Another battle at home for Iraq war veterans

For Iraq veteran Scott Hayes, a car salesman from Norwood, even the Ford dealership where he works can be a minefield of reminders of danger and death.

Last week, after an American flag had been taken in during bad weather, Hayes passed the place where the banner had been placed carefully over a row of boxes. But what Hayes saw, in a searing flashback to his friend's military funeral, was a flag-draped casket instead.

"That gave me a rough few minutes," Hayes said.

Hayes, a former US Army staff sergeant deployed twice to Iraq, is being treated for the nightmarish effects of post-traumatic stress disorder. For Hayes, 29, even a drive down a traffic-free highway can revive fear of roadside explosions.

He is not alone. A 2004 study of combat units found that 17.1 percent of returning Iraq war veterans showed evidence of post-traumatic stress, outstripping the 10.1 percent who reported the problem after seeing combat duty in the 1991 Gulf War.

Whether the US Department of Veterans Affairs and other institutions are in a position to handle the surge in post-traumatic stress cases is unclear, critics said.

"I think one of the major scandals of the war in Iraq will be the inability of the VA health system to deal with Iraq and Afghanistan veterans who come back with some kind of psychological problem," said US Representative Martin T. Meehan, who serves on the House Armed Services Committee.

In a report issued yesterday, the US Government Accountability Office said the Department of Veterans Affairs did not spend $100 million of $300 million in budget increases for post-traumatic stress and other mental health programs over the last two fiscal years. In addition, the GAO said, the veterans agency allocated $35 million of the extra money to VA medical facilities without telling officials the funds were for mental health services.

The GAO also reported that Veterans Affairs did not track the money spent on mental health programs.

Laurie Ekstrand, a GAO director in healthcare, said much of the new money clearly was intended to help returning veterans from Iraq and Afghanistan.

"The GAO only proves that the administration is not doing enough to address a silent epidemic," Meehan said. "This is a failure of priorities."

Veterans Affairs Administration officials defended their mental health services and characterized the GAO report as an "accounting exercise" that scrutinized only the numbers of dollars spent, rather than the quality of the agency's programs.

"In contrast, VA's emphasis has been on building mental health care capacity and high-quality programs to support and treat veterans," VA spokesman Matt Burns said. "VA expends resources for programs that meet these criteria."

Dr. Matthew J. Friedman, executive director of the VA's National Center for PTSD, said the round-the-clock stresses of combat in Iraq are exacting a serious emotional toll.

"When you've been in [Baghdad] for 12 months, worried 24/7 about whether there will be roadside bombs, suicide bombers, et cetera, you can't just flick an on-off switch and resume your predeployment life," he said.

The military and the VA are doing far more for veterans with post-traumatic stress and know more about the disorder than they did previous wars, Friedman said.

He said the Army-supported 2004 study of returning veterans, published in the New England Journal of Medicine, was the first analysis of post-traumatic stress and other mental health conditions conducted during an ongoing US conflict.

In another first, military personnel are screened for mental health problems almost immediately after deployment. Those who show signs of post-traumatic stress are referred for treatment. But Friedman acknowledged that questionnaires can be manipulated. Often, military personnel with a problem want to avoid treatment and the stigma of a mental health condition.

Laurence Fitzmaurice, president of the New England Shelter for Homeless Veterans, said he anticipates an onslaught of Iraq and Afghanistan veterans with post-traumatic stress at the Boston facility in coming years.

Robert Hayes, who works at the shelter with veterans suffering such stress, concurred. "One day, you're going to wake up, and there's going to be so many," he said.

Scott Hayes, however, says he already has lost a girlfriend because of post-traumatic stress. Back in the civilian world since April after an 11-year military career, he still sits with his back to a wall so he won't be surprised. He has nightmares. And Hayes said he ducked for cover when he heard firecrackers explode.

But free counseling by the VA every other week is beginning to help. The agency has been quick to respond to his needs, he said. "It's creating a better atmosphere and a better mood."

Still, he expects a long road back to sound mental health. "Anyone who does some form of fighting over there comes back with something," Hayes said.