Vets' war has second front both physical and mental

[rainvet]

Vets' war has second front
Recovering from wounds both physical and mental is another battle for Jose Mateo.
By Jane Daugherty

Palm Beach Post Staff Writer

Monday, August 22, 2005

His screams pierce the darkness, muffled only by nearby buildings and the oppressive summer heat.

"Get down, get down," Sgt. Jose Mateo shouts to his men as rocket-launched grenades spray shards of jagged metal into their U.S. Army Humvee.

"Fire, fire over there," he points, but the gunner is barely conscious, wounded so badly he cannot move from behind the machine gun mounted atop the Hummer.

Rocked by a land mine, the unarmored Humvee's crew is pinned down by snipers' bullets and more grenade fire. A little dazed by the explosion that slammed his spine against the door frame, Mateo continues to bark orders as he scrambles out, then climbs into the turret, standing on his gunner's legs to return fire.

Everything shifts to ultra-slow motion: the men's movements, the flying debris, the echoing shots. Every acrid smell is heightened, every burst of fire searingly bright. But it is over in minutes. Another patrol arrives and pulls the men of Charlie Company to safety.

Medics lose Mateo's pulse twice and scream, "Sergeant, Sergeant, hang on." Wounded in the shoulder, side and leg, he blinks and reaches down, feels his uniform wet, drenched in blood . . .

No, it is just sweat. He is covered in sweat. It is two years and seven weeks since the ambush in Ramadi, Iraq. But tonight, as on so many nights, his mind is not in his parents' comfortable Port St. Lucie home. Again tonight, Sgt. 1st Class Jose Mateo remains on active duty in his nightmare of Iraq.

The clinical name for what he feels is Post-Traumatic Stress Disorder, which hardly captures the vivid and relentless reliving of the ambush in Ramadi on July 5, 2003, that took his gunner's leg and blew the fingers off another soldier's hand.

The battalion photographer, Spec. Edouard H. R. Gluck, said, "If hell physically exists, if there is in fact a hell . . . it is Ramadi."

Mateo does not disagree. "It was really ugly, hot and filthy. It smelled bad, sewage running in the streets, but that was not the worst of it. It was not knowing when we would be hit, who was hiding in the shadows, where the bombs were planted, whether the concrete barricades were rigged to explode when we drove past on patrol," he said quietly, averting his eyes, as he often does when talking about Iraq.

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Stress cases receiving scrutiny


By Tom Philpott Posted on: Monday, August 22, 2005

Ronald Nesler of Las Cruces, N.M., a Vietnam veteran rated 100 percent disabled by post-traumatic stress disorder, learned this month that his case, as decided in 1997 by the Department of Veterans Affairs, lacked documents to support the finding of service-connected PTSD.

The VA regional office in Albuquerque advised Nesler in an Aug. 11 letter that he has 60 days to provide evidence he was exposed to the stressful wartime incidents described in his claim papers years ago, or there could be "a change in your disability claims compensation."

Nelser's award of about $2,500 a month is at risk because of a VA inspector general review of 2,100 randomly selected PTSD cases with 100 percent disability awards. The inspector general found that 25 percent, or 527 of them, lacked documents to verify veteran-reported evidence.

The review of PTSD cases was released in May, as part of a 200-page report on variances in VA disability compensation across the nation. The VA has announced that starting in January it will review documents of 72,000 PTSD cases, those awarded 100 percent disability ratings from Oct. 1, 1999, through Sept. 30, 2004.

"Everybody talks about how PTSD is a very subjective diagnosis. This is not about diagnosis," said VA spokesman Scott Hogenson. "This is about collecting the empirical paperwork that says, 'Yes, this individual was in this set of circumstances during this time in which these things happened, which may have led to post-traumatic stress.' "

From 1999 to 2004, the inspector general said, the number of veterans awarded compensation for PTSD jumped by 80 percent, from 120,000 cases in fiscal 1999 to 216,000. PTSD payments jumped by 149 percent, from a $1.7 billion total a year to $4.3 billion.

Nesler reached Vietnam in 1970 and served for 13 of his 14 months as a meteorological observer for Battery B, 6th Battalion, 32nd Artillery, part of the 1st Field Forces Vietnam.

The whole war experience was stressful, Nesler said. His most disturbing memories, he said, are of atrocities committed by soldiers. Nesler said he saw an American soldier detonate a directional mine toward a small bus, filled with Vietnamese women and children, near the town of Ninh Hua.

The incident, he said, was covered up, but the screams and faces haunt him still. Nesler said he also feels guilt for not filing an official report.

