The Other Wounds

Written by Rajiv Chandrasekaran, The Washington Post
Published on April 8, 2014

Most Iraq and Afghanistan veterans’ injuries didn’t occur during combat. But their ailments have become an enduring consequence of the conflicts.

Army sniper James Crowell went to war 70 inches tall. He returned home an inch shorter and in constant pain, his spine compressed by the collective trauma of a rooftop fall, a Humvee accident and his heavy body armor, worn almost every day on four deployments.

Billy Birdzell spent eight years in the Marine Corps, half of them in the elite Special Operations command, "running at 8,000 rpms." Racked by insomnia and bouts of intense anger once he exited the military, he discovered that combat stress had wreaked havoc on his hormones.

Chase Villavicencio, a Marine communications specialist, tumbled off a ladder and struck his head as he sought to escape a Taliban mortar barrage in southern Afghanistan three years ago. Since then, he has been suffering from wrenching migraines, bouts of dizziness, spells of intense anger and memory loss.

Daniel Meyer, a former Air Force staff sergeant, inhaled lungful after lungful of acrid smoke as he followed orders to shoot scavenging birds inside a cavernous pit of burning trash on a base in Iraq. Now he's back home in Nevada, and his lungs are failing. He lives his days tethered to an oxygen tube.

Because their injuries were not the direct result of an enemy attack, Crowell, Birdzell, Villavicencio and Meyer were not awarded Purple Heart medals, nor do they show up in the Defense Department's tally of nearly 62,000 service members wounded in action in Iraq and Afghanistan. But their ailments, and similar non-hostile injuries suffered by legions of fellow troops, have become a profound and enduring consequence of the wars.

"War is brutal on the body," said Crowell, a sergeant first class who was stationed in some of the most dangerous parts of Iraq and Afghanistan. "I'll feel it in my back for the rest of my life."

Of the 2.6 million service members dispatched to fight the wars in Iraq and Afghanistan since 2001, more than half say their physical or mental health is worse than before they deployed, according toa poll conducted by The Washington Post and the Kaiser Family Foundation. But most of those health problems are not the result of gunshots, grenades and roadside bombs: Almost eight in 10 of those reporting health problems - about 1 million of them - say they were not seriously injured in combat.

Their wounds stem from the chaos and grind of modern war, the cost of saddling one's frame with a bulky armored vest and extra clips of ammunition, the failure to provide basic safety gear, the mistakes that occur when hulking vehicles are driven by sleep-deprived troops, the eardrum-rattling blasts of gunfire and artillery. During the entire Iraq war, which stretched for almost nine years, the military conducted more medical evacuations by air for troops who had non-hostile wounds than those injured in combat.

The Post-Kaiser survey found a deterioration of physical health in 43 percent of veterans and worsened mental health in almost a third. Among those who served in combat jobs, the changes are even more significant: 56 percent say their physical health is worse, and nearly four in 10 say their mental health has slipped. Rates of health problems are significantly higher in those who deployed for three or more years.

In many cases, non-combat injuries have not impeded veterans from continuing their military careers or pursuing fulfilling civilian lives. And they recognize that their wounds can seem like mere scratches compared with those of comrades who have lost limbs or eyes or are suffering from a severe traumatic brain injury.

But their ailments nonetheless can be life-altering - chronic pain, fits of anger, sleeplessness, incessant ringing in the ears - and have added to the ongoing cost of the wars. Of those no longer serving in the military, 45 percent have sought compensation for service-related disabilities, according to the Department of Veterans Affairs. Thirty-seven percent of them have been deemed disabled enough to receive lifelong payments, a figure that could increase as the department works through a mountain of unprocessed claims.

Other Iraq and Afghanistan veterans may not feel the impact of their service for years. For those who fought in the last century's major wars, requests for disability care and compensation did not peak until three decades after the conflicts ended. "The burden borne by wounded warriors and their families, and thus the public responsibility to treat or compensate them, will persist for many years," the Institute of Medicine, the health-care arm of the National Academy of Sciences, warned in a 2010 report.

The Iraq and Afghanistan conflicts may have their own unique health legacy. Thousands of troops who walked away from roadside bomb blasts, because of luck or mine-resistant trucks or both, may nonetheless have suffered moderate brain injuries that could cause long-term health consequences.