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See images from the scene of the explosions.

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Cops called the twin bombs “IEDs” and a Boston ER doctor said the wounds included “traumatic amputations” normally seen on Iraq battlefields, but now another combat comparison has emerged: Some civilian survivors of the terror attack will suffer PTSD as a result of Monday’s carnage.

A number of the bystanders, runners and public-safety personnel near the blasts — those close enough to see, hear and feel the detonations, those who witnessed or aided the wounded, and the injured themselves — now have a higher risk for developing the same anxiety symptoms known to affect tens of thousands of Iraq and Afghanistan veterans, said a leading expert on Post Traumatic Stress Disorder.

“Absolutely. To be precise, it is called Acute Stress Disorder at the beginning and usually involves some or all of the symptoms of PTSD. If it lasts more than a month, and has enough symptoms, it is then described as PTSD,” said Dr. Harry Croft, a San Antonio-based psychiatrist who has talked with more than 7,000 veterans diagnosed with PTSD.

Common PTSD symptoms include an inability to sleep, nightmares, a craving for isolation and a disquiet when in crowds. Following a decade of wars, experts like Croft have developed a keener understanding of these side effects.

“We know that for some people intensive debriefing after a trauma does not help, and may worsen symptoms in the long run. But getting survivors to safety, helping them understand what has happened, helping them talk — or be quiet but around others — may be of great value,” Croft said. “Mental health professionals are (now) better trained in handling the emotional needs of survivors and passers-by.”

The earlier symptoms to emerge often include a sense of disbelief — in which the event doesn’t seem real — and either no emotion or gushes of emotion, including sadness, fear, anger, Croft said. Typically, people with PTSD have either recurrent memories of the event, or no memory at all. People may discover they are easily startled or abnormally agitated.

Civilians more susceptible?
How prevalent is PTSD among people who have witnessed or were wounded in a sudden and violent situation? The figure most commonly cited by experts is 20 percent, although that rate is known to vary widely among civilians and can depend on the severity of the event, Croft said, adding: "Long term, the amount of PTSD is greater with man-made traumas as opposed to those caused by hurricanes, floods and fires.”

Civilians are “probably” more susceptible to PTSD than military members, he said. 

Veteran Brennan Mullaney, 30, an Army veteran who witnessed some explosions during two tours of Iraq, was between mile marker 24 and 25 when the blasts occurred. He lives in Boston and goes to graduate school at Tufts University. He did not hear the concussions and was not allowed by authorities to get close enough to help the injured.

“My initial concern was with civilians who haven’t witnessed scenes like that,” Mullaney said. “So many of us who have spent time deployed — and I’m not trying to overlook the severity of what transpired yesterday — but we’ve seen it before. It’s infinitively more horrific and disturbing when you see it in your hometown.”

He knows of several Tufts students who were far closer to the finish line when the bombs were detonated and he already has offered to talk with those runners about some side effects they're perhaps feeling two days later.

“Maybe my experience can help them through that. Veterans have been sloughing [PTSD] off for years. The better way is to talk to someone about it. It’s a process. You can talk to them, be empathetic. You can tell them: 'It’s tough; you’re going to have those visions of what you saw for days to come,'” Mullaney said. “How you synthesize that information, [how you] manage and process that, is going to be a big determination in whether that thought re-entering your mind is entirely a negative thing or if there is some type of silver lining to it.

“My share of what I saw in Iraq was probably less than a lot of guys who played combat roles. Yes, I did see some explosions and some aftermath of what that looks like,” Mullaney said. “A lot of times, we didn’t know the people who were hurt or killed. They were Iraqis — a father, mother, a son. They were people, and that human feeling [about them] is there, whether you’re in war zone or whether you’re home and it’s a fellow American.” 

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Jim Seida / NBC News

"I had seen some stuff that I probably would have never seen before in life had I not been in Marine Corps, some good stuff and some stuff I just don't care to think about anymore," said Iraq War veteran Eric Swinney, seen here outside his room at Grand Veterans Village in Phoenix.

By Bill Briggs, NBC News contributor

Despite funding that has reached $5.8 billion annually and a slew of innovative community partnerships, the Obama administration is lagging in its goal to end homelessness among veterans – or, as federal veterans' leaders like to say, “drive to zero” – by the end of 2015.

If the current rate of progress is maintained, roughly 45,000 veterans would still be without homes when the deadline passes -- a big improvement since the drive was launched but also evidence of how difficult it is to eradicate the problem.

"I don’t truly think you can end homelessness,” said John Scott, who heads the Phoenix office of U.S. Vets, a national, nonprofit service provider to homeless and at-risk veterans that receives some federal funding. “Things happen that can precipitate homelessness for anyone, and it can happen quite rapidly. However, we can effect change in veterans who have been chronically homeless.”

Scott, a former Marine Corps sergeant, was a keynote speaker at the November 2009 summit where Veterans Administration Secretary Eric Shinseki proclaimed that he and President Obama were "personally committed to ending homelessness among veterans within the next five years.” (The VA now cites the end of 2015 as its target.)

That crusade thus far has housed 12,990 veterans, an average of 361 per month. At the last count, which took place in January 2012 and was released in December, some 62,000 veterans still were homeless, meaning the campaign would need to average about 1,300 per month to meet its mark.

“While there may have been those who did not think ending veteran homelessness was possible (when Shinseki made his 2009 vow), it brought much needed attention to the matter," Scott said. “And it has, in turn, created many new funding opportunities for veterans experiencing homelessness.”

Scott hammers at the problem in a state VA officials hold out as a shining prototype, where in 2012 veterans accounted for just 13 percent of the adult homeless population — down from 20 percent in 2011. He oversees a tangible symbol of that drive, a former Howard Johnson hotel refurbished into apartments meant to shelter more than 130 homeless veterans. It’s called Grand Veterans Village.

Flashbacks, panic attacks
Manning the community’s gas grill most days is Iraq veteran Eric Swinney, who arrived there in early March. Originally from Mississippi, the former Marine’s barbecued specialties include ribs, chicken and pork chops. He doesn’t talk much about his brief homeless stretch. But his spiral seems fueled by what he saw in Iraq — and what he sees in his nightmares.

“I picked up heads, legs. I picked up blown-up hips from two blocks away, from the roofs of houses. Numerous, numerous occasions. Iraqi people parts,” said Swinney, 26. The human pieces were ripped away and strewn during firefights or suicide-bomber blasts.

Jim Seida / NBC News

Smoking and joking on the second floor of what used to be a Howard Johnson's in Phoenix, Iraq War vets Zeb Alford, left, Trent Stubbs, center, and Swinney pass the time at Grand Veterans Village.

“I have this one image, every time I sleep, of picking up the head of an Iraqi.” In his room at Grand Veterans Village, the flashback wakes him often, he said, leaving him soaked in perspiration.

