Trying to make a life
After a battlefield injury, endless challenges
MIAMI--When John Quincy Adams came home last fall from Iraq, his wife, Summer, was just glad to see him alive. Adams had hovered near death in a military hospital, his brain sliced open by shrapnel, his chances for recovery slim. The doctors warned he might never talk or walk. But today the man standing before her is walking, however haltingly, and talking, though with a slur that makes him sound drunk. Summer has been touched by the kindness of neighbors and friends who help her husband carry out the routine tasks that are now such a challenge--cutting the grass, putting in the air conditioner, even training their young son for soccer. She is aware that she needs to stay calm, but there have been times when she feels overwhelmed. One day she banged her head on the shower safety bar. It hurt, and she was sure that she winced, but John just laughed. Another time she had to fight for control when her husband held a kitchen knife so clumsily that it grazed their young son's skin. "You need to be more cautious," she cried out, conscious of keeping her voice from breaking. Again John laughed.
Sergeant Adams went to Iraq as part of Charlie Company, 1st Battalion, 124th Infantry of the Florida National Guard, 131 civilian soldiers based in North Miami. Once energetic, Adams worked alongside his father-in-law, cutting grass for a living. Born in Chicago and reared in Puerto Rico, he joined the Guard 16 years ago. The military ran in his family--his father and four uncles had been active-duty Army--and Adams was cut from the same cloth. In the Guard, his men loved him, calling him Papa "Oso" --Papa Bear in Spanish--because of his unabashed, big-hearted attention to their needs. Now recuperating in Miramar, Fla., Adams, 38, hears from Guard buddies like Spc. Jason Recio and Spc. Ramiro Mayorga. They keep up with his progress even as they cope with their own battle scars. Summer has urged the guys to be themselves around him, so when he visited Adams one day recently, Spc. Esteban Lora teased him about the metal in his head. "How's it beeping?" he asked.
Netherworld. The transition back stateside varies from soldier to soldier, but the challenges each faces are pretty much alike. In dozens of interviews with returning Charlie Company guardsmen in South Florida, many shared the same concerns. They aren't sure what to do next and feel they don't fit into their old lives. Some have lost jobs; others have seen marriages and relationships end. For the wounded, the challenges and setbacks are compounded by pain and discomfort. Some languished for months in a military netherworld--a limbo called "medical holdover," waiting to go through the Army's physical evaluation boards to determine whether they are fit to stay in the military. Then they must wade through the thicket of benefits administered by the Department of Veterans Affairs.
So far, nearly 17 percent of the 168,000 soldiers back from Iraq have sought VA healthcare benefits, numbers that VA Secretary Anthony Principi calls small, compared with past wars. But the overstretched VA today is bracing for the biggest influx of disabled veterans since Vietnam. A huge challenge, Principi admits, is just identifying Guard and Reserve veterans, who return to their communities without the same support structures as regular Army units.
That's certainly the case with veterans like Adams, Recio, and Mayorga. At dawn on Jan. 19, 2003, they rolled out of the armory in North Miami so fast there was hardly time for goodbyes. "Whatever you do, don't let them hurt my baby," Summer Adams, 30, called out as her husband of six years left for a month of training at Fort Stewart, Ga. Spc. James Bissett laughed: "Don't worry, we'll only be gone six months, tops. We won't see any action. We're the National Guard."
He couldn't have been more wrong. About 40 percent of the U.S. soldiers in Iraq are from National Guard or Reserve units. Joining up with the expectation of responding to emergencies and natural disasters, many guardsmen and women have scant training for conflicts like Iraq. Of the 39,536 National Guard soldiers sent to Iraq and Afghanistan, 149 have died, 1,046 have been wounded.
"Tip of the sword." The men of Charlie Company wound up in Ramadi, a city west of Baghdad in the so-called Sunni triangle where the Iraqi insurgency has been so lethal. Despite assurances they would leave earlier, Charlie Company wound up staying almost a year. Ninety-five soldiers returned in March 2004. They were blessed to have no deaths in their company, but many were wounded. Twenty-three soldiers received Purple Hearts.
When Charlie Company first landed in Ramadi, soldiers were unaware of the city's volatility. Instead, they were cocky. "We were untouchable," says Sgt. Mario Vega, 27. "We became the tip of the sword." That ended abruptly on July 5. Around 11:30 that night, Sgt. Jose Mateo's platoon had to cover a major intersection along the Euphrates River. It was their fourth night out on the same mission. Lt. Ben Baar, 38, protested to the brass about taking the same route at the same time so many nights in a row. We might as well just write up our plans in Arabic, he thought, and pass them around town. Mateo, 34, also had a sinking feeling. "We are going to get hit tonight," he told his guys. "The enemy knows we are tired. They are going to be expecting us." Baar, a 20-year career soldier, was driving the unarmored humvee, or as he called it, the "four-wheel-drive aluminum can."
