Nearly half of the 2.2 million U.S. troops who served in Iraq and Afghanistan have struggled to readjust to American life in part because the Departments of Defense and Veterans Affairs have been sluggish in helping those coming home in droves, according to a sweeping report released today.

After examining veteran suicides and unemployment as well as the military’s handling of sex assaults, women in uniform and same-sex family issues, the Institute of Medicine said returning service members deserve “timely and adequate care,” yet it cited cases in which the DOD and VA are using unproven diagnostic and therapy tools.

"The (federal) response has been slow and has not matched the magnitude of this population's requirements as many cope with a complex set of health, economic, and other challenges," said co-author Dr. George Rutherford. He chairs the IOM’s committee on the assessment of readjustment needs of military personnel, veterans, and their families. The IOM, an independent nonprofit, is the health arm of the National Academy of Sciences. 

"The number of people affected, the influx of returning personnel as the conflicts wind down, and the potential long-term consequences of their service heighten the urgency of putting the appropriate knowledge and resources in place to make re-entry into post-deployment life as easy as possible,” added Rutherford, head of preventive medicine and public health at the University of California, San Francisco School of Medicine.

Another 34,000 U.S. service members will be flown home from Afghanistan during the next 12 months. The high suicide toll among veterans (22 per day) has drawn recent Congressional scrutiny as have the elevated veteran-unemployment rate and access limits to VA mental health care. Congress requested the IOM study. 

Among the recommendations within the 500-plus page report:

• DOD and VA must “boost efforts to reduce the stigma” associated with service members or veterans simply asking for help to deal with mental-health issues or with substance-abuse problems.
• The tool DOD uses to assess cognitive function following a head injury – Automated Neuropsychological Assessment Metrics (ANAM) — carries “no clear scientific evidence” to show that it works. That’s key because more than 200,000 U.S. troops have sustained traumatic brain injuries since 2000 — most non-combat-related. On March 5, Congressional members sent a letter to the chiefs of DOD and VA seeking data to investigate a new theory linking TBIs with the military’s suicide crisis.
• One of the VA’s “first-line treatments for depression” — Acceptance and Commitment Therapy — similarly “lacks sufficient evidence” to show its efficacy.
• Research has found that curbing access to lethal weapons prevents suicides, however, “DOD policy prohibits restricting that individual's access to privately owned weapons” — even if a service member is known to be at risk for suicide.
• DOD and VA should link their databases so that the health records of all service members are available to track their medical conditions from the moment they enter the service through the day any future treatment is eventually rendered by a VA facility. 

"These (recommendations) are meant to be helpful, meant to be more of a roadmap of how to pursue” these issues, Rutherford said. “These are extraordinary challenges that the systems are facing and they’ve gone to extraordinary efforts to try and work with them.

'Demand is large'
“Yeah, it can all be streamlined. Yeah, (the available help) can be matched better to the demands. Yeah, you can improve this stuff. But they are trying like crazy to make it match the demand,” he added. “The demand is large, and it’s growing.”

Compared to past post-war generations, a higher percentage of returning Iraq and Afghanistan Veterans are using the VA for their health care — 56 percent of that population, according to the VA.

"This report provides VA a better understanding of the difficulties some Veterans face as they readjust to home, reconnect with family members, find employment and return to school," read an email from Josh Taylor, a VA spokesman. "Greater collaboration with the Department of Defense (DoD) in the areas of research, treatment and clinical outcomes will further enhance continuity of care as service members transition from active to veteran status."

Pentagon officials will examine the IOM’s suggestions, said Cynthia O. Smith, a DoD spokeswoman.

“DoD appreciates IOM's hard work and will thoughtfully consider the study's key findings and recommendations,” Smith wrote in an email. She added that the agency’s Deployment Health Clinical Center “will work collectively with the VA to provide a joint response to Congress no later than June 2013.” 

