A few weeks after Jarrid Starks ended his Army service in May, he went to an office in Albany, Ore., to enroll for veterans health-care benefits.
Starks brought medical records that detailed post-traumatic stress disorder (PTSD), a twisted vertebra and a possible brain injury from concussions. Other records documented his tours of duty in Iraq and Afghanistan, where his bravery fighting the Taliban was recognized with a Bronze Star for Valor.
None of that was enough to qualify him for health care from the Department of Veterans Affairs.
That's because Starks left the military this year with an other-than-honorable discharge -- his final year of service scarred by pot smoking and taking absences without leave (AWOL).
He was told to fill out a form, then wait -- possibly a year or more -- while officials review his military record to determine whether he is eligible for health care.
"I was absolutely livid," Starks, 26, recalls. "This just isn't right."
Starks is among the more than 20,000 men and women who exited the Army and Marines during the past four years with other-than-honorable discharges that hamstring their access to VA health care and may strip them of disability benefits.
Some were booted out of the military before they deployed.
Others served in combat zones in Iraq and Afghanistan, then struggled upon their return with drug abuse, unauthorized leaves and other misconduct that placed them among the most troubled members of the generation of veterans who fought in the long wars launched after 9/11.
Starks ended his military career this spring with a weeklong stay at Madigan Army Medical Center under psychiatric care. Then, he was escorted to the front gate of Joint Base Lewis-McChord carrying a brown paper bag packed with a 90-day supply for six prescription drugs that included antipsychotics, antidepressants, pain pills and beta-blockers.
As he left the Army to re-enter the civilian world, Starks opted to wear a cap with a peculiar patch: "Warning, This Vet Is Medicated For Your Protection."
Amid a surge in suicides among recent veterans, politicians have increased VA budgets by billions of dollars to help expand and improve the treatment of PTSD, traumatic brain injuries and other conditions. They talk about forging a "seamless transition" from military medical care to the VA.
But federal law draws a sharp dividing line between honorably discharged veterans, who are offered access to veterans health-care and disability compensation, and those whose misdeeds may put those benefits at risk.
Veterans who fall below the threshold of an honorable discharge must submit to a VA review of whether they engaged in "willful and persistent misconduct," and if so, whether that makes them ineligible for health-care or disability benefits.
"Each case is going to be different, so it is important to go through all the evidence," said Leah Mazar, a Veterans Benefits Administration analyst. "This is not something the VA makes up. This is based on the laws and regulations."
In response to a Seattle Times request for the number of veterans ruled ineligible for benefits, VA officials said the department has no way to track how many of these reviews are conducted, how long they take or their outcomes.
1944 federal law
In recent years, the federal law that guides veterans benefits has come under fire from a surprising source: some Army lawyers frustrated by the frequency with which troubled combat veterans are tossed out of the military without ready access to VA health care.
"I would go so far to say that, when we speak of Army values, leaving no soldier behind, there is almost a moral obligation," said Maj. Evan Seamone, chief of Military Justice at Fort Benning, Ga., who in 2011 published a Military Law Review article critiquing the Army legal system.
"We are creating a class of people who need help the most, and may not be able to get it. And, when you do that, there are whole families torn apart, and higher levels of crime. It's a public-health and public-safety issue."
In another Military Law Review article, Maj. Tiffany Chapman, a former Army prosecutor, argues that Congress should overhaul a 1944 federal law that authorizes the VA to determine whether veterans without honorable discharges are eligible for benefits.
"Out of fairness to the Soldier who risked his life in combat, Congress must amend current legislation to ensure that all veterans who suffer from service-connected PTSD are able to obtain treatment regardless of the circumstances under which they were separated from the military."
Others say that granting such benefits would disrespect the vast majority of servicemembers who go to war and complete their service honorably.
"The veterans who advise our program, they are still firm that an honorable discharge should be the standard for care," said George Dignan, a King County official who helps to administer veterans programs.
A King County veterans program and a state program that offer PTSD counseling have patterned eligibility after the federal law and do not extend services to veterans who have an other-than-honorable discharge.
In Congress, there has not been much discussion about changing the law.
Sen. Patty Murray, D-Wash., says that she is concerned about any veterans who find themselves "outside of the VA looking in" and that the appeals process needs to be "vastly improved."
But Murray, chairwoman of the Senate Veterans' Affairs Committee, does not favor new legislation and says these veterans should continue to have their access to health care determined on a case-by-case basis.
Chapman, the former Army prosecutor, noticed a pattern among soldiers who returned from combat, then launched into misconduct that ended their service.
Some of these soldiers led troubled lives long before they joined the military and unraveled even more once they returned from Iraq or Afghanistan. Others appeared to be relatively stable before combat but lost their way after they returned home.
"You just don't know how you are going to react once you have been to war," Chapman said.
A 2010 survey of more than 90,000 Marines, co-authored by Robyn McRoy of the Naval Health Research Center, found that Marines who served in combat zones and received a PTSD diagnosis were more than 11 times more likely to receive a misconduct discharge than Marines who did not deploy and did not have a PTSD diagnosis.
Some say the Marines are quick to crack down on those who get in trouble.
"We have so many Marine cases where there is one-time drug use," said Teresa Panepinto, legal-services director with Swords to Plowshares, a San Francisco-area organization that has provided legal services for hundreds of veterans who received other-than-honorable discharges.
