Disposable Surge in discharges includes wounded soldiers

Kash Alvaro stared at the ceiling of an emergency room in January listening to the beep of an EKG monitor for what he guessed was the 80th time in 12 months. The once-healthy Afghanistan War veteran had collapsed in a hallway that night, then awakened confused in an ambulance and lurched up in alarm, swinging and yelling until the paramedics held him down and injected sedatives. Now he lay alone in a room at Memorial Hospital, quietly weeping.

Alvaro joined the Army at age 18 in 2008. In Afghanistan in 2009, he was hit by multiple bomb blasts, including one that threw him across a road like a lawn dart. Sophisticated armor helped him escape with just bruises, but the blasts battered his brain. Ever since, he has been hit with heart spasms and seizures.

Alvaro is in many ways the typical modern disabled veteran. He survived combat with barely a scratch but later was diagnosed with what have become the most common wounds of a decade of war — traumatic brain injury and post-traumatic stress disorder, which together likely affect more than half a million veterans of Iraq and Afghanistan, the Department of Defense said.

What happened when he came home is increasingly typical, too. At Fort Carson, the damaged soldier racked up punishments for being late to formation, missing appointments, getting in an argument and not showing up for work. These behaviors can be symptoms of TBI and PTSD, and Army doctors recommended Alvaro go to a special battalion for wounded warriors. Instead, his battalion put him in jail, then threw him out of the Army with an other-than honorable discharge that stripped him of veterans benefits. He was sent packing without even the medicine to stop his convulsions.

"It was like my best friend betrayed me," Alvaro said at the hospital, his speech as slow as cold oil. "I had given the Army everything, and they took everything away."

After the longest period of war in American history, more soldiers are being discharged for misconduct than at any time in recent history, and soldiers with the most combat exposure are the hardest hit. A Gazette investigation based on data obtained through the Freedom of Information Act shows the annual number of misconduct discharges is up more than 25 percent Army-wide since 2009, mirroring the rise in wounded. At the eight Army posts that house most of the service's combat units, including Fort Carson in Colorado Springs, misconductdischarges have surged 67 percent. All told, more than 76,000 soldiers have been kicked out of the Army since 2006. They end up in cities large and small across the country, in hospitals and homeless shelters, abandoned trailers and ratty apartments, working in gas fields and at the McDonald's counter. The Army does not track how many, like Alvaro, were kicked out with combat wounds.

"I can tell you that 10-plus years of war has placed significant stress on many of our service members, sometimes manifesting itself in their health and even their discipline," said Gen. Martin Dempsey, chairman of the Joint Chiefs of Staff. But he disagreed that the military is using minor misconduct to discharge veterans, saying, "We go to great lengths to try to rehabilitate those who don't meet or maintain required standards prior to initiating separation."

It doesn't take serious misconduct to be discharged and lose a lifetime of benefits. The Gazette found troops cut loose for small offenses that the Army acknowledges can be symptoms of TBI and PTSD. Some soldiers missed formation a handful of times or smoked marijuana once. Some were discharged for showing up late or missing appointments. Some tested positive once for drugs, then were deployed to combat zones because the Army needed the troops, only to be discharged for the drug offense when they returned.

One two-tour infantry soldier was targeted for discharge after missing three doctor appointments because he had been admitted to a psychiatric hospital for being suicidal.

Like many, Alvaro struggled after being kicked out. Too sick to hold a job, with no medical insurance, no veterans benefits and no family support, Alvaro soon became homeless. He started relying on the ER for care — regaining consciousness at the hospital, getting anti-seizure drugs, and being released onto the streets.

In January, friends wheeled Alvaro into a Department of Veterans Affairs hospital in Denver and pleaded for help, but hospital staff said his other-than-honorable discharge barred him from care, handed him the phone numbers for local homeless shelters and wheeled him out.

Lying in a bed at Memorial Hospital, listening to the beep of the EKG, Alvaro said he had lost one-third of his body weight since being discharged in January 2012 and expected to die before spring.

"When I was young, I carried two jobs, never had no health problems," he said, not lifting his head or moving his eyes. "After I got blown up?"

He let the beep of the EKG monitor finish his thought.

A surge in discharges

Posts with large combat units have seen misconduct discharges soar. Fort Campbell, Ky., and Fort Riley, Kan., both home to a disproportionate number of combat troops, each kicked out 65 percent more soldiers in 2012 than the year before. The Gazette found wounded veterans kicked out for minor violations at Fort Bragg, N.C.; Fort Bliss, Texas; Fort Drum, N.Y.; and Joint Base Lewis-McChord, Wash.

The rise in discharges is driven in part by pressure to downsize the ranks and control costs as the wars in Iraq and Afghanistan wind down. The Army plans to cut the force by 80,000 troops by 2017, and top officials said they may cut an additional 100,000 because of mandated federal budget cuts.

At the same time, an estimated 500,000 troops are thought to have PTSD or TBI. Symptoms can include bad decision-making, frayed memory and incendiary anger, all of which can be indistinguishable from misconduct. Commanders struggle to determine which soldiers are badly injured and which are just bad.

Because of this, observers say, the cuts are most likely to fall on soldiers whose performance has slipped because of invisible combat wounds.

"I've been working on this since the '70s, and I have never seen anything like this," Mark Waple, a retired Army officer who now tries military cases as a civilian lawyer near Fort Bragg, said of the surge in discharges. "There seems to be a propensity to use minor misconduct for separation, even for service members who are decorated in combat and injured."

