Originally published February 12, 2011 at 5:01 PM | Page modified February 13, 2011 at 10:48 AM
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Weight of War: Gear that protects troops also injures them
Military studies acknowledge that combat soldiers are carrying too much weight — often more than 100 pounds. These loads have contributed to soaring numbers of injuries, and higher costs in disability payments.
By Hal Bernton
Before venturing out on patrol in Iraq, Spc. Joseph Chroniger would wrap his upper body in armor, then sling on a vest and pack that contained batteries for his radio, water, food, flashlight, ammunition and other gear. With his M4 rifle, the whole get-up weighed 70 to 80 pounds — and left him aching.
His body hurt the most when his squad came under attack and he tried to run or dive on the ground. His neck and shoulders would burn as if on fire.
Since returning to Western Washington 2 1/2 years ago, Chroniger has been diagnosed with bone spurs in the vertebrae of his neck caused by a degenerative arthritic condition. Sometimes, the pain is intense, and he dreads getting out of bed in the morning.
"This is ridiculous," Chroniger said. "I'm only 25 years old. Arthritis is supposed to happen when you get old. What's it going to be like when I'm 50 or 60?"
Chroniger's injury is a symptom of the overloaded U.S. combat forces that have served in the long wars in Afghanistan and Iraq.
In 2001, an Army Science Board study, noting that weight carried by soldiers could decrease mobility and increase fatigue and injury, recommended no soldier carry more than 50 pounds for any length of time. The Army chief of staff hoped to approach that goal by 2010.
But the loads combat soldiers typically carry remain far above that goal.
That weight has helped fuel an avalanche of musculoskeletal injuries that are eroding the combat-readiness of the military. Long after the fighting ends, injuries such as Chroniger's will remain a painful and expensive legacy of these wars.
• Nearly one-third of all medical evacuations from Iraq and Afghanistan from 2004 through 2007 resulted from musculoskeletal, connective-tissue or spinal injuries, according to a study led by a Johns Hopkins University researcher. That was more than double the number of evacuations from combat injures.
• The number of soldiers medically retired from the Army with at least one musculoskeletal condition increased nearly 10-fold from 2003 to 2009, according to Army statistics.
• The heavy loads contribute to rising numbers of Afghanistan and Iraq war veterans retiring with degenerative arthritis, cervical strains and other musculoskeletal injuries. Disability benefits paid for these injuries by the Department of Veterans Affairs (VA) exceed $500 million annually, according to estimates done by The Seattle Times. That figure is expected to grow as tens of thousands of new veterans apply to the VA for compensation.
Weighing the gear
For years, the Army only had an estimate of how much weight foot soldiers carried in combat.
In 2003, Col. Charles Dean, a military-equipment expert, formed a seven-man team to conduct a detailed study of weight worn in the combat zones of eastern Afghanistan. "What we were proposing was highly irregular, and my chain of command had to pass this all the way to the generals to get approval," Dean said.
Dean, who is now retired, wanted his team to share an infantry soldiers' life, packing the same loads and facing the same dangers.
In Afghanistan, the team joined soldiers of the 82nd Airborne Division. Their missions typically began with a helicopter ride, followed by multiday foot patrols. Before each mission, team members pulled out a digital scale and weighed weapons, ammunition, night-vision goggles, sleeping bags, eating utensils and every other item carried by soldiers, down to ID cards.
The team stayed in Afghanistan for three months, collecting data from more than 750 soldiers with a range of different jobs.
Dean said many soldiers had no idea how much weight they were carrying.
"They were very interested in helping out," Dean said. "If anybody could help ease the burden to them, that was great news."
When soldiers headed out on extended foot patrols, their average load ranged from 87 pounds to 127 pounds. When they came under attack and dropped their rucksacks, most of their fighting loads still exceeded 60 pounds.
In his final report, Dean sounded an alarm.
"If an aggressive ... weight-loss program is not undertaken by the Army," Dean wrote in his report, "the soldier's combat load will continue to increase and his physical performance will continue to be even more severely degraded."
Back in the United States, Dean said "jaws dropped," when he disclosed his findings to Army leaders.
The Army launched new programs to develop lighter gear. But at the same time the Army was looking at ways to lighten the load, it also focused on trying to reduce casualties by beefing up body armor and other measures.
It's unclear if any headway was made in reducing the overall weight during the next six years. A 2009 study by a team of Army advisers indicated some soldier loads had increased by 25 percent or more compared with 2003.
The Army isn't alone in its struggle.
A 2007 study by a Navy research-advisory committee found Marines typically have loads from 97 to 135 pounds. The committee, citing information from the VA, stated that an increasing number of disabilities due to lower-back problems were a "direct result" of carrying excessive loads for long periods.
"Many of these injuries reflect troops carrying far more weight than what medical experts say is reasonable," said Norman Polmar, a Naval analyst and historian who served on the committee.
"You just... suck it up"
For foot soldiers, muscle and bone injuries always have been an occupational hazard. But piling too much weight on soldiers for prolonged periods can intensify the injury cycle, aggravating old muscle tears or cervical strains, and triggering new ones that never heal.
Noncommissioned officers — seasoned leaders who often have shouldered loads through three or four tours in a combat zone — may be hard-hit by these injuries. But many of these leaders feel burdened by responsibility and are unwilling to cede their place in a war zone to less experienced soldiers who may have fewer injuries.
"I had a choice. But I couldn't leave my squad behind just before they were being deployed," said Staff Sgt. James Knower, a wiry, 155-pound soldier from Joint Base Lewis-McChord who served in Afghanistan for a year despite injuries to his arm and rotator cuff.
Carrying loads in Afghanistan, Knower's injuries worsened. On patrols through the Arghandab Valley in southern Afghanistan, his right arm often went numb.
