More than 13,000 active-duty Army soldiers -- the equivalent of four combat brigades -- are sidelined as unfit for war because of injury, illness or mental stress.
In an unmistakable sign that the Army is struggling with exhaustion after nine years of fighting, combat commanders whose units are headed to Afghanistan increasingly choose to leave behind soldiers who can no longer perform, putting additional strain on those who still can.
The growing pool of "non-deployable'' soldiers make up roughly 10 percent of the 116,423 active-duty soldiers currently in Iraq and Afghanistan. Thousands more Army reservists and National Guard soldiers are also considered unfit to deploy, a growing burden on an Army that has sworn to care for them as long as needed.
"These 13,000 soldiers, that number's not going to go away," said Brig. Gen. Gary Cheek, who heads the Army's Warrior Transition Command, which oversees the treatment and disposition of unfit soldiers. "If anything, it's going to get larger as the Army continues the tempo it's on.
"This is an Army at war.''
Among these "non-deployable'' soldiers are those recuperating from combat wounds, some severe, and various forms of brain injury. Far more numerous are soldiers with non-battle conditions, including cases of coronary disease, schizophrenia and bipolar disorder, acute anxiety, kidney disease, leukemia, chronic back pain and dozens of other maladies. Sometimes, these cases are complicated by drug or alcohol abuse, according to senior Army officers and internal Pentagon documents.
The Army is struggling to diagnose and treat this huge pool of unfit soldiers, helping to enable those with the desire and ability to return to their units, and assisting others to transition into civilian life. But more soldiers are pouring into the pool than are going out, leaving the Army scrambling to house, supervise and treat them.
"We are seeing the cumulative effects of years of war -- and they are cumulative, the physical and the mental,'' said Gen. George Casey, Army chief of staff. With the growing number of unfit soldiers, the Army has been forced to send into combat units manned "at less than 90 percent,'' Casey told reporters in May.
"That is not a good place to be,'' he said.
Even with the manpower shortage, combat commanders increasingly are casting off soldiers who have physical or mental health issues, drug or alcohol problems or a history of bad behavior, Army officials said.
The number of soldiers left home by combat units has doubled since 2007, to an average of 135 for each deploying brigade combat team of about 3,500 soldiers, the Army acknowledged. Three years ago an average of 67 soldiers per brigade were being left behind. Deploying combat units are also leaving behind soldiers who are disciplinary problems at a rate 43 percent higher than in 2007, according to Army data.
About 5,000 of the 13,000 troops have serious medical and mental problems. They have been detached from their combat brigades and housed in the Army's Warrior Transition Units. Established in 2007 to care for battle wounded, these units are instead filled mostly with non-battle wounded troops. The other 8,000 non-deployable soldiers are simply left behind under the nominal care of their combat brigade's rear detachment, which has neither the time nor the expertise to supervise soldiers struggling with behavioral or health problems or other issues, Army officers said.
Within this population of 13,000 unfit troops are genuine combat wounded soldiers -- about 10 percent -- as well as those who have fallen ill on deployment, or succumbed to chronic knee or back problems exacerbated over three- or four-year-long combat tours.
But non-deployables also include some who are faking combat stress to win lucrative compensation and a fast ticket out of the Army, according to senior Army officers and senior NCOs who work in Wounded Warrior units.
Other soldiers, senior officers acknowledge, should never have been allowed into the Army in the first place because they have chronic physical or mental problems not discovered when they were recruited, or because they are ill-suited to military life.
"In all honesty, a lot of our unit commanders have found a lot of guys that they perhaps didn't want to take with them'' to combat, said Cheek, an artillery officer educated at West Point and who won a Bronze Star during a combat tour in Afghanistan.
"There are probably some commanders who ... probably transferred some guys that maybe should have had disciplinary actions taken'' against them.
Fallout From Walter Reed
The U.S. military, perhaps more than any other force in history, has gone to extreme lengths to take care of its troops. Or at least it has since February 2007, when The Washington Post broke a series of stories
about severely wounded combat soldiers who were neglected and ill-treated at Walter Reed Army Medical Center, the Army' premier medical facility.
The Army was stung to the core by the Walter Reed scandal, because its neglect of soldiers had violated one of its most sacred ethics: in the words of the Soldiers Creed, "I will never leave a fallen comrade.''
Pressed by angry outcries from Congress and the public, the Army has scrambled to take care of its battle-wounded soldiers and every other soldier with a physical or mental problem, as well as others with undiagnosed complaints.
"We have all kinds, and the policy is we really don't care where you got your injury, we're more concerned with the nature and seriousness of it and where's the best place for this soldier to recover,'' Cheek said.
Four months after the Walter Reed scandal broke, the Army had set up its Warrior Transition Units (WTUs), where ill soldiers are assigned to platoons, companies and battalions so sergeants can help them plan and track their treatment. There are 29 such units at military bases across the country and in Germany.
They aim to treat the "whole'' soldier. The staff of the WTUs and related facilities, including nurses, physical and occupational therapists, medical coordinators, surgeons, chaplains and social workers, work with the soldier-patients to devise detailed treatment plans. Patients also sets goals for financial and family stability, housing, education and future employment for those leaving the service. Progress toward those goals is monitored weekly.
This kind of attention is demanding, even for the Warrior Transition Unit at Fort Drum, N.Y., the home of the continually deploying 10th
Mountain Division. The Fort Drum Warrior Transition Unit, housed in a sparkling new, state-of-the-art barracks, has a staff of 155 for its 302 patients. But WTU officials and staff say that the battle wounded -- only about 1 in 10 WTU patients -- take up the least amount of time.
Soldiers with combat wounds tend to be better behaved, more intent on healing, more self-reliant, and more likely to take charge of their own recuperation. "They're more grateful to still be here,'' said Staff Sgt. Tiffany Compton of Houston, a squad leader at the WTU at Fort Drum.