Spc. Jason Recio, a 23-year-old history major at Florida International University, was in his favorite spot, manning the big gun, an M-240 Bravo. Recio loved action. He had been an offensive lineman at his Catholic all-boys high school and hoped to become a paramedic or a firefighter. Nearby sat Mayorga, a pal who had emigrated from Nicaragua at age 4 and longed to become a U.S. citizen. For Mayorga, 22, the first in his family to go to college, the Guard was a way to show his love for his adopted land--and pay for nursing classes at Florida International University. The platoon medic, Mayorga was joined by yet another Miami friend, Spc. Esteban Lora, 21. He was the radio man.
Recio had just put a dip of chewing tobacco in his mouth when there was suddenly a blistering white flash. It looked like thousands of tiny meteors were flying around the humvee. No one was sure whether it was a rocket-propelled grenade, a bomb, or a land mine. There was silence, then bullets spattered the humvee. "Anyone hit?" Mateo yelled. Baar was sprawled on the steering wheel. Mayorga was screaming, holding his left hand minus several fingers. "Doc got hit! Doc got hit!" Lora yelled. Nearby, Recio cried, "My leg! My leg! My leg!" Shrapnel had torn through his calves. Mayorga wrapped his hand in bandages, then turned to Lora, the only man uninjured, giving him step-by-step instructions on how to save Recio's life. In pain, Mayorga quipped, "Hey, Lora, I'd give you a hand, but I only have one left." Mateo remembers a salty smell and thought it was the nearby river. It turned out to be blood. It was everywhere in the humvee.
By the time Recio got to Walter Reed Army Medical Center in Washington, D.C., doctors thought they could save his left leg, but they had doubts about the other one. The doctors gave him a choice--amputate the leg or fight to save it. Recio, a runner, cyclist, and scuba diver, wasn't ready to give up on the leg.
Mateo wound up in Walter Reed's psych ward, where doctors diagnosed post-traumatic stress disorder. "I lost my humanity in Iraq," says Mateo, who had to pull a headless Iraqi shot by American soldiers from a truck. "I didn't come back the same." His wounds include hearing loss, shrapnel in his head and shoulder, five bulging disks on his neck, and a herniated disk in his back. But of greater concern are his anger and anxiety and his feeling that he is still pumped up for battle. "It's like you are on kill mode," he says. "You come back from an intense environment, but people expect you to be normal like nothing ever happened."
It wasn't until Mayorga reached the hospital in Fort Gordon, Ga., that the gravity of his wounds hit him. He had lost 2 1/2 fingers on his left hand. Then he contracted a serious staph infection and was put in a small isolation unit for nearly a month. He felt depressed, and soured on the daily routine at the base. All soldiers with "medical holdover" status had to report for formation at dawn and walk long distances, even if they took pain medication. They also received work assignments, considered a key to recuperation. "They asked too much of us there," he says.
Baar, the humvee driver, stayed in Iraq. Two days after the attack, a surgeon pulled the shrapnel from his neck. Today, he is recuperating after back surgery in Texas. The former sky diver is beginning to walk again and is eager to return to a full life. He wants to stay in the military but says, "I don't know what's going to happen."
"We broke it." After the attack on the humvee, the men of Charlie Company still in Iraq lost much of their swagger, increasingly on guard as attacks increased. On August 29, Adams and Spc. Will Riddle, 21, of Titusville, Fla., who made pizzas at Domino's before he was deployed, were patrolling in front of Ramadi's main mosque when a homemade explosive went off. Smoke was everywhere. Riddle, bleeding, his eyes filled with dirt, heard soldiers calling, "Sergeant Adams, wake up!" Adams had brain matter spilling out of his head. Bissett, who had joked that the unit would be gone only six months and see no combat, tried to push it back in with his thumb.
Back home, Summer Adams got a call from the state National Guard. "John's convoy got hit," a lieutenant said. "It's a serious injury, but we don't know how serious." She worked the phones and eventually tracked him down at the military hospital in Landstuhl, Germany. The news was shattering: A quarter-size piece of shrapnel was embedded in his cerebellum. More shrapnel went into his right frontal lobe. A small chunk of his ear was missing. Part of his right palm was gone, too. Later, a doctor called her from Landstuhl: "I'm going to be blunt with you. John flat-lined on me. The swelling on his brain was too intense."
Adams survived and was soon transferred to Walter Reed. When Summer first saw him there, he peered at her through his bandages and gave a thumbs up. But painful decisions loomed. Doctors could remove the shrapnel, along with part of Adams's brain, leaving him more impaired. Or they could leave it in and take their chances. Summer didn't hesitate: Leave it in, she said.
