Battle Worn

(Mike Smith)

Former Master Sgt. John Alden Millan of Newland, N.C., had to go a step further. An MP with the Army National Guard, he injured his neck jumping from a truck the day his unit arrived in Iraq. Despite surgery, he says, he still suffers from back pain and severe headaches. When he received a disability rating of 20 percent, he and his attorney, Jack Gately, asked for a formal evaluation board hearing. After Gately presented testimony and Millan answered questions, the board told Millan that his injuries warranted a 40 percent rating. "I said, 'I concur, sir,' signed my paperwork and left," Millan says.

But formal boards reject cases, too. Former Maj. Lionel Walton, who lives in Prince George's County, already had a 20 percent disability from past injuries but had chosen to remain in the Army Reserves ("I bleed green," he says), eventually serving 24 years. In Iraq, he says, he hurt his knee jumping from a truck and running from rockets and car bombs, and injured his back loading heavy cases. Now, at 46, "I can't walk 30 yards without having to sit down; I'm at level 8 pain every day," Walton says. He also struggles with post-traumatic stress disorder.

When his informal evaluation board found him 20 percent disabled -- the same rating he'd had before Iraq -- Walton hired Kastl. In September, the formal evaluation board at Walter Reed Army Medical Center declined to raise his rating. He was stunned: "My government, my country, should do better by me."

Refusing to back down, Walton appealed the formal board's decision to the Physical Disability Agency, and enlisted the help of Maryland Senator Barbara Mikulski's office. He's convinced that her involvement eventually helped raise his rating to 60 percent, and that infuriates him. "It's a shame," he says. "I fought to the end, but a lot of soldiers have given up because of this nonsense."

NORMALLY, THE TWOHIGS AREN'T THE SORT OF PEOPLE INCLINED TO TAKE ON THE MILITARY. Both Richard Twohig's parents were career Marines; his younger brother, Chris, has enlisted in the Marines and shipped off to Parris Island. This is a family that believes every young person should serve this country.

Belinda Twohig trusted so fully in the military's commitment to caring for its own that the idea of looking beyond an Army attorney to represent Richard didn't initially cross her mind. But when she called a friend who was a judge advocate, he warned, "Belinda, you don't fight the Army with the Army." What she needed, he said, was a civilian lawyer specializing in military cases. After a little research, he sent her a name: Mark Waple, a West Point graduate and former judge advocate who practices in Fayetteville, N.C.

Waple has argued perhaps 200 physical evaluation board cases, going back to the Vietnam War era. For most of that time, he says, the evaluation boards "tried very hard to be as fair as possible." Now he describes the system as "broken."

Wounded service members are supposed to be guided through the confusing thicket of disability regulations by physical evaluation board liaison officers, universally known as PEBLOs, whose job is to explain the process, advise service members of their rights and assemble their files. But service members complain that documents get lost, that files are incomplete; some report that the liaisons discourage appeals and the use of outside attorneys.

"Sometimes I feel half of what I do is explain what a PEBLO should have already explained," says Danny Soto, a national service officer for Disabled American Veterans, the only vets organization permitted an office at Walter Reed.

Liaison officers handle many cases; in the Army, for example, they counsel an average of 15 to 30 people a day, not including phone calls. Twohig only remembers meeting his liaison officer once: the day she told him he wouldn't be retired.

The Army has tried to keep up with the sharp rise in disability cases, expanding the Physical Disability Agency staff by 50 percent since 2003, and adding 40 percent more liaison officers and assistants. The Army's caseload, however, has soared by more than 80 percent since 2001.

At Walter Reed, where two part-time Army lawyers handled disability cases in 2003, three lawyers and a paralegal now work full time presenting cases to the formal evaluation board. These lawyers get high marks from their civilian counterparts and from vets groups for knowledge and competence, but low grades on having enough time to put together strong cases, which can involve preparing witnesses and gathering further medical documentation. Each lawyer at Walter Reed handles an average of 256 cases each year, and often doesn't meet a client until the day before the evaluation board hearing, when the attorney spends an hour or so preparing the soldier to testify.

"I don't know how you can prepare adequately for a hearing, a full and fair hearing, if you pick up the case file the day before, two days before," says civilian lawyer David Sheldon, who has a military practice in the District.

The Army disagrees. "Lengthy e-mail messages and in-depth phone calls from the paralegal and the attorney ensure that adequate contact is made in sufficient time before the hearing," says Lt. Col. Samuel Smith, Walter Reed's supervising staff judge advocate, via e-mail because the Army barred in-person interviews with any legal staff or with evaluation board members.

