VA hospitals brace for a wave of post-traumatic stress cases

They may be home from the war in Iraq, yet they are not home free. Replaying gory scenes of death and destruction, some combat veterans are unable to sleep for more than minutes at a time. Some fight anger and anxiety with alcohol and drugs. Depression is common. Almost all bear invisible scars. Michael Culmer, 25, who manned a 120 mm mortar for the U.S. Army outside Ramadi, survived his tour of duty by becoming numb, feeling no emotion even when his commanding officer took a fatal shrapnel wound to the head. Now back in his hometown of Miami, "I just want to get off meds and feel like the person I was," he said. As more soldiers return from the war zone, some from second tours of duty, mental-health counselors with the Veterans Affairs Department in Broward, Palm Beach and Miami-Dade counties are bracing for a growing tide of men and women suffering from post-traumatic stress disorder. "Last year at this time we were seeing a trickle of Iraq war vets. Now we're seeing many more," said Joe Griffis, a readjustment therapist at the VA-run Vet Center in Lake Worth. "And it's going to get worse before it gets better." Months after running high-risk supply convoys across the desert, James Nappier of Loxahatchee finds himself on the lookout for roadside bombs while driving the streets of Palm Beach County, tensing at the wheel when a fast-moving vehicle approaches from the rear, just as he did in Iraq. "I'd like to say I'll be the old me again, but I realize I've changed for life," said Nappier, 46, whose Seabees unit, Naval Mobile Construction Battalion 14, lost seven men. "I feel different from other people." Days past the second anniversary of the U.S. invasion of Iraq, some costs of the war are clear. More than 1,500 American service members have been killed, more than 11,000 have been wounded and the nation itself remains deeply divided over whether the war was worth waging. Other, less visible, costs are mounting as well. With some experts estimating that up to 17 percent of those who see duty in Iraq and Afghanistan may suffer from post-traumatic stress disorder, six of seven VA treatment centers in the United States say they will be unable to serve all those who need treatment, according to the Government Accounting Office study. The U.S. Department of Veterans Affairs has increased the treatment budget by $100 million. In South Florida, both the Miami VA Medical Center, which serves Miami-Dade, Broward and Monroe counties, and the West Palm Beach VA Medical Center in Riviera Beach have applied for federal grants to beef up counseling staffs. "For the next year, we will be able to handle the numbers," said Dr. Maria Llorente, the Miami VA's chief of psychiatry. "But we will feel the pinch." In testimony earlier this month before the House Appropriations Committee, U.S. Army Gen. John P. Abizaid of Central Command warned, "We know that a casualty of war can as much be a psychological patient as a young man or woman that has lost their arm or leg." Counselors at the two South Florida VA hospitals, several satellite clinics and the VA-run Vet Centers in Palm Beach, Broward and Miami-Dade counties have launched aggressive campaigns to reach veterans who need help. "If vets don't come in now, they will come in later when in crisis," said Patrick Murphy, a counselor at the Miami Vet Center who organized a job fair at the center this month that drew 71 people. "We are reaching a lot of guys. But you have to wait them out until they are ready." Indeed, more than 20 years after the American Psychiatric Association defined as post-traumatic stress disorder what in World War II was known as "battle fatigue" or "shell shock," many combat veterans remain reluctant to admit a need for psychological help. "Compared to the time of the Vietnam War, there is more awareness now," said Jerry Troyer, a Vietnam veteran and PTSD program manager at the Riviera Beach VA hospital. "Still, the idea of going for mental-health care while on active duty does not go over well." Yet almost everyone who has served in Iraq -- a combat zone where there are no safe havens -- shows some post-traumatic stress disorder symptoms, counselors agree. "Lots of death, lots of issues to handle," said Bobby White, a Vietnam veteran who directs the Fort Lauderdale Vet Center. Not all combat vets seek treatment, of course. Cory Cunningham, 25, who served a year in Iraq with the 124th Infantry Regiment of the Florida National Guard, said he has adjusted to civilian life without counseling. Yet, he added: "I tend to notice vehicles speeding up on me in rear-view mirror. And I tend to be a little more aware of my surroundings." Out of work for several months, Cunningham, of Palm Beach Gardens, said he has volunteered to return to active duty. He is due to leave for Afghanistan next month. Those who do seek help often have no choice. Culmer, who enlisted in the Army just before Sept. 11, 2001, spent months with the 1st Infantry Division, conducting house-to-house searches and firing mortar rounds at the enemy from Camp Junction City outside Ramadi. "I felt like I was starring in my own movie -- invincible, not scared, just numb," he said. But after flying into a rage he directed at follow soldiers, Culmer was relieved of his gunner duties. Post-traumatic stress disorder Defined as a medical condition after studies in the 1970s on veterans of the Vietnam war, post-traumatic stress disorder, or PTSD, can afflict anyone who has been exposed to an event involving death, serious injury or mass destruction. These events can cause the survivor to react with intense fear, helplessness, hopelessness and horror. Symptoms: Recurrent disturbing thoughts, problems sleeping, nightmares and flashbacks, emotional numbing, anger and difficulty concentrating. Treatments include counseling therapy and medication. Honorably discharged this month, Culmer is attending barber college, repairing his marriage and, with his father, a Vietnam veteran, attending weekly group-therapy session at the Veterans of Foreign Wars Post 8195 in Hollywood. He also is set to begin psychotherapy at the Miami VA. Tall, muscular and articulate, Culmer is physically whole. But he knows he has been hurt by the war and left with a world of unfocused anger. "Sometimes I feel like a different breed, a different species of person," he said. "The war opened another eye in me. I see the world differently." Nappier, too, has been wounded. The May 2004 rocket attack that left him with severe nerve damage to his right leg and arm killed five Seabees, all friends, from his West Palm Beach reserve unit. While taking antidepressants to calm his anxiety, his days are filled with physical therapy and worry. "Not a day goes by that I don't think about the friends I lost," said Nappier, who worked as a water-well driller before going to Iraq. "I have a lot of guilt about what happened. "And now I have a sister over there. So I worry about her, too." By Mike Clary March 28, 2005 Mike Clary can be reached at mwclary@sun-sentinel.com Copyright © 2005, South Florida Sun-Sentinel