Compounding problems, the United States has long had a dual system that enforces strict discipline for troops during war, then extends support when veterans come home. But the system has not adjusted to the new reality in which career troops deploy multiple times and are often war fighter and veteran at once. That can leave commanders with the difficult choice of maintaining discipline or caring for the wounded.

Army leaders are already exceeding their troop reduction goals, Sgt. Maj. of the Army Raymond Chandler told Army Times in April, adding, "I'm proud of the fact that our solders, our leaders, are being engaged in this and taking action."

Chandler did not respond to requests for an interview for this story.

Lawyers who work with veterans say the Marines, also facing cuts in troops, have seen a similar rise in discharges.

Everyone leaving the military is given a character of discharge: honorable, general, other-than-honorable, bad conduct or dishonorable. The last two can be given only as a result of a court-martial conviction. Most soldiers kicked out for misconduct get an other-than-honorable discharge, records show, which strips them of military and VA benefits.

They can appeal. "But that process is extremely difficult," said Malachi Muncy, an Iraq War veteran who helps soldiers with appeals near Fort Hood, Texas. "It takes years, and often it's not successful."

The federal government often stresses its duty to care for combat veterans. In October, President Barack Obama called it "the single most sacred obligation this country has."

In April, Colorado Sen. Mark Udall said, "The American people have an unbreakable covenant with our veterans and we must provide them the very best health care."

But when soldiers are kicked out, the covenant often is severed.

In this respect, troops have less legal protection than other citizens. If Alvaro had been hurt mopping floors or flipping burgers, his employer would have to pay for his care even if he later got in trouble. Because he was fighting for his country, he does not have that right.

An other-than-honorable discharge sets veterans up for continued struggles, experts say. Some slip into a spiral of unemployment, substance abuse and crime.

"I see it every day," said Lenore Yarger, a veterans advocate who works for a veterans rights organization called The Quaker House near Fort Bragg in North Carolina. "We have gotten very efficient at getting people to fight wars but are not prepared to deal with the aftermath."

Army struggles to respond

At Fort Carson, the spike in discharges is a result of stricter enforcement after years of commanders sometimes ignoring Army rules during hurried deployments, said Maj. Gen. Joseph Anderson, who commanded Fort Carson from November 2011 until March and is slated to take command of Fort Bragg.

The number of wounded soldiers caught in the cleanse is "not a huge problem," he added.

But the true number affected is hard to know. While the Army tracks how many soldiers are kicked out for misconduct, it does not track how many of them are wounded, a Pentagon spokesman said. Even if the service did, the count would likely be inaccurate because science still has no objective way to identify who is truly injured when it comes to TBI and PTSD.

"We don't have any clear diagnosis or any way of showing what functions of the brain the injury affects," said Col. Dallas Hack, director of the Army's Combat Casualty Care Research Program, based in Maryland. "Units are crying for it, but the best doctors can do is look at the history of injuries and symptoms."

That means commanders must decide who is injured when not even doctors are sure.

"It's the hardest thing," Anderson said. "We physically, literally struggle with it every day."

He was so concerned wounded soldiers were being wrongfully discharged that he set up a special team of legal and medical advisers at Fort Carson in summer 2012 to review difficult cases.

"We wanted to make sure no mistakes were made," Anderson said.

The team has been a success, he said. Still, critics say, injured soldiers slip through the cracks.

Roughly 1,000 soldiers were discharged for misconduct at Fort Carson in 2012. Fort Carson said 33 were in the medical discharge process that flagged them as having physical problems. Anderson described it as "not a significant number."

Civilian volunteers who help troubled soldiers say the actual number of wounded soldiers discharged from Fort Carson is higher because many wounded troops do not get a proper diagnosis.

"We see case after case of this," said Robert Alvarez, a civilian veterans advocate.

Other soldiers are discharged in a way that does not require their health status to be considered. Fort Carson discharged 71 soldiers for misconduct in 2012, including Alvaro, through a regulation called Chapter 10 that doesn't require a review of war wounds. A Fort Carson email obtained by The Gazette suggests the Army targets wounded soldiers with Chapter 10 at at least one installation because it's a fast way to get them out.

Fort Carson leaders say that thousands of soldiers have returned from war and been medically retired without getting in trouble, so it is wrong to focus on the small number who do. But critics contend that just as a small number of airplane crashes can reveal wider problems, cases like Alvaro's show how Army systems sometimes fail under stress.

'It was bad out there'

A single paved highway, pocked and patched from insurgent bomb blasts, connects the provinces of Helmand and Kandahar in southern Afghanistan. The scores of soldiers and civilians killed there put it in the running for deadliest road in the world.

In 2009, Alvaro was assigned to the highway.

He was a working-class kid from California who watched the twin towers come down on TV in 2001 and vowed to serve. He joined the Army right out of high school. He was assigned to the 569th Mobility Augmentation Company — a crew trained to find and disarm improvised explosive devices, or IEDs. The unit was nicknamed the Assassins.

The 100-soldier company was desperately needed in Afghanistan. The number of IED attacks had doubled every year since the start of the war and by 2009 accounted for 60 percent of troop deaths, the Department of Defense said.

The Assassins' mission was simple and impossible: find all the IEDs on the highway. It meant crawling along the roadsides at a snail's pace, six days a week, 12 to 20 hours a day. The plodding convoys became easy targets for mortars, rocket-propelled grenades and suicide bombers

"It's scary, really," Alvaro said, remembering the long missions. "To sit in a truck and to look for that stuff. It could be right under you. It could be a mile up. It could be a kid pushing a cellphone. You'll never know it's coming."

