Service Civilians and the Wounds of War
By Ann Scott Tyson
The Washington Post
Wednesday 25 July 2007
Many fill vital roles in Iraq, but medical care can be spotty.
Traveling through Sunni insurgent territory north of Baghdad, the U.S. military convoy was nearing a base when a roadside bomb ripped into the lead Humvee, leaving its gunner, Mike Helms, bleeding and swaying from a strap in the open back.
Helms, 31, a civilian counterintelligence expert with the Army's 902nd Military Intelligence Group, had been sent to Iraq in 2004 to help fill a critical intelligence gap in the area known as the Sunni Triangle. While in Iraq, he lived with soldiers and ate military rations, took fire from mortar rounds and small arms, and clocked hundreds of miles manning a machine gun on the back of a Humvee.
Nevertheless, his status as an Army civilian would leave him stranded in the aftermath of the June 16, 2004, attack, when the bomb hit his Humvee so hard it blew his M-60 off its turret.
In the months that followed, Helms recalled, he was denied vital care for his wounds - ranging from shrapnel in his left arm to traumatic brain injury. Forced to rely on federal workers' compensation and turned away from regular care at Walter Reed Army Medical Center and other military hospitals, Helms has faced years of frustration grappling with bureaucracies unprepared to help a government civilian wounded in combat.
"I did not have an 'accident' while working. I was subjected to an offensive attack by an enemy of the U.S. government who attempted to kill me," said Helms, now a counterintelligence agent at the 902nd's Fort Knox, Ky., field office. "Why am I under workers' comp if workers' comp does not recognize a combat injury?"
As the wars in Iraq and Afghanistan strain the U.S. military, the Pentagon is sending civilian workers such as Helms into war zones to provide critical support to the troops, raising questions about their status and treatment.
Several thousand Defense Department civilian employees - with about 3,300 of them from the Army - are serving in Iraq and Afghanistan, according to Pentagon data. Since 2001, about 7,500 DOD civilians have worked in those combat zones or in anti-terrorism capacities elsewhere, including seven who died there and 118 who were injured.
"We must use government civilians ... to fill out the force or we could not do our job right now," said Gary J. Motsek, assistant deputy undersecretary of defense for program support. He called the civilians "unheralded patriots."
Army officials have acknowledged serious gaps in Helms's treatment and have pledged to fix them, but he says that despite repeated assurances over three years, he has not obtained the specialized care he needs. U.S. troops receive coordinated care from military doctors accustomed to battlefield injuries, but Helms's treatment has come from a hodgepodge of mainly civilian providers - a mix of Blue Cross and workers' compensation, plus free drugs from the military that he obtains through a back-door deal with his local Army hospital.
DOD civilians such as Helms perform vital missions in Iraq. They maintain and repair equipment, provide technical expertise on new weapons systems, conduct investigations, oversee contracts and serve in logistics, engineering, medical and intelligence jobs. They work long hours and share the same - often austere - living conditions as U.S. troops. At the time he was injured, Helms was doing intelligence work and training novice troops in weapons and tactics.
An Army jobs Web site currently seeks civilian employees "with sharp military intelligence skills to work side by side with our troops" in Iraq, Afghanistan, Djibouti and elsewhere. "You are expected to perform military intelligence tasks as close as possible to what would be expected of military," one job description reads, while working "a 12 hour day, seven days a week."
In the back of an armored Stryker vehicle, Army civilian Benjamin Needles recently ventured into the volatile town of Baqubah on his job as a senior intelligence analyst for U.S. commanders, covering "a spectrum of issues from counterterrorism to governance," he said. If wounded, Needles added, he would expect to be treated "like any other soldier" - an expectation not fulfilled in Helms's case.
Many DOD civilians, such as Needles, volunteer to serve in Iraq or Afghanistan, including all those currently there, according to the Pentagon. In the war zone, they receive a 70 percent increase over their regular pay plus overtime - and Helms made double his usual income. But their salaries are generally lower than those of U.S. civilian contractors, and unlike contractors and military personnel, DOD civilians do not receive any income tax break while deployed.
Unlike soldiers, civilians can refuse to deploy. But Helms and others say they have little choice but to volunteer.
When Maj. Gen. John Kimmons, then commander of the Army's intelligence command, formed a 130-member task force to help fill a shortage of intelligence personnel in the months after the invasion of Iraq in March 2003, he drew on civilians such as Helms to fill a fifth of its ranks, task force members said.