Nothing new, though. Swinney began feeling what he calls “mental anguish” before leaving Iraq in 2008. From there, his descent reads like a manual on post-traumatic stress disorder: foreboding and booze and bad luck. “Every time something happened that reminded me of Iraq, I would just go get me a bottle and start drinking.” Then, a DUI arrest in Georgia. Then, panic attacks, which left him unable to hold any of his six or so post-war jobs.

He tried to physically flee that internal storm, moving to Phoenix last June: “A new change, a new climate.” He got an apartment. He got a job as a security guard. But when his car was stolen on Super Bowl Sunday, he had no ride to work. The rent money ran dry. He lost his room. “Ever since I left the Marine Corps, stuff just keeps happening.”

During his eight months in Phoenix, however, Swinney also had been visiting the local VA center, meeting with caseworkers. When he became homeless, they steered him to U.S. Vets, to Scott and to Grand Avenue. There, his rent is covered by U.S. Vets. Next, Swinney will be paired with local experts who "are going to assist him with some of the trauma he's brought back from war," Scott said.

The plan is to have Swinney find his financial footing and, eventually, move into a more permanent apartment where he will be responsible for the lease.

'Daunting challenge'
That federal-community safety net — housing wrapped around social services, in dozens of cities — is precisely why VA officials remain outwardly confident they can meet Shinseki's 2015 objective.

"Yes, we know it’s an aggressive goal. But we work hard at this every day to try to achieve it. Because for us, it’s really just not acceptable to have anybody on the streets with the capabilities and the opportunities that are around now," said Vincent Kane, director of the VA National Center on Homelessness Among Veterans.

"With the focus, the attention and the commitment we're putting to this as a health-care system, [VA has] the best opportunity now than at any other point in the history of our program" to hit that mark, Kane said.

One program making a dent is HUD-VASH, run jointly by the VA and the U.S. Department of Housing and Urban Development. Under that plan, veterans receive housing vouchers and access to case management and clinical services. Since 2008, Congress has appropriated $350 million to HUD-VASH, which has handed housing vouchers to more than 47,000 veterans and their families, according to HUD.

Armed with such initiatives, "we believe we are going to quicken the pace" to house all veterans, Kane said. "We know it’s a daunting challenge.

Nightmares and all, Swinney plans to be one of the success stories in that intended final tally of zero. He is a proud man, and thankful for his service, no matter where it has taken him five years after leaving Iraq.

"I hate when people feel entitled to stuff. Being a Marine helped me in a lot of ways. Yes, it had its drawbacks. But what it all boils down to is we’re average Americans, like everybody else. We just had more dangerous jobs," he said. "Nobody owes me anything."

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This story was originally published on Fri Mar 29, 2013 3:16 PM EDT

Courtesy IAVA

Former U.S. Marine Sergeant Derek Coy says he still struggles "both mentally and physically, with the toll it took on me and countless others do as well."

Derek Coy hails from Baytown, Texas, and could be a poster child for American veterans of the war in Iraq as they look back and ask: "Was it all worth it?" 

A former U.S. Marine sergeant based in the volatile Anbar province at the height of the conflict, Coy is proud of his service and believes the "invaluable tools" he gained as a Marine will ultimately help him succeed in life.

But seven years since he left Iraq, he’s fighting a different battle — against anxiety, depression and emotional numbness — the effects of post-traumatic stress. 

"I still struggle, both mentally and physically, with the toll it took on me and countless others do as well," he said.

Tuesday will mark 10 years since the "shock and awe" invasion and more than a year since the last company of U.S. troops left Iraq. But only about 4 in 10 Americans who fought there — according to a Pew Research Center poll — believe the reasons for going to war justified the loss in blood and treasure.

Almost 4,500 U.S. troops were killed and more than 32,000 wounded, including thousands with critical brain and spinal injuries.  Estimates of the number of Iraqi civilian fatalities are staggering, ranging from 100,000 to 600,000.

The monetary cost could exceed $3 trillion.

While the war in Iraq has ended, the sacrifice for vets continues back in a civilian world they often find "foreign" and isolating.

Ann Weeby, a native of Boyne City, Michigan, was deployed at the beginning of the war, attached to the 101st Airborne under then-Major General David Petraeus , in the northern Iraqi town of Mosul.

"Our goal was to find weapons of mass destruction and Saddam Hussein," she said.

"After WMDs were not found and Saddam was captured, I didn’t expect [such a] prolonged U.S. military presence in Iraq," she added.

As the only person her family and friends know who fought in the war, Weeby tries to educate them about the scourges of depression and suicide that U.S. vets face after Iraq. 

"American troops are suffering, and in some cases dying, because a Veterans Affairs' claims backlog is preventing them from getting [mental] health care. Twenty-two U.S. veterans commit suicide every day!" Weeby said, citing a troubling statistic recently published by the Department of Veterans Affairs.

Courtesy IAVA

Ann Weeby, who was attached to the 101st Airborne, went in to look for WMDs and Saddam Hussein. "I didn't expect [such a] prolonged U.S. military presence in Iraq," she said.

'The cost was high'
When Leon Panetta, then secretary of defense, addressed U.S. troops in Baghdad before they pulled out of Iraq, he argued that their core mission had been accomplished.

"To be sure, the cost was high," he said. "But those lives were not lost in vain. They gave birth to an independent, free, and sovereign Iraq."

Today, however, Iraq’s Shiite Prime Minister, Nouri al-Maliki, heads what looks more like an authoritarian regime, propped up by a coercive secret service.

Toby Dodge, an analyst at U.K.-based think tank Chatham House, claimed Iraq had morphed into a pro-Iran police state, where Sunni gunmen and al Qaeda’s suicide bombers seem to strike at will, killing hundreds each week. 

His conclusion: 10 years after regime change in Iraq, little has changed.

"The lives of ordinary Iraqis, in terms of the relationship to their state and their economy, are comparable to the situation they faced in the country before regime change," he said in a report written for Chatham House.

Many Iraq War veterans admit they were fighting more for their battle buddies than for any "island of democracy" in the Arab world.

Courtesy IAVA

Robert Contreras, who had two tours of duty in Iraq, returned to California to finish a college degree, where he has struggled to relate to other students. "The most common question I get … is if I've ever killed someone," he said.

Robert Contreras, from Sylmar, California, left the military after 10 years in the Navy, including two tours of duty in Iraq, and returned to California to finish a college degree.

"Personally, I was not there fighting for Iraq," he said when asked if the war was won or lost.

"I was there to protect those who served alongside me to the best of my abilities," he said.

He’s struggled to relate to his student peers who know little about the wars in Iraq and Afghanistan.

"The most common question I get … is if I’ve ever killed someone," he said.

Contreras also developed symptoms of PTSD. "I was anxious in crowded places and unable to feel at ease anywhere but at home."

Veterans like Weeby and Coy have found a therapeutic way to generate positives from their Iraq War experiences — and better deal with some of the nagging uncertainties about Iraq’s future: They’ve reached out to their fellow vets.

