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About the survey
The poll was conducted from Aug. 1 to Dec. 15, 2013, among a representative random national sample of 819 adults who served in the Iraq or Afghanistan wars as members of the U.S. military in the period after the terrorist attacks of Sept. 11, 2001 (including 231 who are currently on active duty). Interviews were conducted on landline phones and cellphones by SSRS of Media, Pa. The margin of sampling error is plus or minus 5 percentage points for the full sample.
Complete data from the poll, details on the poll methodology and the sampling error for smaller groups are available at washingtonpost.com/polls.

Health issues rife among post-9/11 vets

60% say VA does poor job in aiding them

Moeller
Fort
Washington Post photos

– More than half of the 2.6 million Americans dispatched to fight the wars in Iraq and Afghanistan struggle with physical or mental health problems stemming from their service, feel disconnected from civilian life and believe the government is failing to meet the needs of this generation’s veterans, according to a poll conducted by the Washington Post and the Kaiser Family Foundation.

The long conflicts, which have required many troops to deploy multiple times and operate under an almost constant threat of attack, have exacted a far more widespread emotional toll than previously recognized by most government studies and independent assessments: One in two reports knowing a fellow service member who has attempted or committed suicide, and more than 1 million suffer from relationship problems and experience outbursts of anger – two key indicators of post-traumatic stress.

The veterans are often frustrated with the services provided to them by the Department of Veterans Affairs, the Pentagon and other government agencies. Almost 60 percent say the VA is doing an “only fair” or “poor” job in addressing the problems faced by veterans, and half say the military is lagging in its efforts to help them transition to civilian life, which has been difficult for 50 percent of those who have left active service. Overall, nearly 1.5 million of those who served in the wars believe the needs of their fellow vets are not being met by the government.

“When I raised my right hand and said, ‘I will support and defend the Constitution of the United States of America,’ when I gave them everything I could, I expect the same in return,” said Christopher Steavens, a former Army staff sergeant who was among 819 vets polled. He served in Iraq in 2003 and in Kuwait two years ago, where he was injured in a construction accident. Upon leaving the Army last summer, he filed a claim with the VA, seeking medical care and financial compensation. He has not yet received a response.

“It’s ridiculous that I’ve been waiting seven months just to be examined by a doctor – absolutely ridiculous,” he said.

Even so, the vast majority of recent veterans are not embittered or regretful. Considering everything they now know about war and military service, almost 90 percent would still have joined.

“What we did had a positive impact there,” said Texas Army National Guard Sgt. David Moeller, who spent two yearlong tours in Iraq. “I don’t regret it. It’s something I’d do over and over again.”

Drawing upon detailed interviews with randomly selected war veterans across all military branches, including those still serving and those no longer in the military, the nationwide poll provides an unprecedented glimpse into the lives and attitudes of modern warriors – an undrafted, all-volunteer cadre, most of whom signed up in the wake of the Sept. 11, 2001, attacks. That force, drawn from nearly every county in the nation and often sent on multiple yearlong combat tours, has included more than 280,000 women and thousands of 18-year-olds.

Although more than 6,800 U.S. service members were killed in Iraq and Afghanistan, advancements in body armor, transportation and battlefield medicine gave troops a better chance of coming home than any other generation of war fighters.

“They have come back to a nation that has embraced them – warmly, strongly, positively – and put tremendous value and appreciation into their service,” Defense Secretary Chuck Hagel said in an interview. “That is so important.”

Many are thriving – they are attending college, paid in full by the post-9/11 G.I. Bill; they are finding employers who covet their leadership skills and work ethic; they are receiving the medical attention they need. But the poll also found that hundreds of thousands of others feel they have been left behind on an uncharted postwar landscape, fighting for benefits, struggling to land a job, wrestling with psychological demons unleashed by combat or coping with shattered families.

Their responses reveal nuanced views of their lives, their service and their treatment by the government. Almost three in four believe the average American appreciates their service, but fewer – only 52 percent – like talking about their wartime experiences with casual acquaintances or strangers. Nearly 90 percent performed actions in Iraq or Afghanistan that made them feel proud, yet only 35 percent believe both wars were worth fighting.

“I don’t find that to be in any way a contradiction of data,” Army Gen. Martin Dempsey, the chairman of the Joint Chiefs of Staff, said in an interview. “I think that this aspect of service, and being true and trustworthy to the man or woman on your left or right, is probably what mostly drives the 90 percent figure. They’re proud of what they did. They believe they did their job, and potentially the elected governments of Iraq and Afghanistan didn’t do theirs.”

Some of their present-day challenges – securing a well-paying career and coping with credit card debt – mirror travails of American society as a whole, but other needs are unique consequences of this century’s conflicts: diagnosing and treating traumatic brain injury, acquiring technical skills to compete in a transforming economy and addressing the stress on families from repeated combat tours. More than 600,000 Iraq and Afghanistan veterans who have become partially or totally disabled from physical or psychological wounds are receiving lifelong financial support from the government, a figure that could grow substantially as new ailments are diagnosed and the VA processes a large claims backlog.

Worse for the wear

For many vets, their times in Iraq and Afghanistan were searing experiences. One in three thinks about deployments daily.

