Pain & Pills

Weight of War: Gear that protects troops also injures them
By Hal Bernton

  Military studies acknowledge that combat soldiers are carrying too much weight — often more than 100 pounds. These loads have contributed to soaring numbers of injuries, and higher costs in disability payments.

  Before venturing out on patrol in Iraq, Spc. Joseph Chroniger would wrap his upper body in armor, then sling on a vest and pack that contained batteries for his radio, water, food, flashlight, ammunition and other gear. With his M4 rifle, the whole get-up weighed 70 to 80 pounds — and left him aching.
  His body hurt the most when his squad came under attack and he tried to run or dive on the ground. His neck and shoulders would burn as if on fire.
  Since returning to Western Washington 2 1/2 years ago, Chroniger has been diagnosed with bone spurs in the vertebrae of his neck caused by a degenerative arthritic condition. Sometimes, the pain is intense, and he dreads getting out of bed in the morning.
  "This is ridiculous," Chroniger said. "I'm only 25 years old. Arthritis is supposed to happen when you get old. What's it going to be like when I'm 50 or 60?"
  Chroniger's injury is a symptom of the overloaded U.S. combat forces that have served in the long wars in Afghanistan and Iraq.
  In 2001, an Army Science Board study, noting that weight carried by soldiers could decrease mobility and increase fatigue and injury, recommended no soldier carry more than 50 pounds for any length of time. The Army chief of staff hoped to approach that goal by 2010.
  But the loads combat soldiers typically carry remain far above that goal.
  That weight has helped fuel an avalanche of musculoskeletal injuries that are eroding the combat-readiness of the military. Long after the fighting ends, injuries such as Chroniger's will remain a painful and expensive legacy of these wars. 

• Nearly one-third of all medical evacuations from Iraq and Afghanistan from 2004 through 2007 resulted from musculoskeletal, connective-tissue or spinal injuries, according to a study led by a Johns Hopkins University researcher. That was more than double the number of evacuations from combat injures.

• The number of soldiers medically retired from the Army with at least one musculoskeletal condition increased nearly 10-fold from 2003 to 2009, according to Army statistics. 

• The heavy loads contribute to rising numbers of Afghanistan and Iraq war veterans retiring with degenerative arthritis, cervical strains and other musculoskeletal injuries. Disability benefits paid for these injuries by the Department of Veterans Affairs (VA) exceed $500 million annually, according to estimates done by The Seattle Times. That figure is expected to grow as tens of thousands of new veterans apply to the VA for compensation. 

