Posttraumatic stress comes home
VA is moving aggressively to treat Iraq combat veterans.
By Edward Colimore
Inquirer Staff Writer

Army Sgt. First Class Mark Rizzo speaks in hushed tones of those two June days when four members of his National Guard unit were killed on the streets of Baghdad's Sadr City slum.

Two died when an insurgent's rocket-propelled grenade hit their humvee. Two more were lost the next day when a roadside bomb blew up their vehicle. All were like family, Rizzo said.

"You don't do much sleeping after that," the 38-year-old Pitman resident said of the 2004 attacks. "You have a lot of processing to do. There's mourning, resentment, feelings of 'Why did this happen?' "

Rizzo's field-artillery unit, pressed into service as provisional military police, came home last year with 23 Purple Hearts, 17 Bronze Stars - and a lot more "processing" to do.

Nearly 40 percent of the 180 members sought counseling, New Jersey officials said.

Nationally, at least 35 percent of Iraq veterans received mental-health care during their first year home, according to a Pentagon survey of more than 222,000 returning Army soldiers and Marines since 2003.

Across New Jersey and Pennsylvania, military, state and federal veterans organizations are aggressively encouraging Iraq and Afghanistan veterans to get help with posttraumatic stress disorder.

New Jersey this year has more than doubled the amount to treat the disorder, allocating $800,000, which supplements federal aid. An additional $200,000 is likely to be sought next year as the needs grow, veterans officials said.

Calls to the state's 24-hour hotline rose dramatically after 1,700 soldiers returned in November and December. Five hundred calls came in during the first six months of operation last year; more than 400 were logged in just the first three months of this year.

Pennsylvania, though it has no separate fund for posttraumatic stress treatment, is closely tracking returning troops and making them aware of the vast safety net of federal and state veterans programs.

After a steady increase at the Coatesville Veterans Affairs Medical Center, Iraq and Afghanistan war veterans account for more than 20 percent of all veterans being treated in its posttraumatic stress disorder program or on a waiting list, VA officials said.

Nationally, veterans advocates have called for more spending on mental-health care for returning troops. President Bush's budget proposes a 6 percent spending increase for the Department of Veterans Affairs.

The military has stepped up efforts to train soldiers to spot signs of trauma and get treatment sooner. Troops must take suicide-prevention classes within three months of arriving for overseas duty. They are encouraged to watch for signs of depression among fellow soldiers and to get counseling from combat-stress teams after deadly attacks.

Back home, troops go through "reconstitution" programs to learn about benefits, such as counseling, medical services and school tuition, before resuming their civilian lives.

Many requests for counseling come 30 to 90 days after troops return, said Bill Devereaux, director of veterans programs for the New Jersey Department of Military and Veterans Affairs.

Soldiers report problems with "nightmares, anxiety, anger, antisocial behavior, adjusting to family, overindulging with drugs," Devereaux said. "They miss the camaraderie of their friends, the rush of adrenaline, the call to arms.

"They also remember things that happened over there - dead friends, dead children," he added. An improvised explosive device "goes off, wounds two GIs, and blows up seven Iraqis. Now they feel guilty for being safe. The hardest thing they do now is get through traffic on Route 73."

At the same time, memories of combat trauma can be triggered when least expected.

"A smell will set you off, a certain song, shadows on a dark night," said Devereaux, a Vietnam veteran who was wounded twice. "You don't get rid of it. You just learn to live with it.

"Like physical wounds, you treat it. You continue counseling, group meetings. Talking to peers is the best cathartic medicine."

Marine Reserve Maj. Alex Chotkowski, 35, a West Chester lawyer who served in Iraq in 2004 and last year, said counseling was required after serious incidents, such as the loss of a comrade.

He recalled how he had been sitting at a desk in an aircraft building at a former Iraqi base in Anbar province in 2004 when the thump of an explosion shook the windows and dislodged dust from the ceiling. A beloved Marine staff sergeant - a husband and a father of three who had volunteered for duty in Iraq - had been killed by a munition left on the base when the Americans took over.

"Those who had the closest contact to the situation were required to see a counselor. And anybody else who felt they had a need also sought counseling," said Chotkowski, who investigated the death and mourned the loss with other Marines during a special military ceremony.

Rizzo got through his readjustment feeling so fulfilled by military service that he left a civilian managerial job and now serves full-time with a recruitment and retention unit at Fort Dix.

But he does recall having "a lot of nightmares" when he got home and being startled by loud noises. He also remembers his strange reaction to a disabled car on the side of Route 55.

"I made my wife get in the passing lane," said Rizzo, a member of the Third Battalion of the 112th Field Artillery with units based in Cherry Hill, Vineland, Morristown, Toms River and Lawrenceville. "I said, 'We need to clear the area.' She kind of understood."

Today's veterans "are better educated about psychological reactions and what to do about it" than troops in past wars, said Steven Silver, director of the Coatesville center's posttraumatic stress disorder program.

"Some information has been provided to them during the demobilization process," said Silver, 61, a Vietnam veteran. "They're told, 'If you have problems, get help immediately.' They've heard that message and are acting on it.

"There wasn't any debriefing or demobilization process at all after Vietnam," he said. The troops "turned in their equipment and were discharged to their homes 24 hours after they left the combat zone."

Rather than set aside funding for posttraumatic stress treatment, Pennsylvania depends on the VA network, said Cecil Hengeveld, deputy adjutant general for veterans affairs in Pennsylvania. "Every state does it slightly different," he said.

New Jersey provides funding so veterans don't have to be on waiting lists for treatment, Devereaux said. They can seek treatment from one of 20 private counselors across the state who are paid a prorated amount for their services.

Brig. Gen. Maria Falca-Dodson, deputy adjutant general of New Jersey's Department of Military and Veterans Affairs, said additional state money was needed because of the influx of returning troops with exposure to combat. "It's better to get care up front and not let it become chronic," she said.

Rizzo believes troops suffer posttraumatic stress because, he said, "they have feelings for everybody - Americans and Iraqis.

"Is it logical for one person to kill another person?" he asked. "It doesn't make sense, and soldiers struggle with that."
Contact staff writer Edward Colimore at 856-779-3833 or To comment, or to ask a question, go to