Among them is Nicholas Johnson, a former specialist in the Arkansas Army National Guard, who spent a year in Iraq starting in 2006. His platoon was ordered to fill roadside bomb craters, which required him to jackhammer asphalt while wearing 50 pounds of body armor and gear.

He returned home with a fractured vertebra, three fused disks in his back, ringing ears and debilitating post-traumatic stress because of the frequent carnage he witnessed on Baghdad’s roads.

“I can’t get a good job now because … I have to be upfront and say I have this disability, I have a tore-up back,” he said.

Johnson, who is 32 “but going on 60,” confronts the toll of his service on his drive to a just-over-minimum-wage job at Lowe’s, when he has to avoid Interstate 70 because it reminds him of Baghdad’s insurgent-riddled airport road, when he panics at the sight of trash on the street because that’s what Iraqi guerrillas employed to conceal explosives, when he pops painkillers and anti-anxiety pills, when he has to use a cane to walk or ask his fellow clerks for help moving boxes.

“I left the war zone,” he said, “but the war zone never left me.”

Many vets see themselves as a cut above the rest of American society, as noble volunteers who stepped up to promote and protect U.S. interests while the rest of the nation went about its business as usual. Sixty-three percent think service members are more patriotic than those who are not in the military; 54 percent think the average member of the military has better moral and ethical values than the general civilian population.

Almost seven in 10 feel that the average American routinely misunderstands their experience, and slightly more than four in 10 believe the expressions of appreciation showered upon veterans – often at airports, bars and sporting events – are just saying what people want to hear. More than 1.4 million vets feel disconnected from civilian life.

Moeller, the Texas National Guard sergeant, returned from his first deployment to Iraq with back pain so severe he had to sleep sitting upright. In 2009, when his unit was mobilized again, he “could have waved the medical flag.” But he wanted to head back out with his buddies “to complete the mission, because that’s what I took an oath to do.” So he kept quiet and toughed it out.

According to the Defense Department, 51,908 service members were “wounded in action” in Iraq, Afghanistan or in missions to support the wars. That tally doesn’t include Moeller – or hundreds of thousands of others – because the Pentagon counts only those injured as a “direct result of hostile action.” If a wound did not occur on a combat operation, or it was the result of an accident, or it was caused by wearing armor every day for a year, it does not make the list.

But in Iraq and Afghanistan, where there were no front lines, where improvised explosive devices were the enemy’s weapon of choice, where troops wore bulky protective gear most of the time, wounds that do not fit the military’s classic definition became the norm. Traumatic brain injury. Persistent ringing in the ears. Elevated blood pressure.

Once troops returned home and the adrenaline ebbed, they began to confront the cost of all they wore to protect them, of the bone-jarring trips in mine-resistant trucks, of inhaling desert sand pulverized into jagged particles by armored vehicles. Back pain. Blown-out knees. Headaches. Persistent coughs.

For more than 1.1 million vets, serving in the wars has left them in worse physical health, according to the poll. Eighteen percent – about 470,000 current and former service members – reported being seriously injured while deployed to Iraq, Afghanistan or in support of the wars.

One in three veterans surveyed by the Washington Post and Kaiser said the VA or the Defense Department has determined they have a service-connected disability, a ratio that is almost identical to the VA’s overall tally. Most have no scars.

The poll found that the wars have caused mental and emotional health problems in 31 percent of vets – more than 800,000 of them. When more specific questions were asked, the rates increased: 41 percent – more than 1 million – report having outbursts of anger, and 45 percent have relationship problems with their spouse or partner. Both are indicators of post-traumatic stress and could suggest that rates of affliction may be higher than the government has forecast.

Although the Washington Post and Kaiser did not ask respondents the full battery of questions typically used to make post-traumatic stress diagnoses, previous studies conducted for the Pentagon, including one by the Rand Corp. in 2008, have estimated rates of post-traumatic stress at 14 percent.

For Adam Schiele, a former active-duty military police officer in the Army, it has taken a decade. In recent months, he has been haunted by an Afghan man’s plea for medical assistance for his badly wounded niece at the gate of a U.S. base – and the initial refusal of American medics, which he describes as callous, to examine the girl.

Nothing went boom. Nobody died. It happened a decade ago. But the incident was jostled from the recesses of his mind in the wake of an assault on a fellow guard at the federal correctional institution where he works.

Troops “don’t need to be classified as wounded in action to have been wounded,” he said. “A lot of us got hurt. Some more serious than others, but a lot of us sacrificed part of our bodies out there.”

No easy transition

Iraq and Afghanistan vets are making unprecedented use of the Department of Veterans Affairs, largely because of an Obama administration decision to provide five years of free VA health care to all of them.

Of the 1.7 million who are no longer serving in the active, reserve or National Guard forces, more than 1 million have obtained health care services at least once from the VA since 2002 and about 45 percent of them have sought compensation for service-related disabilities. By comparison, about 21 percent of those who fought in the 1990-91 Persian Gulf War filed similar claims.

Under President Barack Obama, the VA’s budget has grown by more than 60 percent over the past six years, although congressional overseers and veterans’ organizations complain that the department continues to be hobbled by what they consider a bloated and inefficient bureaucracy.

