American Military Casualties in Iraq and Afghanistan Now Exceed 500,000 (Part 1 of 2)

Since 2001, the Pentagon has sought to downplay overall U.S. military losses by artfully redefining what is a combat-related “casualty.” It has published and then changed the rules several times regarding the reporting of casualties. Currently the Pentagon uses DoD Instruction 1300.18 to arbitrarily separate out “wounded in action” from non-battle injuries. Wounded in action is narrowly defined to essentially be an injury directly caused by an adversary. So called “friendly fire” injuries and deaths would apparently not be counted. The emphasis is on acute injuries caused by enemy munitions which pierce or penetrate.

Under this scheme, chronic injuries and many acute internal injuries such as hearing impairment, back injuries, mild traumatic brain injuries, mental health problems and a host of diseases suffered by personnel in Iraq and Afghanistan are usually not counted as being war-related regardless of how debilitating they are. They are either generally lumped into the category of “non-hostile wounded” or simply not counted at all.

Officially, the Pentagon admits that approximately 5,500 troops have been killed and only 38,000 wounded, amounting to 43,500 total casualties. What is left out (according to such sources as the U.S. Department of Veterans Affairs, the New England Journal of Medicine and the U.S. Navy) are:

- 170,000+ cases of hearing damage;

- 130,000+ cases of mild traumatic brain injuries; and

- 200,000+ cases of serious mental health problems.

If these data are included, the total well exceeds 500,000. Even that total would not include:

- over 30,000 serious disease cases, including a disfiguring, parasitic disease called leishmaniasis, which results from bites of sand flies;

- hundreds of thousands of minor disease cases which can be generally characterized as gastrointestinal (i.e., resulting in diarrhea, headaches, stomach cramps etc.). They are all the result of bacterial, viral or parasitic infections which usually have limited, short-term consequences, but not always;

- hundreds of accident injuries. For example, roadway accident injuries suffered by members of a quick reaction force heading to an ambush location are apparently not counted as combat-related;

- thousands of cases of respiratory disease linked to exposure to toxic burn pit smoke;

- hundreds of suicides;

- thousands of cases of back, spinal and foot injuries due to the wearing of cheap and unnecessarily heavy body armor (when lighter titanium layered Kevlar is available).

In a March 25, 2009, report by Hannah Fischer of the U.S. Congressional Research Service on American military casualties in Iraq and Afghanistan, she included the following initial statement:

“This report presents difficult-to-find statistics regarding U.S. military casualties in Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OIF, Afghanistan), including those concerning medical evacuations, amputations, and the demographics of casualties. Some of these statistics are publicly available at the Department of Defense’s (DOD’s) website, whereas others have been obtained through contact with experts at DOD.”

Casualty data should not be “difficult-to-find” for the U.S. Congress and especially for the American public. There is unquestionably a serious transparency problem within the Pentagon on this issue which problem should not exist in a democracy.

If the Pentagon told the truth to the American people about military casualties, the public would learn that the Taliban and al-Qaeda have been stunningly effective adversaries and that both wars seem more akin to defeats than victories. Such revelations might prompt a public discussion over the value of preemptive (and unnecessary wars) and even worse, raise the issue of the competence of Pentagon generals and admirals to wage such wars. To forestall such a public review, the Pentagon has opted to endorse the maxim that truth must remain the first casualty of war.

This two-part series examines the Pentagon’s policy towards and treatment of hearing injuries, brain injuries and mental health problems. This article begins the series and focuses on hearing injuries suffered by American troops.

Battlefield noise can be divided into two parts: continuous noise, and blast or impulse noise. Continuous noise can cause hearing damage over time is the levels are above 85 decibels. The American way of war seems to be inherently noisy. Its addiction to heavy armored vehicles and helicopters guarantees that troops are assaulted by a steady stream of noise. Under the Pentagon’s own studies, riding in a Bradley combat vehicle, at 15 miles per hour, will produce continuous noise of 115 decibels, which presents very serious health concerns to all personnel within the vehicle. While personnel are encouraged to wear hearing protection, such protection, even if worn, is not protective. The reason is that noise does not simply enter the body through the ear canal, but also enters the body cavity. There is extensive evidence that such exposures can lead to a variety of diseases, including vibroacoustic disease (VAB). VAB is a general category of organ and cardiovascular illnesses that can result from exposure to excessive noise.

