Far from winding down, the numbers of U.S. soldiers coming home wounded have continued to swell. The problem is especially acute among those fighting in Afghanistan, where nearly four times as many troops were injured in October as a year ago.
Amputations, burns, brain injuries and shrapnel wounds proliferate in Afghanistan, due mostly to increasingly potent improvised bombs targeting U.S. forces. Snipers' bullets and mortar rounds also are to blame.
Of particular concern are the so-called hidden wounds, traumatic brain injuries and post-traumatic stress disorder that can have long-term side effects such as depression.
Since 2007, more than 70,000 service members have been diagnosed with traumatic brain injury _ more than 20,000 of them this year, according to the Defense and Veterans Brain Injury Center. Most of the injuries are mild but leave symptoms such as headaches and difficulty concentrating.
Vince Short, 42, a former Army specialist who suffered brain injuries in a 2003 roadside bomb attack in Iraq, said he can't help but feel for the soldiers coming home from Afghanistan with similar wounds.
"I cry out for them. It's tough. It's hard to put it in words," Short, who served with the District of Columbia Army National Guard, said in an interview at the Veterans Affairs Medical Center in Washington, where he receives weekly physical and mental therapy.
Thanks to the therapy, he said, he's in a good place. But in the early years of his recovery, he found it difficult to return to work, and his marriage fell apart. Short said he was confident and motivated before he was injured. Now, he has memory problems and suffers from post-traumatic stress disorder.
"At that point, there was still a lot of panicking going on inside of me because it's like, 'What's going to happen to me?'" said Short. "I used to have a career. I used to have a good solid marriage. I was doing really good, and now look at me."
In Afghanistan, spinal injuries have increased significantly, due mostly to the powerful explosives used in the improvised bombs that rattle U.S. troops inside heavily armored vehicles. For those injured by these bombs, recovery can mean a year or more at a military hospital like Walter Reed Army Medical Center, followed by months, years or even a lifetime of therapy and coping with disability.
At least 1,800 troops were wounded in Afghanistan in the first 10 months of this year, about 40 percent of all the wounded U.S. troops in Afghanistan since the Sept. 11, 2001, terrorist attacks. Nearly 1,000 of those injuries occurred in the last three months.
In Iraq, more than 600 troops have been wounded so far this year.
By far, improvised explosive devices are the biggest killer of U.S. troops in both countries.
In Afghanistan in the last four months, the volume of explosives used to make IEDs and the total number of IEDs have increased, Col. Wayne Shanks, chief of public affairs for the International Security Assistance Forces in Afghanistan, said in an e-mail.
Spinal injuries account for one in six of the wounds treated in the Afghanistan battle theater, Shanks said. Of those injuries, about 15 percent involved motor or sensory changes such as a broken back or spinal cord injury, Shanks said.
He said the military has a "concerted counter-IED" effort and is working with the local population to encourage their help.
Garry J. Augustine, deputy national service director of Disabled American Veterans, said improved protective gear and advancements in battlefield medicine have helped _ and have resulted in higher survival rates for those with extreme wounds that often proved fatal in previous wars.
"Getting over the initial injury is one thing, but going about dealing with your life, the rest of your life, with these injuries is quite another," Augustine said.
Sgt. Dirk Bryant, 28, of Creston, Ill., a member of the Illinois Army National Guard, credits those advancements for his survival. He was on patrol near Kandahar, Afghanistan, on Jan. 30 when a bullet cut into his hip and left a softball-sized wound. The experience left him emotional and, at times, depressed as he wondered if he'd be able to walk again.
Through rehab and determination, he said, he has made a near-full recovery. He's currently a student at Northern Illinois University, aspiring to become a museum curator or historian, and could very well go back to Afghanistan to fight.
"I just feel very fortunate," Bryant said. "There's a lot of people that weren't as lucky as I was."
Dr. Joel Scholten, associate chief of staff of rehab services at the VA Medical Center in Washington, said experts are keeping an eye on injury patterns in the war zones so medical treatments can be adjusted as necessary.
"When the war's over, the veterans will still have issues related to service that we'll need to be here for them," Scholten said.
Even when injuries don't involve combat, the recovery process can be a time of reflection and bonding with others in the hospital wards, said retired Lt. Col. Kurt Kosmatka, 50, who came down with a disease while in Iraq in 2007 that's weakened his immune system and left him with respiratory problems. He spent more than a year at Walter Reed and has been at the VA hospital in Washington since January.
He said he feels for those who are wounded and don't have strong family connections to help them through the process.
"It was pretty tough on some guys and girls," Kosmatka said.
On the Net:
Paralyzed Veterans of America: http://www.pva.org/
Disabled American Veterans: http://www.dav.org/
Veterans Affairs Department: http://www.va.gov/