Breaking It Down
Be sure to read the sidebar to this story, Breaking It Down: The Hard Stuff.
After two tours of duty in Iraq, Matthew Gonzales says he has the body of a 45-year-old. Trouble is, he's 30.
Before the war, the South Houston High School product was an avid athlete — a runner and a kayaker, a barrel-chested hard-charger whose Facebook picture shows him riding a racing motorcycle. After two years in the broiling Iraqi scrub with the Army's First Cavalry Division, those prewar-style frolics are over for him now, barring medical treatments he can't afford.
Gonzales wasn't wounded. He doesn't suffer from PTSD or a traumatic brain injury. Instead, he says, his back is ruined and his knees are shot. "I can't run no more. I stay in back pain every day," he says. "Basically, it comes from just jumping out of trucks with all that gear on."
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Gonzales once weighed himself with and without gear. Unladen, he clocked in at 185 pounds. Loaded up for battle with an 80-pound pack and 40 pounds of body armor, he tipped the scales at close to 300 pounds. And he was loaded up day after day, week after week, month after month.
Today, his legs regularly go numb from sciatica. He can't stand on his tiptoes or the balls of his feet. He can't bend over, and he has to lie down to put on pants. When sitting, he has to have one of his legs pointed out in front of him.
Matthew Gonzales is far from alone. Social worker Carroll McInroe saw hundreds of guys like him in his five years as the Iraq/Afghanistan coordinator in the Spokane, Washington, office of the Department of Veterans Affairs. A Vietnam vet who served in Army Intelligence, McInroe helped returning Operation Enduring Freedom and Operation Iraqi Freedom veterans re-acclimate to civilian life. He saw scores of kids with PTSD, and some with severe traumatic brain injuries.
As terrible as those cases were, McInroe believed then and believes now that neither is the most common debilitating ailment veterans of those conflicts face.
"I interviewed five to eight kids a day, totaling about a thousand," he says. "Particularly among the young infantryman and Marines, I would notice them groaning and moaning and grabbing their backs when they would sit down. Some of 'em, a small percentage, would come in just literally dragging their leg. Scraping on the floor."
McInroe, a retiree whose years in the rainy Pacific Northwest have done nothing to erode his steely Texas ranch country accent, says the guys would never mention their aching backs. He would have to draw that out of them himself.
"They would just sit down and go on and talk about their combat — I was assessing them for PTSD and traumatic brain injury and all that sort of thing," he says. "Since I always wanted to know everything about my kids — my vets — by the second week I started asking them, 'What's the matter with your back? How come you guys are always having trouble sitting down?' And that's when they started opening up.'
"Oh Jeez, my fuckin' back is killin' me," he heard, all too often.
McInroe started to ask each and every vet who came through his office if they were suffering back pain. Just about all of them had pain, he says. "I would say 70 percent of them. And not just a little. I'm talking chronic stuff here — misaligned vertebrae, bulging discs, herniated discs, the whole list of back problems." At national conventions, he would share his informal findings with his counterparts at other VA facilities. They told him much the same situation prevailed in their offices. He called around to military hospitals and asked the nurses what their most common complaint might be. Back pain, he was always told.
He saw nothing like that among his cohorts in Vietnam. Since grunts have humped heavy packs since Napoleon's day with no resulting epidemic of back woes, McInroe believes that modern body armor is to blame. "It's too heavy. You can't just put 120 pounds on a 19, 20-year-old musculoskeletal system, 14 hours a day, 365 days a year and not create some real serious problems."
And in his view, this is a real serious problem indeed. If McInroe's estimate — that 70 percent of returning veterans have moderate to severe back problems — holds true across the nation, the costs to America's taxpayers will be enormous, and the bill will do nothing but grow and grow over the next 50 years.
"Typically, when your back is injured it's injured for life," McInroe says. These things just get worse, he says, and adds that veterans who were 50 percent disabled in 2008 will be 70 percent disabled in a couple of years. The peak years for World War II disability payments were in the 1980s, 40 years after Hiroshima and Nagasaki.
And then there are the other costs, namely, addictions to powerful, narcotic pain pills such as OxyContin, Percocet and Vicodin. According to VA statistics, narcotic addictions are the fastest-growing substance-abuse issue today's military is facing.
McInroe says the VA's doctors are enormously overworked, and that they routinely put in 12-hour days, even if they are only paid for eight. "The quickest way for them to see the most patients is to just write scripts. "Not all of them, but a lot of doctors are guilty of over-medicating," he says. "We didn't realize this at the time, but within a few weeks these guys were becoming addicts, and the doctors just kept givin' 'em pills. There was nothing else to do — no pain clinics." (See "The Hard Stuff.")
