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Terrorist bombings and combat at close quarters are taking a toll on America's soldiers. Among the injured: thousands coming back from Iraq with psychological scars. Is the government doing enough to help?

JEREMY LEWIS: You get into a state of hyper vigilance where you can't sleep. Or you start not trusting things. You start being afraid of the dark.

BRANCACCIO: And the wounds of war… One woman's photographs of soldiers on the long road to reclaiming their lives.

JEREMY FELDBUSCH: Even while I was going through college I thought about going into the military.

JORDAN JOHNSON: I mean I cried and cried and cried.

ROBERT ACOSTA: People get brave and ask, 'Oh, what happened to your hand?' and I tell them, 'Oh, I was in Iraq...'


This is Buffalo's Veteran's Park. They have been putting up memorials here to America's veterans ever since the War of 1812, when this city was on the front line for the battle for what was then the frontier.

Many of the vets returning from today's front lines are coming back afflicted with Post Traumatic Stress Disorder. This is a real disease, and its psychological effects can lead to broken families, homelessness, even suicide.

Now that's just one of a range of medical problems facing our returning vets, and as producer Peter Meryash and I found, it's putting enormous pressures on an already-overburdened Veterans Administration.

Jeremy Lewis has done more than most to serve his country. Twelve years active duty in the Navy, 11 more in the Army National Guard. His missions have included rotations in Bosnia and more recently, he was in the thick of things in Iraq.

Last April, Lewis came home to Buffalo. If you just bump into him in the street, it seems he survived without a scratch. But that's deceptive. He carries invisible scars from the war — symptoms he first experienced while serving in Iraq.

JEREMY LEWIS: Getting up every morning at three AM for no reason. I can't go back to sleep. I'm having a lot of trouble falling asleep. I can't stop my mind from thinking.

BRANCACCIO: Lewis is one of the wounded … and like thousands of others from this war so far, he's turning to the V.A. For help.

JEREMY LEWIS: I walked in, told the triage nurse I need to see someone from mental health. And she said why. I said, "Well, I just got back from Iraq and I was seen by the Combat Stress Team. I think I'm having some flashbacks."

DAVID BRANCACCIO: Did you get an official diagnosis?

JEREMY LEWIS: My doctor diagnosed me in April with PTSD.

BRANCACCIO: PTSD or Post-Traumatic Stress Disorder. Up-close combat — face to face with death — can bring on injuries just as crippling as a physical wound.

There's little doubt the V.A. can provide excellent psychiatric care. But critics — and even the government's own reports — say that for many, getting that care today can be difficult.

DAVID GORMAN: Every day we hear reports of deficits, reductions in V.A. medical facilities, health budgets, and veterans not being able to timely access the system. If you're sick, it does absolutely no good to be told to come back for an appointment, that they can schedule for you, in six or seven or eight months or even longer.

BRANCACCIO: David Gorman is with Disabled American Veterans. Having served in the Vietnam War himself, he's worried things at the V.A. will only get worse.

DAVID GORMAN: It's been a problem. It's been exacerbated in recent years. It's now reaching the bursting point with the returning veterans.

BRANCACCIO: Veterans like Jeremy Lewis, who's struggling now with his memories from the war in Iraq.

JEREMY LEWIS: You always had to keep your head on your shoulders. You knew every time you left the wire and went on a mission that you could come under attack or see someone who had.

BRANCACCIO: Sergeant Lewis served in a military police unit, its primary mission was to patrol a main supply route that ran into the Sunni Triangle. He was on constant alert for gunfire, car bombs and RPGs — rocket propelled grenades.

And then one night …

JEREMY LEWIS: Suddenly there was a loud metallic thud. And I initially thought she hit a car with no headlights on. But what it was was an RPG. I think it grazed our brush guard in the Humvee then blew up. Explosion was absolutely deafening. Fireball entered the vehicle. The concussion threw my gunner against his grenade launcher. And it shattered my windshield. We shot back with grenade launchers, with machine guns. And then we regrouped and we started heading south. And 15 minutes later we were in another ambush.

BRANCACCIO: Lewis received the Army's Commendation Medal for Meritorious Service for leading his team through two ambushes without the loss of American life.