Platoons in Alvaro's company started every mission by joining arm in arm in prayer. In one platoon the plea for safe passage was always led by a specialist from Florida nicknamed Preacher. Until Preacher was killed by an IED.

To inflict maximum damage, bombs often came in clusters: one to disable the first vehicle, others to kill the rescuers.

"It was bad out there," said Armando Menchaca, the company's first sergeant. "As soon as we cleared the route, the enemy would plant new IEDs."

Reached by phone recently in Afghanistan, Menchaca, now a master sergeant in another unit, said of his eight combat tours, that was by far the worst.

"The enemy would tunnel under the road and fill it with explosives. We had no way of detecting it. They were smart," he said. "Smarter than us for a while."

The Assassins crawled into sewage-lined culverts, searched mud huts far from the road, pulled all-night missions then slept on the ground in the shade of their trucks. One sergeant boasted that the Assassins were so dedicated they would charge the gates of hell with nothing but a spoon. He was killed with three others by an IED.

The Assassins' battalion, the 4th Engineers, defused more than 300 IEDs. The Army awarded them the Valorous Unit Award for extraordinary heroism — the highest unit honor awarded by the Army.

The Assassins were the best company in the Engineers, finding three times as many bombs as any other, commanders said.

"But we lost the most in the battalion, too," said Maj. Heath Papkov, who commanded the company. "Over 20 wounded, seven dead, guys blown apart, paralyzed. I don't talk about that deployment to anyone. ... I have blocked everything out. It's too painful."

A deadly night

Alvaro, who rose to the rank of specialist, lost count of the number of times his platoon was hit by bombs, snipers and rocket-propelled grenades. "The little ones you forgot. If no one was hurt, you moved on," he said.

But the big ones he never forgot.

For him, the worst came on Oct. 23, 2009. When asked about it, he clenched his jaw and tears slipped down his cheeks.

Like most days, the platoon spent 12 hours creeping down the highway, checking culverts in a landscape dotted with farms and hidden enemies.

When they arrived at the base where they would sleep out in the vehicle yard, it was almost dark. They were pulling down their cots when a call crackled over the radio.

An Assassins platoon had hit an IED. No serious injuries, but the blast had blown the front off a mine-sweeping truck, and it needed a tow. Alvaro grabbed his rifle and climbed into a truck. Before he was out the gate, he said, another message arrived: A second truck was hit. Guys were hurt.

No one realized it until it was too late, but the enemy had buried a ring of at least six massive IEDs.

By the time Alvaro arrived 10 minutes later, he said, a third truck was down.

Alvaro, 20 at the time, was one of the first from his platoon to wade into the wreckage.

"It was just like stuff you see in the movies," he remembered. "Everything destroyed, on fire."

Alvaro walked up to a truck called an MRAP — a 17-ton, $550,000 "mine-resistant ambush protected" troop carrier that had replaced standard Army Humvees starting in 2007 because it provided better protection from IEDs. The truck lay mangled in a crater, the doors blown open, the front end shredded, the 500-pound gun turret flung across the road.

The gunner was a close friend. Alvaro had promised the man's kids he would bring their dad home safe. Now he lay dead far from the truck where the explosion had thrown him.

Alvaro kept moving. As medics tended the wounded and an approaching helicopter kicked up dust, he was ordered to go through the crippled trucks, pulling out weapons, radios — anything the enemy might want. The insides were spattered in blood and bits of flesh. In one truck, Alvaro grabbed a small computer and found the teeth of a lieutenant embedded in a shattered screen.

In the next truck, soldiers had pulled the mangled body of a friend who had three kids. Alvaro picked up the man's bloody gear and carried it away.

It grew dark. Alvaro was standing in the road waving a truck forward when a tire rolled over another IED. There was a deafening crunch then a flash that devoured everything.

The blast hurled Alvaro across the road. He crashed on his head 20 feet away and lay there, out cold, not breathing for what soldiers later said was about five minutes. A medic shoved an emergency breathing tube down his throat. A good friend, later paralyzed by an IED, ran over and started screaming Alvaro's name, Alvaro said, and pounding on his chest until he finally took a breath.

Mice and men

Science is only starting to reveal the full impact of blast injuries like the one that hit Alvaro.

In 2010, researchers at Boston University began exposing laboratory mice to a blast designed to mimic an IED, then testing their brain function. The lead researcher said the results, published ifn 2012 in the journal Science Translational Medicine, were shocking.

"By all appearances, they seemed fine," said Dr. Lee Goldstein, the lead author.

The mice exposed to the blast continued to run around their cages, eat and groom themselves.

After two weeks, the researchers began running the injured mice through a maze to see if more intricate brain functions were damaged. They also ran healthy mice through the maze.

At first, both groups struggled in the unfamiliar maze. After successive trials, the healthy mice learned to find the maze exit on the first try. The mice exposed to the blast, however, wandered around, fumbling each time to find their way.

"They had trouble learning and remembering," Goldstein said. "They had trouble understanding the context of situations."

Using high-speed cameras, the team discovered the cause. The blast had caused a violent "bobblehead effect," whipping the mice's heads back and forth so fast that 10 whips went faster than the blink of an eye.

A month after the blast, researchers dissected the brains. Under the microscope, they found widespread damage. Blood vessels and neurons had snapped, and tangles of toxic protein, called tau, were amassing in the tissue. The brains of mice exposed to a single blast looked like brains of humans with advanced Alzheimer's.

"We were stunned, stunned," Goldstein said. "To see any damage after one blast was unexpected. To see this much? We had to underplay the results because we thought no one would believe us."