Another squad leader at Fort Drum recalled the soldier with a traumatic brain injury (TBI) from repeated exposure to concussive blasts. "He was desperate to get back to duty,'' said Staff Sgt. Charles Anderson, who was asked to work at the WTU after being wounded in Iraq. "He really learned how to help himself, took charge. He worked with the TBI clinic here, he used all the tools we have, and he got better. He went back to Fort Hood and rejoined his unit.
"Ten years ago he would have gotten lost in the system somewhere. Seeing him go back, that's a success story we like to see.''
Soldiers with mental health problems can require more complex and longer treatment and need more attention. Pfc. Daniel Hudman, 19, deployed to Afghanistan with the 10th
Mountain Division's 1st
Brigade this spring and was sent home almost immediately with what he said was post-traumatic stress disorder and major depression. Hudman is currently a patient at the WTU.
"I couldn't handle it,'' Hudman told me about his deployment to Afghanistan. "I wasn't ready.'' He said that his father had recently died and that he was in a custody battle with his wife. His treatment has given him new ways of "dealing with my stress and my anger and hatred,'' he said.
On several occasions, he has been allowed to travel from Fort Drum in northern New York to see his 6-month-old son, in Long Island, N.Y. He said the WTU always sends staff members with him -- a seven-hour drive, one-way.
Among the other non-battle injured patients in the WTUs are soldiers like Spec. Roland Peacock, 38, who ran truck convoys in Iraq and Kuwait and was medevacked with medical problems he declined to identify. "I didn't want to come, I didn't want to be here,'' he said. "I didn't want to put a burden on my other soldiers.''
"Hopefully, I'll get my medical problem solved and get back to duty,'' he said. Meanwhile, he added, "They're taking real good care of me here.''
Soldiers like Peacock are easier to handle, the staff says, because they are intent on healing.
A 'Dumping Ground' for Some
But squad leaders and others who work inside the WTUs say they are filling up with the undeserving -- discipline problems and malingerers. Rather than being processed out of the Army, many of them are sent to the WTU, and they are in no hurry to leave.
"You can chapter out a soldier who doesn't adapt'' to Army life, said Fort Drum squad leader Compton. "More often now guys'll send that soldier over here and say he's got post-traumatic stress. They tend to overlook a lot of soldier misbehavior here and chalk it up to PTSD or multiple deployments.''
WTU squad leaders, who are hand-picked and extensively trained to work with difficult patients, work long and punishing days and are often called out for emergencies after hours. "You do get to go home at night, but that doesn't mean you get to stay there all night,'' said Lt. Col. Patrick Harvey, who commands the Fort Drum WTU.
Almost every weekend, squad leaders get called out because one of their patients has been involved in a drug or alcohol-related incident on base.
"Many of them never should have come to the WTU -- they should have been separated'' from the Army, Compton said. "These soldiers don't want to be rehabbed, they're just going through the motions. Should never have been in the Army in the first place.''
Squad leader Anderson said, "A lot of money is spent on soldiers who just don't want to go back to their units.''
The WTUs have become "a dumping ground for people commanders don't want to deploy with,'' said Noel Koch, who until this spring was deputy under secretary of defense for wounded warrior care and transition policy for Defense Secretary Robert Gates.
An internal Pentagon report observed that WTUs are "burdened with soldiers placed in them by commanders as an expedient means by which to rid their units of their 'undesirables.' This is counter to the fundamental objective of providing the best possible care for Wounded Warriors.''
Mixing combat-wounded soldiers with these others has created some tensions, Pentagon officials said. Another internal Pentagon report said that combat-wounded patients "express concern that they may be associated with those [patients] who stay for long periods of time and 'milk the system,''' for benefits.
To alleviate such concerns, the Warrior Transition Unit at Fort Hood, Texas, has built separate facilities for combat-wounded soldiers.
"I'm kind of in favor of that,'' Cheek told me, keeping a clear distinction between combat-wounded and the others. "Because what I don't want to have, and what I have had, is a guy with acid reflux disease going to ring the bell at the opening of the New York Stock Exchange and portraying himself to America as a wounded warrior.''
Less is known about the 8,000 soldiers who left to their rear detachments. Lt. Col. Harvey, who once served as a rear detachment commander, said it was almost impossible to keep track of his medically non-deployable soldiers and their treatment plans.
"All your medical people go with the unit when it deploys,'' he said. "I'm an infantry officer. I knew where my non-deployables all were, but I didn't know what came next in their treatment.''
The Army is tightening up its supervision of the 8,000 non-deployable soldiers not assigned to WTUs. But it's a work in progress, officials said.
"It's not a perfect program, and with some of the complex conditions [of soldiers] we're not always going to get it right. But we're going to keep trying,'' Cheek said. "Overall, we've got a fantastic program that supports the Army at war very well. We have a lot more to be proud of than to be ashamed of, and we're going to do even better.''
Cheek said the Army recognized the importance not only of taking care of all its sick, wounded and ill soldiers, but also of being seen as taking good care of all its soldiers. Even if, as Cheek allowed, the Army is harboring a few malingerers who are just milking the system for what they can get.
Why don't you just throw out the fakes and misfits? I asked Cheek.
"We have medical professionals whose job is to figure them out,'' Cheek told me. "If a guy slips through a crack or gets one over on us, he'll have to live with himself. We might believe he is a malingerer, and we might be completely wrong.''
But the Army is a volunteer organization, he reminded me, dependent on the willingness of young Americans to commit themselves to the military.
"And if we are seen as casting away or discarding the young Americans who volunteer to serve,'' he said, "it won't be long before we don't have enough volunteers.''