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GUY RAZ, Host:

This is ALL THINGS CONSIDERED from NPR News. I'm Guy Raz.

One of the longest combat missions in American history ended this week. Operation Iraqi Freedom is over. But for many of the men and women coming back from their deployments, it's just the beginning - the beginning of discovering and then coming to grips with the mental anguish that sometimes afflicts those who've seen war. In a moment, we'll hear about how the military is dealing with it.

But first, to the story of one combat soldier who still struggles to leave Iraq behind.

COLBY BUZZELL: My name is Specialist Colby Buzzell. I was an infantryman in the United States Army in the Stryker Brigade and was in Iraq late 2003 to '04.

RAZ: About a year after 9/11, Colby Buzzell had been bouncing around odd jobs in San Francisco. But he didn't feel like his life was going anywhere. So he walked into a recruiting office and signed up.

BUZZELL: I didn't know what I wanted to do or be and I was - our country was at war, you know? This was my chance to be a part of history.

GEORGE W: My fellow citizens, at this hour, American and coalition forces are in the early stages of military operations to disarm Iraq, to free its people and to defend the world from grave danger.

(SOUNDBITE OF EXPLOSIONS)

Unidentified Man: (Unintelligible) huge amounts of (unintelligible) getting much, much closer. All the...

BUZZELL: I remember being at the chow hall at Fort Lewis and paying attention to the news and seeing it. All they were showing was the invasion (unintelligible). And I remember thinking, man, we need to hurry up and deploy over there because if we don't do that soon, I'm going to miss out on the whole experience.

Man: I'm going to have to stay in cover, Jeremy(ph). I'm going to have to stay in cover.

RAZ: Colby got to Iraq in the fall of 2003. That was about five months after President Bush announced the end of the fight.

BUSH: Major combat operations in Iraq have ended.

RAZ: Colby was 26 years old.

BUZZELL: I remember just having this adrenaline in me. Like, I remember in the tent in Kuwait talking to my friend, Specialist Horrocks, telling him how excited it was and couldn't wait to cross the border into Iraq. You know, Horrocks has been in for a while and like, I'll never forget, I remember he told me, it's like, be careful what you wish for, you just get might get it.

RAZ: Colby was sent to a base in Mosul. He saw plenty of combat, but also extended periods of boredom.

BUZZELL: Up and down the same streets over and over and over again, on a mortar mission, patrols, ambushes, raids, you go up on a hill. You dismount, you sit there, you wait. Think of all the things you're going to do once you go back home.

RAZ: And he did go back home. His tour wrapped up in 2004. And, at first, he was glad to be back, excited to return to civilian life, and counting down the days till his commitment to the Army would end.

BUZZELL: But after a while, you're like, hey, wait a minute, you know, you realize you're viewing everything entirely different. You'll be at a bar at a restaurant, and out of nowhere, you'll just be like, well, you know, there's war over there doesn't effect anything that goes on here. The war just seems invisible.

RAZ: He got his discharge and started to get back into civilian life. That is, until early 2008 when a letter arrived in the mail.

BUZZELL: It came in a Manila envelope. I opened it up. And it was my orders telling me to report back to Fort Benning three weeks from when it was sent. And it gave the purpose right there on the form. It said purpose: Operation Iraqi Freedom.

RAZ: Back in 2004, when he returned from his first deployment, Colby started drinking heavily. And he started getting nightmares. And when he got that letter, he was sure he couldn't face going back.

And so, he went to a V.A. hospital to get evaluated by a psychiatrist. Colby suspected he was suffering from PTSD. The next day, the doctor handed him a letter to take to Fort Benning.

BUZZELL: Mr. Buzzell came in to the evaluation visibly distressed, uncomfortable, presenting with - asked about his experience in Iraq, he became more - got one of the main incidents involved the fire fight that lasted all day that took - during the course of talking about this incident, Mr. Buzzell's speech became increasingly - he reported that he drinks heavily every day as a way to avoid these traumatic memories, usually to the point of blacking out to conventionally fall asleep. He is severely isolated, spending most of his days in his room and sometimes going for several days to weeks without speaking to anyone. Severe intrusive - upon returning from Iraq, Mr. Buzzell and his wife divorced. Irritability, hypervigilance, difficulty sleeping, feelings of depression, and avoidance of people, places and things that trigger him or remind him of his service in Iraq.

RAZ: The Army determined Colby wasn't deployable. He never went back to Iraq. And three months ago, he quit drinking. He's still dealing with symptoms of PTSD, but he's trying to work through them by focusing on something else.

BUZZELL: Now, it's school. You know, instead of tuning out, numbing myself to the point of blacking out every night, I'm absorbing myself in the books.

RAZ: I mean, have you gotten to the point now where you don't think about Iraq every day?

BUZZELL: Well, I can sit here and say I try to, but that's impossible. Maybe not certain incidences, but just sort of this feeling that, yeah, I'm a veteran. I was over there. You know, it's just with me every day.

RAZ: That's Colby Buzzell. He spoke to us from KQED in San Francisco. He's written a book, adapted from a blog he wrote during his tour. It's called "My War: Killing Time in Iraq."

Now thousands of soldiers like Colby are diagnosed with PTSD. But there's also another disorder, traumatic brain injury, with similar symptoms. But TBI isn't a psychological condition; it's a physical one.

GREGORY O: Fundamentally, PTSD is a disorder where you remember too much, whereas TBI is a disorder where you don't remember enough.