Subsequent dissections of blast-exposed mouse brains showed the initial trauma caused a cascade of damage to cells, and the mice continued to deteriorate long after the initial injury.

The team found similar damage in deceased veterans exposed to IED blasts.

Human TBI patients face their own maze when they try to navigate society, and evidence shows they struggle. A 1996 study in the Journal of Trauma Injury, Infection and Critical Care found that troops diagnosed with TBI were twice as likely to be kicked out of the military for misconduct.

"Their brains are essentially short-circuited, their executive function is impaired. No one thought the damage was this extensive or this long-term," said Dr. Ann McKee, who analyzed the veterans' brains for the Boston University study. "We need to broaden our view of this injury. This is serious trauma, it's just at a microscopic level. We need to be able to develop a way to assess the damage so that people who are not misbehaving willfully are not needlessly punished."

'What you had to do'

The day after the blast, Alvaro woke up in a hospital in Kandahar with a stabilizing collar on his neck and no idea how he got there. Slowly, he started to piece together what had happened and said he began to cry.

Records show Alvaro stayed in the hospital for at least two days. Typically, the Assassins' head medic said, a soldier hospitalized for a blast is automatically awarded the Purple Heart. For unknown reasons, Alvaro was not. What might have been a simple oversight later plagued him in the United States when commanders accused him of faking injuries.

On the second day, the Assassins' top sergeant visited the hospital, and Alvaro told him he was OK.

"He just said, 'I'm ready to go, First Sergeant'," Menchaca said.

Alvaro still felt shaky but knew the Assassins had lost so many soldiers that they needed him.

"You had to do what you had to do," Alvaro said.

Back out on the highway, he started to fall apart. He had trouble focusing. His left eye drooped to one side. Parts of his memory were wiped clean or reshuffled.

He lost his appetite and dreaded sleep because of the bloody trucks he saw in his dreams — all signals of PTSD.

"Your mind changes," Alvaro said, remembering the remaining four months of the tour. "I don't think I'll ever be the same or have the heart like before I joined. At the time, you did not think about it. You break down sometimes, but you do it alone and get back in the truck the next day."

Alvaro's immediate sergeants grumbled that the soldier no longer seemed to care about his job, Menchaca said. "They said he seemed worn out. But that happened to a lot of soldiers. These guys who had to clean up when comrades were killed, put pieces of their sergeant in a bag. It was hard, and these were good soldiers. By the end, we were all tired and worn out."

Coming Home

The Assassins came home to Fort Carson in February 2010 to a flurry of ceremony. Commanders gave speeches, the Colorado Rockies held a tribute for the 11 soldiers killed in the battalion, the whole unit got a steak dinner from a volunteer group called the All-American Beef Battalion.

Alvaro couldn't handle any of it. He kept seeing the pieces of his friends and smelling the burning trucks. He could not concentrate. He heard voices that were not there. Still too young to go to bars, he drowned his symptoms in tequila in his apartment off-post. Soon after coming home, Alvaro was awarded the Army Commendation Medal for dedication to duty and selfless service but felt as if he had failed. He had not protected his friends. Why had those men, those fathers, died, and not him?

In March 2010, a month after coming home, he went to the hospital at Fort Carson with two broken hands. He told doctors he had hurt them playing football, records show. In reality, he said, he had been thinking about the men who died and punched a wall until he bled.

That spring, Army doctors diagnosed Alvaro with PTSD and TBI, medical records show. He began seeing a civilian psychiatrist weekly and getting medication for depression, nightmares and persistent headaches.

Then the seizures started. One night two months after getting back, Alvaro went to a barbecue at a friend's house. Suddenly, he got a strange metallic taste in the back of his mouth and fell writhing to the floor. An ambulance took him to Fort Carson's hospital. It was a trip he made several more times in the next year, medical records show. Seizures came on unexpectedly accompanied by splitting headaches and chest pains that felt like a heart attack, Alvaro said.

"We'd be chilling in his room or something and his eyes would roll back in his head," said Chance Fraher, a soldier who said he took Alvaro to Fort Carson's hospital on several occasions. Fraher was also later kicked out for misconduct and soon became homeless.

Alvaro started getting in trouble. He didn't seem to listen any more. He had a surly attitude. He was lethargic, soldiers said. He got written up for arguing with a sergeant and showing up late for duty.

"It's not unusual after a hard deployment, 90 or 100 days out to start seeing the problems, the drinking, the fighting," Menchaca said. "A good leader has to look for that and be ready for it."

But 100 days out, Menchaca had left for another assignment. So had the company's captain, Papkov. New commanders took their place.

Alvaro was missing duty to go see doctors. He was showing up late complaining of seizures. Yet he had no Purple Heart proving he'd been injured.

Despite growing medical evidence and repeated efforts to educate the ranks, an attitude lingers in the Army that dishonest soldiers use PTSD or TBI as an excuse to get out of duties — and a way to cheat the Army out of benefits — and doctors are too quick to diagnose them, soldiers said. Despite all that happened in Afghanistan, Alvaro was seen as one of them.

"He was not a good soldier," said Sgt. Kimberly Grant, the senior medic in the company.

Alvaro had been caught in Afghanistan with a government BlackBerry that did not belong to him, she said, and mouthed off to superiors, so he got a reputation as a troublemaker.

"As far as his seizures, no one really believed him," she said.

On top of that, many of his superiors had a poor understanding of his injuries. Asked about Alvaro's blast injury and hospital stay in Afghanistan, Grant said it never happened.

