Defending a nation isn’t easy on the body or the mind. After coming home from battle, many of our soldiers must fight another war for their health whether they remain in service or not. 

Some face debilitating injuries while others combat mental health issues, and no two people are alike.

Physical injuries

From 2001 through October 2014, more than 52,000 service members were wounded in action in the U.S.  Navy, Army, Marine Corps, and Air Force, according to a congressional research report. That includes limb losses but does not account for multiple injuries. It doesn’t include traumatic brain injuries, which numbered more than 307,000, according to the same report.

Compared with civilians, “the individuals we see with limb loss are fairly unique,” says Dr. Paul Pasquina of the Uniformed Services University (USU) in Bethesda, Md. When most people lose a limb, it’s due to a medical condition like diabetes. “With war-related injuries, it’s more common than not to have many associated injuries.”

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In addition to traumatic injuries, service members also frequently have injuries due to overuse. “They’re caused by too much [activity], too fast without time for recovery, in general,” says Colonel Jeff Leggit, a physician and director in the department of family medicine, also at USU.

Pasquina, who is the chair of the department of physical medicine and rehabilitation, says it is also common for injured service members in their care to be grappling with mental health issues. “Their return to life after limb loss is complicated by lots of other problems. That needs to be addressed when caring for them.”

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Stress and mental health

The horrific sights of war and traumatic experiences of combat leave scars of their own. Post-traumatic stress disorder (PTSD) affects survivors of all kinds of events, but is especially common among military personnel who have been in combat. There were 128,496 deployed service members diagnosed with PTSD between 2002 and September 2014.

“There’s a lot of guilt, especially around the holidays. Several people you knew very closely aren’t there,” says JT Thompson, 37, of San Antonio. Thompson served in combat operations in Iraq in 2005, after which he stayed in the service as an infantry instructor. He’s now medically retired and working in corporate banking.

Thompson says he and friends with combat experience would joke with one another that they were “crazy,” but that’s as far as any conversations about emotions went. “You kind of push it as far down as you can because as a leader, you want your men to always look up to you,” he says. “It’s a catch-22 because it really is important for your men to have confidence in you.”

Two years ago, Thompson was diagnosed with PTSD. Although there’s a stigma that sufferers of PTSD are out of touch with reality, he says that’s not the case for him. “If anything, my sense of reality is heightened,” he says. “Because of my experiences, my reality is a lot different from [that of] somebody who never went to combat.”

But Thompson shuts down any notion he’s weak or broken. Accepting and facing the PTSD diagnosis was important, he says. He describes himself as a very highly functional individual who continues to improve with therapy. “I don’t want to let myself go. So I work really hard,” he says.

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Community support

Veterans like Thompson as well as active service members may have to work hard, but they don’t have to go it alone. In addition to rehabilitation and medical services like those offered at USU in Bethesda, healing is best done with family and community support.

“If you’re involved with taking care of folks with disabilities, service members or not, you can’t do enough to increase your awareness of the challenges they have,” Pasquina says. That starts, he says, with empathy. “People without functional injuries or disabilities can take things we do every day for granted.”

And family can help make that difference, Pasquina says. Having loved ones participate in rehabilitation by motivating and reinforcing therapy lessons “has been enormously helpful in terms of motivation and recovery for our service members,” he says.

The military also has a prevention message for service members and their families to help them avoid overuse and nontraumatic injuries. Leggit called it “prehabilitation.”

“We’re promoting a healthy lifestyle for service members and their families.: proper nutrition, proper sleep and proper exercise. It’s a team effort,” he says.

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Thompson says he continues to improve through prayer, meditation and therapy. He has started a family and has an appreciation for life he says he wouldn’t have otherwise. “I’ve just really tried hard to be a positive light. I’ve learned to compliment often. I’ve learned to show people how much I really care about them, and how much I want to help them,” he says. “When you see death like that, you gain an appreciation for life really quickly— how short it is, how precious it is.”