Pain of war

Two years after serving in Iraq, Staff Sgt. Shawn Green lives on pain pills and the charity of the Salvation Army while he applies to the Department of Veterans Affairs for disability benefits. It wasn’t a bullet or an improvised explosive device that left him too racked with pain to work.

The Army reservist said his employer, a Spokane construction company, let him go because the pain running down his back was too great a liability to keep him on. Green believes his pain is from routinely carrying too much weight in Iraq, what the military calls “combat load.”

And, according to new records, Green is not alone.

Inland Northwest soldiers returning from Iraq are more likely to suffer lingering, debilitating injuries from back pain than from battle wounds, according to statistics compiled by VA Medical Center officials in Spokane.

Routinely hefting combat gear that can exceed 120 pounds is sending large numbers of veterans home with back, neck, shoulder, hip and ankle injuries that can cause lasting pain and impairment, says the study of those seeking care at the Spokane VA center. Nearly 70 percent of new war veterans seeking treatment there have injuries related to carrying too much weight, according to the study.

While experts believe a soldier should carry no more than one-third of body weight, Green, who stands 6 feet, 1 inch tall and weighs 235 pounds, believes he routinely carried much more, causing neck and back injuries.

“I’ve never interviewed a group of veterans as heavily laden as these,” said Carroll McInroe, a VA social worker who was first surprised, then alarmed by the number of muscular-skeletal injuries reported by returning soldiers.

“These kids were coming in and sitting down and 10 out of 20 of them were saying, ‘My back is killing me.’ “

Diagnoses of ruptured spinal discs, compressed discs, degenerative disc disease and myofascial pain syndrome, a condition caused by repeated tears in the microfibers of back muscles, have been common.

Many of the ailments can be cured with time and attention, medical experts said. But many also will become chronic, service-related conditions that will cost veterans in pain and loss of productivity, and taxpayers in funding their treatment.

“It would behoove us to do something because one of the doctors told us that once you have a back injury, you have a back injury for life,” said McInroe, who works for the Operation Iraqi Freedom/Operation Enduring Freedom program at the Spokane VA Medical Center.

McInroe analyzed records of 230 soldiers who have come back from war during the past six months and sought medical help at the VA center, out of the 767 National Guard, active and reserve troops who have returned and sought treatment since 2004.

Only 4 percent of those soldiers sought help at the VA for battle wounds, McInroe said.

Sixty-seven percent of the returning soldiers suffered injuries they said were caused by carrying too much weight, McInroe’s study showed. The most common complaint was lower back pain, reported by more than half – 54 percent – of the soldiers. Forty-five percent reported knee pain, nearly a quarter complained of neck pain and 20 percent reported ankle pain, mostly caused by flimsy boots.

Nearly all of those complaints could be traced to the weight of the gear that troops must wear, said Tom Vincent, a VA physician’s assistant who treats the injured soldiers.

“Virtually everybody that comes back that has had to go out and wear the heavy equipment has some kind of muscular-skeletal complaint, absolutely,” Vincent said.

Nationwide, more than 41 percent of nearly 185,000 Iraq and Afghanistan veterans who sought VA health care reported muscular-skeletal problems, mostly back and joint pain, agency statistics showed. The national rate is from medical records and includes veterans from all services. The local rate may be higher because it was gathered from actual interviews with patients, most of whom were infantry.

Some injuries also can be attributed to the unwieldiness of the gear, which restricts mobility, especially in the uneven desert battlefield.

“We can’t run, we waddle,” a soldier reportedly told McInroe.

Green served in Iraq with the 827th Quartermaster Corps, part of the 541st Corps Support Battalion, from March 2003 to March 2004. He believes his injuries were the result of not only carrying too much weight, but also of an accident linked to the bulky gear.

About a month after the invasion, Green’s convoy came under mortar attack while resupplying forward troops 20 or 30 miles north of Baghdad. Exiting his Humvee, Green’s gear got hung up and he had to cut his shoulder strap to get free. He fell out of the vehicle and onto the ground, injuring his shoulder and neck.

“I didn’t want to complain because I wasn’t shot,” he said, adding that at the time there were no medical facilities set up for anything other than serious combat wounds.