Weighing the gear

  For years, the Army only had an estimate of how much weight foot soldiers carried in combat.
  In 2003, Col. Charles Dean, a military-equipment expert, formed a seven-man team to conduct a detailed study of weight worn in the combat zones of eastern Afghanistan. "What we were proposing was highly irregular, and my chain of command had to pass this all the way to the generals to get approval," Dean said.
  Dean, who is now retired, wanted his team to share an infantry soldiers' life, packing the same loads and facing the same dangers.
  In Afghanistan, the team joined soldiers of the 82nd Airborne Division. Their missions typically began with a helicopter ride, followed by multiday foot patrols. Before each mission, team members pulled out a digital scale and weighed weapons, ammunition, night-vision goggles, sleeping bags, eating utensils and every other item carried by soldiers, down to ID cards.
  The team stayed in Afghanistan for three months, collecting data from more than 750 soldiers with a range of different jobs.
  Dean said many soldiers had no idea how much weight they were carrying.
  "They were very interested in helping out," Dean said. "If anybody could help ease the burden to them, that was great news."
  When soldiers headed out on extended foot patrols, their average load ranged from 87 pounds to 127 pounds. When they came under attack and dropped their rucksacks, most of their fighting loads still exceeded 60 pounds.
  In his final report, Dean sounded an alarm.
  "If an aggressive ... weight-loss program is not undertaken by the Army," Dean wrote in his report, "the soldier's combat load will continue to increase and his physical performance will continue to be even more severely degraded."
  Back in the United States, Dean said "jaws dropped," when he disclosed his findings to Army leaders.
  The Army launched new programs to develop lighter gear. But at the same time the Army was looking at ways to lighten the load, it also focused on trying to reduce casualties by beefing up body armor and other measures.
  It's unclear if any headway was made in reducing the overall weight during the next six years. A 2009 study by a team of Army advisers indicated some soldier loads had increased by 25 percent or more compared with 2003.
  The Army isn't alone in its struggle.
  A 2007 study by a Navy research-advisory committee found Marines typically have loads from 97 to 135 pounds. The committee, citing information from the VA, stated that an increasing number of disabilities due to lower-back problems were a "direct result" of carrying excessive loads for long periods.
  "Many of these injuries reflect troops carrying far more weight than what medical experts say is reasonable," said Norman Polmar, a Naval analyst and historian who served on the committee.
  "You just... suck it up"
  For foot soldiers, muscle and bone injuries always have been an occupational hazard. But piling too much weight on soldiers for prolonged periods can intensify the injury cycle, aggravating old muscle tears or cervical strains, and triggering new ones that never heal.
  Noncommissioned officers — seasoned leaders who often have shouldered loads through three or four tours in a combat zone — may be hard-hit by these injuries. But many of these leaders feel burdened by responsibility and are unwilling to cede their place in a war zone to less experienced soldiers who may have fewer injuries.
  "I had a choice. But I couldn't leave my squad behind just before they were being deployed," said Staff Sgt. James Knower, a wiry, 155-pound soldier from Joint Base Lewis-McChord who served in Afghanistan for a year despite injuries to his arm and rotator cuff.
  Carrying loads in Afghanistan, Knower's injuries worsened. On patrols through the Arghandab Valley in southern Afghanistan, his right arm often went numb.
  "Basically, it comes down to: If you want to do your job — and you take pride in what you do — you've just got to suck it up," said Knower, 29.
  A rail-thin staff sergeant in the same platoon, 130-pound Kenneth Rickman, patrolled with armor and gear that typically weighed between 80 and 90 pounds.
  Earlier in his Army career, Rickman suffered a pinched nerve while carrying his gear in Iraq and then a cracked vertebra in his spine while back in the United States. While in Afghanistan, he fell off a roof with all his gear on and injured his shoulder.
  As the months wore on, Rickman described the pain as a kind of bone-on-bone grinding. So he gradually began to shed some of his gear. He ditched some of his extra batteries, three of his seven ammo magazines and switched to a lighter rifle.
  Finally, he headed back to Washington state several weeks early on a flight filled with other injured soldiers. There, he underwent a spinal-fusion operation and the removal of a ruptured disc.
  "I told them I had had enough. I was done," said the 35-year-old Rickman.

Rising narcotics use

  To help soldiers cope with the pain of musculoskeletal injuries, medical providers often prescribe opiates.
  "Primary-care providers ... have had very limited tools in their toolbox. It's medications for the most part, and maybe physical therapy, but very little to offer in addition to that," said Col. Diane Flynn, chief of the department of pain management at Madigan Army Medical Center.
  Through the war years, the use of these drugs has escalated. A 2010 Army report found 14 percent of soldiers had prescriptions for opiates. The Army also is concerned the availability of pain drugs through medics widens the potential for abuse.
  A 26-year-old Army veteran who lives in Seattle said a medic provided him with Vicodin, Dilaudid and morphine to help him through a series of deployments in Afghanistan and Iraq. Some of the worst pain came in 2003 on duty in the steep terrain of eastern Afghanistan as he labored up hills with his body armor, pack and a bulky automatic weapon that sometimes pushed his total load to more than 100 pounds.
  "My lower back would just start aching from running up the hills. It would just break me," said the veteran who requested anonymity.
  For some soldiers suffering from post-traumatic stress disorder (PTSD) and other mental wounds, the combination of chronic pain and opiates to treat their physical injuries can help push them deeper into despair.
  Orrin Gorman McClellan, a veteran of the war in eastern Afghanistan, returned to his family home in Whidbey Island with severe PTSD. He took an opiate he obtained online, but it failed to relieve his muscle and back pain. In May 2009, he committed suicide at the age of 25.
  McClellan's mother believes the physical pain contributed to his suicide.
  "One of the things that he was angry about was that he always hurt. He never really got a break," Judith Gorman said.
  Since his return from Iraq, Chroniger also has struggled with PTSD, which helped him gain an early discharge from the Army that goes into effect this week. But most days, Chroniger said his neck injury causes him the biggest problems.
  He has been prescribed an opiate, Percocet, which he can take up to three times a day. Yet it often fails to quell the pain.
  "The neck hurts so bad, sometimes you can't concentrate on anything other that," Chroniger said.