Weeby is an outspoken advocate for San Francisco Bay Area veterans, while Coy is an associate at the Iraq and Afghanistan Veterans of America, or IAVA, the first and largest non-profit group representing U.S. vets from those wars.

Both are currently in Washington, D.C., part of the "Storm the Hill" offensive, pressuring Congress to address key veterans’ issues, like 9.4 percent unemployment and a bottle-necked health-care program.

"Coming home with a renewed appreciation for my life and freedoms, I’ve committed my career to helping others," reflected Weeby.

U.S. military commanders would argue that the war in Iraq brought important changes there:  Iraqis are better off without Saddam Hussein and have at least gained a fledgling democracy and national elections.

But 10 years since “shock and awe” was supposed to clear the path for a liberated Iraq and a "forward strategy of freedom" that would sweep across the Middle East, Iraqis are instead falling victim to wave upon wave of sectarian violence.

And many of their American "liberators" are fighting for their own survival — back home.

Jim Maceda has covered Iraq since the 1980s.

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The psychiatry staff at Madigan Army Medical Center was not encouraged to overturn diagnoses of post-traumatic stress disorder to save the government money, according to investigation documents provided to NBC News.

The Army previously said it found no evidence of wrongdoing at the Tacoma, Wash., hospital, but had not released the investigation documents until Friday. As recently as last month, the Army said it would not share the findings and denied Freedom of Information Act requests by local media.

The investigation, conducted last spring, sought to determine whether or not the commander of Madigan, Col. Dallas Homas, exerted any “undue influence” on PTSD diagnoses. Homas was reinstated last July and the investigation documents contain numerous glowing reviews of his leadership and no indication that he pressed the staff to consider the cost of diagnosing a soldier with PTSD.

That claim stemmed from a 30-minute presentation given in September 2011 by the hospital’s chief of forensic psychiatry, in which he noted that a PTSD diagnosis could cost the government over $1.5 million in disability payments over a soldier’s lifetime.

The 100-page investigation document contains several interviews with Madigan staff members who say the comment was made in less than a minute and taken out of context.

When questioned about the remark, the commander explained that forensic psychiatrists must take into consideration all factors “that could bear on an individual’s diagnosis,” including financial gain, the document showed.

“... It is clearly being blown out of proportion and used to attack [redacted] and his team,” Homas said. “I have not seen any evidence that concern over saving government money is a driver of arriving or not arriving at a diagnosis.”

In the fall of 2011, some soldiers had complained that their PTSD diagnoses had been switched to conditions like anxiety disorder, which could have affected their medical retirement rating and the amount of their disability payments.

Homas pointed out during the investigation that while 14 soldiers were not diagnosed with PTSD, at least 44 soldiers who entered the medical retirement process were ultimately given that diagnosis.

“If this were about saving money, this section has failed has failed miserably,” he said.

The investigation interviews also revealed that some staff faced tense situations when giving a diagnosis.

“Sometimes some soldiers can get so upset that they might act out in some manner, perhaps expressing threats," the chief of behavioral health said to the investigator. "The easy thing to do is just give the patient what they want. The (forensic psychiatry) clinicians work very hard to do what is right.”

Homas said in his interview that some soldiers made death threats against forensic psychiatrists.

The investigating officer wrote that only two individuals, who were ombudsmen, made “unsubstantiated allegations” regarding the forensic psychiatric process. Both were suspicious of changes to soldiers’ PTSD diagnoses, but did not believe Homas advised staff to consider the cost as a factor.

The investigating officer agreed with Madigan staff that the ombudsmen had misunderstood the context of the Sept. 2011 comment.

One ombudsman said soldiers whose diagnoses were reviewed by the forensic psychiatric team were very distressed upon being told they did not have PTSD. In some cases, medical professionals previously told them they had the disorder.

That ombudsman said their lives had been “turned upside down” as a result, and that some evaluations contained language insinuating that the solders were liars and malingerers.

Though the forensic psychiatry team was essentially absolved by the report, the Army has stopped the practice of using such teams to vet PTSD diagnoses; Madigan was the only Army hospital to do so.

“The fact that the Army had to bring in new doctors to reinstate hundreds of PTSD diagnoses for local servicemembers and that they have implemented major behavioral health policy changes nationwide in the wake of the Madigan cases are clear evidence that problems existed on base in properly identifying the invisible wounds of war,” Sen. Patty Murray, D-Wash., said in a statement to NBC News. Murray pushed for the investigation into the PTSD diagnoses at Madigan.

As part of the investigation, a review of 431 Madigan cases — some of which had been overturned — led to PTSD diagnoses for 150 soldiers by last October. The Army recently said that Madigan’s variance rate for diagnoses was not outside the norm. 

Rebecca Ruiz is a reporter based in the Bay Area.

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Traumatic brain injuries sustained by more than 200,000 U.S. troops may be fueling the military’s suicide crisis, according to a letter co-signed by 53 congressional members who are seeking additional data to investigate the new theory.

In the letter, sent Tuesday to Defense Secretary Chuck Hagel and Veterans Affairs Secretary Eric Shinseki, the lawmakers urged both agencies to provide Congress with a raft of figures, including the number of Iraq and Afghanistan service members and veterans who committed suicide or tried to end their lives after being brain injured by the detonation of an improvised explosive device — “the weapon of choice” in both wars.

“Evidence has suggested that blast injuries, including but not limited to those causing damage to vision or hearing, can have a severe psychological impact ... that can play a major contributing role in suicides,” read the bi-partisan letter.

Between November 2011 and October 2012, there were more than 15,000 IED attacks against U.S. service members in Afghanistan, and 58 percent of all coalition casualties during that span were caused by the hidden bombs, the letter states.

At least three veterans groups, including the Blinded Veterans Association, are backing the congressional push to — as the letter to DOD and VA states — “get a better understanding of the connection between blast injuries and suicide.”

“I’ve talked to a lot of neurologists, military neurosurgeons and trauma surgeons who have all started to ponder if the IEDs that have caused the TBIs are the real cause of the suicides, versus the traditional approach that suicides are all caused by the psychological stresses of combat,” said Thomas Zampieri, head of government relations for the Blinded Veterans Association.

“Let’s collect more information and maybe the epidemiologists will find a way to unlock some of this mystery: Are military suicides actually more related to the brain injuries? I think there may be a big connection,” added Zampieri, who served as a Vietnam-era Army medic. “As the numbers of TBIs go up, the numbers of suicides continue to go up.”

The portion of U.S. service members who sustained TBIs increased each year from 2001 to 2011 — with a total of 266,810 brain injuries diagnosed in American troops between 2000 and 2012, according to the Defense and Veterans Brain Injury Center, part of the DOD. More than 80 percent of those injuries were not deployment-related cases, with many occurring amid crashes of privately owned cars and military vehicles. 

Army soldiers account for the vast majority of diagnosed TBI cases, and those injuries range from “mild” (a concussion) to “severe.” Within the Army, the suicide rate among active-duty members has risen from 9 per 100,000 in 2001 to nearly 23 per 100,000 in 2011, according to the American Foundation for Suicide Prevention.