Already there are hundreds of thousands of men and women drawing well-deserved four-figure checks for back pain, month after month. A growing number of scholars believe that the bill for the wars in Afghanistan and Iraq will surge beyond the bill for Vietnam, despite that fact that the number of killed and wounded is much smaller.
According to the VA's own numbers, 2.2 million men and women have served in Iraq and Afghanistan since September 11, 2001. Almost half that number — 942,000, to be exact — have done two or more tours. In McInroe's experience in Spokane, almost every veteran he spoke to who served more than one tour had back problems, just like Matthew Gonzales.
As of last year, 600,000 of those veterans had already signed up for disability payments, and according to the advocacy group Veterans for Common Sense, an average of 9,700 more were signing up every month at the end of 2011.
The complaint most commonly reported to the VA by those post-9/11 veterans is, simply put, pain. "You look at these numbers of claims, and you wonder what they all are," says Patrick Bellon, a 33-year-old Iraq veteran and the executive director of Veterans for Common Sense. "A majority of these are these sorts of back and lower-leg injuries, because it's a lot of weight and you are carrying it under very difficult conditions."
According to a report by Dr. Drew Helmer of the Michael E. DeBakey VA Medical Center in Houston, 55 percent of the patients diagnosed — 377,205 people according to this set of numbers — in VA hospitals between the first quarter of fiscal year 2002 and the second quarter of FY 2011 suffer from "diseases of musculoskeletal system/connective system."
And given the vagaries of aging, their number will continue to grow year after year, decade after decade. McInroe thinks it is a ticking money bomb.
Think about it. Veterans disability payments range in a complex matrix from $127 a month (for a 10 percent disabled vet with no dependents) up to $3,285 a month (100 percent disabled, with a family), all tax-free.
Let's just split the difference, pick a number right in the middle, say $1,500 monthly. To simplify an amazingly complicated math problem, but also to use what McInroe believes is a wildly understated number, let's round that 377,000 up to 400,000 back-injured veterans. Let's also say that they will be drawing $18,000 a year for the next 50 years. At $7.2 billion a year, that comes to $360 billion, just for the back injuries.
McInroe believes that estimate is extremely low. He believes that more and more veterans will continue to apply for and receive disability payments for back injuries, and that more and more often, those disabilities will max out at 100 percent, or $3,000 a month. In his nightmare scenario, a million men and women would be 100 percent disabled and drawing $36,000 yearly, and before the last check is set, the taxpayers will be out $36 billion a year for 50 years: $1.8 trillion.
"And that's just for compensation," McInroe adds. "That does not include medical care." Nor does it include the 45 percent of veterans disabled by other means, such as the 46,000 combat-wounded, or the 150-000-plus sufferers of PTSD.
McInroe has been trying to publicize this issue for years, dating back to the earliest days of Operation Iraqi Freedom. Starting around 2006, he began telling his higher-ups about his findings at national conventions and such. "I was just screaming about back pain," he says. His counterparts were doing likewise. He says that word came back from Washington to shut up or get fired.
At one convention, McInroe recalls, he led a seminar at which he stressed to some trainees the severity of the back-pain epidemic. Later at the same convention, he ran into Jill Manske, then the head of the VA's social workers, informally.
"She pulls me aside in one of the hallways and says, 'Carroll, I didn't know you were gonna teach classes on back injuries!'"
McInroe reported that he believed he had no choice, as in his view it was the top problem his vets were afflicted with. "And she said, 'God, don't ever do that again. People in the central office in DC are being fired for even mentioning back injuries. The Bush White House does not even want back injuries mentioned.'"
Manske is now retired. Reached at her home in central Texas, she says she had no recollection of such a conversation ever taking place.
McInroe is undaunted by her denial. He believes that the Bush White House saw the back injuries as just one more enormous ladleful of bad news in a hellbroth that was then already boiling over. "Iraq was fallin' apart, the WMDs were never found, they hadn't caught Osama, there were all these IEDs," he says. "This was just one more thing."
Another possible reason the Bush White House might have wanted to conceal the extent of the back-injury epidemic is that it reflected an unforeseen consequence of Donald Rumsfeld's all-volunteer, lean-and-mean modern military.
In contrast with past wars, the shadow army of contractors handled the bulk of the jobs in the rear, whereas in prior wars, front-line units would occasionally rotate back for lighter duty. As one expert put it, today's soldier is "relentlessly in the field," laden the whole time with upwards of 90 pounds of gear. And as Bellon puts it, at least in Afghanistan and Iraq, the concept of a front-line/rear divide was nebulous. "When there is no rear, where are you gonna go to?" he asks.
And then there were all those soldiers who did multiple backbreaking tours, some not by choice.
McInroe also believes that early in the war, the Bush team had informally selected PTSD and traumatic brain injuries as something akin to pet issues for returning vets. "Those injuries caught on with the public," McInroe says. "It was easy to get funding for them because people understood them."