Few of the injured hire their own attorneys to contest findings, even though they have that right. A key barrier is money: A civilian lawyer specializing in military cases will likely charge $5,000 or more to prepare for a formal hearing, with no guarantee of success.

Waple was blunt about that when the Twohigs went to see him in early 2005. He thought Richard was clearly entitled to retirement. But migraines are hard to get rated for, because sufferers can rarely document how frequently they occur, something the physical evaluation board wants to know. Richard would have been better served, Waple said, if his neurologist had told him to go to the emergency room whenever he had an incapacitating headache, or even advised that he keep a diary. Waple, however, could call a witness -- Belinda -- who could explain why there was no record of how often Richard's headaches struck.

Richard's psychological symptoms presented a different problem. Waple knew the board might not give much credence to his mood disorder.

The way the military rates psychiatric injuries -- or doesn't -- is a sore subject among veterans groups and civilian lawyers who handle disability cases. The incidence of mental health problems among those returning from Iraq appears high. An Army research team, reviewing the records of more than 300,000 soldiers and Marines, reported last year that more than one-third of Iraq veterans had visited mental health clinics at least once in their first year at home; they were considerably more likely to show signs of psychological distress than those who had served in other overseas locations such as Afghanistan or Bosnia. Yet critics charge that evaluators are particularly skeptical about diagnoses of post-traumatic stress disorder and other psychological injuries.

"If they've been shot five times and need multiple surgeries, and it's very obvious to the doctors what's wrong, then it's a lot easier," says Charlotte Cluverius, a Washington attorney who represents service members at disability hearings. "The burden on the service member is much, much higher with psychological issues, even though those can be just as devastating and incapacitating."

Danny Soto agrees. At Walter Reed, where he counsels dozens of soldiers each week, he thinks that just 40 to 50 percent are being rated correctly for their injuries. When it comes to clear-cut physical problems, something as visible and inarguable as amputation, "they get that right," Soto says. "If you're talking traumatic brain injuries, psychiatric injuries, it drags on."

The Army rejects the notion that large numbers of injured soldiers aren't being rated correctly. Its Physical Disability Agency reviews 25 to 30 percent of informal and formal evaluation board decisions, and is satisfied with its work.

David Armitage, the agency's senior medical adviser, acknowledges that correctly evaluating post-traumatic stress syndrome and other mental disorders -- or any self-reported disability -- can be difficult. "It's a fact-finding matter," he says. "We look for supportive evidence." Otherwise, a condition such as migraine headaches "is too easily conjured up or exaggerated." But he adds, "that's true throughout the entire disability world, not just in the military . . . I think we're doing better every day."

Waple wasn't so sanguine. He told the Twohigs that he wasn't having much success with the Army and that the odds weren't high that the formal evaluation board would raise Richard's rating to 30 percent. Besides, Waple's services, including the fee for the independent forensic psychologist's evaluation he recommended, would cost about $6,000. Belinda, who had just paid lawyers' fees to divorce Richard's father, blanched. But they agreed to proceed, with each parent paying half the cost.

Richard's case would be heard at Walter Reed, where the evaluation board scheduled the hearing for a day when Waple had a court appearance elsewhere and then refused to grant a five-day delay. That meant Waple would prepare Twohig's case but that an Army lawyer would have to present it.

Still, the Twohigs felt hopeful. Once the board heard the full story, Belinda was sure, "they are going to realize that there was wrong done. They're going to see and say, 'Okay, Richard should be 30 percent.'"

BELINDA ACCOMPANIED RICHARD TO WASHINGTON FOR HIS HEARING IN MARCH 2005. For one thing, he was in no condition to drive, she says, "from the stress and all the meds he was on." In addition to the pain drug Dilaudid, he was taking medications for his migraines, for nausea and sleeplessness, and for depression. Belinda would also be a witness, able to testify about the changes in her son and about what his neurologist had advised.

It was a stressful time. Belinda, who had been teaching ROTC at Florida A&M University, was newly divorced and about to retire from the Marines after 28 years, forgoing an expected promotion to lieutenant colonel. She planned to sell her house in Tallahassee and look for a job in Tennessee, where she would be near Richard and her grandchildren.

"My children have sacrificed a lot for my career," Belinda says. "There were deployments; there were a lot of long hours." She can still tick off her absences: the 10 weeks her two boys stayed with her sister while she was at Officer Candidates School, the six months' further training at Quantico when she got home every other weekend, a stint at Guantanamo . . . "I wasn't always there for them, I feel."