"Basically, it comes down to: If you want to do your job — and you take pride in what you do — you've just got to suck it up," said Knower, 29.
A rail-thin staff sergeant in the same platoon, 130-pound Kenneth Rickman, patrolled with armor and gear that typically weighed between 80 and 90 pounds.
Earlier in his Army career, Rickman suffered a pinched nerve while carrying his gear in Iraq and then a cracked vertebra in his spine while back in the United States. While in Afghanistan, he fell off a roof with all his gear on and injured his shoulder.
As the months wore on, Rickman described the pain as a kind of bone-on-bone grinding. So he gradually began to shed some of his gear. He ditched some of his extra batteries, three of his seven ammo magazines and switched to a lighter rifle.
Finally, he headed back to Washington state several weeks early on a flight filled with other injured soldiers. There, he underwent a spinal-fusion operation and the removal of a ruptured disc.
"I told them I had had enough. I was done," said the 35-year-old Rickman.
Rising narcotics use
To help soldiers cope with the pain of musculoskeletal injuries, medical providers often prescribe opiates.
"Primary-care providers ... have had very limited tools in their toolbox. It's medications for the most part, and maybe physical therapy, but very little to offer in addition to that," said Col. Diane Flynn, chief of the department of pain management at Madigan Army Medical Center.
Through the war years, the use of these drugs has escalated. A 2010 Army report found 14 percent of soldiers had prescriptions for opiates. The Army also is concerned the availability of pain drugs through medics widens the potential for abuse.
A 26-year-old Army veteran who lives in Seattle said a medic provided him with Vicodin, Dilaudid and morphine to help him through a series of deployments in Afghanistan and Iraq. Some of the worst pain came in 2003 on duty in the steep terrain of eastern Afghanistan as he labored up hills with his body armor, pack and a bulky automatic weapon that sometimes pushed his total load to more than 100 pounds.
"My lower back would just start aching from running up the hills. It would just break me," said the veteran who requested anonymity.
For some soldiers suffering from post-traumatic stress disorder (PTSD) and other mental wounds, the combination of chronic pain and opiates to treat their physical injuries can help push them deeper into despair.
Orrin Gorman McClellan, a veteran of the war in eastern Afghanistan, returned to his family home in Whidbey Island with severe PTSD. He took an opiate he obtained online, but it failed to relieve his muscle and back pain. In May 2009, he committed suicide at the age of 25.
McClellan's mother believes the physical pain contributed to his suicide.
"One of the things that he was angry about was that he always hurt. He never really got a break," Judith Gorman said.
Since his return from Iraq, Chroniger also has struggled with PTSD, which helped him gain an early discharge from the Army that goes into effect this week. But most days, Chroniger said his neck injury causes him the biggest problems.
He has been prescribed an opiate, Percocet, which he can take up to three times a day. Yet it often fails to quell the pain.
"The neck hurts so bad, sometimes you can't concentrate on anything other that," Chroniger said.
In recent years, the military has been searching for ways to improve treatment of musculoskeletal injuries.
The Army has created teams of physical therapists and other specialists to serve with infantry brigades in combat areas, and it stepped up screening for serious injuries at clinics. But some soldiers complain these injuries still may be discounted by physician assistants, who often act as gatekeepers to more extensive workups by doctors at military hospitals.
While training for his 2009 deployment to Afghanistan with the 5th Stryker Brigade, an Army sergeant complained of a sore back. A physician assistant at Madigan Army Medical Center dismissed the complaint as muscle pain.
Shortly before his deployment, the sergeant, who requested not to be named in this story, paid out of his own pocket for an MRI that indicated a herniated disc. He opted to deploy and then seek treatment upon his return to Washington state in summer 2010.
The sergeant said medical staff are rightfully on the lookout for "sick-call warriors" who constantly complain of problems when there is nothing wrong. But, he said, "the problem is, now they treat most everyone like they are faking it."
Medical officials say attitudes are changing.
"The faster you can address some of those issues at the clinic level, the less likely the soldier is to need hospital-level care ... in the theater (or need) to be evacuated," said Col. Stephen Bolt, Madigan Army Medical Center's chief of the department of anesthesia and operative services.
The Army also is trying to reduce the use of opiates for pain. An Army report recommended the increased use of alternatives, including chiropractic care, massage, meditation and acupuncture.
At Madigan, Shashi Kumar, a doctor trained in acupuncture, says these treatments have helped many patients substantially reduce pain and narcotics use.
"This has been more than what I hoped for," Kumar said. "The pain-management outcome is fantastic."
Chroniger is one of her patients. During his first treatment, she gently inserted the metal needles about a quarter-inch deep into his neck and shoulder muscles. Then she hooked the needles up to a machine that generated a small electrical current and bathed her patient in the warm glow of an infrared lamp.
After some 15 minutes, she took out the needles and helped the patient back to his feet.
Chroniger said he felt better, not so tight, and will undergo three more sessions. But at Madigan and elsewhere, the Army has few staff trained to offer these therapies, and military insurance does not pay for most of these alternative services from civilian providers.
"That's really one of the things that's holding us back," said Flynn, the Madigan doctor who directs the pain center. "We have such limited access to other than what we call traditional medicine."
The Army also has sought to prevent such injuries by improving the conditioning of soldiers.
While training, soldiers may exercise or run with full body armor and other gear. But even the most physically fit platoon member will be prone to injuries when carrying 100 pounds of gear through a year of combat.
So, the Army continues to pursue an elusive goal: Lightening the load.
Hal Bernton: 206-464-2581 or firstname.lastname@example.org
Seattle Times reporter Justin Mayo and Seattle Times researchers David Turim and Gene Balk contributed to this story. KUOW reporter Patricia Murphy also contributed