Rethinking treatment

  In recent years, the military has been searching for ways to improve treatment of musculoskeletal injuries.
  The Army has created teams of physical therapists and other specialists to serve with infantry brigades in combat areas, and it stepped up screening for serious injuries at clinics. But some soldiers complain these injuries still may be discounted by physician assistants, who often act as gatekeepers to more extensive workups by doctors at military hospitals.
  While training for his 2009 deployment to Afghanistan with the 5th Stryker Brigade, an Army sergeant complained of a sore back. A physician assistant at Madigan Army Medical Center dismissed the complaint as muscle pain.
  Shortly before his deployment, the sergeant, who requested not to be named in this story, paid out of his own pocket for an MRI that indicated a herniated disc. He opted to deploy and then seek treatment upon his return to Washington state in summer 2010.
  The sergeant said medical staff are rightfully on the lookout for "sick-call warriors" who constantly complain of problems when there is nothing wrong. But, he said, "the problem is, now they treat most everyone like they are faking it."
  Medical officials say attitudes are changing.
  "The faster you can address some of those issues at the clinic level, the less likely the soldier is to need hospital-level care ... in the theater (or need) to be evacuated," said Col. Stephen Bolt, Madigan Army Medical Center's chief of the department of anesthesia and operative services.
  The Army also is trying to reduce the use of opiates for pain. An Army report recommended the increased use of alternatives, including chiropractic care, massage, meditation and acupuncture.
  At Madigan, Shashi Kumar, a doctor trained in acupuncture, says these treatments have helped many patients substantially reduce pain and narcotics use.
  "This has been more than what I hoped for," Kumar said. "The pain-management outcome is fantastic."
  Chroniger is one of her patients. During his first treatment, she gently inserted the metal needles about a quarter-inch deep into his neck and shoulder muscles. Then she hooked the needles up to a machine that generated a small electrical current and bathed her patient in the warm glow of an infrared lamp.
  After some 15 minutes, she took out the needles and helped the patient back to his feet.
    Chroniger said he felt better, not so tight, and will undergo three more sessions. But at Madigan and elsewhere, the Army has few staff trained to offer these therapies, and military insurance does not pay for most of these alternative services from civilian providers.
  "That's really one of the things that's holding us back," said Flynn, the Madigan doctor who directs the pain center. "We have such limited access to other than what we call traditional medicine."
  The Army also has sought to prevent such injuries by improving the conditioning of soldiers.
  While training, soldiers may exercise or run with full body armor and other gear. But even the most physically fit platoon member will be prone to injuries when carrying 100 pounds of gear through a year of combat.
  So, the Army continues to pursue an elusive goal: Lightening the load.