The IOM study reports that 44 percent of veterans have had "readjustment difficulties," 48 percent have dealt with "strains on family life," 49 percent have experienced post-traumatic stress, and 32 percent have felt "an occasional loss of interest in daily activities." Those figures were plucked from an earlier Pew Research Center survey. 

"I’m not surprised (by those numbers), talking to my other buddies that have gotten out. I’ve got several buddies that still can’t find jobs but, to be honest with you, I think it's a factor of (their) motivation" to hunt for work, said Ryan Kriesel, 24, an Army tank operator who served two tours in Iraq. He's now a student at the University of Minnesota. He described his own transition as "pretty smooth." 

When it comes to those younger veterans who report a flagging interest in daily life, Kriesel believes some of that may be due to the loss of the emotional rush that once came with combat. 

"Part of it is being back in the civilian world," he said. "There’s not as much adrenaline going on as when you were overseas, out on combat missions several times a day."

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Jessica Mcgowan / for NBC News

Former Marine Paul Menefee, an Iraq war veteran, makes music in his Union City, Ga bedroom, on Feb. 15. Since transitioning to civilian life, Menefee works as a music producer in Atlanta. At home, Menefee spends most of his time in this blacked out bedroom making music and relaxing. Drawing blinds and blacking out windows is a habit Menefee started after his military service to help him feel more secure.

In the first month home from war, one Marine routinely searched his darkened bedroom for the rifle he'd left in Iraq, while another Marine shunned his favorite nightspot for fear that someone in the club might carry a gun. 

In the four weeks after their homecomings, one infantryman drove “white knuckled” at 55 mph while another soldier purposely began living even faster — losing her virginity, going blonde and drinking hard with battle buddies.

Some 34,000 service members will ship home from Afghanistan during the next year, President Barack Obama told the nation last week. 

Amid the gleeful glow of arrivals, many of those troops may quickly confront sensory overloads, social awkwardness and, perhaps, deep cravings for personal freedoms, according to interviews with four younger veterans who weathered such moments.  

“The first 30 days are interesting,” said Alex Horton, who spent 15 months in Iraq as an Army infantryman, including during the 2007 troop surge in Baghdad and Diyala Province.

Today, he works for the Department of Veterans Affairs. "I’ll call it the unraveling. That first week back you’re still high on everything, kissing your wife or girlfriend, sometimes seeing your kids for the first time. But then the tension starts to build.

“You experience culture and weather shock, and notice your senses are heightened,” said Horton, adding that another common theme — albeit something he did not go through — involves disrupting the daily routines established by a spouse and kids during a service member’s absence, and consequently, dealing with strained relationships. 

Distant from family
To that point, two veterans interviewed for this story, including Horton, said they suffered romantic breakups after returning from combat, and two got divorced. 

Jessica Mcgowan / for NBC News

Former Marine Paul Menefee, an Iraq war veteran, shows off his spiritual tattoos at home in Union City, Ga., on Feb. 15. The "Blessed" tattoo is one many Menefee has gotten after his two tours in Iraq.

"Trying to get back to my regular life was hard because I wouldn’t talk much to anybody. I didn’t want to talk about what went on in Iraq, didn't want to describe the details," said Paul Menefee, a former Marine who was deployed twice to Iraq and fought in the Battle of Fallujah in late 2004. 

"Things that happened, I didn’t want to remember. I was trying to cope in my own way, not deal with the images in my head," added Menefee, who eventually divorced his wife. "I was distant from my wife, mother, cousins, brothers, sisters, aunts, uncles. At Sunday dinners, I pretty much stayed off to myself."

Old habits came home, too. During his first 30 days back at Camp Lejeune, N.C., Menefee grew jittery in a Wal-Mart checkout line because other customers were queued up behind him. He left the store immediately. He avoided nightclub outings with friends because the bar crowds seemed unpredictable.

He chose seats in the backs of restaurants so he could watch all the patrons and map each exit. At home, he kept his blinds drawn, his door locked and always looked left then glanced right when passing a hallway or an open corner. 