JEREMY LEWIS: Every week there was something. Maybe twice a week there was something. A patrol came under fire-- the camp. We heard gunshots. We heard explosions constantly, 24/7. So you were constantly in that mindset of you're in danger.

DAVID BRANCACCIO: Did you feel mentally prepared for that?

JEREMY LEWIS: You get into a state of hyper vigilance where you can't sleep. Or you start not trusting things. You start being afraid of the dark. I don't think anyone can be prepared for that.

BRANCACCIO: So Lewis went to see the combat stress team … a medical unit set up in Iraq to help soldiers suffering from the intense stress in the field. He good-naturedly calls them "the brain rangers."

After a psychological exam, Lewis was given anti-depressant and anti-anxiety pills. But with a shortage of troops, he says, the military couldn't afford to send him home.

JEREMY LEWIS: It's funny because they had told me that they didn't want me driving for three days while I was taking the medication to see how I reacted to it. No driving. But they still let me carry a gun.

BRANCACCIO: He returned to his unit which was soon rotated to a more secure base. But it took five long months before his unit could ship home.

In Buffalo, Lewis was back in a truck — now as a driver — his old civilian job. But the battlefield came with him.

JEREMY LEWIS: For about a month it went fine. Then I started to notice I was really getting nervous about time. I had to go from Buffalo, New York to Columbus, Ohio. It's about a five hour and 45 minute drive. And if I wasn't in Columbus by two o'clock I was starting to get really anxious and paranoid.

Then if I saw a dead deer on the side of the road or something like that, I'd always try to move over thinking there was a bomb under the deer. And if traffic got heavy, it wasn't comfortable because one of the ways they ambush you is to block you into traffic. So I started feeling this hyper anxiety coming back, the hyper vigilance.

DAVID BRANCACCIO: And you were aware this was sort of weird.

JEREMY LEWIS: I knew that I shouldn't be feeling this because of based on seven years of experience I never felt this before.

BRANCACCIO: So Lewis has turned to the V.A. For help … like thousands of others vets around the country. The V.A. has been at the forefront of post traumatic stress treatment. Doctor Bruce Kagan is a leading psychiatrist in the field.

DR. BRUCE KAGAN: In general, the treatments are highly effective. And people who undergo the treatment generally report significant improvement in symptoms, and in functioning.

BRANCACCIO: But Dr. Kagan, whose views are his own and not the V.A.'s, is worried about what lies ahead.

DR. BRUCE KAGAN: I think we are coming up upon a potentially very large wave of new veterans who need treatment, and who could stretch us very thin.

BRANCACCIO: Cutbacks have been felt across the country — efficiency and better out-patient care says the V.A. At the veterans hospital where Dr. Kagan works in Los Angeles, California, for instance, over the past 10 years, the number of inpatient psychiatric beds has been cut from 366 to 90. And vets with a mental crisis no longer can go to the hospital's specialized psychiatric emergency room. Instead they're now sent to the V.A.'s regular E.R. Critics say such cuts have come at a bad time — that is to say, during war time.

Nationally, the V.A. Will be seeing a flood of PTSD patients. Last year, more than a quarter of a million veterans were treated for the condition. By next year, 60,000 more patients are expected.

Dr. Jonathan Perlin is the Under Secretary for Health at the Department of Veterans Affairs.

DAVID BRANCACCIO: Does the V.A. have the resources to meet the needs of current veterans as well as the new veterans coming back from Iraq and Afghanistan? DR. JON PERLIN: Absolutely. Nearly one out of every $3-- in all of VA's budget goes to the care both for physical and mental health needs of patients with mental illness. So the resources are absolutely substantial.

BRANCACCIO: Tell that to Jeremy Lewis. He had to wait two months for his first appointment at the V.A. Hospital in Buffalo. And since then, the appointments have been few and far between.

JEREMY LEWIS: I'm gonna see a therapist from what I've been told once a month with a therapist and once every three months with my primary care doctor. So it doesn't seem like they have the resources to do more. Or--

DAVID BRANCACCIO: It sounds like you could use more.