During that same span, according to the DOD’s brain injury center, the number of annual TBI diagnoses among American troops has ballooned from 11,580 in 2001 to 32,609 in 2011 — an increase of 182 percent.

“What is significant is that we are looking at a potential paradigm shift of significant proportion if the link between low-level TBI from IEDs emerges,” said retired Army Col. Bob Morris, founder of the Global Campaign against IEDs.

“The current automatic approach is to connect everything to Post Traumatic Stress Disorder and look at it all as psychological when it may be a physiological,” Morris added. 

The lawmakers additionally asked the DOD and VA to supply "specific autopsy findings (of service members or veterans) potentially indicative of prior TBI." The members said they want to know whether such post-mortems found "chronic traumatic encephalopathy", which has been detected in the brains of a number of NFL players who recently committed suicide. 

Numerous Iraq and Afghanistan veterans have been diagnosed with both TBIs and PTSD, as well as with hearing loss — the most common disability among the men and women who served in those wars. 

"There is no higher priority for VA than the mental health and well-being of our courageous men and women who have served the nation," said a VA spokesman, responding to the congressional letter. "Under the leadership of Secretary Shinseki, VA has made significant progress in providing increased access to mental health care services and strengthening our suicide prevention efforts, but there is more work to do. VA is committed to providing all Veterans the care and benefits they have earned and deserve.”

A Pentagon spokeswoman said Hagel "responds directly to correspondence received" and that it would inappropriate for her comment on the letter. 

Rep. Dan Benishek, R-Mich., a surgeon who worked at a VA medical center for 20 years, led the effort to collect congressional signatures for the letter to Hagel and Shinseki.

“Far too many of our veterans and military personnel have taken their own life after bravely serving our nation. Frankly, it’s tragic and unacceptable,” Benishek said in a statement Tuesday. “I am hopeful that by working together we can make sure our guys and gals in the military and the VA have the support they need to recover from the damaging psychological effects of war.”

"There is particular evidence linking suicide to those wounded by IEDs," added Rep. Richard Hanna, R-N.Y. "It is my hope that through additional research we will be able to identify and reverse this painful trend. One suicide is too many and we should do all we can to address this as quickly as possible."

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The results of a months-long investigation into the reversal of post-traumatic stress disorder diagnoses at Madigan Army Medical Center are being kept confidential.

Earlier this month, Army Secretary John McHugh told reporters at Joint Base Lewis-McChord in Washington state that the Madigan findings would not be disclosed.

Days later, the Army denied Freedom of Information Act requests for documents related to the controversy made by three Seattle-area news organizations.

George Wright, an Army spokesman at the Pentagon, told NBC News that “concerns brought up in the Madigan matter will be addressed” in a separate forthcoming report by the Army's Task Force on Behavioral Health.

Wright said he had not viewed that document, which is an Army-wide review of mental health diagnoses as far back as 2001, and could not comment on what information it would include about the Madigan inquiry.

The Madigan investigation, completed last fall, sought to determine whether or not a team of forensic psychiatrists inappropriately changed soldiers’ PTSD diagnoses, perhaps to save the federal government money.

In a memo obtained last year by the Seattle Times, a Madigan Army Medical Center psychiatrist gave a presentation to colleagues in September 2011 in which he noted that a soldier medically retired with a PTSD diagnosis would collect $1.5 million in disability payments over his or her lifetime. The psychiatrist warned his colleagues against “rubber stamping” a PTSD diagnosis.

Around the same time, several soldiers screened at Madigan complained that their PTSD diagnoses had been switched to conditions like anxiety disorder, which could have affected their medical retirement rating and the amount of their disability payments. 

A subsequent review of 431 Madigan cases — some of which had been overturned — led to PTSD diagnoses for 150 soldiers by last October, according to the office of Sen. Patty Murray, D-Wash.

Murray pushed for the investigation into the PTSD diagnoses at Madigan — an Army hospital in Tacoma, Wash., that serves soldiers stationed at Joint Base Lewis-McChord — but has yet to see its findings. 

The Madigan investigation was reported by the Seattle Times in January 2012. In May, McHugh announced the Army-wide review, which is said to contain 24 findings and 47 recommendations, and now according to Wright, details related to Madigan. Murray is scheduled to be briefed on the review in the next few weeks, Matt McAlvanah, a spokesman for the senator, told NBC News.

Last year, Seattle-area news organizations asked to see documents related to the inquiry through Freedom of Information Act requests.

Request denied
Patricia Murphy, a reporter at KUOW Puget Sound Public Radio, said the Army denied the station’s attempts to obtain information and subsequently denied an appeal. The Army described the Madigan documents as “pre-decisional,” a legal privilege extended to documents that influence new rules and regulations. In a letter to the station, the Army said this designation is meant to “protect the quality of agency decisions by encouraging frank and open discussions of agency policy.”

Murphy said she understood that the documents might contain sensitive government and patient information, but was hopeful the Army could strike a balance for transparency. “We don’t care about the names,” Murphy told NBC News. “We care about the reasons they were doing this and whether or not this was a cultural issue at Madigan.”

The Army has said that Madigan was the only Army hospital to employ a team of forensic psychiatrists who vetted PTSD diagnoses and said it had stopped that practice.

Last February, it announced that the hospital’s commander, Col. Dallas Homas, was reassigned during the inquiry. The Army reinstated Homas several months later after finding that he did not "exert any undue influence on PTSD diagnoses." The Army provided that document to KUOW in response to a FOIA request. 

The Army also issued new guidelines for PTSD screening last April, discouraging staff from using testing to identify patients who might be "malingering" or faking their symptoms, an approach some soldiers claimed was utilized at Madigan. 

Despite these corrective actions, critics of the decision to withhold the Madigan findings say that transparency is key to restoring trust in the Army’s ability to accurately diagnosis and treat PTSD.

Tom Tarantino, chief policy director of the advocacy organization Iraq and Afghanistan Veterans of America and a former Army captain, said that keeping the report confidential reflected a “shocking amount of tone deafness.”

“I don’t want anybody to release information that violates HIPAA, privacy or endangers national security, but there has to be some sort of accountability,” Tarantino said. He also fears that withholding the findings sends the wrong signal to soldiers who worry that the problems at Madigan could be widespread and might not seek mental health care as a result.

“You have to actually show patterns of behavior and convince people that you’re willing to change.”

Wright said the Army wanted to make public its report on behavioral health “as soon as possible,” but that it was weighing the feasibility of the recommendations and how to implement them.

“We expect that work to be completed shortly,” he said, “and then we will be able to share not only the findings, but the way ahead.”

Rebecca Ruiz is a reporter based in the Bay Area.

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Eighty percent of veterans who attempted suicide and survived had received mental health care one month earlier from the Department of Veterans Affairs, underscoring the potential peril of 50-day average wait times they face in trying to access VA treatment, a suicide expert told a Congressional committee Wednesday.