His VA health care provider has told him he probably suffered neurological damage. His symptoms include “sometimes unbearable” pain, inflammation and swelling in his neck, left shoulder and back.

Critics of concerns about back pain, however, note that low levels of combat injuries and relatively low mortality rates can be traced directly to improved body armor and other protective gear. It may be heavy and awkward, they say, but it’s effective.

“Add up muscular-skeletal back pain versus coming home in a box,” said Tom Collins, a physician’s assistant treating soldiers at the veterans hospital.

Green said that view is often shared by soldiers who may have been similarly afflicted but are reluctant to come forward because they have seen much more serious wounds in battle.

“They got buddies with arms or legs blown off and they don’t think it’s a big deal,” Green said.

But the U.S. military, with all of its resources, should be able to balance the competing demands of protection and risk, said McInroe.

“We ought to be able to do both,” he said. “We ought to be able to get them home without being hurt by our own equipment.”

In 2004, a groundbreaking study showed that troops in Afghanistan routinely carried up to 33 percent more than suggested maximum weights and up to nearly three-quarters of a soldier’s own body weight.

The study was conducted by Lt. Col. Charles Dean, now retired, an infantry officer serving as an Army liaison to the Institute for Soldier Nanotechnologies at the Massachusetts Institute of Technology. At the time, Dean said weight was twice what it should be and that the only solution was to reduce soldiers’ loads.

“It brought reality to the forefront,” said Fred DuPont, a representative at the Natick Soldier Center at Fort Benning, Ga., who worked on the study. “We’ve been recording weights since the beginning of time. We just haven’t studied it.”

Last year, researchers at the Johns Hopkins Medical Institutions and elsewhere revealed some of the same conclusions echoed by McInroe’s local study. Analysis of injuries at two military pain management centers showed that more than half of soldiers suffered from low back pain and that injuries were caused not by combat wounds, but by more mundane motor vehicle accidents, falls and heavy lifting. Only 2 percent of soldiers who suffered those injuries were able to return to combat.

The researchers, whose findings were published in October 2005 issue of the journal Anesthesia & Analgesia, studied soldiers at Walter Reed Army Medical Center in Washington, D.C., and the Landstuhl Regional Army Medical Center Pain Clinic in Germany. The authors called for better preventive measures, but did not detail whether that would include an overhaul of soldiers’ equipment.

The average soldier carries 75 to 100 pounds of gear into battle, according to several military sources, including Capt. Jeff Landis, spokesman for the Marine Corps Systems Command. McInroe interviewed soldiers who said they routinely toted 120 pounds or more.

There’s no question that that amount of weight is exacerbated by constant wear and the extreme climate of the Middle East, soldiers said.

“When you sleep in it and wake up in it and sleep in it and wake up in it, you have problems,” said Lance Cpl. Robert Carter, 21, a former Marine wounded in battle in Fallujah.

Carter was 19 when he served with Charlie Company, 1st Battalion, 3rd Marines in some of the bloodiest fighting in the Iraq war. Future back pain is the last thing on a soldier’s mind as he heads into a firefight, Carter said.

“It doesn’t matter to us. You need it to survive,” he said. “It could weigh 5 pounds or 500 pounds. You carry it just the same.”

The problem of reducing combat gear weight while maintaining protection is not new, said DuPont, the Fort Benning representative.

“We’d love to send people into combat wearing nothing but shorts and a T-shirt,” he said. “The command is aware of this.”

This spring, the Army introduced a new kind of body armor that promised increased protection from side attacks. The Interceptor weighs about 16 pounds, about 9 pounds lighter than the previous 25-pound flak jacket.

But reactions to the Interceptor line have been mixed and heated, a review of several military blogs and chat rooms revealed.

McInroe said there’s a growing awareness of the link between the load soldiers bear into battle and the injuries they reveal back home.

The Spokane social worker emphasized that he admires the hard work and dedication of the soldiers and their commanders. He said he understands the need to carry protective equipment.

“We must provide them all they need to survive,” McInroe said. “All I am suggesting is lighter, cooler personal body armor and a rethinking of what our young military men and women should be required to carry each and every 14-hour day for one or two or three years.

“We cannot expect them to carry weight beyond human capacity and not pay a terrible personal price over the long run.”