Despite all you've heard about PTSD and TBI, McInroe still maintains that back pain is a far larger issue. (And he stresses that he does not want it thought that he belittles PTSD or TBI or those who suffer from them.)
"When I retired, the occurrence of PTSD was around 15 percent," he says. "The VA was very happy letting the public think it was 50 or 60 percent because that meant more funding." The same went for TBI, he says. "The VA would like to have people think that it's a pervasive wound," he says. "It is a terrible wound. It's horrible."
One case of TBI seems to have given McInroe himself a case of social worker PTSD. Again and again in the course of our interviews, he talked about a former high school football star from rural Washington. This young man enlisted in the army and was assigned machine gun-turret duty atop a light armored vehicle. On patrol one day, an IED exploded and detached half of this kid's head. "His buddies should have let him die, but they loved him," says McInroe. Today, the young man exists in a persistent vegetative state that could last for decades. "Imagine you were that boy's mama," he says.
So McInroe is not one to take TBI lightly, nor PTSD, which he says is a terrible problem. And yet in terms of numbers, McInroe believes that TBI has been completely overstated. "Percentagewise, it's very little," he says. He maintains that fewer than 1 percent of all wounded and injured have the sort of permanent, life-altering TBI the public has read so much about. "And that's a good thing," he says.
McInroe says that a huge number of those that are labeled with TBI will make full recoveries inside two years, barring organic injury to the brain itself. "If you were about 40 feet from an explosion and it knocked you on your ass and really rang your bell, you may have symptoms for 12, 15, 18 months but they will normally remit. And after that, you don't have traumatic brain injury."
In contrast, McInroe says, the back guys just get worse, and in his years at the VA, precious little was done to treat their underlying ailments, while perhaps too much was done to alleviate their pain.
First, he says, he grants that the VA simply cannot afford to pay the salaries of competent trained neurosurgeons. "They cost $2 million a year and that's not in the budget," he says, and adds that what little neurosurgery was being done in the Pacific Northwest in his time at the VA was performed by interns in Seattle. "And the success rate is pretty low," he says. "I would tell our guys, 'Don't go there. It's too great a risk. It's not a real neurosurgeon, it's a neurosurgeon-wannabe hacking on your spine.'"
Absent neurosurgery, McInroe lobbied for the creation of back-pain clinics in every VA hospital from coast to coast, staffed by pain-management doctors. "Those would be cheaper but still could help take care of this back pain. We never did succeed here."
And so what happened, all too often, was that back-pain sufferers were simply prescribed pills and sent on their way.
Two veterans the Houston Press spoke to described frustrating experiences with the VA's medical system. Though his days are filled with pain, Matthew Gonzales, the First Cavalry scout, says he is still dealing with red tape. He still doesn't draw a penny of disability, and he says the application process has been "long and freakin' crappy." None of the treatments he has yet obtained have brought much if any relief. For him, most of the time powerful pain pills are off the table because of his job's demands — he is an electrical/mechanical technician for Schlumberger. "I don't take no chances like that. If the pain gets too bad, then yes, I do," he says. A doctor in private practice has told him he needs steroid shots in his back. "But I don't have money like that," he says.
Anthony Rene Gonzales (no relation to Matthew) has also had to look beyond the VA for a solution to his back injury. Though he was an army mortarman during the war in Iraq, Anthony believes his back pain stems less from being heavily laden than it does from the IED blasts he survived, the last of which hurled him across a truck with such force it damaged the discs in his back.
"It was a catastrophic kill on the vehicle," he says. As with the other two explosions, Anthony was knocked cold. The difference between the last one and the first two was that when he tried to get up this time, the whole right side of his body just gave out.
Since he was careful about getting his injury documented, he has been able to start collecting a 70 percent disability check.
Getting his injury diagnosed was another matter, in fact, something of a nightmare, he says. "I went through so many VA doctors," he says. "The first guy tried to tell me it was all in my head. He was like, 'Oh, you missed a couple of mental health therapy sessions.' I was like, 'Dude, you gotta be kiddin' me, dude. I'm gonna choke you out for saying that.'"
Still the pain continued, lightning bolts of stabbing agony shooting from the small of his back down the rear of his leg and across the bottom of his foot and into his toes.
He went to see another VA doctor, who misdiagnosed him with a torn muscle. "And then I got a damn MRI at the VA, and they said, 'Oh yeah, it's a torn muscle,' and I was like I know you guys ain't telling me the truth," he says. And still the pain continued.
Finally, Matthew looked beyond the VA. A doctor in private practice told him that it sounded like his sciatic nerve was pinched. "She took an MRI and that was it," he says. He was diagnosed with two bulging discs in his lumbar spine. Getting the correct read on his medical situation took a year.