“When they had contact a month prior, the question I ask is: How long was it until their next (VA) appointment? Was it scheduled six weeks out? Is that the problem? Or was it scheduled one week out?” David Rudd, head of the National Center for Veteran Studies, testified before the House Committee on Veterans’ Affairs.

“My concern is — from the individuals I talk with that we treat to surviving family members of those who have died — often times, it’s an issue of the (VA) system getting in the way to keep an appointment, to get an appointment, or to get to an appointment,” Rudd said. 

According to a VA report released earlier this month, 18 to 22 veterans commit suicide each day. And that rate “has remained steady” since the Iraq and Afghanistan wars began 12 years ago, said Veterans' Committee chairman Rep. Jeff Miller, R-Fla., who noted that during that same span the VA has increased its budget by 39 percent and its staffing by 41 percent.

“When a veteran is in need of care, the difference of a day or a week or a month can be the difference between life and death,” Miller said. “ ... Something somewhere is clearly missing.”

In his State of the Union address Tuesday night, President Barack Obama announced that 34,000 U.S. troops would head home from Afghanistan during the next year.

Given that mammoth flow of young veterans into an already-backlogged VA system, Miller questioned whether the agency’s “one-size-fits all approach” will leave thousands of ex-service members mired in a bureaucracy that “fails to recognize that addressing mental-health needs ... is a task that the VA cannot handle by themselves.”

“We’ve improved our services for veterans but we know there’s a lot more work to be done,” testified Dr. Robert A. Petzel, the VA’s undersecretary for health.

In 2012, for example, the VA’s 24-hour crisis line fielded 193,000 phone calls that resulted in more than 6,400 “rescues” of veterans who were threatening to hurt themselves or their family members, Petzel said.

While the volume of calls to the hotline is increasing, fewer of those calls are “acute” — or people making an imminent threat — “demonstrating that VA’s early intervention appears to be working,” Petzel added.

What’s more, in the past year, VA has hired 1,058 new mental-health providers and the agency expects to meet its hiring goal of 1,600 extra clinicians by June, Petzel testified, adding that last year 1.3 million veterans received mental-health care from the VA, up from 927,000 in 2006. That increase, he contends, shows that “proactive screening” is working to find and treat veterans for Post Traumatic Stress Disorder, depression, substance abuse issues, and the effects of military sexual trauma.

“Your focus is on the process, the number of people hired. Numbers, numbers, numbers,” Miller responded. “The most important number is the number of veterans getting healthy, healthier or helped.”

“It’s time for us not to do the same thing,” Rudd agreed. “More of the same thing isn’t working ... The way we’ve (tried to address these problems) over the years since the start of these wars is we’ve made the VA larger. I think the evidence would suggest the VA does not need to be larger. I was not encouraged when I heard they’re hiring over 1,000 individuals.”

Instead, Rudd testified, VA should partner with the Department of Defense’s health system TRICARE “because their providers are already in those small communities and available."

“That means shifting money to a non-traditional model,” he added. “But that’s how you connect people to people” instead of linking individual veterans into a vast system.

Related: 

• Soldier Hard's hip-hop lyrics reveal PTSD's rough edges
• 22 veterans commit suicide each day: VA report
• Concern grows about military suicides spreading within families

Sleep-starved from a repeating nightmare and weary from wondering when all that therapy would reignite his fading hope, former Army tank gunner Jeff Barillaro took aim at his stubborn target with an attack as brilliant as it was simple.

He decided to break up with PTSD.

And he would do it in his increasingly famous style — studio-recorded hip-hop, under his stage name, Soldier Hard.

“I thought: If I could write a letter to PTSD, what would I say to PTSD? Then I thought: Oh, wow, this is going to be powerful,” said Barillaro, an Iraq War veteran, out of the service since 2010, who has steadily gained fame among active-duty troops, young veterans and their families for his bare, often-bleak music about the daily demons of living with severe Post Traumatic Stress Disorder. 

Last May, “Dear PTSD,” streamed from his busy mind to his scribbling fingers and, ultimately into a microphone: “Did you listen good when I said, Leave me be? PTSD, get the hell away from me. Cuz you held me down, didn’t even let me sleep, didn’t even let me breathe, didn’t let me live in peace.”

Courtesy of Omar Diaz Photography

Jeff Barillaro, a.k.a. Soldier Hard.

Within the genre of modern military music, Barillaro has ventured a bit further from the mainstream with his growing stockpile of PTSD songs — lyrics and beats tapped from his anger, isolation, divorce, and what he calls “my dark world,” all byproducts, he believes, of extended combat tension and witnessed war horrors.

He has recorded 14 albums, laying down his first tracks on “a minimum setup” at Camp Taji, Iraq, where he discovered that “between missions I could create music as my escape.” He has launched a nonprofit record label, Redcon-1 Music Group, that already boasts a roster containing an Air Force staff sergeant, a Navy sailor, Marine Staff Sgt. Jerry Lozano, and two Army soldiers, including Fort-Hood-based Spc. Stephen Hobbs.

'Music has saved my life'
“I wanted to give other military artists and veterans a chance to tell their stories,” Barillaro said. “Because I know how much music has saved my life. Maybe it can save their life, too.

“I want them to know that same feeling I get when it comes to music, when I’m writing it, and when I’m done and I’m listening to it. I forget where I’m at, any problems I’m having, any bills I can’t pay. It keeps my mind clear. It keeps me sane. That’s why I believe music can really heal people.”

Some of the fans Barillaro has attracted say they are alive only because of the ex-gunner’s lyrical lash outs at anxieties affecting an estimated 20 percent of the men and women who served in Iraq and Afghanistan.

One night in 2007, former Army Corp. and Iraq veteran Keith Briggs said he “was sitting at the computer with a bottle in one hand and a gun in the other,” contemplating shooting himself. He had been diagnosed with PTSD in 2005 just after returning from his second deployment.

Courtesy of Jeff Barillaro

Jeff Barillaro looks at old records of former Iraqi prisoners at Camp Taji, Iraq, after U.S. forces took control of the base.

“For some reason I decided to get on Youtube and I found his song ‘Support Us.’ It changed my outlook on PTSD,” said Briggs, 30, who lives in Shelbyville, Ky. “I knew I was not alone. Soldier Hard's music has saved my life. It has stopped me from suicide. PTSD is a real threat to veterans. Soldier Hard’s music is the tool to fight this."

PTSD expert Dr. Sydney Savion, a retired military officer who has heard Barillaro’s songs, said many of the artist’s themes — particularly when he confronts PTSD — could evoke positive emotions in listeners with post-combat stress. They feel, she said, that he is speaking directly to them, forging a vital bond across the Internet and reinforcing the notion that they are not alone as they all strive to recover.