Hal Bernton: 206-464-2581 or

His story is a warning about use of painkillers
By Gregg Zoroya,
Jan. 2011

  Standing before a packed hall of 700 military doctors and medics here, the deputy commander of the nation's elite special operations forces warned about an epidemic of chronic pain sweeping through the U.S. military after a decade of continuous war.
  Be careful about handing out narcotic pain relievers, Lt. Gen. David Fridovich told the audience last month. "What we don't want is that next generation of veterans coming out with some bad habits."
  What Fridovich didn't say was that he was talking as much about himself as anyone.
  For nearly five years, the Green Beret general quietly has been hooked on narcotics he has taken for chronic pain — a reflection of an addiction problem that is spreading across the military. Hospitalizations and diagnoses for substance abuse doubled among members of U.S. forces in recent years. This week, nurses and case managers at Army wounded care units reported that one in three of their patients are addicted or dependent on drugs.
  In going public about his drug dependency during interviews with USA TODAY, Fridovich, 59, echoes the findings of an Army surgeon general task force last year that said doctors too often rely on handing out addictive narcotics to quell pain.
  An internal Army investigation report released Tuesday revealed that 25% to 35% of about 10,000 soldiers assigned to special units for the wounded, ill or injured are addicted to or dependent on drugs, according to their nurses and case managers. Doctors in those care units told investigators they need training in other ways to manage pain besides only using narcotics.
  "I was amazed at how easy it was for me or almost anybody to have access and to get medication, without really an owner's manual," says Fridovich, deputy commander of the nation's roughly 60,000 Green Berets, Army Rangers, Navy SEALS and secretive Delta Force teams.
  For such a high-ranking military officer, publicly acknowledging drug dependency was unprecedented.
  Retired Army major general Paul Eaton, a former commander in Iraq, says Fridovich has now joined a small cadre of senior military leaders willing to discuss publicly personal struggles, such as living with post-traumatic stress disorder. Such admissions are difficult professional decisions, Eaton says.
  "Nobody wants to show weaknesses. You want to be perceived as perfection," he says. "But sometimes moral courage kicks in where moral courage is demanded."
  Fridovich agreed in recent weeks to talk openly about his reliance on drugs as part of what he says is a personal commitment to push the Army into better addressing pain management and drug addiction.
  "Here's my story," he says. "I feel like there is some real value — maybe cathartic, don't know — but really, more than anything else, how can you help people?"
  His own experiences are his bona fides on the issue, Fridovich says, and others agree.
  "This is huge for Fridovich to be willing to talk about this as a three-star general," says Gen. Peter Chiarelli, Army four-star vice chief of staff. "We're finally coming clean and admitting at all levels this is an issue."
  Fridovich says narcotics altered his personality, darkened his mood and management style and strained his 35-year marriage.
  When Fridovich finally went through treatment and detoxification to reduce his drug reliance in 2008 — he still relies on weaker doses of narcotics to combat pain — his wife, Kathy, hid or destroyed more potent pain pills so he could not use them.
  "I was fighting the pain. And I was fighting the injury. And I was fighting the narcotics," he says. "We have an obligation to the soldiers to look them in the eye and say, 'I know what you're going through. You don't want to be like this for the rest of your life. You don't have to be.' "
  Pentagon statistics show the number of pain-relief prescriptions given to troops, including narcotics, growing 86% from 2001 to 2009, when 3.7 million doses were handed out. That dipped last year to 3.5 million prescriptions, the data reveal, but is still more than any year prior to 2009.
  From 2005 to 2009, the number of troops diagnosed each year with substance abuse disorders jumped 50% to nearly 40,000, the Pentagon says. And substance abuse hospitalizations increased from 100 troops per month in 2003 to more than 250 per month in 2009.
  "The abuse is getting higher and higher and more and more," Fridovich says, "and that leads to a very dark, deadly, dangerous place."
  Narcotics entered Fridovich's life in May 2006, after he severely injured his back exercising between trips to war zones. At the time he was a two-star general in command of all special operations forces — Green Berets, Navy Seals and Army Rangers — operating in the Pacific.
  Fresh from a trip to Iraq and slated to go to the Philippines, he was in a Marine base gymnasium on Oahu leg-pressing 400 pounds when lower vertebrae shattered. Doctors later said his back was brittle from decades of soldiering and scores of parachute drops.
  He said he felt a twinge at the time and worked through it, continuing a regimen of weight-lifting, handball and racquetball for several days.
  But by Memorial Day, he awoke barely able to stand. "All I could do was just lie in bed and writhe," Fridovich recalls, describing pain radiating from his lower back down his left leg.
  "It felt like someone had taken a baseball bat from here to here," Fridovich says, gesturing from waste to kneecap.