Since he got the correct diagnosis, Matthew's pain has been brought to heel. After a round of steroids courtesy of the private-practice doctor, he has undergone a series of nerve-root injections. They have helped keep down the inflammation and have tempered his sciatica, he says. "They aren't a cure-all, but they have cooled it down," he says.
On good days, he can even run.
Tales of long waits and drawn-out processes and red tape are common today. Despite having hired 2,700 new employees in the past year, the VA is being swamped with new disability claimants and hospital patients, and while some older vets will tell you that service has improved since the 1970s, often they will say in the next breath that back then it had been positively medieval.
Veterans for Common Sense praised the Department of Veterans Affairs' budget request of $140.3 billion for fiscal year 2013, which includes $76.3 billion for benefits.
"VA's budget demonstrates that the Obama administration has heard the concerns of veterans voiced by VCS in the media and in meetings with Congressional and Administration officials," Bellon said in a statement. "President Barack Obama is serious about making progress to address many of the longstanding deficiencies at VA. In public policy terms, a budget is a statement of priorities. VA's FY2013 budget shows that veterans have been made a high priority by the Obama administration. It will not of course correct every problem, but it goes a long way in that direction and is a good thing for veterans."
McInroe is not sure that money is being well spent, at least not until there are pain-management clinics in every VA hospital. "The bottom line is that we need to be doing something more for these guys besides addicting them to powerful narcotics," he says.
Lighter body armor has also been one of McInroe's pet projects. He knows that little can be done to lighten the load in soldiers' packs: "They need all those beans and bullets," he says. He says that his calls to lighten the body-armor load were met at times with claims that he would see kids "coming home in pine boxes." He doesn't believe that's true. He simply believes that modern technology can come up with something less backbreaking than the stuff worn in Iraq and Afghanistan.
That search has borne mixed results. In 2008, Marines serving in Afghanistan, who often had to fight at altitudes approaching two miles above sea level, were in fact issued lighter and more flexible body armor. These vests were issued to complement rather than supplant the armor they already had, with the choice of which to wear up to the commanding officer's assessment of the threat level.
The Army has had a harder time finding a solution. After a years-long litany of delayed roll-outs and squabbles over safety testing of its own lighter armor, Congress put the Department of Defense on notice and announced at the same time that they were back at square one. In the 2011 National Defense Authorization Act, it required that the defense secretary come up with a way to "more effectively address the research, development and procurement requirements regarding reducing the weight of body armor." (Since the Marines and the Navy units that fight alongside them on land favor agility and smaller units over the Army's brute force, they have been able to use the lighter armor that is already available.)
In any event, for the hundreds of thousands of men and women who fought in Iraq and Afghanistan over the last ten years, the damage has been done, and in these uncertain economic times, veterans with damaged backs face even more daunting prospects than the rest of us.
"This is a working-class army, just like Vietnam," says McInroe. "There are few middle-class kids, fewer upper-middle-class kids, and there damn sure aren't any rich kids. So these kids are gonna have to come home and make their livings with their hands and their backs, not their brains. I'm not sayin' these kids are dumb because they aren't. They just don't have the educations."
Today, Anthony Gonzales works for SNP Technologies. Even after the moderate success of his treatments, the 28-year-old Scarborough High School grad is still in pain every day. "The last couple of days, my sciatic nerve has been flaring up, and I'm barely able to walk but I am still at work, just dealin' with it," he says. He drives a forklift now, and there's occasional lifting required. Each day is a battle, he says. "I wear steel-toed boots on a hard-concrete floor and I am here ten hours a day," he says. "It's not too demanding on my back like the job I had before, working in a warehouse. Oh, man. That just killed my back. I had to go find something else."
And some days are worse than others. "Some days it gets to the point where I can't bend," he says. "I'm a tough guy, but sometimes when I get up from a nap and I put my foot down on the ground, yeah, man, I almost cry like a girl. My girlfriend's like, 'It must be painful if it will make you cry,' and I'm like, 'Yup. This ain't no joke.'"
Other days are not so bad. "I try to stay physically active," he says. "Sometimes I'll go for a run, but sometimes I just can't do it. Like right now because my back is so jacked-up."
Matthew Gonzales is not so lucky. Barring the potential success of treatments he can't afford right now, his running days are over. "I'm an athletic person," he says. "I like to go biking, running, kayaking, whatever, and when I've got something like a back problem stopping me from doing all that stuff, that's gut-wrenching. That hurts."
And then there's Patrick Bellon. While he says he suffers from a level of back pain unknown to most 33-year-old men, the former cavalry scout has a buddy who has it so much worse.
"I have a friend who's at the pain level right now where he will do almost anything for one hour's relief: acupuncture, magic, whatever," he says. "Guy's like 27 and he's suffering like an old man. He tells me every day his pain gets worse all day long. At the beginning of the morning he feels fine, and then there's this sundowning effect. For a young guy...something's just not right there."
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