JEREMY LEWIS: And both doctors told me I should be getting more. But they said that we just don't have the money in our budget to do this anymore. We've taken so many cuts in the past two years. We can't give you the therapy as frequently as we'd like to give it to you. We can only work with what we've got. So I'm kind of stuck.

DAVID BRANCACCIO: The V.A.'S own committee on Post-Traumatic Stress Disorder found last year that "… PTSD services are lacking in many V.A. medical centers and are severely limited at community based outpatient clinics." The report concluded: "unfortunately, V.A. does not have sufficient capacity" to meet the PTSD "needs of new combat veterans while still providing for veterans of past wars."

DAVID BRANCACCIO: The V.A.'s own special committee on PTSD has found that there are insufficient resources to meet the growing needs in this area.

DR. JON PERLIN: This, by the way, is a committee that reports to me. It makes recommendations to the Undersecretary for Health. And. in fact, they have identified that we've actually met the expectations on a majority of the areas that they made recommendations. And we're working together to create a bold, ambitious mental health strategic plan to make further improvements. Toward that end in 2005. We've identified $100.1 million for additional care, including your areas such as PTSD, outreach to our newest combat veterans of Operation Iraqi Freedom and Enduring Freedom. And in substance use disorders. And so this is an area we will continue to invest in. But we have the resources there.

DAVID BRANCACCIO: Actually talked to a veteran. Came back from Iraq just last year. Unfortunately, suffering from Post Traumatic Stress Disorder. He has the diagnosis now.


DAVID BRANCACCIO: Took him two months to get an appointment at the V.A. And then he's being seen for his mental health condition once a month. He's being seen by a doctor every few months. His doctors think this isn't enough. They feel frustrated. They've expressed this to him that he needs to be seen more regularly. But that there aren't the resources to meet that need.

DR. JON PERLIN: Well, you know, I appreciate hearing about this incident. And, if you share details I will take care of this immediately. But, overall, the goal is to make sure that, that patients are seen timely and with the frequency necessary.

BRANCACCIO: There are different ways to cast the numbers. The V.A. told us — according to the most recent data — in most cases, veterans waited 30 days or less for a primary or specialty care appointment. OK … but that still leaves more than 300,000 appointments where veterans had to wait longer than 30 days.

And after a few years of significant improvement, the waiting list is starting to grow again. As of March, more than 40,000 veterans will have to wait six months or more for a non-emergency visit — almost a three-fold increase from last May.

That's tough news for a patient suffering with PTSD … where quick and consistent treatment can make all the difference.

DR. BRUCE KAGAN: Obviously, one wants to have the availability for veterans to come in, and be seen in a relatively short period of time, and to be treated relatively rapidly. And- relatively intensively. You know, most of the psycho-therapeutic treatments require one or two sessions a week with a therapist.

DAVID BRANCACCIO: But critics charge the resources are not there. Veteran advocates are angry at congress for not providing enough funds. They say the 100 million dollar increase in next year's mental health care budget is not nearly enough to keep up with medical inflation and the thousands of new veterans seeking care.

What's more, it falls far short of the nearly 1.7 billion dollars the V.A. itself projected in this briefing document that it will need to cover the gap in mental health care funding by the end of 2007.

CHET EDWARDS: I know for a fact that veterans hospitals all across America today are using their capital budgets and dollars from their equipment budgets to just keep the lights on and to pay salaries. They're eating their seed corn. They're going to hurt the quality of care for veterans.

BRANCACCIO: Democratic Congressman Chet Edwards is fighting for more money for veterans. He sits on two committees which oversee the V.A.'s budget and spending. He's also fighting to keep the V.A. from closing a hospital in his home district in Texas. Its specialty — psychiatric care.

CHET EDWARDS: You couldn't pick a worse time for reducing capacity for V.A. mental healthcare services considering we have so many tens of thousands of veterans coming back from Iraq and Afghanistan who need that care. If we're going to go to war and ask Americans-- young Americans to fight those wars, we have a moral obligation as a country to not forget them when they return home.

BRANCACCIO: But some are forgotten.