  In the emergency room at Tripler Army Medical Center in Honolulu, X-rays showed shattered bones and pinched nerves. Motrin and morphine were the first medications, followed by fistfuls of fast-acting roxicet and longer-lasting Oxycontin, both listed by the federal government as highly addictive with significant potential for abuse.
  Doctors wanted him to wait on surgery to gauge progress. "That was a little bit more than wishful thinking," Fridovich says now.
  Eager to quell pain and resume command, Fridovich during one 24-hour period swallowed five dozen Oxycontin pills. His calculus was simple, he says: If the drugs were for pain relief, more drugs must equal more relief.
  But the price was a disturbing fogginess of mind and dark, frightening thoughts. Fridovich recalls contemplating, almost irrationally, whether he should simply have his stricken left leg amputated and be done with it.
  He says he pulled out the written warnings about narcotics and realized he was in treacherous territory. "That scared the hell out of me, (the) anxiety, depression, real bad thoughts," he recalls. "I got scared so bad that I stopped."
  Fridovich says he immediately cut his consumption of pills drastically — but not entirely. Instead, Fridovich fell into a lifestyle he now concedes was a mistake — ingesting two to four pain pills daily, even as he continued commanding troops and moving up through the ranks.
  The demands of his job, the need to travel by plane and helicopter around the globe and stay functional, meant that the roxicet and Oxycontin pills would be part of his daily diet.
  "Somebody should have challenged me," he says. "I should have challenged myself and said, "Wow, I'm on this stuff way too long. What's the deal?' "
  His wife, Kathy, the college sweetheart he married on the eve of joining the Army in 1976 — the couple have one child, a daughter — found herself in a dilemma. She could see her husband was in chronic pain, but she hated the medication.
  "I don't like the drugs," says Kathy Fridovich. "I knew he was taking a lot. I read all the little fine print. Drugs are scary."
  She became her husband's conscience, urging him to find a way off the drugs.
  For a time in Hawaii, Fridovich sought out acupuncture and managed to reduce his intake of narcotics.
  He received his third star in July 2007, and an assignment as director of the Center for Special Operations. He and Kathy moved to Tampa, where Special Operations Command headquarters are located and the acupuncture treatment ended. Special Operations troops have played a central role in the Iraq and Afghanistan wars since 9/11 and the pressure on Fridovich to remain fully functional meant that the pain had to be kept in check. The easiest way was the pills, he says.
  "Starting a new job and wanting to do well, he just worked as hard as he could, and they helped him get through," Kathy Fridovich says. "(But) I kind of wondered about the quality of what he was doing."
  "I did, too," echoes Fridovich.
  The drugs were altering his personality. Fridovich found himself becoming cross with colleagues and less tolerant of new ideas. "I found myself being, in some ways, very isolated, very combative," he says. "It's not what I wanted to be known for. I wanted to build teams. I wanted to bring people together."
  Doctors at Walter Reed Army Center in Washington, D.C., finally decided to operate on Fridovich's back in January 2008. The surgery removed shattered bone and fused vertebrae. It would provide some long-term relief, but for a while the pain intensified.
  Oxycontin and roxicet no longer were enough. He was given morphine.
  Within a few weeks back in Tampa, doctors finally advised the three-star general that he had a long-standing dependency on narcotics. He needed some way of managing his pain without relying only on drugs.
  At the time, Special Operations doctors were facing the same issues with soldiers suffering chronic pain, dependency or addiction. They found the Andrews Institute for Orthopedics and Sports Medicine, a Pensacola-based center that provides an array of services including surgery, rehabilitation and pain management.
  Fridovich would be the test subject.
  For four weeks, doctors, therapists and rehab specialists worked with Fridovich through physical training, psychological counseling and nutrition to train his body in more natural ways to deal with pain. They also put him through detoxification.
  He was placed on a weaker narcotic, buprenorphrine, less amenable to abuse.
  Detoxification left Fridovich physically and emotionally wrung out, he says, suffering the shakes, sweats, aches and nausea. "It's the most sickening feeling that racks your entire body," he says.
  Fridovich — who was named deputy commander of Special Operations Forces in May 2010 — says the therapy, detox and reduction in narcotics cleared his head, eased his temperament and brightened his outlook on life. "I should probably take an ad out in a national newspaper apologizing for everything I've said or done, because I'm a different person," he says with a grin.
  He hopes one day to leave narcotics behind entirely.
  When the Army's surgeon general office developed a plan last year to institute service-wide some of the same holistic methods that helped Fridovich, the general was part of the campaign.
  "I want to be involved," Fridovich says. "I want to listen to where this is going and see if my playing a part would lend any sense of urgency or importance — get it moving in a way that we start getting things done."
  He says Army medicine must be better prepared to treat pain with aggressive monitoring of medication, drug education, acupuncture, nutrition and proper exercise. "We ask great things of (soldiers). Don't we owe them great things as well?" Fridovich says. "It's about the human expense."

