Shortly after the planes hit the World Trade Center, Mike McElhiney’s boots hit the ground in Afghanistan. A U.S. Army Green Beret, he was part of a team dispatched to the south of the country to help oust the Taliban.
On Dec. 5, 2001, they were on a ridge north of Kandahar, using a laser device to pinpoint enemy targets and transmit their coordinates to a B-52 bomber overhead.
When the device ran low on power, an airman quickly changed the battery. He didn’t realize that when he turned it back on, the device defaulted to its own location and sent those coordinates to the bomber.
America’s longest war had barely begun.
Over the next two decades, the conflicts in Afghanistan, Iraq and elsewhere claimed the lives of 7,000 U.S. troops and damaged and maimed hundreds of thousands more. Many deployed over and over, seeing more raw combat than veterans of previous wars. They survived previously unsurvivable injuries.
Even as the United States tries to turn the page after declaring the war over in Afghanistan, the disabilities from that conflict and others in the global war on terror remain. So does our debt to those who sustained those injuries – it’s what the country promised them in exchange for signing up.
That debt, monetary and otherwise, is steep.
McElhiney remembers seeing a huge, red flash as a 2,000-pound bomb landed about 40 yards away. The blast mangled his arms and blew a hole in his chest. When he came to, he couldn’t feel anything below his waist. He saw blood gushing from the top of his uniform and a puddle of fuel running like a creek beneath him.
“I knew I was gonna go out," he recalled. "I remember talking to myself, kind of going, ‘OK, when you go out, don't go face down because you'll drown, so turn your head to the left.’ And I turned my head to the left and collapsed.”
The bomb killed three members of his unit and wounded the rest, along with dozens of Afghans.
McElhiney and the rest of the wounded were airlifted out, first to Oman, then to Germany and eventually home to the USA. He spent months recuperating at Walter Reed National Military Medical Center before heading home to Tennessee.
He is cavalier about his brush with death, but he carries with him the indelible imprint of that day: the scars from the shrapnel and the stump where his right arm used to be.
A steep and growing cost
Roughly 40% of post-9/11 veterans have some form of disability, according to Harvard University researcher Linda Bilmes. More than 1 million have a significant disability. That's more than the World War II, Korea and Vietnam eras combined.
Costs for medical care, disability compensation and other benefits are higher not just because health care costs have grown and their injuries are more severe, but because medical advances mean more conditions are diagnosed and treated than in wars past.
The Department of Veterans Affairs has expanded to meet the need. Federal spending on veterans increased fourfold from 2001 to 2020, even though the number of veterans is down from 25.3 million to 18.5 million.
Bilmes expects the cost will continue to grow, stretching far into the future as veterans age. She predicts the tab could reach at least $2.5 trillion by 2050. That's more than the United States spent on direct military funding for the wars.
"If we don't do something now, to track and monitor and try and set aside funds for those who have fought in these wars, then we are at risk of shortchanging these men and women who have already given a lot,” Bilmes said.
Mental health costs also will linger, Brown University researcher Stephanie Savell said. More than four times as many service members and veterans of the post-9/11 wars died by suicide than in combat, according to research published this year as part of Brown’s “Costs of War” project.
Savell, co-director of the project, said the trauma underpinning those figures "doesn't go away after the fighting stops.”
“For every person that died, you can imagine all the people who are living with just all this mental trauma and physical trauma and are just having to cope,” she said. “It’s really difficult.”
A moral injury
Bryan Lett deployed to Afghanistan shortly after President Barack Obama authorized a surge in troops in 2009. Lett's mind and body recorded details of what transpired, and they still haunt him.
A room filled with children, all executed at point-blank range. Frantically trying to stop the bleeding after a man's arm and chest were blown apart by a mortar, then trying to calm him as he died.
The nightmares and flashbacks that make Lett worry he’ll hit his wife are the ones about going door to door, clearing houses in the battle of Marjah. His job in the Marine Corps was as a combat correspondent for the American Forces Network, but that day he left his camera behind and joined a four-person team hunting insurgents.
He had volunteered to go in first. He was single at the time, 29 years old and without children. The others had wives, children – “more to lose.”
Lett remembers making sure the front room in one house was clear, then turning right and seeing a black blur. The butt of a gun crashed into his head, snapping his neck back.
In a matter of seconds, the other Marines rushed past to secure the house, Lett grabbed his attacker, and after a struggle, drew his 9mm pistol and “finished the altercation.”
