Iraq Vets Falling Through Health-Care Cracks

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"The nature of the wounds is completely different because of the improvised explosive devices," added Phil Kraft, program director for the National Veterans Services Fund, in Darien, Conn. "The guys who were injured to this extent in Vietnam are dead. These guys are being saved when, ordinarily, they wouldn't have made it. The VA system is designed for soldiers who took a bullet, stuff like that. These aren't your traditional wounds."

The VA's plans for a "seamless transition" from military to civilian health care are largely unrealized. About 80 percent of soldiers recently discharged after serving in Iraq have not even enrolled as patients in the VA system.

Pepper, a former Army combat engineer, hasn't seen a doctor since he left Walter Reed in September 2005. He did enroll with Tricare, an agency that administers a national health-care plan for military personnel, veterans and their families, but said he was unable to contact the civilian primary-care physician that Tricare referred him to.

Pepper takes escalating doses of a barbiturate-containing pain medication left over from Walter Reed, along with medications to reduce his anxiety and help him sleep. At the same time, he has cut his daily antidepressant dose in half and has gained 50 or so pounds since his discharge from Walter Reed. He feels he can't exercise safely because he can't see.

Emme also has not seen a doctor since his discharge. His headaches have largely disappeared since his skull was reconstructed, but he still has muscle twitching (a result of his brain injury), sleep apnea and anxiety, which may be a symptom of PTSD. Emme also enrolled in Tricare but has yet to follow up with a civilian neurologist.

Neither Pepper nor Emme has a case manager to ensure continuity of care.

"Everybody has tried to come up with a system that involves case managers to try to help them stay on top, but they're not using them," Okie said. "Theoretically, they could both get them simply by arranging it."

And it's hard to say precisely where or how people are slipping through the cracks.