On interstate highways, Menefee — a truck driver in Iraq — often pulled four lanes to his left if he spotted a blown tire or crumpled, food wrapper lying on the right shoulder: The types of hiding places in which insurgents routinely planted IEDs in Iraq. While driving in an American city, he would take an early left or an abrupt right if he saw garbage or roadkill on an approaching curb.

"You don’t realize that (your senses are) very fine-tuned to your environment, everything from hearing things to seeing things," Horton said. "I imagine this is what blind people feel with their other senses. You rely on them so much (in combat), they have no business being that acute in the civilian world."

"When I got into a car and drove on a highway for the first time," Horton added, "I was white knuckled."

For former Marine Christian Gutierrez, who returned from Iraq in spring 2008, the open road at first carried a mix of old caution and fresh freedom.

During quick trips to the grocery store, he frequently would exit his car then quickly circle back, thinking he'd left his rifle in the front seat, momentarily forgetting he didn't carry a weapon anymore. 

"But I love cars and love driving. So I drove a lot because it was my time," Gutierrez said. "That moment was your moment. You had control of your car. You had control of that moment."

'Lucky I didn't die'
Soon, he bought a motorcycle to further feed that rush of independence, to expand his new-found personal space — and because combat left him with another sharp bit of wisdom: Your moments on this planet may be few.  

"Being back taught me that if I want to do something, I’d better do something right now. You never know," he said. 

That same compulsion drove Iraq veteran Laura Cannon to use her first 30 days home to mark, she said, "the beginning of a new life for me," a time in which she stepped away from both Evangelical Christianity and the strict rules under which she'd been living since enrolling at West Point.  

"I knew that if I didn't make drastic changes, being at war would be the last adventure I would ever experience," said Cannon, a former Army infantry member who was part of the 2003 Coalition invasion. "Surviving a war completely changed my perspective. I needed to start living for me. So I made a mental list of goals to accomplish. No. 1 — lose my virginity. I was 24 for God's sake!"

During her first month home, Cannon also bought an SUV, broke up with a boyfriend, dyed her hair blonde, visited Ground Zero, posted a personal best in a 5K race, and found time to "party my ass off with my war buddies — heavy drinking."

In Iraq, "there was (stuff) blowing up everywhere. I'm lucky I didn't die. I hadn't done enough with my life," she said. "I had survived a war. I had a second chance to live differently. I was not going to let others control me anymore. It was time to make more adventures and maybe get some baggage along the way. I was so far behind. Lots to catch up on."

"The rapid pace at which I compensated for my repressed life, especially in the first 30 days after the war," Cannon added, "were completely catalyzed by combat." 

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Dale G. Young / The Detroit News

Whitney Kropp was named to the homecoming court as a joke by her classmates, but the tiny farm town of West Branch, Mich. has rallied around her.

Whitney Kropp, a sophomore at Ogemaw Heights High School in West Branch, Mich., said she was surprised to learn that she was picked by her classmates to be in the running for her school’s homecoming queen.

“I never thought I would be part of it because, really, it’s just for, like, the big popular people,” Kropp, 16, told NBC News' Kevin Tibbles on TODAY.

But she was soon humiliated when she learned Sept. 13 that her selection to the homecoming court had been part of a prank by other students. She said students pointed at her in the hallways and laughed, and the boy who was picked with her withdrew.

“Some kids thought it would be funny just to put me in there as a joke to make fun of me,” Kropp said. 

But Whitney’s ridicule didn’t stop didn’t there. Her mother, Bernice Kropp, told NBC News on Monday that the bullying continued on Facebook.

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Kropp said her daughter, a sophomore, had been picked on before at school, but not to the extent of the peer vote that selects students to the court, which traditionally names a queen, king and princes and princesses from each class. The high school has about 800 students.

“I felt like I wasn’t worthy. Why even be a part of this community, this world if I’m just going to be tossed around like basically a piece of trash?” Whitney Kropp said.