The other type of noise is impact noise or sudden spikes in noise levels. These are caused by gunshots, explosions or even the sound of a hammer slamming into a nail. There is some disagreement regarding the danger levels for impulse noise. While experts within the U.S. Public Health Service and the National Institute on Deafness and other Communication Diseases agree that any exposure to impulse noise at or above 140 decibels (even for a second) will cause some permanent hearing damage, many experts believe that the danger level is in fact 130 decibels and still others believe it to be as low as 120 decibels.

Some examples of impulse noise are:

- An American M-4 rifle will produce 157 decibels to the shooter;

- An American SAW rifle will produce 160 decibels;

- An American Javelin anti-tank weapon will produce 172 decibels;

- An American TOW missile will produce 180 decibels;

- An American light anti-tank weapon will produce 182 decibels; and

- An American 60 mm mortar will produce 185 decibels.

In order to protect one’s hearing while firing a 60 mm mortar, the operators must wear hearing protection that reduces (attenuates) the impulse noise by 46 decibels (if one believes the American Government) or up to 66 decibels if one wants to be completely safe. The problem for American troops is that the Pentagon does not provide hearing protection that will permit the safe operation of the 60 mm mortar, even though such protection is available.

In order to achieve a satisfactory level of hearing protection, soldiers must be outfitted with multiple layers of hearing protection, including hearing inserts which are custom-made for their ears (as every ear is slightly different). Companies, such as Westone, have experts who will create impressions of each soldier’s ears and will then custom manufacture devices for each of them but this author has found no evidence that the Pentagon has ever purchased these services or products. The U.S. Army’s inventory consists of CAE (combat arms earplugs) which are cheap and inadequate, and some better, but still inadequate, musicians’ earplugs, along with a variety of headset ear protection. Even if one combined the CAEs with a headset, it still would not provide adequate protection. This author has confirmed that American retailer Home Depot carries better hearing protection than most American troops are issued.

The Pentagon seems to be “nickel and dimming” (to use an American expression) its troops by purchasing cheap hearing protection. A package of 24 ear plugs costs the Pentagon $15.55, while musician’s ear pieces can cost $102.60 (according to the General Services Administration). Custom ear pieces can cost hundreds of dollars a pair and computerized headsets with built-in communications gear can cost over $1,000 a pair.

The January/February 2010, issue of “Hearing Loss Magazine” carried a story entitled “Hearing Loss --- The Price of War.” That caption is misleading. While some hearing loss is inevitable during war (such as that suffered in a sudden ambush or due to a rocket attack on a Forward Operating Base or due to traumatic brain injury resulting from an IED strike), other hearing losses (such as resulting from firing at the range, operating heavy equipment, riding in a Bradley fighting vehicle or operating a mortar) are preventable. The attitude that hearing loss is natural and inevitable helps to explain why the Pentagon does not consider hearing damage resulting in a combat zone to be an injury or a casualty.

Hearing Loss Magazine reported on a survey that revealed that 28% of American soldiers returning from Iraq had diminished hearing. The U.S. Department of Veterans Affairs has certified that over 90,000 veterans who served in Iraq and Afghanistan have service-connected tinnitus (permanent ringing in the ears), with another 80,000 suffer actual hearing damage. This does not include those who have completely lost their hearing due to an IED explosion. VFW (Veterans of Foreign Wars) Magazine’s July 2006 issue reported on a U.S. Army study that found that 16% of soldiers surveyed had hearing loss so severe that it “would likely affect their performance in combat.” The test the Army used was one where a soldier with normal hearing could detect a weapon being cocked from 1,000 meters, while a soldier with degraded hearing could only hear such a sound from 46 meters.

These injuries, in many cases, were probably preventable, but these types of injuries are likely to continue because the Pentagon refuses to recognize that there is a problem. An Associated Press story from March 7, 2008, entitled: “Hearing Loss is Silent Epidemic in U.S. Troops” found the military hearing injury rate to be “staggering.”

The Pentagon’s refusal to acknowledge all the consequences of the decision to go to war (because of fear of repercussions), will not make these casualties go away. These casualties are real and are a direct result of fighting two wars. The soldiers, sailors, marines and airmen who have suffered these combat injuries deserve to be recognized and the American people deserve a proper accounting of the mounting costs of their two seemingly endless wars. That accounting begins with an honest casualty count.