Dave Phillipps / The Gazette – 2013-05-27 22:22:09

http://cdn.csgazette.biz/soldiers/day1.html

Kash Alvaro — Waking up at the hospital in Kandahar

(May 26, 2013) — Kash Alvaro stared at the ceiling of an emergency room in January listening to the beep of an EKG monitor for what he guessed was the 80th time in 12 months. The once-healthy Afghanistan War veteran had collapsed in a hallway that night, then awakened confused in an ambulance and lurched up in alarm, swinging and yelling until the paramedics held him down and injected sedatives. Now he lay alone in a room at Memorial Hospital, quietly weeping.

Alvaro joined the Army at age 18 in 2008. In Afghanistan in 2009, he was hit by multiple bomb blasts, including one that threw him across a road like a lawn dart. Sophisticated armor helped him escape with just bruises, but the blasts battered his brain. Ever since, he has been hit with heart spasms and seizures.

Alvaro is in many ways the typical modern disabled veteran. He survived combat with barely a scratch but later was diagnosed with what have become the most common wounds of a decade of war — traumatic brain injury and post-traumatic stress disorder, which together likely affect more than half a million veterans of Iraq and Afghanistan, the Department of Defense said.

What happened when he came home is increasingly typical, too. At Fort Carson, the damaged soldier racked up punishments for being late to formation, missing appointments, getting in an argument and not showing up for work.

These behaviors can be symptoms of TBI and PTSD, and Army doctors recommended Alvaro go to a special battalion for wounded warriors. Instead, his battalion put him in jail, then threw him out of the Army with an other-than honorable discharge that stripped him of veterans benefits. He was sent packing without even the medicine to stop his convulsions.

“It was like my best friend betrayed me,” Alvaro said at the hospital, his speech as slow as cold oil. “I had given the Army everything, and they took everything away.”

After the longest period of war in American history, more soldiers are being discharged for misconduct than at any time in recent history, and soldiers with the most combat exposure are the hardest hit. A Gazette investigation based on data obtained through the Freedom of Information Act shows the annual number of misconduct discharges is up more than 25 percent Army-wide since 2009, mirroring the rise in wounded.

At the eight Army posts that house most of the service’s combat units, including Fort Carson in Colorado Springs, misconduct discharges have surged 67 percent. All told, more than 76,000 soldiers have been kicked out of the Army since 2006. They end up in cities large and small across the country, in hospitals and homeless shelters, abandoned trailers and ratty apartments, working in gas fields and at the McDonald’s counter. The Army does not track how many, like Alvaro, were kicked out with combat wounds.

“I can tell you that 10-plus years of war has placed significant stress on many of our service members, sometimes manifesting itself in their health and even their discipline,” said Gen. Martin Dempsey, chairman of the Joint Chiefs of Staff. But he disagreed that the military is using minor misconduct to discharge veterans, saying, “We go to great lengths to try to rehabilitate those who don’t meet or maintain required standards prior to initiating separation.”

It doesn’t take serious misconduct to be discharged and lose a lifetime of benefits. The Gazette found troops cut loose for small offenses that the Army acknowledges can be symptoms of TBI and PTSD. Some soldiers missed formation a handful of times or smoked marijuana once.

Some were discharged for showing up late or missing appointments. Some tested positive once for drugs, then were deployed to combat zones because the Army needed the troops, only to be discharged for the drug offense when they returned.

One two-tour infantry soldier was targeted for discharge after missing three doctor appointments because he had been admitted to a psychiatric hospital for being suicidal.

Like many, Alvaro struggled after being kicked out. Too sick to hold a job, with no medical insurance, no veterans benefits and no family support, Alvaro soon became homeless. He started relying on the ER for care — regaining consciousness at the hospital, getting anti-seizure drugs, and being released onto the streets.

In January, friends wheeled Alvaro into a Department of Veterans Affairs hospital in Denver and pleaded for help, but hospital staff said his other-than-honorable discharge barred him from care, handed him the phone numbers for local homeless shelters and wheeled him out.

Lying in a bed at Memorial Hospital, listening to the beep of the EKG, Alvaro said he had lost one-third of his body weight since being discharged in January 2012 and expected to die before spring.

“When I was young, I carried two jobs, never had no health problems,” he said, not lifting his head or moving his eyes. “After I got blown up?”

He let the beep of the EKG monitor finish his thought.

A Surge in Discharges
Posts with large combat units have seen misconduct discharges soar. Fort Campbell, Ky., and Fort Riley, Kan., both home to a disproportionate number of combat troops, each kicked out 65 percent more soldiers in 2012 than the year before. The Gazette found wounded veterans kicked out for minor violations at Fort Bragg, N.C.; Fort Bliss, Texas; Fort Drum, N.Y.; and Joint Base Lewis-McChord, Wash.

The rise in discharges is driven in part by pressure to downsize the ranks and control costs as the wars in Iraq and Afghanistan wind down. The Army plans to cut the force by 80,000 troops by 2017, and top officials said they may cut an additional 100,000 because of mandated federal budget cuts.