"They thought I was a malingerer," Alvaro said. "They'd say things like 'worthless soldier, you're just garbage; I don't know why you are in the Army.' "

"He was a dirt bag," his former squad leader, Sgt. David Daniels, said when reached on Facebook.

A new first sergeant, Paul Jones, took over the Assassins. Jones, assigned to rebuild the company for another deployment, said he would not be giving medical discharges for any "sorry excuses," soldiers said.

"He didn't like you, whatever you may have done wrong, even if you haven't done nothing wrong, he was going to bring something up on you, and he did," Alvaro said.

Jones and 22 other soldiers, sergeants and officers in the company contacted for this story did not respond to requests for comment, but doctors' notes in Alvaro's medical records tell a story of a unit bent on making his life difficult.

The Assassins interfered in medical appointments, refusing to give Alvaro rides to appointments, then writing him up for the appointments he missed.

When an ambulance showed up in September 2010 after Alvaro collapsed during training, an incident report shows, a sergeant told the paramedics Alvaro "has done this before" and "This 'episode' is just another attempt to gain sympathy."

Invisible wounds

With Alvaro, the Assassins were struggling with a larger problem the military has yet to solve: If a wound is invisible, how can anyone tell it is real? And even if it is real, how can anyone tell if it's responsible for a soldier's conduct?

In the past five years, the military has spent more than $700 million on TBI studies, in part to try to answer these questions. It has spent millions more so the Army can identify and treat soldiers. Since 2007, Fort Carson has increased its behavioral health and brain injury staff by four times.

Col. Dallas Hack, who heads the Army's medical research branch, said technological advances will one day be able to definitively show not only whether brains are damaged but how the injuries affect decision-making.

"We are in the midst of a neuro trauma renaissance. We are making very fast progress," he said. "But some of these advances are still years in the future."

For now, Hack said, the military is in the difficult position of knowing TBI and PTSD are serious injuries but not being able to say definitively who has them or what functions they affect.

The uncertainty can cause confusion for leaders who must enforce discipline, especially young leaders at a platoon level who encounter the injuries most often.

"It's hard to figure out," said Maj. Gen. Anderson, who was the final authority for discharging soldiers at Fort Carson. "You are asking young captains, 30-year-old guys, platoon leaders, 25 years old, to decide if this guy is sick or this guy is not sick when the doctors don't know for sure."

The uncertainty sets up clashes. The Gazette has uncovered several cases at Fort Carson where doctors and commanders were in direct conflict. Doctors sent one soldier who pointed a gun at the soldiers in his squad to a psychiatric hospital, and commanders pulled him out and put him in jail. Doctors said another soldier who tested positive for marijuana could not be kicked out because he had a brain injury. Commanders discharged him anyway. Another soldier tried to commit suicide by crashing his car into a light pole. Doctors said he had PTSD and depression; commanders discharged him for damaging property.

Several doctors contacted at Fort Carson refused to comment.

Anderson refused to discuss individual soldiers but stressed he can't ignore regulations because someone is hurt.

"You do your job, we're going to do right by you," he said. "But guys that are being disrespectful, steal from their buddies, all those things that bring down discipline on the post, we are not going to tolerate."

The Army is allowed to kick out wounded soldiers who break the rules as long as someone in the behavioral health staff determines the conduct was not caused by service-related injuries. This creates an incentive for soldiers to be misdiagnosed, critics say.

With no clear guidelines, Anderson said, he judges soldiers by their service.

"My job is to look at the pattern," he said. "We all make mistakes, and soldiers in that population are a high-risk population. We don't crucify them all for one offense. Two offenses? It depends. There is no set rule. I look at every case independently and say what is medical and what is the pattern of conduct up to that point."

A review of recent Fort Carson cases shows, though, that soldiers are discharged for one offense.

In October, a sergeant named Dennis Tackett, who had been a handler of bomb-sniffing dogs in three tours in the wars in Iraq and Afghanistan, came before Anderson. Diagnosed with PTSD, with a history of suicide attempts and in the medical discharge process, the soldier with a clean record had punched a man in the face while drunk.

Anderson had the authority to let the sergeant medically retire but threw him out for misconduct.

"He said my PTSD didn't make me drink," Tackett said. "I made that decision."

The waiting wounded

A collision of forces created the surge in misconduct discharges, observers say.

First, the Army no longer needs as many soldiers. During the height of the wars in Iraq and Afghanistan, Fort Carson would overlook drunken driving or minor civilian charges and even illegally deploy soldiers with active felony cases. Now, the Army is looking to cut 80,000 soldiers by 2017 and may eliminate an additional 100,000 troops during the next 10 years due to the sequester. In response, it has tightened discipline standards.

"You have a bunch of worn-out, used-up troops. The easiest thing to do is get rid of them. They did the same thing in Vietnam," said William Brown, a professor of sociology at Western Oregon University who was a lieutenant at Fort Carson during the Vietnam War and now studies veterans.

Second, the system for medically discharging injured soldiers, known as the Integrated Disability Evaluation System, or IDES, is overwhelmed. Army-wide it has 28,000 soldiers. More wounded troops are waiting longer to get out of the military. It now takes on average 418 days at Fort Carson, not including the months before the soldier enters the formal process. In the meantime, troops suffering from injuries that can encourage misconduct are more likely to "engage in negative behavior" that could get them thrown out, a 2012 Government Accountability Office report about the stalled medical process said.

Third, the waiting wounded are a burden to their units, observers say, because the wounded can't deploy but can't be replaced until the clogged medical system discharges them. The Army has special battalions designed to take wounded soldiers off the rolls of combat units, but it is difficult to get in with just PTSD or TBI, according to civilian advocates and Army medical staff at posts across the country.