Now, she intended to be. So while Richard lay in the back seat of her '94 Mustang, she drove north, stopping at a highway rest area when a headache nauseated him and he needed to vomit.

This wasn't the son she had raised. Growing up mostly in Jacksonville, N.C., he was the kind of kid who was happiest outdoors, a deer and duck hunter, a year-round surfer at nearby beaches, a halfback on a traveling soccer team. "Richard always had friends; Richard used to joke a lot," she remembers. She wasn't pleased, when she and her husband went off one weekend, to learn that Richard had invited his soccer buddies over for a beer bash that drew the police. But the incident does remind her that back then, "he liked to be around people. He was always dragging someone home."

He went off to North Carolina A&T to study business management, and, toward the end of freshman year, met a young woman in a club. He and Sang, the daughter of Cambodian immigrants, went out for a while, had Lizzie when they were both 19, then married. Twohig left school and took jobs flushing radiators at Jiffy Lube and loading United Parcel Service trucks, but he had trouble earning enough for a family, and none of his employers supplied benefits. The military would. It might be "the best option to get my degree and help the family," he thought. "My mom did it that way, went in the Marine Corps, got her education. So did my dad." And the Army was offering $20,000 signing bonuses. He walked into the recruiting station in Jacksonville and enlisted in early 2001. When he graduated from boot camp, his mother swore him in, an officer's prerogative and an act she now sometimes regrets.

Twohig was sure after September 11 that he'd be sent to Afghanistan. But his unit remained at Fort Bragg until Iraq, a war whose political dimensions he gave little thought to. "I looked on it more as a job," he explains. "You're supposed to do it. Your feelings don't really matter."

He had been a good soldier, his mother thought, and he was a good man. She had faith, and not solely in the military.

In the months since his accident, Belinda, a churchgoing Catholic, prayed the rosary as she walked around the track at Florida A&M each morning. She was praying again as they rounded the Beltway and headed for a hotel in Silver Spring.

THAT AFTERNOON, THE TWOHIGS MET WITH ASSIGNED MILITARY COUNSEL DAVID WHITE, who, using Mark Waple's brief and materials, would represent Richard at the hearing next day. White explained the procedure and, as Belinda remembers it, said Richard stood a decent chance of having his 20 percent rating raised.

Richard hardly slept that night. When they reported to Building 7 at Walter Reed the next morning, both in uniform, he felt ill and vomited a little in a hallway water fountain; Belinda fished some tissues from her briefcase and cleaned up the mess. To ward off an approaching migraine, he took his anti-nausea pills and Dilaudid, which tended to undermine his already-diminished ability to concentrate. "He looked like a zombie," his mother says.

The Physical Evaluation Board at Walter Reed is one of three meeting around the country for the Army; the others are at Fort Lewis in Washington state and Fort Sam Houston in Texas, sometimes supplemented by a mobile board. (The Navy and Air Force have their own physical evaluation boards.) A typical board has three members, one of whom is a physician. But that doesn't mean anyone on the board has had previous experience in evaluating disabilities; the physician hearing about brain injuries could be a dermatologist or an obstetrician. Members of the Army board take a five-day classroom course before they start adjudicating cases; the rest of their training comes on the job.

Inadequate training is among the problems that investigators have repeatedly cited in calling for improvements to the disability system. For nearly two decades, studies by both military and civilian teams -- the Army Audit Agency, the Defense Department's Inspector General, the Rand Corp. -- have criticized the system's inconsistencies, its delays, its lack of oversight and quality control. The latest report, issued by the Government Accountability Office last year, sounded many of the same themes, and the Defense Department didn't disagree. The Pentagon says a number of improvement efforts are now underway, including the long-planned computerization of all health records.

The Army, however, insists that it is already doing a good job. Armitage, who helped develop the Army's five-day training course, defends the members of the evaluation boards and their preparation. "These are people who know what soldiering is all about; they know the stresses that soldiers undergo; they know what the requirements are for soldiers to perform," he says. "They've been there."

The evaluation board that met to consider Twohig's case included a longtime infantry officer as president (he has since retired), a retired Navy psychiatrist as the medical member and a personnel management officer who had served in Iraq. They met in Room 235, a small space hung with Army insignia and posters of the human spine. Each of the three members and the soldier had a microphone on the table before him so that the hearing could be recorded on a CD.

It's supposed to be a non-adversarial proceeding. Some soldiers find it intimidating, nonetheless. For Twohig, it mostly seemed perplexing. The transcript shows that several times, as the attorney had him describe his injuries or board members chimed in with questions, he sounded muddled, not quite able to grasp what was being asked.