Early studies indicate that head injuries like Adams's are a frequent byproduct of the Iraq war. Michael Xydakis and John Casler, military head-and-neck surgeons, have gathered data that show about 1 in 5 soldiers injured in Iraq and Afghanistan and airlifted to Landstuhl over a 14-month period was treated for injuries to the face, neck, or throat below the helmet. During the first eight months of this year, the Defense and Veterans Brain Injury Center at Walter Reed treated 355 patients from Iraq and Afghanistan with traumatic brain injury, known as TBI. Depending on its severity, TBI can result in headaches, sleep difficulties, decreased memory and attention, irritability, and depression. Patients do recover, but more serious brain injuries often mean long-term problems.
Adams sustained "significant brain damage," says Yolanda Reyes-Iglesias, his neurologist at the VA Medical Center in Miami. The shrapnel in his cerebellum affects his speech and coordination. The damage to his frontal lobe affects his mood swings and memory, as well as his ability to solve problems, plan events, and behave in an appropriate way socially, causing his laughter at awkward moments.
Soldiers like Adams and his men must deal with two big bureaucracies: the Pentagon and the VA. "Medical holdover," or med hold, as soldiers call it, was intended to make sure no one leaves the military until medical problems are stabilized. "We want to return them to the level they were at," says a senior Army medical official. "The idea is, 'We broke it, we fix it.' " Although wounded soldiers receive their active-duty pay while being treated, many are assigned to bases far from home. About 23 percent of the roughly 14,600 reserve soldiers who have entered medical holdover are still there; the average number of days spent in med hold is 136. Aware that many soldiers want to heal closer to home, the Army recently initiated a community-based program. Still, many soldiers express frustration. VA Secretary Principi acknowledges that a young soldier can "get stuck in a netherworld" while the Army tries to determine whether he is fit to stay in the military. "We should not be holding them up unnecessarily," Principi says, "for prolonged periods of time."
Limbo. During his time on medical holdover, Jason Recio has been bounced back and forth between Walter Reed and Fort Stewart and Miami for treatment and convalescence. Over the past 16 months, he's had at least 18 surgeries; his shattered right leg is made up of metal and cadaver bone and grafted muscle and skin. Recio, however, feels so limited that he says now he wishes he had decided to have his leg amputated, an option he and his father say may yet be their preference. "There's something to be said for having your leg," he says, "but I'm 23, feeling like a 60-year-old. I want to cut my losses."
Much of the time, Recio has been at Walter Reed, alone and depressed. His parents visit Washington as often as possible, and his wife, whom he married shortly before deploying, stayed with him, too. "At Walter Reed, he has nothing to do all day," says his father, Jorge, who owns a lumberyard in Hialeah, Fla. "When he is alone there, he gets down. More than a year of his life has been wasted." Recio's depression is in striking contrast to his younger self, when his parents were convinced he would become a priest. Idle and bored, he eventually became hooked on painkillers, taking 15 a day, grinding them and snorting them. Finally, in August, his wife persuaded him to quit, and he gutted out an agonizing week of withdrawal.
In Recio's perfect world, he would like the Army to medically retire him and let him return to Miami to restart his life. What exactly that new life will look like is still unclear. His marriage recently collapsed under the strain of his recuperation, but despite his growing bitterness, he is proud of his service in Iraq. "I support the war completely," he says. "I'm prouder than hell. At least I got hurt doing something I believe in. I wish I could stay in the Army."
While on medical holdover, soldiers go through the Army's physical evaluation board, which soldiers call the med board. That is essentially an exercise in form filling: Doctors evaluate a soldier's disability to see if he is fit to serve and pass that along to the board, which decides the soldier's fate: It can keep him on active duty, discharge him with a lump sum payment, or medically retire him with monthly retirement pay.
Recio hasn't reached that stage yet, but Ramiro Mayorga, the young medic who has had eight hand surgeries, languished at Fort Gordon for more than a year on med hold while his evaluation dragged on. "Your life is on pause," he says. "You basically sit there, and whatever the doctors write on the paper is what you get evaluated on. You are a paper to them." The med board finally retired him at a 40 percent disability. That means he gets 40 percent of his base pay--he takes home $640 a month. Mayorga had hoped for 50 percent but decided not to appeal. "I just said, 'Screw it.' "
"Profound change." Mayorga finally got home to Miami September 29, almost 15 months after his injury. Being retired from the military made him eligible for the second part of the bureaucratic process: applying for benefits from the VA, which offers healthcare, compensation, and burial benefits for 70 million potentially eligible people--veterans, their families, and survivors. Principi says "a significant, profound change" has been placing VA staffers at military hospitals and bases to help soldiers begin to file for VA benefits "so they don't have to wait until they get their discharge papers." Indeed, the VA hospital in Miami actively tries to reach out to new war vets, but Mayorga has not yet hooked up with the hospital for physical therapy for his hand or counseling. He did, however, apply for disability compensation for his hand, hearing loss, and PTSD; he learned last week the VA will give him 70 percent disability, or $1,029 a month.