Nesler, a staff sergeant, was discharged in 1975 after eight years. As the years passed, he grew more anxious and had nightmares, insomnia and difficulty concentrating, all of which the VA later would tie to the war. In 1997, before VA approved his PTSD claim, Nesler gave to VA the names of a senior officer, two warrant officers and several senior enlisted soldiers who likely could verify the bus incident.

"I thought that was my proof," he said. A VA official told him only recently that the people were never contacted. Still, the VA ruled in 1997, based on "unrefuted evidence," that Nesler had served in a combat zone, had witnessed "a bus being bombed" and had a well-founded diagnosis of PTSD. It found "total occupational and social impairment" from a variety of symptoms.

"Sometimes if I smell gas or fireworks, the movie takes over in my head and I'm right back there in the firefight. I can smell the gunpowder and the blood," said Mateo, a polite, soft-spoken soldier still technically on active duty with the National Guard, First Battalion, 124th Infantry.

His flashbacks and panic attacks are classic symptoms of Post-Traumatic Stress Disorder, which was first formally recognized in 1980. PTSD occurs after exposure to a life-threatening event. Insomnia, nightmares, depression and nervousness are among its symptoms. The disorder also can cause biological changes and emotional collapse.

A landmark study by doctors at Walter Reed Army Hospital's Institute of Research, published in the New England Journal of Medicine last July, was the first to document that almost one in five U.S. military personnel returning from Iraq suffers from PTSD, major depression or generalized anxiety. That's almost double the rate of veterans returning from duty in Afghanistan, who were less likely to face active combat.

The study also said that, of the returning soldiers found to be suffering from a mental disorder, "Only 23 to 40 percent sought mental health care."

Physical wounds attended to

For Sgt. Mateo, like most U.S. soldiers, the treatment of his physical wounds was prompt and systematic. First, Army doctors in Kuwait stabilized him; then he was flown to Germany for surgery, then on to Walter Reed Army Hospital in Washington and later Fort Stewart, Ga., to further repair wounds in his shoulder and leg. He was fitted with tiny amplifiers to restore hearing lost in both his ears. Surgeons cut shrapnel from his side and leg. Later they removed a half-inch piece of previously undetected metal embedded in his skull.

But so far they haven't been able to remove the smell of cordite and diesel fuel, the searing pain of the ruptured disk in his back, the blinding fear and screams of the wounded from his head.

"He has a lot of issues. . . . Lots of physical things are wrong that cause him enormous pain, and chronic pain over time has to be successfully managed," said Dr. Ramon Cuevas, one of Mateo's doctors at the Veterans Affairs Medical Center in Riviera Beach, where he has been treated since November. "But the mental issues in some ways are worse. He has nightmares, a lot of psychic pain and guilt.

"It becomes worse when the injuries are not as clearly visible. If you lose a leg, it's very apparent that something terrible happened to you. With back pain, people can't see it . . . and when you have post-traumatic stress, it is a lot worse."

Cuevas, who spoke of Mateo's treatment with his permission, is the chief of physical and rehabilitative medicine at the VA medical center, where more than 500 soldiers returned from Iraq and Afghanistan are being treated.

Mateo, 35, thought he was prepared for battle. He first enlisted in the National Guard when he was 16, a high school student in the Bronx who idolized his soldier-uncle. "It was the only way you could enlist at 16," he said.

Later his parents sold the bodegas they owned in the Bronx and bought a convenience store in Delray Beach. In the early '90s, Mateo's father, his namesake, called and told his son he needed help with his business, so Jose headed south with his high-school-sweetheart bride.

"Maybe I wouldn't have stayed in the Guard for so many tours," Mateo said, "But I love my country and after 9/11, I was really angry that someone would attack us like that, so cowardly, so I reenlisted, half expecting to be sent to Afghanistan to hunt down Osama bin Laden."

Instead, he wound up in Iraq, patrolling land-mined streets and alleys in the Sunni Triangle west of Baghdad. His battalion, whose men came from the area from Miami to the Treasure Coast, remains the only infantry battalion sent to Iraq so far to bring everyone back alive: all 512.

"It's funny, people keep telling me I'm a hero," Mateo said. "I don't feel like a hero. I came back before all my guys were out. I wanted to get patched up and go back and finish my tour. I just did my job, what I was trained to do. . . . But nothing in my 16 years of National Guard training prepared me for what we saw in Ramadi."

Fireworks set off stress

What he saw resurfaced on a December night at Disney World last year on a belated honeymoon with his new wife Giselle, whom he had married just four months before being called to active duty.

They settled down to watch Disney's legendary fireworks. But as soon as the explosions and flashes started, Mateo dived under a nearby table, shaking uncontrollably, feeling like he was back in Ramadi, under fire.