RAZ: That's Dr Gregory O'Shanick. He is the national medical director for the Brain Injury Association of America. And he says many soldiers who actually suffer from TBI are diagnosed instead with PTSD.

SHANICK: Well, the main differences are that individuals with traumatic brain injuries also will have neurologic symptoms such as headache, light sensitivity, dizziness and will have difficulty, many times, with balance. Whereas, individuals with post-traumatic stress disorder will have more of the re-experiencing the symptoms, feeling ashamed, feeling guilty, avoidance types of behaviors, things of that nature.

RAZ: I'm wondering, I mean, TBI, presumably, has been around since the invention of explosives. I mean, it's been a by-product of war. But it's really something that we've only started to hear about with the wars in Iraq and Afghanistan. Why is that?

SHANICK: Well, number one, you're correct. TBI has been around ever since individuals have learned how to hit their heads on things. But currently, the reason is that we are becoming more able to keep people alive that previously would have died from severe injuries.

RAZ: What kinds of trends are you seeing among troops returning from Iraq and Afghanistan who are experiencing symptoms of PTSD or TBI?

SHANICK: One of the disturbing trends is still the sense of underdiagnosis, of looking at the PTSD as being the only disorder that exists.

I'll give you a good example. With mild traumatic brain injury, one of the primary areas that's injured is with our frontal lobes. Our frontal lobes is what guides our behavior, what provides structure to our day. So when I get up in the morning, I've got to figure out what I'm going to eat, what I'm going to put on. I've got to figure out the route that I'm going to go to work. All of that is governed by our frontal lobes.

When you're in the military, these kinds of things are already determined for you, so you may have damage to your frontal lobes that are not manifest while you're in service. And then you go home to your community, where you're asked and expected to be able to initiate these things yourself and you have difficulty. So you end up having problems initiating. You look lazy. You may be seen as being anxious and depressed. You may start drinking because your relationships aren't going well.

So, many of these subtle kinds of changes really do represent damage to the starter part of our brain.

RAZ: That's Dr. Gregory O'Shanick. He is the national medical director for the Brain Injury Association of America. He joined us from the studios of member station WCVE in Richmond.

Dr. O'Shanick, thanks so much.

SHANICK: You're very welcome. Thank you very much.

RAZ: NPR'S Daniel Zwerdling and T. Christian Miller of ProPublica have been investigating how the military treats soldiers with TBI. Danny's in the studio with me.

And, Danny, why do so many of these men and women go undiagnosed?

DANIEL ZWERDLING: A number of reasons. One reason is that many commanders in the military still don't believe that traumatic brain injury is really...

RAZ: Real.

ZWERDLING: ...an injury. That's right. Another reason is that a lot of the doctors were never trained to diagnose traumatic brain injury. You know - and you know this, Guy, from having reported on the military, a lot of the doctors who went to the war were pediatricians.

RAZ: Right.

ZWERDLING: Or they were foot doctors.

RAZ: Right.

ZWERDLING: Or they were family practitioners. You know, they saw the occasional concussion, but they didn't have any training in blast injuries.

RAZ: Now, Danny, I know you spent a lot of time with troops on bases. What kind of care do they receive when they get it?

ZWERDLING: I can't speak about all the bases, but we focused on one big base. It's the third biggest Army base in America, Fort Bliss in El Paso, Texas. We found soldier after soldier after soldier after soldier who would come back with terrible cognitive problems, not getting good care; in fact, often getting blown off for months or years, even though they were complaining about their symptoms.

RAZ: Hmm. It sounds so (unintelligible), but I'm wondering if in any way, I mean, the military presumably was saying, look, you know, these are isolated cases. We are really on this. We understand it. We're getting this.

ZWERDLING: We have talked a few times with the vice chief of staff of the U.S. Army, Peter Chiarelli. And he has acknowledged that a lot of commanders still don't get it. I asked him recently, all right, if 10 is where you think the military needs to be in terms of understand and treating traumatic brain injury, where do you think the Army is now? He said I think we're at a six, but we came from a two...

RAZ: Yeah.

ZWERDLING: ...or a three. And I think we're edging towards seven. But still, a long way to go.

RAZ: Danny, something you've been working on with ProPublica, which will air next week on NPR, is whether soldiers who are suffering from TBI should get the Purple Heart.

ZWERDLING: Here's the most symbolic gesture that the military can do to say you have been wounded and I should...

RAZ: Yeah.

ZWERDLING: ...give you the Purple Heart. And we found that soldiers across the country who we talked to, who've been diagnosed with traumatic brain injury, treated for TBI are not getting the Purple Heart.

RAZ: Are they eligible for it? I mean, you don't have to draw blood to get the Purple Heart.

ZWERDLING: No, that's right. Oh, that's right. There's been a big debate in recent years over whether people with post-traumatic stress disorder should get a Purple Heart.

RAZ: Yeah.

ZWERDLING: Many people think they should. But the regulations of all these excluded them. The regulations have always said, if you get diagnosed with a concussion, mild traumatic brain injury, then you do get the Purple Heart. But we're finding that's often not the case.

RAZ: That's NPR's Daniel Zwerdling. You can hear NPR and ProPublica's reporting on the Purple Heart and TBI controversy next week.

Danny, thank you so much for coming in.

ZWERDLING: Thank you, Guy.

You're listening to ALL THINGS CONSIDERED from NPR News.

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