In Awad’s case, he needs to think of a reason each morning not to kill himself. He can’t even look at the framed photograph that shows him accepting a Marine heroism medal for his recovery work at the Pentagon after the terrorist attack. It might remind him of the burned woman whose skin peeled off in his hands when he tried to comfort her. He tries not to hear the shrieking rockets of Iraq either, smell the burning fuel, or relive the blast that blew him right out of bed. The memories come steamrolling back anyway. “Nothing can turn off those things,” he says, voice choked and eyes glistening. He stews alternately over suicide and finances, his $43,000 in credit-card debt, his $4,330 in federal checks each month. They bring the government’s compensation for total disability from post-traumatic stress disorder. His flashbacks, thoughts of suicide, and anxiety over imagined threats – all documented for six years in his military record – keep him from working. The disability payments don’t even cover the $5,700-a-month cost of his adjustable home mortgage and equity loans. He owes more on his house than its market value, so he can’t sell it and may soon lose it to the bank. “I love this house. It makes me feel safe,” he says. Awad could once afford it. He used to earn $100,000 a year as an experienced Marine with a master’s degree in management who excelled at logistics. Now, he can’t even manage his own life. There’s another twist. This dedicated Marine was given a “general” discharge 15 months ago for an extramarital affair with a woman, also a Marine. His military therapists blamed this impulsive conduct on PTSD aggravated by his Middle East tours. Luckily, his discharge, though not unqualifiedly honorable, left his rights intact to medical care and disability payments – or he’d be in sadder shape. Divorced since developing PTSD, Awad has two daughters who live elsewhere. He spends much of his days hoisting weights and thwacking a punching bag in the dimness of his garage. He passes nights largely sleepless, a zombie shuffling through the bare rooms of his home in Southern California wine country, not far from his old base. Few anticipated the high price of caring for Awad and other Middle East veterans with deep, slow-healing wounds. Afghanistan seemed quiet, and Saddam Hussein still ruled Iraq one year after the Sept. 11 attacks. That’s when the U.S. Department of Veterans Affairs guaranteed two years of free care to returning combat veterans for virtually any medical condition with a possible service link. Later, few predicted such a protracted war in Iraq, one in which Iraqi insurgents would rely on disfiguring bombs and bombardment as chief tactics. Better armor and field medicine have kept U.S. soldiers alive at the highest rate ever, according to one study based on government data. But many are returning with multiple amputations or other disabling injuries. The Pentagon counts more than 29,000 combat wounded in the Middle East since the terrorist attacks on New York and Washington. Tens of thousands more got hurt outside of combat or in ways that only surface later. There was no mistaking the injuries of Cambodian-American Sgt. Pisey Tan of Woodlyn, Pa. Eight months into his second tour in Iraq, a makeshift bomb blasted his armored vehicle and took both his legs. Still, Tan has had to rely on private donations and family, as well as government. The government treated him and paid for his artificial legs. But his brother left college to live with him at a military hospital for almost a year. “That’s how our family is,” says the veteran. “We always take care of our own.” The government says it does too, and with some truth. Of 1.4 million U.S. forces deployed for Iraq and Afghanistan, more than 185,000 have sought care from the VA – a number that could easily top 700,000 eventually, predicts one academic analysis. But many also need to help themselves. Iraq veteran John Waltz, of Hebron, Ky., sought treatment for PTSD but ran up about $12,000 in medical bills while his condition and claim were evaluated, he says. “We have to be really frugal, as far as what groceries we buy,” Waltz says. “I think we’re down to just a couple dollars now, until the next time we get paid.” On a national scale, the costs of caring for the wounded certainly won’t crush the immense American economy or the VA. But the price tag will challenge budgets of governments and service agencies, adding another hungry mouth within their nests. Economic forecasts vary widely for the federal costs of caring for injured veterans returning from the Middle East, but they range as high as $700 billion for the VA. That would rival the cost of fighting the Iraq war. In recent years, the VA has repeatedly run out of money to treat sick veterans and had to ask for billions more before the next budget. “I wouldn’t be surprised if these costs per person are higher than any war previously,” says Scott Wallsten, of the conservative think tank Progress and Freedom Foundation. Federal officials generally defend the quality of care. At a recent ribbon cutting, the Army’s vice chief of staff, Gen. Richard Cody, trumpeted a new rehab center for amputees as “proof that when it comes to making good on such an important promise, there is no bottom line.” White House budget spokesman Sean Kevelighan says medical spending for all veterans has risen by 83 percent during President Bush’s time in office. The VA didn’t respond to several requests for comment. Recently, though, outgoing chief Jim Nicholson acknowledged trouble keeping up with the pace of disability claims. But earlier this year, he also insisted that veterans “will invariably tell you they are really getting good care from the VA.” Not invariably. The VA takes the lead in treating wounds and paying for disabilities of veterans. And it usually does a good job of handling major, known wounds, especially in the early months, by many accounts. However, many veterans and families say the VA often restricts rehabilitation or cuts it off too quickly. Denise Mettie, of Selah, Wash., says she fought successfully for VA funds to rehabilitate her brain-damaged son, an Iraq veteran, in a private hospital where he was given five times more therapy. But she’s been living “paycheck to paycheck” to cover travel to his bedside and other costs of his care. A presidential panel has also recommended broader disability compensation for lost quality of life. Some wounded veterans turn to private health insurance and other programs outside the federal government, which also swells costs for states and towns. Service nonprofits also pay for housing, food, clothing and transportation for wounded veterans. Veterans groups sued the VA a few months ago, seeking quicker care and disability payments for those with PTSD. They claim that the crush of shattered troops has sent the agency into a “virtual meltdown.” Last week, the VA challenged the lawsuit on technical grounds. Its lawyers also argued that even though VA rules commit to two years of free care, that depends upon Congress setting aside enough money. 160Want local news?Sign up for the Localist and stay informed Something went wrong. Please try again.subscribeCongratulations! You’re all set! Gamal Awad, the American son of a Sudanese immigrant, exemplifies an emerging group of war veterans: the economic casualties. More than in past wars, many wounded troops are coming home alive from the Middle East, a triumph for military medicine. But they often return hobbled by prolonged physical and mental injuries from homemade bombs and the anxiety of fighting a hidden enemy along blurred battle lines. These troops are just starting to seek help in large numbers, more than 185,000 so far. The cost of their benefits is already testing resources set aside by government and threatening the future of these wounded veterans for decades to come, say economists and veterans’ groups. “The wounded and their families no longer trust that the government will take care of them the way they thought they’d be taken care of,” says veterans advocate Mary Ellen Salzano. How does a war veteran expect to be treated? “As a hero,” she says. By Jeff Donn and Kimberly Hefling THE ASSOCIATED PRESS TEMECULA – He was one of America’s first defenders on Sept. 11, 2001, a Marine who pulled burned bodies from the ruins of the Pentagon. He saw more horrors in Kuwait and Iraq. Today, he can’t keep a job, pay bills, or chase thoughts of suicide from his tortured brain. In a few weeks, he may lose his house too.