“Research does suggest that certain music can regulate negative emotions,” said Savion, a Texas-based applied behavior scientist. “But conversely, some therapists have found some music with spoken words or lyrics could cause and has caused agitation when its played for those diagnosed with PTSD. So there is a duality between whether the music will evoke a positive feeling or whether it will conjure up those memories that can cause negative feelings. Not everyone’s going to respond to the music in the same way.

“But there is no definitive line that a rapper should or shouldn’t cross,” she added, “because each individual will respond to it differently.”

'Telling horror stories'
Of course, the quiet irony underscoring Barillaro’s art: PTSD has typically — and purposely — remained a private struggle for many young war veterans. Within the military, the unofficial mantra has been: “Take care of your own business,” or worse: “Getting help is for the weak.” That has affixed PTSD with a social stain common to other mental health issues.

Barillaro, however, has literally shouted out almost every step of his path away from PTSD, stigma and all.

At first, he admits, he was tentative about revealing too much.

“I didn’t want to be looked at as a weak person, and I didn’t want people to be scared (of me). But I was just going to say it because it’s how I feel,” Barillaro said. “And I know there’s a lot of people out there who feel the same way I did. So I decided: I’m going to write it and I’m going to start telling horror stories.

“And then it became not about myself anymore. Because I started seeing how much the music would help other people. Then I was like: Alright, I’m just going to let loose now and let everything out because these people out there are going through same thing I was going through and this gives them some hope.”

The music has helped him. It hasn’t cured him completely. The old nightmare still haunts his sleep: He’s with his buddies in a “Middle Eastern setting,” he said. They begin to take fire from the enemy. His friends are shooting back. But in the dream, Barillaro tosses away his weapon, hides his head and begins sobbing.

“That same dream always, always. But that’s not how I reacted while I was in combat. I was on it," he said. "I don’t even sleep anymore when I wake up from one.”

Courtesy of Jeff Barillaro

Jeff Barillaro, a.k.a. Soldier Hard, crouches in an abandoned building at Camp Taji, Iraq, in 2005

Which — to no one’s surprise — inspired a song released last July: “Intro-Therapy Session.” He takes listeners inside a conversation with a psychologist during which he is asked about any nightmares he’s been experiencing.

“I’m scared, crying and I’m frightened. Then I wake up hella sweaty," he raps. "Tell me why this be. I just wanna die, please tell me: Why me?”

The song’s final verse — accompanied by an ominous, sharp pop and a woman's scream — is not pretty. But, as Barillaro has been preaching all these years, neither is living each day with PTSD. 

Related:

• Hundreds of thousands of veterans spurn free benefits
• Some wounded vets thrive on 'Alive Day,' others wear black
• One inch: Death in combat hinges on the tiniest margins

The weekend homicides of ex-Navy SEAL and “American Sniper” author Chris Kyle and a friend in Texas have stoked fresh concerns among mental-health experts and veteran advocates that the crime’s PTSD theme will further stigmatize and dampen an already-soggy job market for men and women home from war.

“What worries me about this story is it will frighten potential employers away from hiring veterans who have been in Iraq and Afghanistan,” said Dr. Harry Croft, a San Antonio-based psychiatrist who has talked with more than 7,000 veterans diagnosed with Post Traumatic Stress Syndrome.

“The myth is all of them have PTSD  — not true, only 20 percent.  Another myth is that all of them who have a severe case of it — not true; it goes from very mild to severe. The third myth is that everybody with PTSD is aggressive, unreliable, or trouble in the workplace, and none of that is (true) either. It scares me,” Croft said.

The unemployment rate for post-9/11 veterans was 11.7 percent in January compared to 9.1 percent in January 2012, according to the U.S. Bureau of Labor Statistics. Younger female veterans grappled with a 17.1 percent unemployment rate last month — virtually unchanged from one year ago — while the unemployment rate for younger male veterans was 10.5 percent in January, which marked an increase from 7.7 percent during the same month in 2012.

“One of the things I talk about in the presentations I give to employers is how the stigma of the crazed vet like Sgt. (Robert) Bales, or, now, this young man in Texas, is very rare and it’s atypical. Now, that doesn’t mean that a vet with PTSD doesn’t have anger and agitation issues. But generally, it’s worse at home than it is at work,” said Croft, who co-authored “I Always Sit with My Back to the Wall: Managing Traumatic Stress and Combat PTSD.”

Eddie Ray Routh, 25, a Marine Corps corporal from 2006 to 2010 who deployed to Iraq in 2007, was arraigned Sunday on two counts of capital murder in the deaths of Kyle, 38, and Chad Littlefield, 35, at a shooting range in North Texas. Both men were killed with a semi-automatic handgun.

According to Erath County Sheriff Tommy Bryant, Routh "may have been suffering from some type of mental illness from being in the military himself." Bryant added that Routh's mother possibly contacted Kyle to try to help her son. The sheriff also learned, he said, that the three men might have been at the range “for some type of therapy that Mr. Kyle assists people with.”

Some veterans who toil in the job-mentoring trenches to try to deflate those unemployment stats share Croft’s concern that Texas shootings may bolster an existing PTSD stigma and inject more doubt into the minds of some hiring managers.

“Unfortunately, I think that’s a possibility,” said John E. Pickens, executive director of VeteransPlus and the Yellow Ribbon Registry Network. VeteransPlus has offered financial counseling to more than 150,000 current and former service members. The nonprofit also has partnered with The WorkPlace, Citi and Wal-Mart to help long-term, unemployed veterans improve their job candidacies and find work.

“But I’m not sure how to address that (stigma) because for those people who read something like this and take away a negative impression, it’s very difficult — other than having a one-on-one, good experience with a veteran — to be able to overcome that,” said Pickens, a former Army combat medic.

Iraq veteran Ed Richardson, who’s now attending college but who’s been scouting for a job since December 2011, has watched employers offer subtle signals about his war service during job interviews.

“I’ve had people’s body language completely change with me — their eyes get large and they want to lean back in their chair” when the topic arises with hiring managers, said Richardson, 49, who is in the Army Reserves and who lives in Kentucky. “Some ask me: ‘Have you had any issues? Because some veterans have had the problems.’

"Being a veteran and having that going against me (in job hunting), you have to have something to counter it and I believe having an associate degree can help, or preferably a bachelor’s degree,” Richardson said. He ideally wants to work in federal law enforcement. “But I’m very positive about my outlook.” 

Related: 

• Murder of former Navy SEAL turns spotlight on veteran hunting and shooting clubs
• Ex-Navy SEAL sniper Chris Kyle died pursuing his passion
• Florida guide uses hunting as rustic therapy for combat veterans

Firing bullets at a gun range — as a Marine reservist was doing Saturday when he allegedly killed ex-Navy SEAL and "American Sniper" author Chris Kyle — can ignite combat flashbacks, a leading expert on post-traumatic stress disorder said Monday, adding, however, that hunting and target practice can be therapeutic for veterans if their shooting buddies intimately know war.