These wounded soldiers can cripple a combat unit, affecting its ability to fight and inhibiting the career advancement of its commanders, Army officers said. Because of this, commanders have incentive to find ways to get rid of the wounded. The fastest way is a misconduct discharge.

Finally, other avenues for quickly getting rid of underperforming troops have been blocked by Congress. During much of the Iraq War, the military could discharge soldiers by saying they had a pre-existing mental condition, often what it called a "personality disorder." An estimated 31,000 veterans have been discharged this way since 2001. After Congressional hearings in 2007, the military put safeguards in place that made that type of discharge increasingly slow and difficult, causing some commanders to look for other quick ways to discharge problem soldiers.

"The system is broken," said Michael Chumbler, a command sergeant major in the Army Reserves who works as a civilian with troubled veterans in Colorado Springs. "In the last 10 years, warfare has evolved. Armor has evolved. Medical care has evolved. We have a lot of guys coming home who never would have. And the system that deals with them afterward has failed to evolve, too. Something has to change."

'A pig in a python'

The Assassins wanted to get rid of Alvaro through something called Chapter 14.

The ways a soldier can get an "administrative separation" from the Army are spelled out in separate chapters of Army regulations, so soldiers often call it getting "chaptered out." Soldiers can get chaptered out for all sorts of things including Chapter 8, pregnancy; Chapter 9, alcohol or other drug rehabilitation failure; and Chapter 14, separation for misconduct.

In September 2010, the Assassins tried to chapter Alvaro out for mouthing off and stealing the BlackBerry, but the unit was stopped because Army rules require any soldier who is in trouble but has TBI or PTSD to have a full medical evaluation. An Army psychologist halted Alvaro's Chapter 14, saying the soldier "has significant symptoms of PTSD and TBI and cannot be cleared." He recommended Alvaro for a medical discharge instead, medical records show.

Regulations don't prohibit the Army from kicking out a wounded soldier but do require the soldier to complete the medical evaluation process first so the Army can know the extent of injuries.

That put the Assassins in a tight spot. They were headed to Afghanistan again in 17 months. Medically discharging Alvaro would take about 14 months. Until he was gone, the unit could not get a replacement.

A medical discharge requires a gamut of physicals by the Army and VA to identify injuries and assign a disability rating that determines cash benefits.

"It can take a long time," said Lt. Col. Vincent Barnhart, who runs the medical discharge system at Fort Carson, adding that the surge of injured now working their way through the program is like "a pig in a python" and Fort Carson still has a significant bulge.

The situation is the same at Army posts across the country. The glut has increased the wait for medical discharge 47 percent Army-wide since 2008, the Government Accountability Office said.

The military and VA are adding staff to deal with the backlog but have yet to cut the wait, the Department of Defense said.

The delay encourages units to kick soldiers out, observers say.

"It makes commanders do what they wouldn't ordinarily do," said an officer at Fort Carson who wished to remain anonymous for fear of retribution. "They have a motive to circumvent the system. And it's the soldier who pays the price."

Transfer denied

There was a better option for Alvaro — the Warrior Transition Unit.

The Army created Warrior Transition Units in 2007 in part to ease the burden on combat units, which could transfer wounded soldiers to the WTU and get replacements. Soldiers would still count as part of the Army's total numbers, but they could focus on healing. Combat units could focus on the mission.

In the same month the doctor said Alvaro couldn't be kicked out of the Army, he also recommended moving the soldier to the WTU, medical records show. He drew up paperwork for the transfer. Alvaro said he got the papers signed by his captain and squad leader, but, he said, 1st Sgt. Jones refused.

"He left it on his desk," Alvaro said. "He said, 'Oh, I'll get to it when I get to it.' "

Alvaro said the sergeant never got to it.

Jones did not respond to repeated requests for comment.

In October 2010, Alvaro's Army psychologist noted Alvaro's "unit continues to harass him including not giving him a ride to his appointment today." The psychologist called his commander to encourage him to move Alvaro to the WTU but got only his voice mail, records show. There is no record the commander called back.

Even with the paperwork, it is unclear whether Alvaro could have gotten into the WTU. Fort Carson's unit has been steadily shrinking from 900 soldiers in 2008 to fewer than 300 in 2013, and a Fort Carson officer said now "it's nearly impossible" to get PTSD and TBI cases in. Army-wide, the WTU population has shrunk from 13,500 in 2008 to about 8,000 in 2013.

"The WTU is chronically full," said Alex Bacon, a veterans advocate near Joint Base Lewis-McChord in Washington. "If you have PTSD or TBI, you can pretty much forget it."

Anderson, Fort Carson's former top general, said the decline is explained by better health care in combat units, which decreases the need for the WTU.

Chumbler, the sergeant major, said another force is at work. "It counts against end strength. Every soldier you have in the WTU is a soldier you don't have in a line unit. The Army doesn't like that."

The head of the WTU system, Brig. Gen. David Bishop, declined an interview.

Kept out of the WTU but still working through the medical discharge process, Alvaro spent the next year with the Assassins. The Assassins couldn't chapter him out until the medical evaluation was done, but couldn't use him as a soldier either. He couldn't train. He didn't like his command, and they didn't like him, he said. But he had to show up every day to do nothing. He grew increasingly despondent, even suicidal. The Army sent him four times to psychiatric hospitals.

