Soldiers still say, however, that despite the Army's efforts, languishing in medical holdover only compounds one's psychological issues. "Everything is uncertain, you're denied care, and you know they don't give a damn whether you get well or not. It's getting to the point where soldiers will do anything to get out of here," says a 45-year-old non-commissioned officer in medical holdover at Fort Knox who was afraid to give his name. "The stress here is higher than in Iraq, and I was there."

Some soldiers say they spend as much time as possible in their rooms, as they fear both crowds and their own temper. The main picture they paint is one of heavy medication -- "You've got soldiers on so much meds all they do is sleep; they can't even make formation," says a 37-year-old reserve soldier in medical hold at Fort Knox -- and of maddening red tape, administrative runarounds, and, at best, indifference.

Also, Fort Knox, for one, is a training post. "They're firing all the time," says the military policeman now on convalescent leave, who, like many of his comrades, is startled by a mere footstep. "That's a trigger for me." (He has addressed this concern to the inspector general's office on post, who acknowledged the complaint, but so far no action has been taken.)

Soldiers do report positive individual experiences with physicians -- the 37-year-old reserve soldier, who didn't trust his own violent temper, says his psychiatrist saved not only his life, but likely someone else's as well. While each soldier in medical holdover is assigned a case manager to help him work with the medical system, some complain that not all case managers are as caring or as knowledgeable as they need to be. In fact, several of the more experienced soldiers in Fort Knox medical holdover have seen fit to become de facto experts on the Army's byzantine medical and benefits systems. The military policeman on convalescent leave is himself at work on designing a series of flow charts and writing a lengthy booklet about the disability evaluation system to serve as a guide for other soldiers.

Beneath the bureaucracy, the matter of military culture runs even deeper -- and is harder to transform. In his report to the Armed Services subcommittee, Stephen Robinson said extensive research and tours of medical posts by his organization showed that soldiers in medical holdover receive "little to no counseling regarding traumatic events experienced during war." Why not? More often than not, he says, they're not asking for it -- and they shouldn't have to in the first place.

According to the Army Medical Command, screening for mental health issues in medical holdover is done via self-reporting in questionnaires, or ad hoc by physicians treating soldiers for physical issues. "I'm sure that during the course of treatment a soldier will give off signs that will suggest that the individual needs some mental health counseling of some kind," says Cavazos of the Army Medical Command.

Robinson counters that it's essential for Army medical personnel to initiate intervention for mental health issues, even among soldiers coming home for physical injuries. "Questionnaires are not sufficient to establish physical and mental fitness," he says, especially given the stigma against seeking psychological help or admitting "weakness." Indeed, the Walter Reed study found that the fear of stigma was "disproportionately greatest among those most in need of help from mental health services." Says Robinson: "Fear of stigmatization will remain a problem until the military changes its culture."

By some soldiers' accounts, their commanding officers will not be at the vanguard of that change. Their job, after all, is to get soldiers back to duty.

"I was told [by higher-ups] to 'not worry about it,'" says the 45-year-old NCO in medical holdover at Fort Knox, of the insomnia, anxiety and panic attacks that eventually got him on Zoloft, BuSpar, Ambien, and trazodone. "These soldiers come here all wired," he said, referring to the hypervigilance that's typical of PTSD, "and they immediately start telling them that they're going to try to return them to Iraq." According to him, they're told by their chain of command: "Don't settle down because you're going to need that high intensity when you go back."

Spc. Laurence Kiefer, 30, a crane operator with the quartermaster combat support unit of the Montana National Guard, was brought home from Iraq to Fort Carson in May, in part because of injuries relating to a truck accident. He was suffering from combat trauma -- at one point he'd had to drive a 22-ton crane at its maximum speed of 10 to 20 mph, for a 17-hour, 350-mile trip, often under fire -- compounded by other stresses, including fear that he'd be sent back to serve in the same unit with hostile command. However, he didn't get summoned for his official "outprocessing" exam for nearly three months. In the meantime, after first "self-medicating" with alcohol, he eventually sought medication and psychological treatment.

Soon thereafter, he was told to pack up and re-deploy. He appealed to his psychologist, Jacqueline E. Delano, who felt that he wasn't ready, and who later asserted in writing that in a subsequent phone conversation, Kiefer's commanding officer "made statements indicating that he felt Spc. Kiefer was over-exaggerating his symptoms to get out of going back to Iraq" and "was not interested in this psychologist's professional opinion." Delano was able to delay Kiefer's departure by insisting on further evaluation; she then diagnosed him with a personality disorder, a preexisting condition that renders him both unfit to serve and ineligible for benefits. A civilian psychologist later asserted that Kiefer's condition was PTSD; Kiefer is currently fighting the "personality disorder" designation.

What recourse do these solders have? Says the 45-year-old NCO at Fort Knox: "The attitude here is: I don't trust these people. I'll wait till I get home and go to the V.A." Vets may apply for benefits through the V.A., which has a more generous ratings system. Five thousand veterans of Iraq and Afghanistan have gone to the V.A. with mental health diagnoses already. For those reasons and others, the V.A. is an appealing resource for soldiers in, and just out of, medical holdover. "The V.A. has no legal authority. They can't take what we say and turn it against us," says the NCO. "They can't hurt you like the Army can."

Now back at home and a civilian, Lemke is still doing his best, via word of mouth, to help soldiers who are confused or feeling mistreated by the system, or who are simply struggling with PTSD themselves. He even gets contacted by soldiers' wives who are desperate to find out "what's wrong" with their husbands. No matter what, he knows what his fellow soldiers have been through. "First I fought the war," Lemke says. "Then I had to fight a war for my treatment."

Editor's Note: This story has been modified since it was originally published.

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