“The question being asked is: Wouldn’t the shooting of a weapon out in the open trigger feelings, nightmares, flashbacks? The answer is, yes, it can,” said Dr. Harry Croft, a San Antonio-based psychiatrist who has talked with more than 7,000 veterans diagnosed with PTSD. “But the hope would be that those would be triggered in a situation that’s safe, where other people are there who understand PTSD and could help the person cope with the thoughts that may come back to them.

“In situations like a shooting range, the sounds may set off a hyper-vigilant response, maybe flashbacks and nightmares at night. But it doesn’t make you violent, like you’re going to kill the person around you. And if the person around you is a Chris Kyle, a Navy SEAL who knows and can support you, then that experience can have a more positive effect,” Croft said.

Eddie Ray Routh, 25, a Marine Corps corporal from 2006 to 2010 who deployed to Iraq in 2007 and Haiti in 2010, was arraigned Sunday on two counts of capital murder in the deaths of Kyle, 38, and Chad Littlefield, 35, at a shooting range in North Texas. Both men were killed with a semi-automatic handgun.

According to Erath County Sheriff Tommy Bryant, Routh "may have been suffering from some type of mental illness from being in the military himself." Bryant added that Routh's mother possibly contacted Kyle to try to help her son. The sheriff also learned, he said, that the three men might have been at the range “for some type of therapy that Mr. Kyle assists people with.”

Organized veteran hunting excursions and shooting clubs — meant to be part bonding experience, part brief return to comfortable turf and tools — have proliferated across the country in recent years, particularly as American troops departed Iraq and as they continue to pull out of Afghanistan. Croft estimated that about 20 percent of Iraq and Afghanistan veterans have a form of PTSD, ranging from mild to severe.

“I talk all the time about the importance of good support systems for those suffering from PTSD, and articulate, bright, fellow military members like Kyle might have an ability to help a young troop with PTSD more than most (others) might,” said Croft, who co-authored “I Always Sit with My Back to the Wall: Managing Traumatic Stress and Combat PTSD.”

“That’s why it would be very rare if, all of a sudden, (the suspect) got triggered feelings and then would turn the gun and shoot this guy in the back. Something happened that we don’t know or understand, I believe,” said Croft, who has never worked with Routh. “This behavior is totally atypical for people with just PTSD. There can be rage, anger, aggression, agitation, even violence, yes. But it’s generally directed toward family members or one’s self, in terms of this suicide epidemic. Rarely is it outside of that circle.”

The U.S. Department of Veterans Affairs has occasionally partnered with the Tampa, Fla.-based Black Dagger Military Hunt Club to hold shooting programs for veterans. In July, the club is sponsoring the trap shooting competition for the 2013 National Veterans Wheelchair Games in Tampa, providing ammunition and clays. Black Dagger, made up of ex-military members, also holds four to six shooting events per year. Every participant is briefed beforehand by “range safety officers" and supplied weapons. The veterans then work one-on-one with expert shooters, said founder Dave Winters, a 20-year Air Force member who retired as a senior master sergeant.

“We tell them: If at any time you feel uncomfortable about what’s going on out here, if the noise is too loud, put your weapon down, talk to your range safety buddy and just indicate that you need to walk away,” Winters said.

“We’ve had several who were real uneasy about approaching it at first, but once they saw that it was a comfortable thing, (and of course that) no one is shooting at them, that’s what I think helps them. It kind of normalizes them,” Winters said. (One Afghanistan veteran in the club), who feels like no one can relate to him, said that when he’s back out at the range, shooting and talking, it's just like when he was in his unit. It just makes them feel a lot better.”

In central Florida, the Sportsmen’s Foundation for Military Families escorts combat veterans — and their spouses, children, parents or siblings — onto leased land for weekend hunting trips.

“We never cater to just the veteran. Two veterans — or a group of veterans — who are out in the woods together, that does not improve coping skills, generally speaking. What improves their coping skills is their family,” said Barry Hull, a retired Navy commander and F/A-18 Hornet pilot who flew on the first night strike of Desert Storm. He has helped the Sportsmen's Foundation on the business side and attended several hunts.

The group is based on the concept that hunting trips “give the veteran and family a sense that they can once again be like they were, that those good days can be had again, particularly with those who have physical injuries and limitations,” Hull said.

“What improves a veteran’s coping skills is their family. And I know a lot of people want to say, 'Well, they're my military family.' They’re really not your family. Your family is really what I would call the classical definition of family — that's it for the long haul,” Hull said. “If you can develop those coping skills, communication picks up at home. We know that just simply being able to identify your demons lowers the effect (of PTSD). And that's what we do when we get the family out there on these adventures.

“The worst thing you can do is get a bunch of veterans out there in the woods, whooping and hollering and telling war stories, maybe drinking some beer, and not including the family. What does it do? It drives a bigger wedge between the veteran and the family. It's another distance maker,” Hull added. “What does that do? It adds more stress.”

Related:

• Ex-Navy SEAL sniper Chris Kyle died pursuing his passion
• 'American Sniper' author Chris Kyle fatally shot at Texas gun range
• Florida guide uses hunting as rustic therapy for combat veterans

Peter Millett / Reuters

Army Staff Sergeant Robert Bales (L) and Judge Col. Jeffery R. Nance is seen in a courtroom sketch as he is arraigned on 16 counts of premeditated murder, six counts of attempted murder and seven counts of of assault at Joint Base Lewis-McChord, Wash. on Thursday

U.S. Army Staff Sergeant Robert Bales, charged with killing 16 Afghan villagers in a pre-dawn rampage in March, will face a sanity board, the judge in the case said Thursday.

In such a mental health review, neutral doctors are charged with evaluating the defendant's mental state at the time of the crime and whether he's competent to stand trial.

Bales , a 39-year-old father of two from Lake Tapps, Wash., is accused of slipping away from his remote outpost in Afghanistan on March 11 after drinking with fellow soldiers, and killing 16 people, including nine children, in two nearby villages.

Prosecutors say Bales acted alone and with "chilling premeditation" when he visited the villages in the dark, armed with a pistol, a rifle and a grenade launcher. He reportedly returned to his base between his visits to the two sites and told a fellow soldier: "I just shot up some people."

Military judge Col. Jeffrey Nance, hearing the case at Joint Base Lewis-McChord, Wash., said he would order the official review of the soldier’s mental health after prosecutors argued that without it, the defense should not be allowed to raise mental health issues as mitigating factors.  

Bales appeared in court wearing green military dress, entered his deferred plea through one of his defense attorneys, who also waived reading of charges against Bales, Reuters reported.

The soldier faces 16 murder charges, as well as other charges, including attempted murder, assault and drug and alcohol charges.

On Thursday, when asked if he understood that his conviction could result in the death penalty, Bales answered, "Sir, yes sir."

In previous pre-trial hearings, defense attorneys for Bales have raised a number of mental health factors that may have affected Bales — including repeated deployments, a traumatic brain injury and the use drugs provided by the military.

Prosecutors argued that in the absence of an outside review, the defense should be barred from presenting mental health arguments, The Associated Press reported.