He replays the scenario over and over in his head. When he goes to bed, he positions himself so he can't hurt his wife if he throws punches in the night.
Then there are the times when he's awake.
“I'm sure you've heard the term ‘moral injury,’” Lett said. “That's kind of something I struggle with all the time.”
He knows the man he killed wanted to kill him. “But I struggle with the fact I was in his country, his house. So why would I expect him to do anything less?” Lett said. “That's a part of me that I'm still circling and trying to figure out.”
Lett medically retired from the Marine Corps in 2015. He’s considered 90% disabled, counting his neck injury, which required spinal fusion, and post-traumatic stress disorder.
A system stretched
More than one in three post-9/11 veterans have suffered from PTSD, according to a Pew Research Center survey from 2019. Mental health care has accounted for roughly 20% of the VA medical budget since 2015, Bilmes, the Harvard professor, found.
Since 9/11, a confluence of factors has stretched the capacity of the VA. As the war on terror produced a new generation of veterans grappling with disabilities, those from Vietnam were becoming infirm and more reliant on VA care. The demand fueled a national crisis in 2014 after dozens of veterans died waiting to be seen at the VA in Phoenix.
The VA has since hired more than 50,000 employees, opened clinics across the country and established or expanded benefits and treatments, including for women’s health and traumatic brain injuries.
By 2020, the VA had more than 400,000 employees and an annual budget of more than $240 billion. That’s nearly four times its budget in 2001, even when adjusted for inflation, Bilmes found. Back then, there were 219,000 employees.
Joy Ilem, the national legislative director for Disabled American Veterans, said the needs of post-9/11 veterans will probably grow as they age and war-related injuries surface or worsen. Traumatic brain injuries may cause personality changes. Cancers may develop from exposure to toxic substances – such as when massive burn pits were used to dispose of wartime waste.
“There's sort of a watch and wait and see how veterans’ health is impacted," Ilem said. "We’re 20 years out, and there's still a lot of argument over what is the real impact of burn pits, for example.”
Bilmes wants the government to set up a trust fund, much like it has for Social Security, to pay for veteran care. She said it could be funded with an excise tax on large defense contractors or by a percentage of spending on future wars.
“A veterans trust fund is a kind of no-brainer, good-government, nonpartisan way to get the government to start taking seriously the fact that there is this long-term cost of care for veterans,” she said.
A different kind of battle
On Aug. 31, hours after the last U.S. troops flew out of Afghanistan, McElhiney was headed to get a new prosthetic fitted for his right arm. He dreaded the fight he would have to put up to get the VA to pay for a cosmetic cover. He said he has to fight for it every five years.
But he's happy with much of his care. "I had broken teeth from the blast, and you know, I get dental care at the VA, and it's great. Eyeglasses, if I ever want to go, I get that," he said. "All my appointments are great."
He has noticed a difference as the agency has evolved since 9/11. "They've got new equipment, new budget, they're building new facilities," he said.
After leaving the military in 2010, McElhiney joined the Minnesota Department of Veterans Affairs, where he helped secure funding for three new veterans homes. He's now chief of staff.
He doesn’t expect the U.S. government to set up a trust fund or another mechanism to cover costs of veteran care. He said veterans and their advocates will have to step up to make sure that happens.
"We're going to have to continue to fight into the future, just like they fought for 100 years for benefits,” McElhiney said.
Lett, the veteran with PTSD and a neck injury from the battle of Marjah, is married with two small children. As the last U.S. troops left the Afghan capital of Kabul, he said it was difficult to articulate the gamut of emotions he felt.
"I'm glad that my story is becoming a part of history," he said. “For me, Afghanistan's going to live forever, regardless of whether there's troops there or not.”
Lett relied on VA facilities in New England and Cincinnati after returning from the war, including for PTSD counseling. "I started as soon as I got back, and I didn't really like it," he said. "I go in, and I pull out. So it's a bit of a back and forth."
Lett, who took a job with Disabled American Veterans after leaving the Marines in 2015, prepared to start a new job this month – at the VA, doing outreach to veterans about future support.
Veterans who need help can call the Veterans Crisis Line at 1-800-273-8255 and press 1. They can reach someone by text at 838255 or chat at www.veteranscrisisline.net.
This article originally appeared on USA TODAY: Home from Afghanistan war, disabled veterans fight their forever war