When those veterans seek health care at the VA, hospital staff can inform them about the misconduct review that might result in benefits. The staff can then fill out the forms that kick off the review process, according to Kristin Cunningham, a VA Health Administration official.
But the process apparently is not always well understood.
Some veterans with other-than-honorable discharges said they were never informed of the review process when they initially showed up at VA hospitals.
"They told me I wasn't a veteran, and should leave," recalls Clayton Lawson, an Iraq veteran with an other-than-honorable discharge who sought health care at American Lake, a VA hospital south of Tacoma, after leaving the Army in 2010.
Lawson had served at Lewis-McChord, where he spent his final year in the Army in a destructive cycle of drug and alcohol abuse, attempted suicides and AWOLs. At Lewis-McChord, he was diagnosed with PTSD, a diagnosis later changed to an anxiety disorder, according to his medical records.
After getting rebuffed at American Lake, Lawson turned to the Seattle Vet Center, the only arm of the VA authorized to aid all veterans regardless of their discharge. The Vet Center could provide counseling but couldn't provide medical care or medications that had been prescribed before his discharge.
Lawson continued to abuse drugs and went through more bouts of suicidal depression.
With Lawson having no VA hospital benefits, the costs of caring for him shifted to other providers as he cycled in and out of Western State Hospital and a hospital in his home state of Kentucky.
For weeks, Lawson lived in a tent he erected in a patch of woods in Lakewood, Pierce County.
Encouraged by a Vietnam veteran who befriended him, Lawson tried again to enroll for VA health care this year. This time, he was accepted, apparently because the VA employee who took his application that day failed to note the other-than-honorable status of his discharge.
Suddenly, Lawson was transformed from outcast to a high-priority VA patient. He received a week of inpatient treatment in Seattle. Later in the summer, he is scheduled to undergo an intensive program at American Lake for PTSD and substance abuse.
"I just wish this could have happened sooner," said his wife, Devon Lawson.
Other veterans say they were discharged from military service with no information about the review process.
One Marine veteran who had been stationed at Parris Island, S.C., said she was specifically told by a claims adviser and Marine Corps superiors that she would never receive any VA health-care benefits because of her other-than-honorable discharge.
The veteran, who requested anonymity, says she had gone AWOL after being raped, and had hoped to access a VA sexual-trauma program and hospital services. Earlier this year, she was surprised to learn she might still be eligible for VA care and submitted an application that is now under review.
"I am just grateful that the possibility of help exists, contrary to the misleading advice of my superiors at Parris Island," the veteran said.
Toll on body, mind
For most of his military career, Starks appeared to be an Army success story.
After his initial tour of duty in Iraq, Starks was promoted up the ranks to serve as a staff sergeant in the 5th Brigade, 2nd Infantry Division, deployed to Afghanistan in 2009.
Three months into his deployment, Starks, in command of an eight-wheeled Stryker, chased insurgents to a mud-brick compound where they then began to fire on his vehicle. When an automatic-weapons-system froze, he fended off the enemy by manually operating the heavy .50-caliber machine gun. His actions earned him a Bronze Star.
Afghanistan took a toll on Starks' body and mind.
Early in his tour, he was knocked unconscious by a controlled detonation that went awry. He had an eerie sensation that he had died and was somehow pulled back to life.
In another incident, on a night patrol, his Stryker drove off a 25-foot bluff, slamming his back against the vehicle's cupola and knocking him out.
Many of his nightmares stem from a January 2010 foot patrol.
At the end of the patrol, a Stryker vehicle that came to pick up Starks and his soldiers was destroyed by a bomb, killing one of his friends. The villagers who had set the bomb fled on motorbikes. Starks ended up killing one of them along with an 8-year-old boy seated on the bike.
"For most of that deployment, I did not see myself returning," Starks said.
He did return. But his father, a Vietnam veteran who lives in Salem, Ore., noticed a huge change.
"He was really distant. He didn't laugh much," recalls Lonnie Starks. "He got really nervous. Absolutely no crowds."
A year ago, his PTSD was deemed so severe that his medical records indicated he was unable "to carry and fire" a weapon. These records also noted evidence of a mild traumatic brain injury, and all this set the stage for a medical retirement.
But the heavily medicated Starks, living off the Lewis-McChord post, started not showing up for duty and eventually went AWOL for a total of more than a month. While absent, he holed up in his small apartment in Rochester, Thurston County.
Finally in April, he came to the base for another medical examination he hoped would get his retirement back on track. But his AWOLs and repeated positive tests for marijuana resulted in his being jailed for several weeks.
Depressed and suicidal after his release, he was admitted to Madigan for a week of treatment, then dismissed from the Army.
According to documents reviewed by The Seattle Times, Starks' brigade commander on March 28 recommended he receive a general discharge that would have allowed him access to the VA "in the hopes he will avail himself of benefits and turn his life around."
But that recommendation wasn't followed, and he received the other-than-honorable discharge.
Since leaving the Army, Starks has been living with his father in Salem, and plans to enter community college in the fall to study psychology.
Through the summer, he continued to take his six medications until he ran out of pills.
In early August, he was surprised to receive a letter from Gen. Eric Shinseki, the VA's secretary. It welcomed him home, and singled him out as a combat veteran eligible for five years of free VA health care.
"On behalf of the men and women of the VA, and a grateful Nation, thank you for your service," Shinseki wrote.
The letter prompted him to call a county representative assisting with his VA claim.
"I was told this was nothing more than mass mailing," Starks said. "And I should disregard the letter."