— When U.S. Army Lt. Joshua Pitcher woke up in a military hospital in Kandahar province, he immediately looked toward his feet.

The last thing he remembered was a doctor promising he would try to save the soldier’s left leg, which had been shredded by a roadside bomb. Now Pitcher stole a look downward at the sheet covering his lower body. There was one mound instead of two. He swore.

“And then I just spiraled down into complete depression,” Pitcher recalled.

Two years later, the 25-year-old is serving in Afghanistan again, but this time with a prosthetic leg — going on missions with an M-4 assault rifle and 50 pounds of body armor and gear strapped to his body.

A total of 1,564 soldiers or Marines have lost at least one leg, arm or hand in Iraq or Afghanistan, according to the Pentagon. Pitcher is one of a tiny minority — just 57 — who have returned to war zones.

In the past, the idea of an amputee returning to combat was virtually unthinkable, even though the occasional soldier remained on active duty after losing part of an arm or a leg. Now, thanks to advances in medical care and sturdier prosthetics, more service members can at least try.

But Pitcher’s story shows how daunting the road back can be.

He had to overcome severe mood swings, the skepticism of doctors and military commanders, and a drug dependency so severe he was popping 40 pills a day.

He had to learn not only how to walk again but also how to run and do dozens of sit-ups and push-ups. And he had to prove he could jump out of planes.

Because, while most amputees who remain in the military take desk jobs or support positions, Pitcher had other ideas.

He wanted to return as a paratrooper.

Initial defiance

From the age of 4, Pitcher was determined to be a soldier. The son of an Army combat flight medic, he was raised on military bases in Germany, Texas, Georgia, Alabama and Kentucky.

He joined the 82nd Airborne Division after he graduated from Eastern Kentucky University. In April 2012, just two months after arriving in Afghanistan, Pitcher was on a mission when he stepped off the road to urinate. As soon as he zipped up his pants, he heard what sounded like a small firecracker.

“I looked down at my foot, and I was like, ‘Uh-oh,’ ” he recalled.

Initially, Pitcher was defiant. When he arrived at the U.S. military hospital in Landstuhl, Germany, two days after the initial operation, he opened up Facebook on his iPad. “I will return,” he wrote.

Soon after, when he had moved to Walter Reed National Military Medical Center, he insisted to staff that he was well enough to attend when his fiancee, Michelle, graduated from Eastern Kentucky University.

“They said, ‘Josh, it’s too early. You can’t go,’ ” recalled Pitcher’s father, Randy.

“ ‘No, I am going,’ ” Pitcher responded, according to his father’s account. “Take the damn IVs out of my arm, and I will prove to you I can go.”

When he returned to Walter Reed, though, he endured one infection after the other.

One day in June 2012, he was scheduled to receive his prosthetic leg. Pitcher had gotten up early and was lifting weights, when two doctors rushed in and told him he needed an operation because of yet another infection in his stump.

“That meant I had to wait another month, and that took depression to a whole new level,” Pitcher said. “You are so tired of being in a wheelchair, so tired of being on crutches.”

Pitcher began lashing out in “extreme anger,” recalled Michelle, now his wife. He also started drinking heavily, persuading friends and fellow soldiers to sneak him out of Walter Reed for trips to bars in Maryland.

Soon, Pitcher said, he was gulping up to 40 Oxycontin pills a day, despite the drug’s reputation for
being extremely addictive. He was “zombie-like,” Michelle Pitcher said.

He ‘really wanted it’

Yet over that summer, Pitcher started to come to terms with what he called his “new reality.”

Pitcher’s younger brother was also in the Army in Afghanistan at the time, and the siblings had been competitive since childhood. When Pitcher thought about leaving the military, he would become nauseated.

“It was clear he didn’t want to go out this way,” his father said.

When he got his prosthetic leg in July 2012, Pitcher said it took him only a week to learn how to walk with it.

Though he was still on medication, Pitcher began hitting the gym three times a day, both at Walter Reed and in an apartment building in the White Flint section of North Bethesda where he and his wife had moved.