"I had to go to the hospital," he said in a whisper, looking down at the ground.

"Part of the problem in treating PTSD is that those who suffer from it feel shame," said Cuevas, who has seen hundreds of cases. "Often they feel so much shame that they won't ask for treatment. The other problem is, we can't predict how long it will last or when it will first surface."

In a television interview in Miami last year when Mateo received a Bronze Star for valor and a Purple Heart for wounds in battle, Giselle Mateo talked about the flashbacks: "He has these terrible nightmares, wakes up shouting orders. . . . I want my old Jose back."

Two months later, they were divorced.

Now, two or three days a week, Mateo maneuvers his motorized scooter around the towering, modern VA medical center at Military Trail and Blue Heron Boulevard. Just a few years ago, the hospital seemed headed for mothballs — or at least conversion of some of its inpatient floors and clinics to federal office space as the needs of aging World War II and Vietnam-era vets diminished.

Now it buzzes with the ministrations of hundreds of pastel-gowned medical specialists dealing with the wounds, physical and mental, of a new generation of veterans. Usually, Mateo is greeted at the door by a member of the "Seamless Transition Team," a small group of specialists empowered to smooth the way for returning Iraq vets so they are treated promptly.

The first face he sees is Bonnie Haggerty's. "He's an absolute sweetie," Haggerty said. "Sometimes you can tell he's in so much pain, but he always tells you first of the progress he's made." Haggerty is one of five specially trained Seamless Transition Team members working at the center.

But seamless transition is not what is occurring for wounded Iraq veterans in some parts of the country. When Mateo was sent to Fort Stewart, Ga., last year for treatment, he sometimes waited months for an appointment with the specialist he needed.

"They were clearly treating returning National Guardsmen as second-class soldiers," Mateo said.

In Washington last month, members of Congress harshly criticized the Department of Veterans Affairs and the Pentagon for not doing enough to aid soldiers returning from Iraq and Afghanistan with Post-Traumatic Stress Disorder.

"All I hear is, 'We're doing everything right.' All I hear is, 'Everything's fine.' Everything's not fine," said Rep. Bob Filner, D-Calif. "We have suicides. . . . We have neglect," Filner told a panel of witnesses from the VA and the Army.

Col. Charles Hoge, psychology chief at the Walter Reed Army Institute of Research and co-author of the Iraq veterans study, testified that almost one in three returning Vietnam combat veterans eventually experienced PTSD. For many of them, there was no early intervention or any mental-health treatment through the VA for many years.

U.S. Rep. Steve Buyer, R-Ind., the Veterans Affairs committee's chairman, also cited what he called an "alarming" VA report that indicated the number of PTSD patients grew by nearly 100,000 from 1999 to 2004, to 215,871 cases.

Only half of VA centers have teams

The American Psychiatric Association told the committee that only half of all VA medical centers have PTSD clinical teams, and 39 of those 84 teams might not have staff assigned to PTSD duties.

Mateo's prospects for effective treatment of PTSD seem promising.

"Everyone at the VA really seems to care about me getting better," he said. "That helps, but the best thing I have going for me is my daughter, Brianna," he said, cracking a smile for the first time in hours of interviews. "She's what keeps me going. She's the reason I have to conquer the pain in my back and my shoulder and get these nightmares out of my head."

Several days a week, Mateo drives to school to pick up Brianna, 7, who lives nearby with his first wife, to have dinner and do homework — and "just goof around," Brianna said. "We like to go out and get some air. He rides his scooter and I ride my bike or my scooter around the block. . . . He's a really good daddy — he keeps all his promises."

But sometimes, when the epidural injections or the pain medications are fading, going around the block can be exhausting, Mateo is loath to admit. "But I'm getting stronger, I have to get stronger for her. I've got to go to cheerleading practice, and we've got a birthday party to go to on Saturday."

In somber moments, he admits he may never be able to return to the job he loved as a certified mechanic at Bev Smith Toyota. "Man, I loved that job. The people are just like family, and the products are good, and I was really good at my job," he said.

"But right now, I can't think about that. I just have to concentrate on getting my leg better and getting more mobility in my shoulder," he said.

Brianna bounces back into the room, bringing him an ice pack for his foot and adjusting it just right.

Asked what she wants to be when she grows up, she does not hesitate: "I want to be a doctor, a cheerleader, an astronaut and a salon person — what do you call it, a hairstylist — and maybe some other stuff."

And what if she wants to be a soldier? Mateo is asked later. "Oh, wow, I've actually thought about that because she thinks I'm some big hero, but no, I would have to veto that. Maybe the Air Force, maybe she could serve in the Air Force."