TONI REINIS: We're still picking up the pieces after Vietnam. We have people that lived in cardboard boxes for the last 20 years that we're just bringing in now. So we don't want that to happen this time.

DAVID BRANCACCIO: Toni Reinis and her colleague John Keaveney run New Directions Inc. — a long-term drug and alcohol treatment program in Los Angeles that serves more than 800 homeless veterans a year. They're dealing with what happens when veterans don't get the right care.

TONI REINIS: The veteran needs to be able to take care of themselves somehow. And if they're not sleeping or if they're angry and anxious, they may turn to drugs and alcohol in order to help themselves. So rather than getting the kinds of treatments that they need in a timely and adequate-- in an adequate services that they need it's unfortunate that we might-- we may lose some. They may just filter through the cracks.

BRANCACCIO: It's been estimated that half a million veterans are homeless at some time during the year … 76 percent of them with substance abuse or mental health problems.

To keep these men and women from falling further through the cracks, New Directions tries to get their lives back on track … providing food, shelter, mental health care and rehab.

They help veterans find work with job training in food services or the construction business. For all they do, new directions says it gets only about 27 dollars a day per veteran from the V.A. Money is critically short.

TONI REINIS: If the Veterans Administration is not able to provide those services, New Directions will provide them. We'll go to foundations and we'll beg, borrow and steal in order to be able to have a comprehensive program.

BRANCACCIO: And the needs are only expected to grow. THE NEW ENGLAND JOURNAL OF MEDICINE reported that up to seventeen percent — that's one in six — of Iraq veterans surveyed suffer from "major depression, generalized anxiety, or PTSD."

And those findings are conservative: "it may simply be too early to assess the eventual magnitude …" the JOURNAL cautioned, since it can take years before PTSD or other psychological problems develop.

Here in Buffalo, Jeremy Lewis is already struggling. He takes medicine for his psychiatric condition that prevents him from long-haul truck driving, his livelihood. For him it's now also a financial crisis.

DAVID BRANCACCIO: So what are you supposed to do, Jeremy, if you can't drive the truck?

JEREMY LEWIS: You could do other jobs. You just can't drive. So you go from making $700, $900 a week and you start looking for anything basically.

DAVID BRANCACCIO: So did you look around?

JEREMY LEWIS: Yeah. But it's kind of a double edged sword because they ask, "Why'd you leave your current job?" Do you be honest and tell them, "Well, I'm being treated for Post Traumatic Stress Disorder and I can't drive due to medications." Or do you lie to them and tell them, "Well, I just didn't feel comfortable anymore." I don't think it's very wise to lie to an employer in an interview. But it's not very smart to tell the truth either. So you're kind of stuck.

BRANCACCIO: It took five months for Lewis to be formally diagnosed by the V.A. with PTSD. He's now filed for veteran's disability … but he's been told it could take until next year before he sees his first disability check.

DAVID BRANCACCIO: What are you living on right now as you and I are talking?

JEREMY LEWIS: I got about $8.00 in the bank left. If I need money, my friends are always willing to give. My sister-- she's paying the bills at my house and her house now. So-- basically I'm living off of my friends. That's the bottom line.

BRANCACCIO: There are statistics about the thousands of casualties of this latest war. Each represents a life that has been changed.

Photographer Nina Berman wanted to better understand both these soldiers and their war by meeting face to face with those who fought it. With no official list of the wounded to go by, she tracked down newspaper articles on returning veterans.

She put her photographs of twenty veterans and their stories in her book PURPLE HEARTS.

NINA BERMAN: The war had just begun. It was the spring of 2003. And-- I would hear on radio and on TV, reports of soldiers being wounded. But I was never seeing any images. I wanted to track down who these soldiers were who had been wounded, what it means to be wounded in this war, and how they were doing once they had gotten home.

I didn't want to photograph them in public situations. I wanted to avoid the homecoming parades, or you know, the pinning of the medals by generals. I wanted to do something really personal, and for this reason, I really wanted to see them at home, see them in the settings where they grew up, and where they made their decision to enlist.

JEREMY FELDBUSCH: There are lots of other things I could have done. But I was just like, you know what? I would like to go into the military.