The Weight Of War: Protection Vs. Mobility
Patricia Murphy
A Seattle Times/KUOW Report

  In some ways modern warfare has not been kind to the modern warrior. Advanced weapons technologies, satellite communications and battle field simulators help soldiers and Marines fight the enemy. But despite the military's efforts, soldiers' gear loads are still weighing them down.
  Marine Captain Matthew Kutilek believes some of the problem was exacerbated by the reaction to IED (improvised explosive device) explosions in Iraq. The Pentagon — under pressure from families and Congress — reacted by beefing up body armor.
  Kutilek: "Maybe in the political eye it looked like we were protecting people by making them wear more body armor. But in reality it hindered the way we fought, and most of all it reduced our maneuverability in combat."
  Service members deployed in Iraq and Afghanistan routinely carry loads from 60 to more than 100 pounds.
  KUOW's Patricia Murphy teamed up with The Seattle Times to explore the weight of war.


Sound: "We're under attack"

  This is a YouTube video of a firefight in Afghanistan. US troops are under attack. They can be seen sprinting from their armored vehicles in full combat load to engage the enemy. It's an intense and physical firefight.
  Marine Captain Matthew Kutilek has deployed twice to Iraq and once to Afghanistan. He says this kind of dismounted battle where troops are on foot is common in Afghanistan's rugged terrain.
  Kutilek: "When we walked into Laki last January 4, we had never been there before, we carried everything on our back, we had vehicles behind us but we carried everything on our back to be sustainable. And I carried, we carried, every Marine carried roughly 110 to 125 pounds minimum, and some guys carried more, and we walked 13 kilometers under the cover of darkness."
  Studies have recommended that troops carry no more than a third of their bodyweight in gear. Yet despite some effort by the military, truly effective light–weight body armor has yet to be developed. 

There are some options.

  While in Afghanistan, Kutileck says he went to his Battalion Commander with concerns about the weight they were carrying. As a result they switched to lighter body armor which he says offered a dual benefit.
  Kutileck: "We had the opportunity to wear the SAPI [small arms protection inserts] plate carrier which is lighter — it's much more mobile, you have much more range of motion in your arms and your shoulders. It's still heavy but it's not as heavy as the other gear. To me, mobility trumps massive, cumbersome, heavy protective equipment every day."
  But some troops don't have the same access to lighter equipment.
  There's anecdotal evidence that some military personnel are turning to illegal steroids to help shoulder the combined load of body armor and gear. In 2008 soldiers confessed to using steroids during an investigation at Joint Base Lewis–McChord.
  One soldier said he almost fell out of formation during a road march through the woods. His weapon was taken. He said he turned to steroids because wanted to make sure it didn't happen while he was deployed.
  Kutilek says the key to maintaining physical health while on duty is staying fit, staying hydrated and stretching.
  Kutilek: "Believe it or not the human body gets used to wearing 65 to 70 pounds of gear. It doesn't like it, but it gets used to it."
  Bottom line, Kutilek says Marines will do all they can to go out on patrol and not let their buddy down.
  Kutilek: "They don't want to be perceived as weak and making up an injury or being a malingerer."
  After each patrol Kutilek says it was not uncommon for Marines to visit the corpsman for some type of medication or Tylenol for pain.
  Kutilek: "I think every Marine, every infantry Marine experiences a lot of discomfort, a lot of initial superficial pain, when they're in Afghanistan carrying this load. Absolutely. Does that equate to other injuries when you get back? I think it does in certain instances."
  Relieving pain in the field has proven tricky for the military. According to the Department of Defense many of its deployed troops are now regularly abusing prescription drugs. Pain killers like Vicodin and Percocet.
  In fact prescription abuse in the military tripled between 2002 and 2008.
  Army Specialist Joseph Chroniger says he was in great shape when he deployed to Iraq in 2007. Today he's facing chronic pain that on the worst days immobilizes him.
  Chroniger: "Well I have a degenerative neck disease, they call it DDD [degenerative disc disease], and it started pretty much after we got home. My neck started cracking and popping all the time."
  Degenerative disc disease is an arthritic condition that's usually associated with aging. Chroniger is 25.
  While in Iraq Chroniger says like most people in his unit, he spent his downtime lifting weights. He was a private when he deployed and that meant carrying even more than the usual gear load.
  Chroniger: "Privates get stocked with all the extra stuff so I had, you know, radio with a battery in it and that adds some weight, then all the extra antennas. Squad leader captains, all their extra land warrior batteries. All of my magazines, grenades, your NODs [night observation device] — you know, your night vision — you got your helmet with all its little racks that you put on, like the rhino mount and everything, then you've got your boots plus just your regular gear."
  Sometimes his missions required him to stand in full gear for hours which bothered his neck.
  Chroniger: "My neck burned. It was like a deep burn too, like to your bone. It hurt so bad. But you get used to it eventually, but then it causes problems."
  Chroniger is still in the military but is in the process of being retired for medical reasons.
  The Army has made an effort to embed physical therapists within some units, but for the most part access to this type of care is still limited to combat support hospitals.
  Muscle strain is usually a short term condition that has always been prevalent among soldiers. But after a decade of war in Afghanistan the numbers of acute injuries that have progressed to the level of chronic pain has grown significantly.
  Part of the problem may lie within the very thing that makes a good warrior: mission–focused toughness and determination.
  Chroniger: "In the infantry world the way it goes is, it's almost frowned upon to complain about an injury."
  Researchers from Johns Hopkins University found that between 2002 and 2007, 31 percent of all medical evacuations from Iraq and Afghanistan were due to muscular, skeletal or spinal injuries.
  More than double the number of medical evacuations due to combat injures.
  Like many in his situation Army Specialist Joseph Chroniger has applied to receive disability for his injury. The Veterans Affairs says musculoskeletal injuries account for many of the disability claims for veterans of the wars in Iraq and Afghanistan. Chronic low back and neck pain and degenerative arthritis of the spine are the most common.
  It's an expensive problem. Currently these types of injuries are costing taxpayers more than $500 million a year. That figure could potentially climb into the billions as ten of thousands new veterans receive disability for musculoskeletal injuries.

