By Anne Hull and Dana Priest
Washington Post Staff Writers
Sunday, October 14, 2007
M ichelle Turner's husband sits in the recliner with the shades drawn. He washes down his Zoloft with Mountain Dew. On the phone in the other room, Michelle is pleading with the utility company to keep their power on.
"Can't you tell them I'm a veteran?" asks her husband, Troy, who served as an Army scout in Baghdad and came back with post-traumatic stress disorder.
"Troy, they don't care," Michelle says, her patience stretched.
The government's sweeping list of promises to make wounded Iraq war veterans whole, at least financially, has not reached this small house in the hills of rural West Virginia, where one vehicle has already been repossessed and the answering machine screens for bill collectors. The Turners have not been making it on an $860-a-month disability check from the Department of Veterans Affairs.
After revelations about the poor treatment of outpatient soldiers at Walter Reed Army Medical Center earlier this year, President Bush appointed a commission to study the care of the nation's war-wounded. The panel returned with bold recommendations, including the creation of a national cadre of caseworkers and a complete overhaul of the military's disability system that compensates wounded soldiers.
But so far, little has been done to sort out the mess of bureaucracy or put more money in the hands of newly disabled soldiers who are fending off evictions and foreclosures.
In the Turner house, that leaves an exhausted wife with chipped nail polish to hold up the family's collapsing world. "Stand Together," a banner at a local cafe reminds Michelle. But since Troy came back from Iraq in 2003, the burden of war is now hers.
Michelle has spent hundreds of hours at the library researching complicated VA policies and disability regulations. "You need two college degrees to understand any of it," she says, lacking both. She scavenges information where she can find it. A psychotic Vietnam vet she met in a VA hospital was the one who told her that Troy might be eligible for Social Security benefits.
Meanwhile, there are clothes to wash, meals to cook, kids to get ready for school and a husband who is placidly medicated or randomly explosive. Besides PTSD, Michelle suspects that Troy may have a brain injury, which could explain how a 38-year-old man who used to hunt and fish can lose himself in a three-day "Scooby-Doo" marathon on the Cartoon Network.
"He can't deal with everyday stresses of living," Michelle says. "He can't make decisions. He is a worrywart. Fearful. It's like they took Troy and put him in a different person."
As thousands of war-wounded lug their discharge papers and pill bottles home, more than a quarter are returning with PTSD and brain trauma. Compensation for these invisible injuries is more difficult and the social isolation more profound, especially in rural communities where pastures outnumber mental health providers. Troy's one-year war has become his wife's endless one.His Illness, Her Full-Time Job
The Turners live in a small rental house in the northern tip of West Virginia, surrounded by enormous blue sky and the dark spine of South Branch Mountain. There is a VFW tavern in town, but Troy doesn't bother. After one of his distraught soldier buddies from Iraq got so drunk he wrapped his motorcycle around a tree, Troy stays away from alcohol. Still, the techniques he learned to calm his PTSD in Army and VA treatment programs -- tai chi meditation and classical music -- seem like distant remedies in this county of farm equipment and Ford pickups.
Michelle thinks Troy's anxiety and depression are worsening, and she tells anyone who will listen -- her pastor, doctors and counselors at VA. His speech is sometimes soupy from mood stabilizers. The meds give him tremors. He used to cut the grass and bring home a paycheck, but now he stays inside like a perpetual patient. His memory is shot, and he relies on Michelle for everything.
"What is the name of the doctor who looks at knees?" he asks one day.
Michelle takes a breath. "Orthopedic," she says. "Troy, please try."
At 31, her eyes are hollowed by worry and her brown hair is turning gray. The Turners live 80 miles from the Martinsburg VA Medical Center, where Troy receives his care, and sometimes they go once a week. The all-day journey requires a babysitter for the kids -- ages 10 and 11, both from previous marriages -- and burns $25 worth of precious gas.
"This is the part you don't see on TV," Michelle says.
One hot morning, they set out for Martinsburg yet again. Troy recently screened positive for possible traumatic brain injury -- he was exposed to multiple blasts in Iraq -- and the hospital wants him back for more comprehensive testing. Troy and Michelle are quiet on the ride into Martinsburg. A Bible rests on the back seat. The cornfields and emerald hills spread out from the two-lane highway. Troy's pill box is between them, along with the silence.
Finally Troy says he thinks his new medication is making him less aggressive.
Michelle is skeptical. "You don't have an 'off' button anymore," she says.
Troy, in the passenger seat, keeps his eyes on the road. "They broke it off when I was over there."
He served with the 3rd Infantry Division during the 2003 invasion of Iraq. Before that, he spent a decade with the National Guard, pulling a tour in Bosnia. A laconic country boy with a plug of tobacco in his cheek, Troy was a cavalry scout with the 3rd Battalion, 15th Infantry Regiment that pressed into Baghdad. His platoon sergeant was decapitated by a rocket-propelled grenade, and others he knew were obliterated.