But then, her mother said, “other kids started coming up to her and saying, ‘Whitney, don’t let them stop you from going to homecoming. You need to go ahead, you need to do it.'”

Bernice Kropp described her daughter as quiet, polite and kind, rarely finding fault with peers and people. She said Whitney has decided to attend the dance despite the prank as businesses and neighbors in the tiny farming town have rallied around Whitney. 

Kropp said Whitney even has a date for the dance this Saturday, "and it’s her boyfriend who has been very quiet and supportive through all of this." 

"You want to protect your kid, and you feel angry and mad at what has happened, but at the same time the outpouring to help her has been beyond expected," she said. 

Watch the most-viewed videos on NBCNews.com

Word spread quickly through the community of about 2,100 residents in West Branch. Resident Jamie Kline started a Facebook support page, gaining more than 4,000 likes in Michigan and nationwide. Personal stories of bullying and messages of encouragement filled the page, among them:

"You go, girl! From here in California, it looks like you won the vote legitimately but some of your "friends" got jealous and nasty about it. Their "joke" never really happened! Hold your head high and have a good time," Raymond Puffer.

"Whitney YOU are a beautiful gal inside and out and dont ever let anyone tell you any different,” Karen Morrison Gross.

"I am so proud of this young lady ((((You GO, Girl))))), her family and the awesome community we share! It's high time we ALL take a stand against bullies. They come in all sizes, ages and social arenas. Be Kind ALWAYS,” Ginger Warren.

Jen Case, who is with Whit’s End Salon in West Branch, said the salon owner donated services to cut, color and style Kropp’s hair. "Bullying is a big thing and we wanted to turn this into a positive moment," Case said.

Other local businesses are paying for Whitney’s dinner, gown, shoes and a tiara for the dance.

"We live in this community and we’re about the community and giving back," Case told NBC News. "We wanted to help this young lady have a special night."

“I’m excited to go because I can prove everyone wrong and say, you know, I’m not this joke that you guys thought of. You guys doing this has made me stronger and I’ve got more self-esteem than what I had," Whitney Kropp said.

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Dale G. Young / The Detroit News

Whitney Kropp was named to the homecoming court as a joke by her classmates, but the tiny farm town of West Branch, Mich., has rallied around her.

A tiny farming town in Michigan is rallying around a 16-year-old girl who was voted to be on a high school homecoming court as part of a prank. Local businesses are picking up the tab for her special night, while a neighbor started a Facebook support page.

"It’s been overwhelming," Bernice Kropp told NBC News on Monday. Her daughter, Whitney Kropp, is at the center of the controversy at West Branch’s Ogemaw Heights High School, north of Saginaw.

Kropp said Whitney was humiliated when she learned Sept. 13 that her selection to the homecoming court had been part of a joke. She said students pointed at her in the hallways and laughed, and the boy who was picked with her withdrew.

"She was getting ridiculed in school and on Facebook," Kropp said.

"But then," Kropp added, "other kids started coming up to her and saying, 'Whitney, don’t let them stop you from going to homecoming. You need to go ahead, you need to do it'."

Kropp said her daughter, a sophomore, had been picked on before at school, but not to the extent of the peer vote that selects popular students to the court, which traditionally names a queen, king and princes and princesses from each class. The high school has about 800 students.

"I thought I wasn't worthy. I was this big old joke," Whitney told The Detroit News.

Dan Cwayna, the superintendent of the West Branch-Rose City School District, told NBC News he is aware of the situation. “I do not have much to add at this time,” he said, adding “I am hesitant to say anything out of privacy and concerns for the student involved.”

Kropp described her daughter as quiet, polite and kind, rarely finding fault with peers and people. Kropp said Whitney has a date for the dance this Saturday, "and it’s her boyfriend who has been very quiet and supportive through all of this."

"You want to protect your kid, and you feel angry and mad at what has happened, but at the same time the outpouring to help her has been beyond expected," Kropp said. 