"An accused simply cannot be allowed to claim a lack of mental responsibility through the introduction of expert testimony from his own doctors, while at the same time leaving the government with no ability to overcome its burden of proof because its doctors have been precluded from conducting any examination of the very matters in dispute," Maj. Robert Stelle wrote in a Jan. 3 motion obtained by the AP.

Up to now, defense attorneys have refused to let Bales take part in the sanity board, objecting to the terms set out.

However, in a reply to the government's motion, defense attorney Emma Scanlan wrote Tuesday that Bales will participate — as long as only certain information about the results are forwarded to government prosecutors. They say findings about Bale’s state of mind at the time of the attacks should not be provided to prosecutors until Bales' defense team officially gives notice that it will pursue mental-health defense.

"There is no authority for the bizarre proposition that the accused has to submit to a compelled mental health examination before he gives notice of a mental defense," Scanlan.

The judge said conditions for the sanity board will be worked out later.

Related reports from NBC News

Bales case echoes loudly for ex-soldiers on hotline for vets
Witness: Sgt. Bales, accused of Afghan massacre, was deemed a top soldier
Witnesses to describe massacre at Sgt. Bales hearing

Courtesy Jesse Holder

Jesse Holder, a 173rd Airborne trooper, was wounded in 2007 while serving in Afghanistan by shrapnel from an RPG round.

Four soldiers, four battles — and, between them — four total inches separate the slim expanse between death and life.

One died because his armor plating wasn’t one inch higher. Three survived by that same tiny fraction, left to mull the unanswerable: "Why am I still here?"

In the final days of 2012, the somber tally of American service members wounded in action in Afghanistan surpassed 18,000 while the number of U.S. military men and women killed there eclipsed 2,040, according to the Department of Defense.

As Jesse Holder can attest, many of those 20,000-plus causalities are here — or are gone — based on a cold geometric fact of war: So often, everything comes down to a single inch.

"I got hit in the neck and I thought I was done," said Holder, a 173rd Airborne trooper wounded in 2007 by shrapnel from a rocket-propelled grenade while in Afghanistan. The round detonated just above and to the right of Holder’s head as he rode in the turret of an Army truck, patrolling a steep-walled riverbed.

"I said, out loud, 'Oh, this is it. I’m going to die right here.' Everybody in the truck was thinking the same thing because of all the blood."

He was airlifted to a makeshift hospital where a surgeon removed the metal fragment. The doctor then revealed that if the chunk had entered Holder’s neck "one centimeter to the left," it would have opened an artery. He likely would have bled to death in the truck. Instead, he was back on the line 10 days later. He never lost consciousness.

"After the fire fight," Holder said, "when you're back at your base talking about it, that's when it usually comes out: 'I was inches away.' You'll hear: 'If that glass shield hadn't been there, or if that tree hadn't deflected the bullet, I wouldn't be here now.'

"During combat, you try not to think about it. But I think that's why, when people come back, some have a hard time," added Holder, who recently published a book, "Chutes, Beer, & Bullets," recounting some of those close calls. "I've been good at compartmentalizing it, and not thinking about it. But I lost a friend like that. It was the one inch that killed him."

'It could have been me'
That buddy was Army Spc. Jacob Lowell, 22, a 173rd Airborne trooper who had been in Afghanistan for two weeks when his unit clashed with enemies armed with small arms and grenades on June 2, 2007.

Courtesy Jesse Holder

Jacob Lowell, left, is pictured with a fellow soldier. Lowell was killed in action after a bullet narrowly missed his protective armor.

"All my friends, all at one time, they got wiped out," said Holder, who was not part of that mission. "A lot of our guys didn't make it home. My good friend did die by a narrow margin. The bullet went right above Jacob’s protective armor."

The feeling dubbed "survivor guilt" is a sentiment that Dr. Harry Croft, a San Antonio-based psychiatrist, has often heard expressed during his conversations with more than 7,000 veterans diagnosed with Post Traumatic Stress Disorder.

"I've heard lots of stories, including: 'I was so close, it could have been me.' For some, it's almost like they're saying: 'I feel worse about that than if I would have died.' So they bring home this terrible, burdensome guilt," said Croft.

Recovery can be helped by "learning to reframe that event — not to forget it, but to be able to understand it in a different way," Croft said. 

Therapy can include coaxing veterans to talk about — and eventually accept — the notion that "in the heat of war, a lot of things happen, things you wouldn’t wish on your worst enemy," Croft said.

What's more, combat includes the mathematical equation that thousands of deadly projectiles are whizzing back and forth, up and down; some hit vehicles; some hit trees or rocks or dirt; some hit people, and breeze an inch past human flesh.

'There's a reason I'm here'
Former Army helicopter pilot Joe Baginski has lived more than 40 years since a Vietnam mission during which he nearly was wounded or killed so often in the span of just five minutes, he can't even calculate the number of near misses. But he's put his own survival into healthy — and folksy — perspective: "I must have been smiling just right because I never got a scratch."

In November 1968, Baginski, then 21, hovered his chopper at about 75 feet in thick foliage as other men on board dropped crates of ammunition to U.S. soldiers who were running low on bullets amid a battle with a far larger North Vietnamese force. The helicopter's tail rotor spun inches from branches thick enough to bring down the craft. At the same time, North Vietnamese Army troops fired on the chopper. Bullets pierced the floor. The co-pilot was struck in the arm. A sergeant major was hit in the foot. The instrument panel and numerous gauges — directly in front of Baginksi — were obliterated in the barrage. When the ammo drop was complete, he carefully maneuvered the bird up and through the jungle canopy.

"I have no idea how many rounds we had hit on the inside of that helicopter," Baginski said. "But there had to be at least a dozen that struck that instrument panel and fragments were going anywhere. I don't know how close I came but it had to be pretty close."

For soldiers who beat heavy odds to survive harsh battles, finding deeper meaning in their post-military lives can help them deal with nagging wonders about why they came home when buddies did not, Croft said.

"They decide: 'I guess there's a reason I'm here.' That can be the impetus to move forward with life," Croft said. 

That's a sentiment embraced by John Bennett, who was dropped by a sniper's bullet in Iraq in 2005. The bullet entered his right side, shattered two vertebrae, fractured a third, and cost him his colon, his spleen, half his pancreas and his ability to walk.

"An inch to the left, it would have deflected off my ballistic armored plate and I would have been fine. And an inch to the right, it would have hit my liver and it would have more than likely killed me," said Bennett, a former infantry soldier who lives in Cascade, Mont. 

"In the earlier stages of my recovery it was a daily thought: Half inch left and I wouldn't be in this situation. And I still think about it periodically. But, I don't dwell on it," Bennett said. "I am a firm believer in everything happens for a reason. I don't know what the reason was for me to stay alive and be in this wheelchair, but it was for something. Maybe it was to help with articles like this that help others believe they can move forward, no matter what their situation is. Who knows?"

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