Troy's problems started after his tour. While he was on home leave from Fort Stewart one weekend, Michelle found him sitting on the bed with a bottle of pills. He said he couldn't go back. Michelle drove him to the Martinsburg VA hospital, which shipped him to Walter Reed for three weeks of psychiatric care.
He was sent back to Fort Stewart and returned to duty, a reality he could not cope with. Twice he tried to commit suicide and was hospitalized at Winn Army Community Hospital before being medically discharged for PTSD in 2004. After 13 years in uniform, Troy got nearly the lowest disability rating possible, a $11,349 severance check and no benefits.
Michelle was dating Troy at the time. She had visited him at Walter Reed. When he asked if she wanted out of the relationship, she said she would stick by him as long as he continued to treat her well. They were married on Valentine's Day in 2005.
For 18 months Troy worked as a truck driver until his symptoms began to worsen. He imagined he saw Army vehicles on the interstate, causing him to shake and panic. His family needed the $2,600-a-month salary, so Troy kept driving and Michelle rode in the truck with him. Finally VA doctors increased Troy's medication, and he became too zonked to drive.
VA rated Troy's disability level at 50 percent, resulting in $860 a month in compensation. Like many wounded soldiers, he was clobbered by a fine-print government regulation known as "concurrent receipt," which prevents double compensation. That meant before he could receive his VA disability check, Troy had to pay back the $11,349 he received when he left the Army. For 13 months, VA withheld his check until the Army amount was reimbursed.
The Turners' foothold in working-class America completely slid away when Michelle -- who has worked as a teacher's aide and an inventory-control specialist at Wal-Mart -- developed health problems and was forced to quit her job. Now her full-time job is Troy.
His illness has eroded their marriage, but on the morning they arrive at the Martinsburg VA hospital, she leads the charge on his behalf. The concrete behemoth serves 129,000 vets from West Virginia, Maryland, Virginia and Pennsylvania. It is at once efficient and numbingly bureaucratic.
Michelle and Troy move down the hallways, passing a room near the PTSD residence where a group of young vets, some tattooed and still muscled from the desert, are playing a game of ring toss. The cafeteria smells of bleach and canned peaches.
In the small lobby of the neuropsychological department, Troy leans over the sign-in clipboard, pen in hand, staring at the sheet. Michelle tells him what day it is. They sit together on the hard chairs until Troy's name is called.
With two hours to kill, Michelle wanders into the hallway and runs into a Vietnam vet she has befriended. A former Marine with ramrod posture, the vet has PTSD and an encyclopedic knowledge of VA procedures. "Don't take no for an answer," he tells Michelle. "Huntington [a VA regional office] says you are his fiduciary, right?"
"They say they need to come out and do a home study," Michelle says.
The vet shakes his head angrily. "Don't let these people get over on you!"
She returns to the waiting room. A flier on the bulletin board catches her eye: "Coming Soon, Help for Veterans and Families." A door opens, and one of Troy's doctors asks her to step into his office. When Michelle emerges 15 minutes later, she stands alone in the waiting room, twisting the handle of her purse. The doctor said Troy is getting worse.
Not knowing where else to go, Michelle heads upstairs to the PTSD offices. Troy has already done one 45-day stint in the residential program, and Michelle has been trying to get him in again. She knocks on the door of a counselor, a big, bald, friendly man who does not wave off the intrusion.
"You think he's violent at this point?" the counselor asks.
Michelle dodges the question. "He's not getting any counseling," she says, leaning against the door.
The counselor explains that all 50 beds in the program are full and the waiting list is 25 deep. "I apologize for not being able to get him in right away," he says.
Michelle's voice breaks. "I know you are doing the best you can," she says. "Anymore, he's just ashamed. I wish I had a video camera set up to show the people at the VA: This is what an average day looks like."
She goes back for Troy, who has finished his tests. He is yawning and tired. He tells Michelle how hard he tried, and she smiles and touches his arm. They go upstairs to make an appointment with Troy's psychiatrist. The clerk tells Michelle that unfortunately the doctor is on leave for the next month. The first available slot is five weeks out, at 8:30 a.m.
"Is there anything later than 8:30?" Michelle asks, politely. "We have a three-hour drive."
Nine o'clock is the best they can do. The appointment is for 20 minutes.
The last stop of the afternoon is the travel reimbursement office on the first floor. The government has promised to care for its wounded, but the proof is often in cramped places such as this, where disabled veterans stand in line to get their mileage reimbursed. The VA mileage rate has not changed since 1977. While a federal worker gets 48.5 cents per mile, a disabled veteran is still paid 11 cents a mile.
Michelle steps to one window and gets a receipt for $14.52. At the next window, $6 in government "deductibles" are taken out, bringing the grand total to $8.52.