Physical Evaluation Board president Col. James Babbitt (after Twohig testified that he had trouble concentrating): If the 1st Sergeant tells you, "Go to 1st Platoon and find the Platoon Sergeant and tell him I want to see him at 2 o'clock," can you do that?

Twohig: Yes.

Babbitt: If he says, "Go find the 1st Platoon Sergeant, tell him I want to see him at 2 o'clock, find the 1st Squad Leader and tell him I need to see him right now, and tell the 2nd Squad Leader I'll see him tomorrow," would you have any problem delivering those messages?

Twohig: What?

Belinda Twohig also testified, speaking at length about the changes she had seen in her son since his accident, his isolation and memory problems, his physical incapacity. "There is depression, because he feels he is incapable or cannot achieve any dreams that he had before," she said. "I think that the depression is coming because he doesn't know how to get better, and, you know, I don't either . . ."

But Babbitt prevented her from testifying about what the neurologist had said about not needing to seek further medical attention when the migraines hit. "We've brought that out already," he said. "That's not necessary. That's just duplicious."

After nearly two hours, the board recessed briefly. Then Babbitt read its decision: that Richard was physically unfit to perform his duties, that he had "post-concussive syndrome associated with headaches, dizziness, bilateral tinnitus, nausea, decreased concentration and forgetfulness" that "limit his activities of daily living." That he took "a narcotic substance, mood stabilizing and antidepressant medications." That he further had "mood disorder with depressive features manifest by chronic irritable mood, insomnia, decreased appetite, social withdrawal and low self-worth."

It sounded to the Twohigs as though the board saw things their way. Then Babbitt read Richard's rating: 10 percent.

After thanking Richard for his service, the board adjourned; the recording equipment was turned off.

Belinda Twohig remembers erupting in shock. "I don't believe this!"

"Mom, what happened? What are they saying?" Richard didn't understand.

"I gave the Army a perfectly capable young man, and what you give me is somebody incapable of working, and you tell me that's only worth 10 percent?" Belinda exclaimed.

The board president said he understood her distress.

"I don't believe we are not taking care of him," she said.

"That's what the VA is for," she remembers Babbitt saying.

One board member, Lt. Col. Nick Gnemi, disagreed with the finding and announced he would submit a minority report, a rare occurrence. As the Twohigs waited in the anteroom while Gnemi wrote it, Richard was anxiously wondering how he could take care of Sang and the kids. They would have to sell the house they had bought just two years earlier. "He was just ripping inside," Belinda says.

Sounding stronger than she felt, she told him not to worry, that they would get through this. She didn't want Richard to see her in tears, and she didn't want to show emotion before the other officers, "especially that president." So she found a corner downstairs, wept briefly, dried her face.

Gnemi handed them a copy of his two-page minority report, explaining his disagreements with the rating and concluding, "This combat veteran needs to be given the benefit of the doubt and be placed on TDRL [temporary disability retirement list] to continue additional rehabilitation and medical care." He told the Twohigs he hoped it would help.

Enervated, they left Walter Reed and started the long trip home. Richard was feeling sick.

"Do you want to stop?" Belinda asked.

"No, I just want to get the hell out of here."

So she paused just long enough for him to open the car door at a stop sign, lean out and vomit. Then she drove on.

RICHARD TWOHIG IS VERY QUIET on the 40-mile drive out to his mother's farm in Sweetwater, Tenn. It's the first time he has left the apartment in a couple of days.

Smoking Newports, he steers his SUV off the interstate, along a two-lane blacktop that climbs past fields of Queen Anne's lace and dairy cows in fenced pastures. Belinda first visited this area during a vacation in the Smokies, and bought her tract of fields, creeks and woodland six years ago. She hadn't expected to move here this soon, but now that seems the best solution for everyone.

Her plan is to raise, breed and sell alpacas. She already owns eight, currently boarded in Georgia while she prepares paddocks and barns. Richard, always an animal lover, has spent time learning to care for them. Alpacas are one of the few subjects for which he can, sometimes, summon real enthusiasm -- talking about how "they're real skittish" until you've worked with them for a while, how "they love kids," how their fleece comes in lots of colors, "gray, silver, black, white."

So Belinda's great hope is that he and the kids will move into a log cabin she's building on the property, where she can help raise her grandchildren while her son helps raise her flock.