"My name was put on the list as 'you're going,' " said Helms, a heavyset man with close-cropped hair and glasses who had been a sergeant in the active-duty Army. "At that point, I knew it was inevitable," he said. Because Helms was designated an "emergency-essential" Army civilian, he could be involuntarily transferred overseas during a military crisis.
Some of Helms's colleagues dropped out for medical reasons. Others resigned. But he needed his job, and having served three tours in the Balkans from 1996 to 2001, he thought that he could help inexperienced soldiers.
"We were going into combat, and we had guys who had never shot these weapons," he said. Because the 902nd task force was not part of a scheduled deployment, it lacked such basic equipment as Humvees and rifles. "I needed to train them as best I could," Helms said.
A civilian colleague of Helms's who previously spent 20 years in military intelligence on active duty explained: "Civilians went out because we were experienced. The young soldiers had no experience with radios, with weapons."
As a result, Helms and other civilians took turns manning the M-60 on convoys. On June 16, it was his turn. At midday, as the convoy headed toward Samarra, the bomb exploded on the left shoulder. The driver was knocked out and the Humvee veered across the road, with Helms cheek down in the back, held in by a cargo strap and "flopping around like a dead person," his comrades said.
"Helms was in a state of shock," said Spec. Damian Werts, the gunner in the vehicle just behind. Helms was carried off the vehicle and given an IV, then placed in the shade under a truck. His left arm had a fragment wound, and his helmet was splintered, according to official military accounts.
Evacuated to the U.S. military base at Landstuhl, Germany, Helms was improperly coded as a civilian contractor, so he was turned away from Walter Reed after he arrived there. "They wouldn't admit me or give me a room," said Helms, who moved in with the wounded sergeant who was driving his Humvee. "They left me sitting in the waiting room." After about a month of ad hoc care, the sergeant moved out and Helms also left.
"This was the first in a series of problems resulting in Mr. Helms being denied timely treatment within military treatment facilities in the U.S.," according to a November 2004 memo by Kimmons. It found "systemic failures in the provision of medical treatment to civilian employees who are injured in the line of duty."
Under Pentagon policy, DOD civilians evacuated to a military medical facility in the United States because of injury or illness "may receive medical treatment in the military medical system or they can be transported to a civilian medical treatment facility of their choice."
A co-worker said the problem was rooted in the hasty way that civilian intelligence workers were deployed. "They hadn't thought through what they would do if someone got hurt, and unfortunately Mike became the test case," said the co-worker, who like others declined to be identified by name because the Army last week issued e-mails prohibiting employees from discussing Helms's case without permission.
Meanwhile, Helms's case was accepted by the Office of Workers' Compensation for "shrapnel wound upper left arm," "post concussive disorder" and other ailments. But because workers' comp covers only workplace accidents, the injury codes do not match Helms's battlefield wounds. "There is nothing for combat injuries, so it is up to the provider to weasel it in," he said.
Care has been slow and uncoordinated, as civilian doctors with little experience treating combat wounds have handled his ear injuries, broken tailbone and nerve damage. "There is no consistent care at all," he said.
Doctors at the Defense and Veterans Brain Injury Center later diagnosed Helms's brain injury, but overall he has received limited care from military facilities. The Army declined to discuss his case, citing privacy laws, but said that "the Army assists injured Army civilian employees, and helps them seek the care and benefits they are entitled to as Federal employees." It said that in the case of an IED injury, a case worker at Walter Reed should coordinate civilian care, which Helms says never happened.
During a recent visit to the Army's intelligence command headquarters at Fort Meade, Helms looked over the thousands of pages of documents related to his case, spread in piles on a hotel room floor. He shook his head.
"I am on Month Six waiting to see a behavioral specialist and internal medical doctor, and on the first month of waiting for a sleep doctor," he said, adding that the person who approves his workers' comp claims at the Labor Department "works only on Thursday and does not have voice mail, e-mail or fax."
Helms wears hearing aids and suffers from short-term memory loss, irritability and post-traumatic stress disorder. He said that he survives mainly on maple-flavored instant oatmeal and Gatorade because his medication-racked system cannot tolerate anything else.
He pulled out a laminated card that he uses to keep track of seven medications he takes for sleep, nausea, depression, anxiety and PTSD. "No one will change my meds," he said, because he lacks a primary-care doctor capable of managing all his injuries and ailments.
Helms - who has been awarded the Secretary of Defense Medal for the Defense of Freedom, the civilian equivalent of the Purple Heart - is single and lives alone. "Work is all I have," he said. During time off, he works on his truck, watches the History Channel or researches his medical problems. He has tried dating but usually his relationships don't last.
"My short-term memory is so bad, I will forget to call for days," he said. "They can tell something is wrong with me."