Chapter 10

"How frustrating it is," when units are waiting to discharge a wounded soldier Fort Carson's lead prosecutor at the time, Maj. Javier Rivera, wrote in an email to the post's other prosecutors Aug. 14, 2009. "The soldier continues to use drugs, doesn't show up to work, gets in trouble all the time ... and believes himself untouchable just because he is pending (medical discharge.)"

Email obtained by The Gazette: Fort Carson's legal advice on kicking out wounded soldiers

"It is time to start teaching these kinds of soldiers a lesson," he wrote in the email, which was given to The Gazette by a Fort Carson officer. Rivera wrote that he had figured out a quick and easy way to get these wounded soldiers out: Chapter 10.

Chapter 10 is an Army regulation that allows soldiers facing court-martial to offer to resign in lieu of prosecution. It's supposed to be a win-win: The Army is spared the expense of a trial, and the soldier avoids prison. In exchange, the soldier is stripped of benefits.

Because, in theory, the soldier voluntarily proposes to resign, Chapter 10 immediately stops the medical discharge process that is required under other chapters. A wounded soldier can be out in days or weeks instead of more than a year.

Fort Carson began misusing Chapter 10, Army lawyers at Fort Carson said. They realized that threatening a soldier with court-martial and prison time, then offering a Chapter 10, was a faster way of getting a soldier out than a standard misconduct discharge.

After the email was sent, use of Chapter 10 discharges tripled at Fort Carson from 30 in 2009 to 90 in 2010, discharge records show. Use increased again by 60 percent to 147 in 2011.

It became the dominant way to kick out soldiers in Alvaro's battalion and several other units, Fort Carson documents show.

Army regulations state: "commanders will ensure that a Soldier is not coerced" to take a Chapter 10. But a senior Army lawyer said Fort Carson often threatened soldiers with prosecution then encouraged them to sign a Chapter 10.

"It was designed to help soldiers. Instead, it has been used to circumvent safeguards put in place by Congress," the lawyer said. "It is illegal and morally reprehensible. Regulations say you can't use a Chapter 10 just because it is quick and easy, but that is what they started doing."

'Extract a signature'

As Alvaro languished, he got in trouble for things like being late, he said. The Army would not release information about his misconduct.

In September 2011, Alvaro said, the first sergeant wrote him up for patterns of misconduct and gave him 28 days of extra duty, scrubbing toilets and mopping floors. When he finished work at midnight, he would take a handful of pills for seizures, depression, headaches and nightmares and go to sleep so he could be up at dawn for formation.

Alvaro watched one battle-worn Assassin after another rack up misconduct infractions and get kicked out, he said. "There's a few close friends that got released that are just as bad off as me. They are living life hard now, too."

In October 2011, just months away from completing his medical discharge, Alvaro was still trying to transfer to the WTU. He said he went to the first sergeant to ask him to sign the papers. When the sergeant didn't, Alvaro said he told him, "You are supposed to help your soldiers. If you are not going to help me, then I am going to help myself."

Alvaro left Fort Carson vowing never to return. He was AWOL.

He said he holed up in his apartment, angry and scared. He didn't want to go back, but without medicine, his seizures and nightmares would roar back. Finally, he said, after about two weeks, he called the Assassins and said he was sorry. He was coming back.

Alvaro expected extra duty for his misbehavior. Instead, as soon as he got to Fort Carson, he said, the Assassins stripped him of his uniform, gave him an orange felon's jumpsuit and took him to the El Paso County jail.

Fort Carson usually locks up soldiers only if they pose a physical danger, lawyers said. Alvaro had never been violent but said he was told he was a threat.

"They put him in the county jail with one intent, to extract a signature," said Alvarez, the Colorado Springs volunteer who helps veterans. He said he has seen several soldiers in the past year treated in the same way.

In jail, medical records show, Alvaro had seven seizures.

After four weeks, he said, his commanders came to see him. The Assassins were going to court-martial him for patterns of misconduct, he said they told him. If convicted, he faced up to five years in prison.

"You can fight it if you want," he remembers his captain saying. "But you'll lose."

The captain slid Chapter 10 paperwork across the table, Alvaro said. The soldier signed.

"They said if I signed this paperwork everything would be alright and I would get out," Alvaro said. "I thought they said I'd still have my benefits. I didn't really understand. I'm not as smart as I used to be."

His captain, Dustin Centofanti, did not respond to requests for comment.

A few weeks after Alvaro signed, in November 2011, the Department of Defense's newspaper, Stars and Stripes, published an article detailing how coerced Chapter 10s had become Fort Carson's "unofficial policy, and that leaders used the system to get wounded, troubled soldiers out of the Army fast."

Chapter 10s dropped sharply after the publicity, data shows, but overall discharges did not. Fort Carson shifted back to discharging soldiers by Chapter 14 and started kicking out more soldiers than ever.

The Army did not curtail use of Chapter 10 overall. At other posts, Chapter 10s are on the rise. Army data shows from 2011 to 2012 use of the discharge shot up 60 percent, from 30 to 46, at Fort Campbell and 258 percent, from 30 to 75 at Fort Drum.

"We see it all the time, mostly for minor stuff," said Greg Rinckey, a lawyer in nearby Albany who specialized in military cases. "A lot of these guys should go though a medical discharge but this kills the process. It's too bad. And I think with the downsizing we will see it more often because it is a quick way of getting rid of people."

'A dark time'

Alvaro said he was out of jail a day after he signed.