On the way home, Michelle pulls into a Flying J truck stop, pumping gas in the hot breeze, watching the numbers spin higher.'Ain't a Scratch on Me'
Money became so desperate this spring that Michelle contacted Operation Homefront, a national organization that gives emergency assistance to deployed service members and the returning wounded. In a sign of the deepening financial crisis faced by many back from war, Operation Homefront has provided $2 million in bailout funds to 4,300 families so far in 2007, double last year's caseload.
The Turners received $4,500 to cover three months of late car payments, rent and various other bills, and a grocery card for food. Troy was angry and embarrassed, but Michelle told him they had no other choice. The $860 VA disability check barely covers expenses.
Michelle has been pushing to have VA reevaluate Troy in hopes of getting his disability rating raised and his compensation increased. He can't drive, he can't work, he can barely function without her. A Black Hawk model set is next to his recliner, a therapeutic hobby made impossible by the shaking in his left arm.
The house is small, and the blare of Nickelodeon from the TV chokes the day.
"I am at the end of my rope," Michelle says. But at least now she has the help of an assistant officer with the West Virginia Division of Veterans Affairs in a little office in Moorefield, about 30 miles from Romney. The officer submits the right paperwork to have Troy reevaluated.
Doctors find that his condition has worsened and that his PTSD is "chronic and severe." Michelle gets copies of the medical records and sits down with them on her living room floor. Wearing an Army T-shirt that says "Got Freedom?" she begins reading. The documents are a gold mine of information that validate what she has said all along. But instead of feeling exonerated, she feels sickened.
He has nightmares frequently, two to three times a week, in which he sees himself back in Iraq . . . and Baghdad. He sees himself fighting, sees dead bodies, parts of bodies, blood rushing from bodies. In the dreams he smells blood and burnt flesh and he hears bullets passing over his head. He is fearful and scared and wakes up in cold sweats. Flashbacks are also frequent, 2 or 3 times a week, triggered by helicopters passing over, burn flesh smell, barbecue, current Iraq news and sometimes seeing military vehicles brings flashbacks.
Michelle goes page by page. Troy is in his recliner holding the remote control. From time to time she looks up at him, then her eyes go back to the records.
He has a lot of guilt feelings that he could not save his sergeant.
She comes to a page that lists Troy's problems.
Michelle calls out to Troy. "They are saying your memory is extremely low," she says. "And here's another thing. 'Hearing loss. Exposure to artillery and machine gun fire.' "
VA concludes that Troy's worsening condition merits an increase of his disability rating to 70 percent, raising his monthly check to $1,352 a month. According to VA, he doesn't meet the criteria for 100 percent because his impairment is not "persistent," with "persistent delusions" or a "persistent danger of hurting himself or others." He is still able to perform his own hygiene.
From Michelle's point of view, Troy can hold a toothbrush, but he can't hold a job. "Even at 70 percent, you can't raise a family," she says. She has a year to appeal the rating.
But there is good news: The VA hospital in Martinsburg finds a bed for Troy in the PTSD residential rehab program.
Michelle is relieved. Troy will get help and she will get a respite. Troy packs his small suitcase with resignation. He doesn't want to go. During the intake session in Martinsburg, he is withdrawn and sullen. When the doctor asks if he has been having suicidal thoughts, he says yes. The news punches Michelle in the gut.
Troy is allowed to come home on weekends, so Michelle makes the four-hour round trip to pick him up on the first Friday night. On Sunday, he refuses to go back. He says he has been through it before. Michelle pleads with him to get in the truck but he won't, and he loses his spot in the program.
Troy returns to his recliner. VA tells Michelle that a contract counselor who visits rural counties will be in touch to schedule time with Troy. Two weeks later, Troy has his first appointment. Whatever is discussed in the 60-minute session causes him to cry the next day.
The Turners decide to pack up and leave their $475-a-month rental house for a $450-a-month mobile home in Moorefield to save money and be near Troy's mother for help. They are strained beyond belief. Still, there are moments of gallows humor. "I have PTSD, what's your excuse?" Troy kids Michelle.
"I have a husband with PTSD," she says.
Before they leave, someone from Hampshire County's Heritage Days parade calls to see if Troy wants to ride on the veterans float. Troy declines. It's not just the crowds.
"Other people got wounded, and all I got was a mental thing," he says.
Michelle raises an eyebrow. "It's still an injury."
"I think about that doctor down there," Troy says, referring to a psychologist at Fort Stewart who suggested he was faking it. "Plus, the fact that guys are missing arms and have bullet holes and everything else. Ain't a scratch on me."
To remember who Troy used to be, Michelle keeps a photo of him hidden in her camera case. In the picture he is smiling and eager, ruggedly at home in his Army fatigues. Now she looks at the man in the recliner. "It's people like you that made our country," Michelle says. She goes back to filling out forms, and Troy goes back to Nickelodeon.
Staff researcher Julie Tate contributed to this report.