"Daddy! Daddy!" Lizzie and Damon, who have spent the night with Belinda ("Grammy") and her fiance, Robert Rhyne, come dashing over as Twohig pulls into the drive. "Did you bring our water guns?"

"I didn't think of it," he says. He has a headache, one of the milder ones, but he sits on the front porch of the cabin -- Belinda and Robert are hanging kitchen cabinets inside -- and plays several rounds of tic-tac-toe with Lizzie. "No more," he says, after a few minutes. He watches Damon run his battery-powered truck up the pile of dirt next door to the cabin.

He and the children bounced around a good deal after his hearing and separation from the Army. The Veterans Affairs office in Winston-Salem, N.C., processed his benefits application at near-record speed -- probably helped along by an article in the Fayetteville Observer about his plight. The VA often assigns higher ratings; it uses the same guidelines as the military but applies them according to its own regulations and practices. It found Twohig 100 percent disabled, including a 50 percent rating for his headaches and 70 percent for his cognitive and mood disorder, with lower ratings for several other physical problems. "It is clear," its report says, "that you are unable to acquire and/or maintain substantially gainful employment in either a physical or sedentary setting . . ."

But while the VA began paying him $2,700 a month, it also -- by regulation -- deducted the Army's severance payment from his checks until the entire $12,000 was repaid. Unable to maintain a household on so little income, Richard sold the family's brick ranch in Fayetteville, and he and the kids lived for a while with his mother in Florida, then with his father in Tennessee and with Sang in Virginia. When he and Sang separated this past summer, they agreed that Richard should take the children because he wasn't working and could be at home.

He wouldn't get higher monthly income as a retiree than he currently gets from the VA. But TriCare insurance would let him see local civilian doctors; he would not have to drive nearly two hours to the VA hospital in Johnson City, Tenn. And it would cover Lizzie and Damon. Providing them with health insurance is the reason his estranged wife enlisted, so they're okay for now, but Sang has said she isn't loving the Navy. What happens if she leaves?

An appeal filed with the Physical Disability Agency was denied in April 2005, but Waple said he was willing to take Twohig's case to the ultimate level, the Army Board for the Correction of Military Records.

Even after Waple reduced his normal fee ("These people have been through hell," he explains), the appeal would cost another $2,500. "Mom, don't waste your money," Twohig urged. But Belinda considered that a reasonable investment if it brought her grandchildren health insurance until adulthood. "If I don't do this for the kids' sake, for their medical benefits, I'll regret it for the rest of my life," she decided.

So in July, Waple filed a petition arguing that the physical evaluation board failed to award the appropriate disability percentage, based on the regulations and the evidence presented. A decision could still be months away.

Belinda remains optimistic. "If I was sitting on that board and this was not my son, and I looked at everything," she says, "I would give him that 30 percent."

Meanwhile, the farm is taking shape. Belinda teaches ROTC in a Knoxville high school, and on weekends she and Robert, a jovial former contractor, do as much of the construction work themselves as they can. The main house, a dormered colonial of clapboard and fieldstone, is going up just across the meadow from the cabin. It will have three bedrooms upstairs and one on the main floor for Belinda's mother.

The cabin, where soon everyone is eating sandwiches and sitting on lawn chairs and upended spackle buckets on the porch, is just 400 square feet. Belinda can use it for meetings with prospective buyers and seminars on alpaca-raising. But it has a kitchen and a bathroom and could easily be expanded, which is her not-very-secret plan.

She's treading carefully, trying not to pressure Richard; she knows he needs to make his own decisions. She's mindful of the time she offered to ferry Lizzie to and from school each day -- the elementary school is near the high school where she's teaching -- and her son objected, "Mom, I have to have a purpose in life." Sometimes, beset by pain and depression, he says caring for his children is all that keeps him going. So Belinda hasn't pushed for a decision.

"I'm just in transition," Twohig says. "I don't know what I'm doing." In the coming months, as he turns 26, he'll move out to a rented house near the farm -- but not onto it.

Nevertheless, when Belinda stands on the porch and looks out at her property, a quiet haven without another house in sight, she envisions building a couple of bedrooms onto the cabin for Richard and the kids and the dog. He could help with the alpacas, with feeding and watering, shearing, trimming toenails. And when he had a bad day, Belinda and her mother would be just a few hundred feet away, ready to care for the kids until he recovered.

He'd never have to contend with crowds or noise or pressure or bosses. He could raise children and alpacas, and she'd have his back. He could, perhaps, be happy.

Paula Span, a contributing writer to the Magazine, can be reached at spanp@comcast.net. She will be fielding questions and comments about this article Monday at noon.