That fall, Pitcher took part in the Army Ten-Miler, an annual race that ends at the Pentagon. He was not able to sprint. But he loaded about 50 pounds of weights into his Army backpack and briskly walked and jogged.

In January 2013, Pitcher completed the Army Physical Fitness Test, doing 80 push-ups and 80 sit-ups, and finishing a two-mile run in 14 minutes and 23 seconds. His fitness score put him in the top 10 percent of active-duty soldiers.

Still, Pitcher had to battle skeptics.

In February 2013, he attended a skiing outing in Colorado with the Wounded Warriors program. His snowboarding skills were so impressive that some case managers suggested he try out for the U.S. Paralympics Team instead of returning to active duty.

“I was like, ‘No, I am staying in the Army,’ ” Pitcher said.

Benjamin “Kyle” Potter, the chief orthopedic surgeon for the amputee care program at Walter Reed, said Pitcher was helped by the fact his amputation took place below his knee. But the doctor said amputees need to “feel it in their heart” to swiftly become physically active.

Pitcher, he said, “really wanted it.”

Amputees are allowed to return to active duty if they can prove they can still do the job and won’t be a danger to themselves or others. In 2005, David M. Rozelle, then an Army captain, became the first military amputee to go back to combat when he redeployed to Iraq.

Three years later, then-Sgt. John “Mike” Fairfax, a member of the Army Special Forces who lost a leg in Afghanistan, set another milestone, as the first amputee to complete the jump master course, in which soldiers train to parachute from aircraft.

Citing a yet-to-be-published study by researchers at the San Antonio Military Medical Center, Potter said 13 percent of amputees have remained on active duty. Just 2 percent have returned to their old roles.

His first jump

Last June 16, Pitcher took a deep breath, stepped off a C-17 plane over Fort Bragg, N.C., and plunged 800 feet. He didn’t know whether his prosthetic leg would hold up. As he fell, he focused on one of the first lessons taught to want-to-be paratroopers.

“Keep your feet and knees together,” he told himself.

“He landed pitch-perfect,” said his father, who was watching from the landing zone. “At that point, he walked over and said, ‘Okay, I can do this.’ ”

He was the first amputee from the 82nd to requalify as an Airborne paratrooper, according to a unit spokesman.

But Pitcher was still taking Oxycontin. Army substance abuse counselors had warned he’d have to give up the painkillers if he wanted to regain command of a combat platoon.

In August, he got orders to deploy to Afghanistan for about a year. A few days later, with his wife at his side, he flushed the remaining pills down the toilet.

“He wanted to be strong for his guys,” his wife said.

As his departure date drew nearer, though, Pitcher started having doubts.

He was eager to start a family, and his wife made him promise he’d retire if he got a second Purple Heart. His father could tell he was anxious.

“But he has already faced his demons,” Randy Pitcher said. “He is back to doing what he is supposed to be doing.”

Back in Afghanistan

Since last November, Pitcher has led a platoon of 21 paratroopers at Camp Spann on the outskirts of Mazar-e Sharif in northern Afghanistan.

He uses a prosthetic that includes a curved blade at the bottom, which allows him to dig into the mud and snow for balance.

When Pitcher runs, his left kneecap smashes onto a titanium prosthetic leg. The 6-foot-1 paratrooper must sit for hours with his legs cramped underneath the dashboard of armored vehicles. He still gets a “phantom” sensation that his missing foot is intact and has fallen asleep.

“You just have to accept it’s going to hurt and deal with it your own way,” Pitcher said.

Before a recent mission in Samangan province, Pitcher playfully picked up a knife and positioned it at the end of his prosthetic as if it were a bayonet.

“If we get attacked, I will just kick,” Pitcher said as he raised his leg.

The mission involved escorting a military audit team to an isolated Afghan police outpost. After Pitcher arrived, several police officers walked up, smiling, and asked if they could be photographed with him. They had never seen a man who had lost his foot and returned to war.

“Our government is not taking care of us like that,” said one officer, Faizel Ahmad, 32. “If we lost our leg, then we are useless.”

Pitcher said being useless isn’t an option for him.

That’s why, when going out on missions, he always steps out with his left foot. If he hits another bomb, he hopes, he will only have to replace his shoe.