe in, and we’re proud of it,” said chapter leader Aaron Collins. “We’re trying to give people courage. We want to show them, if you stand up for what you believe in, you’re not going to be crucified.”

With that goal in mind, other chapters of the National Alliance have posted billboards in Utah, Nevada and Florida. The group has also coordinated massive leaflet drops, distributing 100,000 racist fliers in a single night in states as diverse as New Jersey, Alabama and Nebraska.

The National Alliance even bought a membership list and mailing labels from the Florida Bar Assn. last year so it could send an eight-page recruitment letter — complete with anti-Semitic cartoons — to 2,500 criminal defense lawyers.

“If we had the money to advertise during the Super Bowl, we’d try that too,” said Shaun Walker, the organization’s chief operating officer.

Civil rights monitors consider the National Alliance one of the most virulent neo-Nazi organizations in the country. It was founded in the 1970s by the late William Pierce, who called for herding Jews, homosexuals and “racemixers” into cattle cars and sending them to abandoned coal mines.

Although the group’s website says it “does not advocate any illegal activity,” National Alliance members have been convicted of violent acts over the last two decades, including armed robberies, bombings and murders. The FBI’s senior counterterrorism expert told Congress in 2002 that the National Alliance represented a “terrorist threat.”

“They clearly have a track record of encouraging members to take their vision of race war to the streets,” said Devin Burghart, who monitors hate groups for the Center for New Community in Chicago.

Potok estimates that the National Alliance has fewer than 700 members, but it’s one of the best-financed supremacist groups in the country because it owns a music label, Resistance Records, which long dominated the white-power music scene.

The white supremacist movement encompasses scores of other small — often feuding — organizations, with total membership estimated at 100,000. They too are reaching out.

Last fall, residents of Columbia, Mo., awoke to find the Aryan Alternative — a new tabloid promising “uncensored news for whites” — next to the Sunday paper on their driveways. In Louisville, Ky., in December, a branch of the Ku Klux Klan sneaked fliers inside copies of the Courier-Journal rolled up for home delivery.

And in a bold bid to recruit youths as young as 13 to the movement, the Panzerfaust record label last fall gave away thousands of CDs packed with hard-driving white-power music, distributing them in schools and malls in numerous states, including California. Sample lyrics: “Do you feel the pride as the skinheads march by? Do you see as I do that our enemies must die?”

The Panzerfaust company dissolved this month when one of the label’s founders accused his business partner of being half-Mexican — an ethnic heritage considered treasonous in the white-power world. Already, however, other groups have stepped up teen recruitment, selling swastika pendants online and promoting a “pro-white radio station” that streams supremacist ballads, heavy metal and rock songs.

Public outreach is not new for white-supremacist groups. The Knights of the KKK have been picking up litter for Missouri’s Adopt-a-Highway program for years.

But hate-group monitors say the latest recruitment campaigns are much broader than any they’ve seen before.

Neo-Nazi organizations are not only putting up billboards, they’re also instructing members to hide tattoos and dress for rallies in conservative suits to avoid being dismissed as extremists. Thomas Robb, the national director of the Knights of the KKK, urges his members to serve on community boards and in political parties so they can push their white-power agenda from positions of social respect.

“I encourage them to do that, absolutely,” Robb said. “Though it has to be done gently.”

The National Alliance, meanwhile, is increasingly tailoring its leaflets to current events. Local members seize on any racial tensions in their community as an excuse to blanket the area with articles explaining the white-power worldview.

As Walker, the chief operating officer, put it: “The current powers that be constantly demonize us. But if we can get our message out to enough people, we’ll gain legitimacy with the public.”

Civil rights advocates call this new emphasis on legitimacy insidious, because it could lure people into neo-Nazi circles before they fully understand what they’re being sold.

Some of the National Alliance’s ads and websites make it look “like the focus is on mainstream conservative issues,” said Karen Aroesty, the Midwest director of the Anti-Defamation League. The Las Vegas billboard, for instance, urged: “Stop Immigration.” The one in Salt Lake City declared: “Securing the Future for European Americans.”

Although no one offers hard numbers, white supremacists contend — and their sharpest critics agree — that the recruitment strategy is working.

Many of the promotions are short-lived; the MetroLink ads were up just a week before transit officials removed them in response to a complaint. Such controversy, however, generates media coverage that can be even more valuable than the ads themselves.

Media reports about the Salt Lake City billboard drove 4,500 visitors to the National Alliance’s local website in a single week — compared with average traffic of 100 hits a month, Walker said.

When the flap about the MetroLink ads made news here, the National Alliance got so many calls that the phone company insisted that the group upgrade its voice mail system, said Collins, the chapter leader. He wouldn’t give precise numbers, but said 80{cd9ac3671b356cd86fdb96f1eda7eb3bb1367f54cff58cc36abbd73c33c82e1d} of the callers listened to the two-minute white-power message on the group’s answering machine, then hung up. He said there were two angry callers but that many people asked for more information. “I had to appoint three people just to call people back,” he said.

“What evidence we’ve seen indicates that real-world advertisement and promotion has far more impact on recruitment than online work does,” said Burghart, the Chicago human rights monitor.

“They reach a different demographic,” he said. Many middle-aged recruits, he said, feel more comfortable joining a group they’ve seen on TV or have heard advertised on the radio, rather than one that makes its presence known mostly through racist rants in Internet chat rooms.

Hate groups recognize the power of that outreach. So they intend to keep at it.

“You know the old saying: It pays to advertise,” Walker said. The thought chills Marilyn Mayo, an associate director of the Anti-Defamation League.

“Only a very small percentage of the population supports them,” she said. “But they always will attract a certain number — and how many is too much?”

Iraq War Veteran Convicted of Killing Wife

An Army reservist was convicted of killing his wife, who had hailed him and other soldiers as heroes in a letter to the editor while he was serving in Iraq.

The jury found Matthew J. Denni, 39, guilty of second-degree murder Wednesday in the shooting death last March of his wife, Kimberly, 37. He had been charged with first-degree murder, but he testified he was in a rage because she had been having an affair, and the jury decided the crime was not premeditated.

Her body was found in May in a footlocker in Denni’s van after her brother reported her missing. Prosecutors said her husband had conceiled her body for two months.

The night of the shooting, the couple had argued and Kimberly Denni said she was going to going to her boyfriend’s house, Denni testified. “I just thought, `No, you’re not.’ I reached down, opened the drawer and pulled out the gun,” Denni said. He said he had not planned to kill her.

A supply sergeant based at Fort Lewis, [Washington] Denni served several months in Iraq before he was sent home in October 2003 after he was accidentally shot in the leg. He said he had been unable to sleep and had nightmares because of the stresses of war and collapse of his marriage.

In September 2003, Kimberly Denni had written to The Columbian newspaper, referring to a plan to release an action figure based on President Bush’s appearance aboard an aircraft carrier that May, declaring declaring major combat operations in Iraq to be over.

“If they want action figure heroes, it’s time they look at who the heroes really are,” she had written. “I wish people could understand that the soldiers are in Iraq because it’s their job, but many don’t want to be there.”

Denni faces 15 to 23 years in prison when he is sentenced March 10. The Dennis’ daughter, who was 7 when her mother was killed, is in the care of a relative.