The VA awards compensation for a disabled soldier's loss in earnings capacity, but the system is enormously complex. The schedule of ratings for specific disabilities runs well over 100 pages. These ratings assign percentages for specific problems--loss of the use of a nonpredominant hand, for instance, is 60 percent. Congress assigns a dollar amount to each percentage: 60 percent is $817 a month, tax free. The assigned amounts range from $106 a month for a 10 percent disability to $2,239 for 100 percent disabled, though the most seriously disabled are eligible for additional amounts up to $6,404 a month, plus extra help for attendants. Is that enough? "Those catastrophically wounded on the battlefield, we can never do enough for them," says Principi. "It may be calculated on loss of earnings capacity, but to me, there's more to it than that." Soldiers are not permitted to take both the military and VA compensation awards; most opt to take the VA payments because they are tax free and often more generous than the med board's awards. Still, the VA's system is subjective, and veterans service organizations say the VA's 57 regional offices interpret the ratings system differently. Veterans can, however, appeal those decisions, often successfully.
The application process is also complicated. The VA has reduced its backlog of disability claims, but 300,000 claims still are pending. The average processing time is 156 days, the agency says, down from 241 in 2002. So far, more than 26,600 vets from Iraq and Afghanistan have filed disability compensation claims; of those, more than 9,700 are pending. To Mayorga, the money is small consolation: "I'd rather have my fingers and my hand back than the money," he says. And his dream of citizenship has not yet become a reality. Even though President Bush has ordered expediting citizenship for active-duty soldiers, Mayorga still is not a U.S. citizen despite his concerted efforts. The medic wants to return to college to study occupational or physical therapy next spring, and he nurses the hope that he can remain associated with the military.
John Adams is making progress. He came home to his modest house in Miramar, Fla., on Oct. 25, 2003, after several weeks at Walter Reed and intensive therapy at a VA hospital in Tampa, part of the military's national network of brain-injury centers. Today a hospital van transports him to the VA hospital in Miami twice a week. Speech therapist Daphne Santa has been teaching Adams how to speak again. She gives him exercises in raising his pitch, breathing, and emphasizing certain words. In one exercise, he has to try to convey various emotions. Over time, his voice will get smoother, but it will always sound a little strange. Down the road, Adams will take a five-hour memory evaluation so doctors can better understand his brain damage.
He is adjusting to the stark changes in his life. He takes powerful antiseizure medication and must be careful not to shift the metal in his head. He can't drive anymore, and alcohol is out of the question because it makes him depressed.
As with many of the wounded soldiers returning from Iraq, Adams's future is uncertain. He, too, is still on med hold, taking home about $3,500 a month--a substantial increase from the $1,600 a month he used to earn cutting lawns. Even though he's been home for more than a year, he hasn't gone through the med board process yet. But VA counselors have told Summer his disability most likely will be rated at 100 percent, for which the VA will pay him $2,239 tax free. He may get extra amounts for Summer and the boys.
As for Adams, he hopes to go to college and perhaps work with computers someday, unless he can somehow realize his fondest aspiration: "If I could and if they wanted me, I'd go back to Iraq."
Lives Altered By Injury
When a soldier is injured or becomes ill during active duty, he or she may apply to the VA for disability compensation; the agency then decides on a monthly payment by considering the type of injury and calculating the loss of earnings capacity. The VA uses a 0 to 100 percent disability rating scale with set dollar amounts.
Disability Dollar Example of disability
Percentage amount
10 $106 Mild mental symptoms decreasing
work efficiency
20 205 Deep scars more than 12 inches,
not on head, face, or neck
30 316 Loss of one ear
40 454 Amputated foot
50 646 Loss of both ears
60 817 Amputation of leg at middle or
lower thigh
70 1,029 Amputation of five fingers of
dominant hand
80 1,195 Loss of part of skull with brain
hernia
90 1,344 Amputation of leg with loss of
pelvic girdle muscle
100 2,239 Total work and social impairment
due to mental disorders
Source: VA and Code of Federal Regulations
Contributors to the entire 16-page report are Angie Cannon, Nancy Shute, Susan Brink, Elizabeth Querna, Marianne Szegedy-Maszak, Dan Gilgoff, Carol Hook, Jennifer L. Jack, Nancy L. Bentrup, Allegra Moothart, Ann M. Wakefield, Jill Konieczko, and Monica M. Ekman
With Elizabeth Querna, Susan Brink, Nancy E. Shute, Marianne Szegedy-Maszak, Daniel Gilgoff, Carol Susan Hook, Jennifer L. Jack, Nancy L. Bentrup, Allegra Moothart, Ann M. Wakefield, Jill Konieczko and Monica M. Ekman
This story appears in the November 29, 2004 print edition of U.S. News & World Report.