I'm Patricia Murphy KUOW News.

Seattle Times reporter Justin Mayo and Seattle Times researchers David Turim and Gene Balk contributed to this story. KUOW reporter Patricia Murphy also contributed.


A Reservist in a New War, Against Foreclosure
Thursday, 27 Jan 2011
By: Diana B. Henriques
The New York Times

  While Sgt. James B. Hurley was away at war, he lost a heartbreaking battle at home.
  In violation of a law intended to protect active military personnel from creditors, agents of Deutsche Bank foreclosed on his small Michigan house, forcing Sergeant Hurley’s wife, Brandie, and her two young children to move out and find shelter elsewhere.
  When the sergeant returned in December 2005, he drove past the densely wooded riverfront property outside Hartford, Mich. The peaceful little home was still there — winter birds still darted over the gazebo he had built near the water’s edge — but it almost certainly would never be his again. Less than two months before his return from the war, the bank’s agents sold the property to a buyer in Chicago for $76,000.
  Since then, Sergeant Hurley has been on an odyssey through the legal system, with little hope of a happy ending — indeed, the foreclosure that cost him his home may also cost him his marriage. “Brandie took this very badly,” said Sergeant Hurley, 45, a plainspoken man who was disabled in Iraq and is now unemployed. “We’re trying to piece it together.”
  In March 2009, a federal judge ruled that the bank’s foreclosure in 2004 violated federal law but the battle did not end there for Sergeant Hurley.
  Typically, banks respond quickly to public reports of errors affecting military families. But today, more than six years after the illegal foreclosure, Deutsche Bank Trust Company and its primary co-defendant, a Morgan Stanley subsidiary called Saxon Mortgage Services, are still in court disputing whether Sergeant Hurley is owed significant damages. Exhibits show that at least 100 other military mortgages are being serviced for Deutsche Bank, but it is not clear whether other service members have been affected by the policy that resulted in the Hurley foreclosure.
  A spokesman for Deutsche Bank declined to comment, noting that Saxon had handled the litigation on its behalf. A spokesman for Morgan Stanley, which bought Saxon in 2006, said that Saxon had revised its policy to ensure that it complied with the law and was willing to make “reasonable accommodations” to settle disputes, “especially for our servicemen and women.” But the Hurley litigation has continued, he said, because of a “fundamental disagreement between the parties over damages.”
  In court papers, lawyers for Saxon and the bank assert the sergeant is entitled to recover no more than the fair market value of his lost home. His lawyers argue that the defendants should pay much more than that — including an award of punitive damages to deter big lenders from future violations of the law. The law is called the Servicemembers Civil Relief Act, and it protects service members on active duty from many of the legal consequences of their forced absence.
  Even though some of the nation’s military families have been sending their breadwinners into war zones for almost a decade, some of the nation’s biggest lenders are still fumbling one of the basic elements of this law — its foreclosure protections.
  Under the law, only a judge can authorize a foreclosure on a protected service member’s home, even in states where court orders are not required for civilian foreclosures, and the judge can act only after a hearing where the military homeowner is represented. The law also caps a protected service member’s mortgage rate at 6 percent.
  By 2005, violations of the civil relief act were being reported all across the country, some involving prominent banks like Wells Fargo and Citigroup. Publicity about the violations spared some military families from foreclosure, prompted both banks to promise better compliance and put lenders on notice that service members were entitled to special relief.
  But the message apparently did not get through. By 2006, a Marine captain in South Carolina was doing battle with JPMorgan Chase to get the mortgage interest rate reductions the act requires. Chase eventually reviewed its policies and, earlier this month, acknowledged it had overcharged thousands of military families on their mortgages and improperly foreclosed on 14 of them. After a public apology, Chase began mailing out about $2 million in refunds and working to reverse the foreclosures.
  For armed forces in a war zone, a foreclosure back home is both a family crisis and a potentially deadly distraction from the military mission, military consumer advocates say.