At the same time, an estimated 500,000 troops are thought to have PTSD or TBI. Symptoms can include bad decision-making, frayed memory and incendiary anger, all of which can be indistinguishable from misconduct. Commanders struggle to determine which soldiers are badly injured and which are just bad.

Because of this, observers say, the cuts are most likely to fall on soldiers whose performance has slipped because of invisible combat wounds.

“I’ve been working on this since the ’70s, and I have never seen anything like this,” Mark Waple, a retired Army officer who now tries military cases as a civilian lawyer near Fort Bragg, said of the surge in discharges. “There seems to be a propensity to use minor misconduct for separation, even for service members who are decorated in combat and injured.”

Compounding problems, the United States has long had a dual system that enforces strict discipline for troops during war, then extends support when veterans come home. But the system has not adjusted to the new reality in which career troops deploy multiple times and are often war fighter and veteran at once. That can leave commanders with the difficult choice of maintaining discipline or caring for the wounded.

Army leaders are already exceeding their troop reduction goals, Sgt. Maj. of the Army Raymond Chandler told Army Times in April, adding, “I’m proud of the fact that our solders, our leaders, are being engaged in this and taking action.”

Chandler did not respond to requests for an interview for this story.

Lawyers who work with veterans say the Marines, also facing cuts in troops, have seen a similar rise in discharges.

Everyone leaving the military is given a character of discharge: honorable, general, other-than-honorable, bad conduct or dishonorable. The last two can be given only as a result of a court-martial conviction. Most soldiers kicked out for misconduct get an other-than-honorable discharge, records show, which strips them of military and VA benefits.

They can appeal. “But that process is extremely difficult,” said Malachi Muncy, an Iraq War veteran who helps soldiers with appeals near Fort Hood, Texas. “It takes years, and often it’s not successful.”

The federal government often stresses its duty to care for combat veterans. In October, President Barack Obama called it “the single most sacred obligation this country has.”

In April, Colorado Sen. Mark Udall said, “The American people have an unbreakable covenant with our veterans and we must provide them the very best health care.”

But when soldiers are kicked out, the covenant often is severed.

In this respect, troops have less legal protection than other citizens. If Alvaro had been hurt mopping floors or flipping burgers, his employer would have to pay for his care even if he later got in trouble. Because he was fighting for his country, he does not have that right.

An other-than-honorable discharge sets veterans up for continued struggles, experts say. Some slip into a spiral of unemployment, substance abuse and crime.

“I see it every day,” said Lenore Yarger, a veterans advocate who works for a veterans rights organization called The Quaker House near Fort Bragg in North Carolina. “We have gotten very efficient at getting people to fight wars but are not prepared to deal with the aftermath.”

Army Struggles to Respond
At Fort Carson, the spike in discharges is a result of stricter enforcement after years of commanders sometimes ignoring Army rules during hurried deployments, said Maj. Gen. Joseph Anderson, who commanded Fort Carson from November 2011 until March and is slated to take command of Fort Bragg.

The number of wounded soldiers caught in the cleanse is “not a huge problem,” he added.

But the true number affected is hard to know. While the Army tracks how many soldiers are kicked out for misconduct, it does not track how many of them are wounded, a Pentagon spokesman said. Even if the service did, the count would likely be inaccurate because science still has no objective way to identify who is truly injured when it comes to TBI and PTSD.

“We don’t have any clear diagnosis or any way of showing what functions of the brain the injury affects,” said Col. Dallas Hack, director of the Army’s Combat Casualty Care Research Program, based in Maryland. “Units are crying for it, but the best doctors can do is look at the history of injuries and symptoms.”

That means commanders must decide who is injured when not even doctors are sure. “It’s the hardest thing,” Anderson said. “We physically, literally struggle with it every day.”

He was so concerned wounded soldiers were being wrongfully discharged that he set up a special team of legal and medical advisers at Fort Carson in summer 2012 to review difficult cases. “We wanted to make sure no mistakes were made,” Anderson said.

The team has been a success, he said. Still, critics say, injured soldiers slip through the cracks.

Roughly 1,000 soldiers were discharged for misconduct at Fort Carson in 2012. Fort Carson said 33 were in the medical discharge process that flagged them as having physical problems. Anderson described it as “not a significant number.”

Civilian volunteers who help troubled soldiers say the actual number of wounded soldiers discharged from Fort Carson is higher because many wounded troops do not get a proper diagnosis.

“We see case after case of this,” said Robert Alvarez, a civilian veterans advocate.

Other soldiers are discharged in a way that does not require their health status to be considered. Fort Carson discharged 71 soldiers for misconduct in 2012, including Alvaro, through a regulation called Chapter 10 that doesn’t require a review of war wounds. A Fort Carson email obtained by The Gazette suggests the Army targets wounded soldiers with Chapter 10 at at least one installation because it’s a fast way to get them out.

Fort Carson leaders say that thousands of soldiers have returned from war and been medically retired without getting in trouble, so it is wrong to focus on the small number who do. But critics contend that just as a small number of airplane crashes can reveal wider problems, cases like Alvaro’s show how Army systems sometimes fail under stress.

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