Word spread quickly through the community of about 2,100 residents in West Branch. Resident Jamie Kline started a Facebook support page, gaining more than 4,000 likes in Michigan and nationwide. Personal stories of bullying and messages of encouragement filled the page, among them:

"You go, girl! From here in California, it looks like you won the vote legitimately but some of your "friends" got jealous and nasty about it. Their "joke" never really happened! Hold your head high and have a good time," Raymond Puffer.

"Whitney YOU are a beautiful gal inside and out and dont ever let anyone tell you any different,” Karen Morrison Gross.

"I am so proud of this young lady ((((You GO, Girl))))), her family and the awesome community we share! It's high time we ALL take a stand against bullies. They come in all sizes, ages and social arenas. Be Kind ALWAYS,” Ginger Warren.

Jen Case, who is with Whit’s End Salon in West Branch, said the salon owner donated services to cut, color and style Kropp’s hair. "Bullying is a big thing and we wanted to turn this into a positive moment," Case said.

Other local businesses are paying for Whitney’s dinner, gown, shoes and a tiara for the dance.

"We live in this community and we’re about the community and giving back," Case told NBC News. "We wanted to help this young lady have a special night."

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The highest number of U.S. Marines will exit Afghanistan in August compared to any other month in 2012 as a large exodus of American troops continues, U.S. Marine Corps Maj. General David Berger said today in a phone interview from Afghanistan. 

In the country's southern Helmand province — a swath once so volatile that an additional 10,000 Marines were massed there three years ago — the Marine contingent will continue to shrink drastically over the next three weeks, said Berger, commanding general of the 1st Marine Division (Forward). 

"We’re not going to give out detailed numbers on where we’ll end up, but it’s a cut of about two-thirds of the size of strength here (compared to) a year ago, and it will be somewhere between 7,000 and 10,000 Marines when we finish up," Berger said. 

"There will be more Marines and soldiers and equipment moving in August than any other month. All the ones that are deploying from Afghanistan on the Marine Corps side, they’re going back to their home bases on the East Coast, on the West Coast."

Adek Berry / AFP - Getty Images

US Marines from Kilo Company of the 3rd Battalion 8th Marines Regiment patrol in Garmser, Helmand Province on June 29.

The pullout of U.S. forces this year is expected to reach 23,000 total troops. The NATO coalition's combat mission in Afghanistan is scheduled to finish at the end of 2014. Last year, President Obama ordered 10,000 U.S. troops out of Afghanistan.

While shifting more control to Afghan security forces and Afghan police, Berger said he has seen "amazing progress last year into this year," first, in terms of the Afghans' military development and, second, in their available fighting equipment and ability to man those tools.

"The third part is confidence — confidence in themselves and the people’s confidence in them," Berger said, "Each week, they’re more confident in what they can do in the field. The police are more confident. The people can begin to trust them in a way that was really challenging a year and a half ago.

"Now, I think the people (here) see the Afghan security forces as ... really the public face of their government. So the more they see of this, the more confidence people have that the Afghan government can protect them, can take care of them. So from where we sit, it’s absolutely going in the right direction."

However, Berger acknowledged that the massive swarm of Marines headed home — particularly those who will be retiring from the military and trying to enroll in college or land civilian jobs — will only begin that long transitionary phase after they return to the United States. 

"It happens after they leave country for the most part," Berger said. "While they’re over here, they’re pretty much occupied by the reason they were sent here. 

"But those who make the decision to move on into their civilian life, when they get back they’ll go into a formal program that first will lay out all the benefits coming to them. There’s a second part that helps them prepare for everything from doing a resume to doing an interview, to narrowing a field of choice, to getting an education.

"If you had gone through that process of separating from the service to entering the civilian world four or five years ago, you would be very much surprised by the program that’s in place right now — in a good way," Berger said. 

Related: Obama announces 'reverse bootcamp' for veterans

Still, with tens of thousands of service members headed home, that influx will only further tax a huge backlog of disability claims already clogging the U.S. Department of Veterans Affairs and it could potentially exacerbate a high college drop-out rate and sluggish job hiring now plaguing many veterans of the wars in Iraq and Afghanistan. 

