Battle Worn

Frightened as she was, she told herself that at least the Army would, in her words, "take care of him" and his family. After more than two decades in the service, she knew the outlines of the disability system, and she assumed he would be able to retire. For her son, though, this was uncharted territory.

The magic number, he quickly learned, is 30 percent -- the point at which a disability is considered to be severe enough to prevent someone from functioning normally in the workplace. Those with 30 percent or higher disability ratings can retire with benefits that include monthly checks for the rest of their lives, access to commissaries and post exchanges on military bases, travel on military aircraft and, most coveted, coverage by TriCare, the military's health insurance plan, for themselves and their dependents, present and future. Those rated below 30 percent usually receive a severance check from the military: two months' pay for each year's service, up to 12 years. They can then apply for benefits from Veterans Affairs, which also rates disabilities and provides monthly checks but doesn't offer the other advantages of retirement.

The practice of compensating injured soldiers dates to Colonial times, but the current system has its roots in World Wars I and II. Congress mandated the development of ratings for disabilities in 1917; the Career Compensation Act of 1949 then linked the amount of payments to the degree of disability, establishing the 30 percent threshold. "The thinking was, those rated less wouldn't be so handicapped as to warrant long-term disability pay," explains Rick Surratt, deputy legislative director of Disabled American Veterans. "A lump sum would hold them until they could get reestablished in the workplace."

Getting any rating at all can take many months, however. Once an injured service member is medically stable, he must wait for a military doctor to write a narrative summary of his condition. Then a board of physicians reviews the medical records -- often thick with test results, multiple diagnoses, lists of medications and addenda -- to decide whether he meets retention standards. If not, an informal Physical Evaluation Board assesses the severity of each disability that makes a service member unfit for duty and assigns it a numerical rating, based on detailed guidelines in the Veterans Affairs Schedule for Rating Disabilities.

"What we're attempting to do is approximate the average loss of earnings capacity," says Tom Pamperin, who oversees revisions to VA's guidelines, a nearly unceasing project. Amputation at the upper third of the thigh, for instance, merits an 80 percent disability rating. Amputation at the middle or lower third of the thigh: 60 percent. Mental disorder characterized by "occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking or mood . . .": 70 percent. Migraines "with characteristic prostrating attacks occurring on an average once a month over the last several months": 30 percent.

Twohig picked up the gist of the process at the Fort Bragg gym, where he worked with other soldiers too disabled for regular duty. He checked ID cards and handed out towels four hours a day -- and says he found even that difficult, because the clanging of free weights and the thunking of basketballs brought on migraines. Meanwhile, he and his buddies pondered the mysteries of disability retirement. There was ample time to compare notes; the pace at which cases proceed can be exasperatingly slow, in violation of the Pentagon's own guidelines.

Twohig waited 17 months to receive the medical evaluation board report that found him no longer fit to serve. Meanwhile, he watched as others received ratings too low to qualify for retirement. One guy with what Twohig describes as "titanium vertebrae" got a 10 percent rating. Another received no severance.

In fact, the majority of injured soldiers fall short of the magic number; the informal evaluation board rates them below 30 percent. The Defense Department reports that the Army, which handles more than half of the military's disability cases, put less than 4 percent of the 10,460 active duty soldiers and reservists it evaluated last year on the permanent disability retirement list and less than 15 percent on the temporary list. (Temporary retirees undergo periodic reassessments of their condition for as much as five years before a final decision.) By comparison, the Navy (including the Marine Corps) retired about 35 percent of its injured, temporarily or permanently, and the Air Force about 24 percent, the Defense Department says.

The difference, the Army's disability agency says, may reflect a higher proportion of musculoskeletal injuries that can interfere with soldiers' duties but have "mild" impact on civilian employability, resulting in severance pay rather than retirement. The Army also has "a unique policy" of not granting retirement for pain that has "no clear cause or objective findings." But, the agency concedes, "it is not possible to state with certainty what might account for the difference" between the Army's and the other branches' retirement rates.

At Fort Bragg, soldiers sometimes find it hard to understand why some people qualified for disability retirement and others didn't. "You don't really know too much about it until you start doing it," says Twohig's friend Jacob Biehn, a former specialist who suffered multiple gunshot wounds in Iraq and eventually received a 30 percent disability rating -- which allowed him to retire but struck his comrades as minimal, given his injuries. "When you go to find out what they decided," he says, "it could be a good day or a bad day."

For Twohig, it was a bad day. He called his mother from Fort Bragg on Nov. 2, 2004, sounding "shaken up," she recalls. "He said: 'Mom, it came back 20 percent . . . How am I going to survive? How can I take care of my family?' I said, 'Son, calm down. We're going to fight this.'"

TWOHIG HAD THE RIGHT TO CONTEST HIS DISABILITY RATING BEFORE A FORMAL PHYSICAL EVALUATION BOARD, and his mother stood ready to help him. A lifelong Marine and a congenital optimist, Belinda felt more determined than discouraged, convinced that the system had erred and would correct itself.