“There’s always room for improvement,” said ShinsekiVA Secretary Eric Shinseki, who believes the widespread frustration is rooted not in the quality of service but by the delay in processing disability claims, which he has pledged to eliminate by the end of next year.

Overall, more than half of vets say the government is not doing a good job in addressing the requirements of this generation of veterans. But when asked to rate their own treatment, almost 60 percent say the government’s response is “excellent” or “good.”

They are far less sanguine about the transition to civilian life. Half think the military is not doing enough to help vets adjust to the world beyond their U.S. and overseas bases, where men and women who never had to worry about where to live or how to write a résumé now must learn to navigate American streets and survive job interviews. Just as many say their own transition to civilian life was either somewhat or very difficult.

Forty-three percent of enlisted vets have taken an extra job or worked additional hours because they need the money, compared with just 16 percent of officers. A quarter of enlisted members have had trouble paying their rent or mortgage; only 11 percent of officers say the same.

Upon leaving the Marine Corps in 2012, April White figured she would find a steady job to support herself and her then-7-year-old son in North Carolina. Although enlisted, she had been a sergeant with supervisory experience, and she had military logistics skills, honed during a 2007 deployment to Iraq.

She sent out a raft of applications for secretarial jobs and transportation-related work. She landed just one interview, with an employer who was seeking someone with a college degree, which she lacks. After four months on unemployment assistance, she signed up for the only option she could find – as a contractor in Afghanistan.

“I thought once I got out (of the Marines), life was going to be normal,” she said. Now back in Jacksonville, N.C., White has opted to take advantage of the post-9/11 G.I. Bill to remain close to home, pay her bills and attend a nearby college, where she is taking engineering classes. The VA-administered program, which pays for tuition and provides a stipend for books, school supplies and housing, has been used by almost half of all Iraq and Afghanistan vets.

“The days of getting out of the military and getting a job – a good job – right away are over,” White said. “You have to study, and you have to be patient – and you have to be lucky.”

Too many left behind

Despite their overwhelming pride and negligible regret, the veterans look back on the necessity of the conflicts with decidedly mixed feelings. Only 53 percent of them believe the war in Afghanistan has been worth fighting, and just 44 percent say the same for Iraq. Slightly over a third – almost 900,000 vets – “strongly” believe the Iraq war was not worth it.

Many among this generation of vets regard their service as a profession – almost half signed up intending to serve for at least 20 years – and they have divorced their individual missions from the worthiness of the overall wars.

“Right, wrong or indifferent, it was something we signed up to do,” said Kenneth Harmon, a retired Marine master sergeant who served for 23 years and deployed to Iraq and Afghanistan. “It was our job. We got orders. We followed them.”

That detachment was easier for those who saw value in the wars.

“When I see people smile because we’re there, when I see kids happy that there are American troops with boots on the ground over there, it had always reaffirmed my belief that we were doing the right thing,” said Santino Fort, a retired Air Force technical sergeant who deployed twice to Afghanistan and once to Iraq.

The military’s retirement program awards pensions and lifetime family health care to those who have served 20 years or more. The system, which provides nothing to those who spend less than two decades in uniform, has left many Iraq and Afghanistan vets – including those who signed up after September 2001, were deployed multiple times but then chose to leave the military – without any retirement benefits.

The vets, however, do not see it as a trade-off. More than half feel the 20-year system provides “about the right amount” of compensation to retirees. But they also want to increase benefits to those who served in the wars and then left before hitting the two-decade mark. Slightly over half say that group receives fewer benefits than they deserve.

Among them is Jeffrey Arena, a former Army sergeant in the 101st Airborne Division who had two yearlong combat tours in Iraq and one in Afghanistan. He had planned to serve 20 years in the Army and then use his infantry skills to land a law-enforcement job. Last year, however, his hip and leg began to hurt during his morning fitness routine.

A doctor on Fort Campbell, Ky., told him that a leg injury he suffered in Iraq during a 2006 mission to pursue insurgents was far more serious than he had been told by field medics at the time: He had fractured his femur and torn cartilage in his hip.

The military offered him a hip replacement, which he turned down.

“I’m only 35, and I don’t want a hip replacement at 35,” he said. “There would be no more running or jumping. I have three kids. I want to be active with them.”

Replacement or not, the diagnosis spelled the end of his military career. Because he was unable to pass his annual fitness test, the Army moved to retire him on medical grounds. But it deemed him only 20 percent disabled, which meant that he would be ineligible for a military pension or lifetime health coverage, even though he spent 38 months at war and suffered a serious injury while deployed.

“I beat up my body for this nation,” he said. “It should count for something.”

Worried that his hip injury will disqualify him from law enforcement jobs, he plans to head to flight school in Arizona, where he will live in a trailer for a year while his family remains at their home in Kentucky.

“In the Army, you’re taught to never leave a man behind. Well, they’ve basically left a man behind,” he said.

“It was easy to send us off to war. Taking care of those who need help – and there are lots of us – will be much tougher. But if our nation is going to send us to war, it has a responsibility to do right by us when we come home.”

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