AUSTIN, Texas — They survived the battlefields of Iraq and Afghanistan. But they did not survive the homecoming.
A six-month investigation by the Austin American-Statesman of Texas’ Iraq and Afghanistan veterans who died after leaving the military found that an alarmingly high percentage died from prescription drug overdoses, toxic drug combinations, suicide and single-car crashes — a largely unseen pattern of early death that federal authorities are failing to adequately track.
The newspaper obtained autopsies, toxicology reports, inquests and accident reports from more than 50 agencies throughout Texas to analyze the causes of death for 266 Texas veterans who served in operations Enduring Freedom and Iraqi Freedom and were receiving VA benefits when they died.
The newspaper began with 345 fragmentary, nameless records provided by the Department of Veterans Affairs. Reporters used obituaries, widely scattered public records and interviews with veterans’ families and friends to identify the dead, determine causes of death and reveal a phenomenon that has largely been hidden from public view.
The investigation found that:
• More than one in three died from a drug overdose, a fatal combination of drugs, or suicide. Their median age at death was 28.
• Nearly one in five died in a motor vehicle crash.
• Among those with a primary diagnosis of post-traumatic stress disorder, the numbers are even more disturbing: 80 percent died of overdose, suicide or a single vehicle crash. Only two of the 46 Texas veterans of the Iraq and Afghanistan conflicts with a PTSD diagnosis died of natural causes, according to the analysis.
• The 345 Texas veterans identified by the VA as having died since coming home is equal to nearly two-thirds of the state’s casualties in Iraq and Afghanistan. But that only includes veterans who have sought VA benefits, meaning the total number of deaths is likely much larger.
The analysis also highlights the problem of prescription drug overdose among veterans, which has received scant attention compared to suicides: Nearly as many Texas veterans died after taking prescription medicine as committed suicide. VA prescriptions of powerful narcotics have skyrocketed over the past decade even as evidence has mounted that such painkillers and PTSD make a dangerous combination. In effect, experts say, the military and VA have exposed an especially vulnerable population to a flood of dangerous drugs.
Although the startling number of suicides among active-duty service members has been widely reported, there has been little examination of what happens to the nation’s soldiers, airmen, Marines and sailors after they leave the service.
The Department of Veterans Affairs, which serves nearly half of recent veterans, does not regularly track individual causes of death, a shortcoming that critics say prevents it from understanding the scope of the problems facing those who fought in Iraq and Afghanistan.
“This is the data we’ve been looking for,” said Texas state Sen. Leticia Van de Putte, D-San Antonio, who chairs the Texas Legislature’s Veteran Affairs Committee. “We know very well the numbers of active duty (deaths), but what we don’t know is what happens once they separate from the military.
“Unless we know the extent of the problem, people don’t tend to act on things,” Van de Putte said. “I’m hoping people will be appalled ... and feel compelled to take action.”
The deaths reported by the newspaper represent a fraction of the nearly 53,000 Texas veterans of the wars who have applied for VA disability benefits. Most have returned home without major trauma.
Yet the autopsy reports and investigation narratives obtained by the American-Statesman paint a mosaic of pain, desperation and hopelessness among a significant number of Texas veterans.
Among them was Chad Mitchell, 40, a veteran of seven overseas deployments who had settled in Austin after leaving the Navy. He died in September 2010 with a half-dozen prescription drugs in his system, including anti-anxiety medication and powerful painkillers oxycodone and methadone prescribed by private and VA physicians. Mitchell, who suffered from PTSD, suffered pain from a complicated chest surgery, as well as a shoulder injury in Iraq.
Among them was Justin Languis, a 31-year-old veteran of Iraq who shot himself to death in January 2011 at the Fort Hood memorial wall commemorating fallen soldiers of the 1st Cavalry Division. Languis had deployed with a unit of the division in 2004, serving as a combat medic during the battles of Fallujah and Najaf. Several soldiers from the unit were killed during the deployment, their names etched in the wall where Languis died.
Among them was Paul Robert Norris, a 24-year-old Army veteran, who died when he lost control of his Honda Civic and slammed into a rock wall along an El Paso street. Police said Norris was speeding; his father said his son was usually a cautious driver and believes his son was experiencing a flashback to his time in Iraq when he lost control of his car.
The newspaper’s findings show that deaths from suicide and overdose are far higher among the veterans receiving VA benefits than for the overall state population: The percentage of suicides was nearly five times higher, while the percentage of deaths from overdose and toxic drug combinations was 5.3 times as high.
Former Texas state epidemiologist Dennis Perrotta said that while differences between the groups — mostly male war veterans who were receiving medical treatment, versus a much more diverse overall population — account for some of the discrepancies, the results are nevertheless meaningful. The newspaper’s findings are also echoed by broad data compiled by the Texas Department of State Health Services that indicate elevated levels of suicide and overdose among veterans under the age of 35.
VA officials said that because they don’t track individual causes of death, they couldn’t verify the newspaper’s numbers or determine whether they mirror causes of death for young veterans nationally.
“These are important conclusions, but I would caution against applying them nationwide or VA-wide,” said VA spokesman Mark Ballesteros, adding that the VA is working to address gaps in its data collection and is planning a mortality study based on 2010 death records.
U.S. Rep. Bill Flores, R-Waco, who serves on the House Veterans Affairs Committee, said the VA needs to fix its data collection limitations.
“We don’t do a very good job of tracking these folks,” Flores said. “I would like to see a little more action and less talking.”
In many of the cases reviewed by the Statesman, veterans of Iraq and Afghanistan died in relative anonymity. Unlike those who die during active duty, the veterans’ deaths often aren’t noted in press releases.
Some did not even get an obituary in their local newspaper, including about a third of those who committed suicide.
In Austin, a 44-year-old Navy veteran was buried in Travis County’s pauper’s cemetery after dying of a self-inflicted gunshot wound in October 2007. The man’s body was discovered after neighbors noticed fliers piling up around the door to his North Austin apartment.
Inside, police found a mostly empty bottle of rum and a .38-caliber handgun under his hand. In the closet, they found a bag of medical records that revealed a lengthy battle with psychological problems.
Colleen Rivas of New Braunfels, Texas, whose husband Ray took his own life in 2009 outside a military hospital in San Antonio, said her husband and his comrades who have died since returning home deserve to have the circumstances of their deaths investigated, in hopes of finding ways to reduce the death toll among veterans.
“They had a life, they had a story,” she said. “They were soldiers and they mattered. And they all left behind someone who loved them.”