  “It can be devastating,” said Holly Petraeus, the wife of Gen. David Petraeus and the leader of a team that is creating an office to serve military families within a new Consumer Financial Protection Bureau.
  “It is a terrible situation for the family at home and for the service member abroad, who feels helpless,” Mrs. Petraeus said. “I would hope that the recent problems will be a wake-up call for all banks to review their policies and be sure they comply with the act.”
  Chase’s response, however belated, is in sharp contrast to the approach taken by Deutsche Bank and Saxon in the Hurley case.
  Sergeant Hurley bought the land in 1994 and “was developing this property into something special,” he said in a court affidavit. He put a double-wide manufactured home on the site and added a deck, hunting blinds, floating docks and storage buildings.
  According to his lawyers, his financial troubles began in the summer of 2004, when his National Guard unit sent him to California to be trained to work as a power-generator mechanic in Iraq. Veterans of that duty advised him to buy certain tools not readily available in the war zone, he said in his affidavit. With that expense and his reduced income, he said, he fell behind on his mortgage — a difficulty many part-time soldiers faced when reserve and National Guard units were mobilized.
  Believing he was protected by the civil relief act — as, indeed, he was, as of Sept. 11, 2004 — his family repeatedly informed Saxon that Sergeant Hurley had been sent to Iraq. But Saxon refused to grant relief without copies of his individual military orders, which he did not yet have.
  Although Saxon’s demand would have been legitimate if Sergeant Hurley had been seeking a lower interest rate, the law did not require him to provide those orders to invoke his foreclosure protections.
  Nevertheless, Saxon referred the case to its law firm, Orlans Associates in Troy, Mich., which completed the foreclosure without the court hearing required by law. The law firm filed an affidavit with the local sheriff saying there was no evidence Sergeant Hurley was on military duty. At a sheriff’s sale in October 2004, the bank bought the property for $70,000, less than the $100,000 the sergeant owed on the mortgage.
  Orlans acknowledged in a court filing that one of its lawyers learned in April 2005 that Sergeant Hurley had been on active duty since the previous October. Nevertheless, neither Saxon nor the law firm backtracked to ensure the foreclosure had been legal or took steps to prevent the seized property from being sold, according to the court record. Lawyers for Orlans Associates did not respond to a request for comment.
  When Sergeant Hurley sued in May 2007, the defendants initially argued that he was not allowed to file a private lawsuit to enforce his rights under the civil relief act. Federal District Judge Gordon J. Quist agreed and threw the case out in the fall of 2008.
  That drew a fierce reaction from Col. John S. Odom, Jr., a retired Air Force lawyer in Shreveport, La., who is working with Sergeant Hurley’s local lawyer, Matthew R. Cooper, of Paw Paw, Mich.
  Colonel Odom, recognized by Congress and the courts as an expert on the Servicemembers Civil Relief Act, knew Judge Quist had missed a decision that overturned the one he had cited in his ruling. In December 2008, Colonel Odom appealed the ruling.
  In March 2009, Judge Quist reversed himself, reinstated the Hurley case, ruled that the foreclosure had violated the civil relief act and found that punitive damages would be permitted, if warranted.
  Despite that legal setback, the defendants soldiered on. As the court docket grew, they argued against allowing Sergeant Hurley to seek compensatory or punitive damages in the case. Judge Quist ruled last month that punitive damages were not warranted — a ruling Colonel Odom has said he has challenged in court and, if necessary, will appeal.
  “Nothing says you screwed up as clearly as a big punitive damages award,” he said. “They are a deterrence that warns others not to do the same thing.”
  When the trial on damages begins in early March, Sergeant Hurley will have been fighting for almost four years over the illegal foreclosure, a fight he could not have waged without a legal team that will probably only be paid if the court orders the defendants to cover the legal bills.
  Regardless of the trial outcome, Sergeant Hurley’s dream home is likely to remain as far beyond his reach as it was when he was in Iraq. Its new owner has refused to entertain any offers for it and recently bought an adjoining lot.
  Sergeant Hurley said he still loved the wooded refuge he drives past almost every day. “I was hoping I could get the property back,” he said. “But they tell me there’s just no way.”

This story originally appeared in the The New York Time