NINA BERMAN: Sergeant Jeremy Feldbusch, he was the very first soldier I photographed. I had read a small newspaper story about this Army Ranger who had been injured in an artillery attack. And was completely blind. And there was a quote from his Mom saying, "My son lives in darkness."

They live in Blairsville, Pennsylvania. And I drove out there. I was greeted by Charlene, his Mom. He wakes up, and he walks out of his room, and he's like gently touching the walls of his house? You know, this is the house he grew up in.

I used for this project, a camera called a Hasselblad, which is very kind of clunky and noisy. And every time I hit the shutter, Jeremy would flinch. This guy is like 6'2", you know, he was first in his class of 228 Rangers. He was in the prime of his life. And he was scared at the sound of my camera.

NINA BERMAN: Lieutenant Jordan Johnson-- she was 23. She was in charge of protecting the Generals of the First Armored Division. She spent a lot of time in Black Hawk Helicopters. She was a woman, you know, in a world of men basically.

She was injured when a Humvee she was driving in flipped. And a soldier was killed in the accident and she was crushed her legs were crushed. Jordan was a superior athlete-- terrific runner. Now her legs were basically immobile. She was in a coma.

She told me she has chronic Post-Traumatic Stress. She doesn't sleep at night. There was a while where she was crying all the time. She spent months in rehabilitation at Walter Reed Hospital in Washington, D.C.

JORDAN JOHNSON: I was a lot more emotional. I would-- you know, I would cry more definitely more. I mean, I cried and cried and cried. Because I was very, for the first time, scared for me. I'm just not a-- I'm not that kind of person.

NINA BERMAN: Tyson Johnson was a mechanic with military intelligence. And he was stationed at Abu Ghraib prison, and lived in a tent, which he said was about nine feet from the prison gate.

And he was injured in a mortar attack. And messed up really, really badly. He lost a kidney, he had shrapnel in his lungs. When I met Tyson, it was in his home town of Prichard, Alabama. A really nice, smart young man, wanted to do good in life. Joined the military to get out of the town. He told me all his friends were dead, in jail, or cracked up.

He kept saying that he wanted a computer. Maybe he could go to school, remotely through the computer. But then, his hands hurt so much that he couldn't touch a keyboard. He wears these black leather gloves, because the pain in his hands are so intense.

TYSON JOHNSON: Sometimes my hands will be so red, fire red, to they hurt-- that's how-- they hurt so bad. I had to put on my gloves to drive. I still push myself now. But I'm not able to touch anything.

NINA BERMAN: Specialist Robert Acosta, he was 20-years-old when I met him. He was wounded outside Baghdad International Airport when his Humvee was ambushed and someone threw a grenade into it. He went to reach and throw the grenade out and it detonated in his hand.

He told me a story that he was driving his car down the freeway in southern California and he almost crashed because he was convinced there was a land mine in the freeway. And he was swerving to avoid the landmine. So, you know he's never slept a full night since he's gotten home from Iraq. And it's been almost two years now.

ROBERT ACOSTA: I've had people ask me-- people will get brave and they say; What happened to your hand? I tell 'em; I was in Iraq, you know. They're like-- 'you know the war still going on?' Or like; 'Oh, my god! Are you serious.' People don't get it. They're like; 'I thought the war was over.' Like, right. Keep watching CNN.

NINA BERMAN: You can see that somehow there's-- there's a separation that now exists between the soldier and the civilian. Cause the soldier knows things that the civilians don't. I think that they have a keener perception. And I think that with this perception, there's also a loneliness and alienation from the rest of the world that kind of just goes about it's business. You know it's very easy to tune the war out. But these soldiers can't ever do that. And, so-- for that reason I think it's really important that they tell their stories. Whatever those stories are.

BRANCACCIO: Next week we return again to the issue of jobs in America. Can you say David and Goliath?

Migrant workers at the bottom of the pay scale taking on a fast food giant…

SEAN SELLERS: We weren't going to be able to make a difference in Southwest Florida by just writing letters to our representatives or Senators.

BRANCACCIO: And that's it for NOW. From Buffalo, New York, I'm David Brancaccio. We'll see you next week.

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