While Alvaro was locked up, the first sergeant who had been so hard on him was caught drinking on duty and was relieved from his post, soldiers say, but Alvaro's Chapter 10 went forward anyway. The sergeant remains at Fort Carson. Anderson discharged Alvaro on Jan. 5, 2012, with an other-than-honorable discharge. The soldier got no severance pay or job counseling. He said he did not even get a bottle of anti-seizure medicine.

That night, he ended up in the emergency room, records show.

"It was a dark time," he said. "I was angry, real short with people. My nightmares were getting worse."

So were the seizures, he said. Much of the time, he lay in bed, exhausted by convulsions and pinned down by depression. When he looked for work, no one was willing to hire a disgraced vet with a serious medical condition.

After a few months, he lost his apartment. He sold his car and furniture. He crashed with Army buddies, friends and friends of friends.

He tried hiding his injuries to get a job. After the Waldo Canyon fire, he shoveled wreckage from burned neighborhoods, never mentioning his seizures. But after a month, he missed too many days of work and his boss fired him.

He said he would likely be on the street if he had not met a 21-year-old woman named Angel Moreno in October. In a few weeks, he had moved in with her mother, father and her two young kids. He slept on the floor by the TV in the front room.

Alvaro's seizures at first were scary, Moreno said, but his gentle ways and sweet humor drew her in. Soon her kids were calling him dad.

Another quick discharge

When an ambulance took Alvaro to the hospital in January, his heart was beating erratically, as if he was having a heart attack, but he knew doctors would give him some drugs and discharge him without further care as they had dozens of times before. In the meantime, he stared at the ceiling.

After midnight, his girlfriend arrived and sat by his bedside. They talked quietly until the conversation turned to the night of the blast. Suddenly, Alvaro's voice dropped, and he started to stutter.

"The gunner ... He, he, he was blown out of his truck, and the turret cut, cut, he, he, he in half," he said, starting to weep. "You ... You think you can help. You think you will be able to resuscitate your best friends, save them, help them."

His girlfriend wiped away his tears. "Just relax," she said.

"Those same guys, I had to carry their coffins onto the plane," he said through his tears. "Those guys. When I got home, I went to the family because I was the closest to them."

His nose started to bleed.

"Let's talk about something else," Moreno said softly.

"No! I feel bad!" he yelled through sobs. "You hope you'll be that same person but ... That day we got hit, we got hit four times. We asked for backup. It never came."

At that moment, a doctor came in with a clipboard and an efficient smile. "Good news," he said. "We don't need to put you in the hospital. There is nothing wrong with your heart."

There was no more they could do at the ER, he said, and Alvaro should make an appointment with his cardiologist.

"W-w-w-w-w-what to look for if it is a heart attack?" Alvaro stammered.

Have a cardiologist check it out, the doctor said.

Alvaro haltingly explained that with no insurance he could not see a cardiologist.

"I'm sorry," the doctor said, already glancing at his clipboard and the door. "I guess that is the fiasco of our health care system. Maybe you can live with it."

A nurse came in with discharge papers for Alvaro.

Alvaro lifted a hand that was fluttering like a trapped bird and signed.

"Perfect," the nurse said and left. A half-minute later, Alvaro had a seizure.

His arms locked. His eyes rolled back in his head. He stopped breathing.

His girlfriend pressed a pillow to the metal rail of the bed with a practiced hand to protect his head.

She stroked his hair and whispered, "Breathe, baby, breathe."

Nurses rushed back in. Tubes went back into Alvaro's arms. He woke with a jolt then slumped back, too exhausted to move.

After an hour, the doctor stepped in with his clipboard. He told Alvaro there was nothing more they could do at the ER; Alvaro really needed to see a neurologist.

'We owe it to them'

Alvaro eventually got some help from a collection of volunteers that is sometimes called "the patchwork network."

In December, Alvaro contacted the Veterans of Foreign Wars asking for help.

A specialist with the VFW in Lakewood, Terry Jacobson, started trying to get the Army to change Alvaro's discharge. Then he connected Alvaro with a volunteer from Denver who started making calls to get the soldier Social Security benefits. She called another volunteer who brought Alvaro food, clothes and furniture. That volunteer called Alvarez, the veterans advocate in Colorado Springs, who found a cardiologist willing to see Alvaro for free.

Alvarez signed Alvaro up for food stamps and drove him to get his medical records so he could appeal his Army discharge. He helped Alvaro apply for indigent medical care, tried to get him admitted to a VA hospital, paid for medicine out of his own pocket and slipped him cash for Christmas presents for Moreno's kids.

Late in February, Alvaro qualified for disability benefits from Social Security. He will eventually get some medical care and a small monthly payment for living expenses. With help from a volunteer he got a grant to take college courses online.

Still, the help has not undone what happened in Afghanistan. In April, Alvaro started bleeding in his intestines and losing weight. His vision, never right since the blast, grew blurry. Paralyzing headaches made studying nearly impossible.

In late April he landed in the hospital with tingling in his legs and double vision. He had a seizure in the ER.

With hooded eyes fixed on the ceiling, he talked about what he would do if he could ever get better.

"I'm going away," he said. "Go to the mountains, somewhere quiet. Where I don't have to worry. Just live there. Die there. And die in peace." He was discharged hours later.

With so many invisibly wounded from a decade of war, Alvarez said he gets calls from soldiers like Alvaro every week.

"I don't understand it, how the Army kicks these guys out," he said one day as he walked out of Alvaro's apartment. His phone rang, and he looked at the caller ID. "This guy calling here did three tours. Got a DUI. Now they want him out. These guys have seen some of the most horrific things you can imagine. We broke them; we owe it to them to take care of them."

He shook his head.

"Anything else would be dishonorable."