Slideshow: Afghanistan: Nation at a crossroads

Ahmad Jamshid / AP

More than ten years after the beginning of the war, Afghanistan faces external pressure to reform as well as ongoing internal conflicts.

Launch slideshow

Retired sergeant Thomas Maretich, who in June earned a medical retirement from the Army, said he knows of many service members still in Afghanistan — and some still in Iraq - who "are not letting go those jobs" because they worry that what awaits them in America is simply the unemployment line. 

"They’re afraid. This is the worst possible time for anybody to look for work let alone anybody who has been wounded and has the cards stacked up against them," said Maretich, who was wounded by a car bomb in Iraq in 2009 and has had trouble finding work in his current city, Colorado Springs. "They could retire (from the military) at 20 ...  They just don't see a job in the civilian world that is safe and pays the same."

What's more, "they don't have enough mental health (help available) now at the VA. Many soldiers will need medical care for problems with their neck, back, or knees and the system that is already trying to catch up will be paralyzed again," he said. "Mix in budget cuts and what a mess we will have."

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When Marine Staff Sgt. Jeremy Cooney, 31, returned home from Afghanistan to Camp Lejeune in North Carolina last December, he was taken aside and escorted into a gymnasium where his wife and five children waited.

There across the basketball court was his 6-year-old son, Michael, who suffers from cerebral palsy. Doctors told Jeremy and his wife, Melissa, 30, that Michael would never walk.

While Jeremy was deployed, though, Michael discovered how to stand up unassisted. His teachers, Melissa says, then began trying to teach him how to walk with a cane. Michael did them one better: he took several steps on his own.

Having seen the many military homecoming videos of returning parents surprising their children, Melissa decided that instead Michael would surprise Jeremy. She asked family members and friends not to post photos of Michael walking on Facebook or share the news of his progress with Jeremy.

Courtesy Melissa Cooney

Michael Cooney, who suffers from cerebral palsy and was not expected to walk, greets his father, Marine Staff Sgt. Jeremy Cooney.

When Jeremy entered the gym, he did not know his son could walk. Michael took dozens of halting steps toward his shocked dad, who crouched down on the ground and motioned for Michael to keep coming. As soon as Michael got close, Jeremy picked him up and embraced him.

The touching moment was posted Wednesday on Welcome Home Blog, a site dedicated to military homecomings. The video has since been viewed more than 767,000 times on YouTube.

"I can’t describe it," Jeremy said of the reunion. "It was years in the making just trying to get him limited mobility with surgery and a walker. It's probably one of the happiest moments of my life."

The reunion was orchestrated with the help of a family readiness officer who contacted Jeremy's supervisors in Afghanistan. Melissa and her five children arrived at Camp Lejeune at 10 p.m. and the buses came at 5 a.m. "Michael is a full-blown daddy's boy," Melissa said. "He stayed up the whole time."

In the months since Jeremy's return, Michael has been more active than ever. He has stopped using his walker at school. The family was able to take him into a cavern on a family vacation to Tennessee. Before, Jeremy says, he would have had to carry Michael. And this Easter, he was able to hunt for Easter eggs in the family's backyard. In years past, Michael had to crawl on the ground. "This [Easter], he got to go all over the place," said Jeremy.

Melissa says Michael's insistence on independence is characteristic of his personality. "I think that’s just who he is. He wants to be the same as everybody else. That’s the personality he has and I don’t think anybody can stop him."

Jeremy didn't expect the video to be viewed so widely, but says the focus should not be on his homecoming.

"The biggest story is [Michael] and his desire  -- once he sets his mind on something he doesn’t settle for less," Jeremy said. "Parents are supposed to inspire their kids. In our kids, it’s the opposite. Michael inspires us on a daily basis. He’s a one-of-a-kind child."

Rebecca Ruiz is a reporter at msnbc.com. Follow her on Twitter here.

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