Elizabeth Dole Foundation
Hidden Heroes Caregiver Journey Map Campaign for Inclusive Care
May 19, 2014

Caregiver, now his wife, helps save veteran

Caregiver, now his wife, helps save veteran
Veteran with caregiver

Ledger Enquirer

A decade ago, Tom Smith came home from a year of war in Iraq, grateful to be alive and seemingly in one piece. But so much of him was broken inside: physical, mental and emotional pain, topped off by a divorce from his wife and separation from his two children.

He was transferred in 2004 from Fort Campbell to Fort Benning, where he was tasked to trained incoming soldiers. Although his deployment was over, a different kind of war ensued.

For four years, as he fought personal demons with alcohol abuse, he also battled Army superiors who became adversaries in a system that didn’t provide the help he needed.

Then, in 2008, he met Steff — the loving and unrelenting force who became his wife nine months later and charged through the military bureaucracy to get her husband the treatment he deserved.

Now, the retired staff sergeant receives full military disability payments. He has cut in half the 28 medications he waSteff Smith - copyright photo - not for distributions taking daily. He quit alcohol cold turkey. And he barely remembers his two suicide attempts.

No wonder a national program chose Steff to represent Georgia among the country’s caregivers of military service members and veterans. She is an Elizabeth Dole Fellow, calling for more awareness and support for their cause.

According to a RAND Corp. study commissioned by the Elizabeth Dole Foundation, 5.5 million Americans are caring for a veteran, including more than 1 million post-9/11 veterans, but only 47 percent of them receive proper support.

Tom was among the unsupported before Steff came into his life.

Rock bottom

Tom, a native of New Mexico, served in the U.S. Army and Marines a total of 23 years, including the initial invasion during the Iraq War in 2003-04 with the 3-502 Infantry of the 101st Airborne Division. Multiple blasts left him with a traumatic brain injury, but it went undiagnosed, as did his post-traumatic stress disorder upon his return to the U.S.

He had migraine headaches, memory loss, confusion, hyper-vigilance, flashbacks and night terrors. He also suffered injuries to his knee, back and shoulder.

But he self-medicated with whiskey to sooth his sorrow instead of seeking help.

“I was pretty much at rock bottom,” said Tom, 42. “It was nothing for me to down a bottle of Jack a day. But she came along and pretty much straightened me out and helped me through all the problems I was going through with the military. At the time, the chain of command wasn’t involved with the PTSD or any of the issues that were going on with combat vets.”

Steff’s father was an Air Force veteran of the Vietnam War, so she understood the ramifications of military service. She also was in a Troy University master’s degree program for social work, so she understood how to identify folks in trouble and how to help them.

“That was my prep for Tom,” Steff said with a smile.

In 2008, Tom was on his way back to Fort Benning from an eight-month deployment to Korea when he met Steff online. Both were divorced and had children — and, lo and behold, Steff just so happened to be living in Columbus.

Steff took her wingman along to check out Tom before their first date in September 2008 at Players, where Tom shot pool. After the wingman’s blessing, Steff left with Tom to talk some more downtown. They kept talking until 5:30 a.m., when Tom had to leave for PT on post.

“It just clicked,” said Steff, 43. “Everything just kind of clicked right then. Within a week, I think we knew. We both had bad marriages, bad relationships. We both were doing the tap dance around acknowl

edging it, but we were seeing each other every single day.”

“She is everything I was missing in past relationships,” Tom said. “I mean, we could talk. That first night, we kind of both put everything on the line. There was no hiding anything.”

Even his alcohol problem. A month later, she told him, “I’m not going to watch you drink yourself to death. No answers are found at the bottom of that bottle.”

And no answers were easily found in the Army.

Broken chain of command

Tom’s memory loss was causing problems for him at Fort Benning, yet no treatment was forthcoming.

“He had a commander that had never deployed but was one of those Billy Bad Ass guys,” Steff said. “If you had a broken leg, you were injured. But if he couldn’t see it, you weren’t.”

Tom summed up the military’s macho mentality.

“The mental capacity of everyone is that, if you need to seek counseling, you’re a slacker,” he said. “You’re showing weakness.”

Steff noted the Army handles PTSD much better now, but she still fumes at how her husband’s case was overlooked and how she had to study the Uniform Code of Military Justice to protect him.

“They tried to put him out of the Army,” Steff said. “They tried to do UCMJ action. We had medical documentation that this was brain injury. He has PTSD. He’s not deliberately doing stuff. He needs some help. But that command wouldn’t listen. They ignored directives. I was spending most every night reading the UCMJ and handing them their own policy.

“I would say, ‘By reg, you can’t do this,’ and they would just steamroll right over it.”

Tom was in and out of the hospital for more than a year. His doctor even put him in psychiatric day treatment for 4½ months “to keep him away from his chain of command,” Steff said, “because they were making him worse. We had documentation that the Army was making him worse.”

So she learned as much as she could about PTSD online. She got a referral for a counselor from Military One Source, and by December 2008 Tom was diagnosed with PTSD.

“His score was off the chart,” Steff said.

But it took until the spring of 2010 for Tom to be allowed to join the Warrior Transition Battalion, where his job was to get better or go through the Medical Evaluation Board to become medically retired.

“I was sending off Congressional inquiries,” she said. “I sent one to every member of the Senate Armed Services committee. They were not listening. We even had his private doctor come on post to talk to his command and say, ‘He needs medication, intervention, hospitalization or you’re going to kill him.'”

Steff compared the Army’s treatment of her husband to America’s treatment of her father.

“My dad got spit on at the airport in San Francisco coming back from Vietnam,” she said. “That’s not OK. This was the equivalent, but he was being spit on by his own army — not OK.”

Steff’s persistence got the Army vice chief of staff at the time, Gen. Peter Chiarelli, and Fort Benning’s commander at the time, Lt. Gen. Michael Ferriter, involved in her husband’s case.

“General Ferriter called us in, and he said, pretty much, this was b——- and the chain of command failed from the top down,” she said. “The order was issued for WTB the same day, and the med board was initiated immediately.”

Tom sighed and added, “That felt good. Finally, somebody was listening.”

Medically retired

It took 18 more months for Tom to get approved for medical retirement. The med board determines whether each ailment or disability is connected to the soldier’s military service. Then the board assigns the soldier a disability rating.

The med board rated him 90 percent disabled. The VA also rated him 90 percent disabled then increased it to 100 percent. So he waived his Army retirement in favor of VA disability payments.

“You can’t double dip,” Steff said.

Now, instead of having to worry about getting evicted because he couldn’t pay his rent, Tom can focus on getting better. And now, Steff’s full-time job is taking care of Tom. She is a third-tier caregiver in the VA, which gives her $1,900 per month, based on what it would cost the VA to send an in-home health aid every day.

Tom laughed as he explained why he needs a full-time caregiver.

“I’d forget my a– if it wasn’t attached,” he said. “I mean, I can be making a pot of coffee and holding the filter and the pot in my hands and it’s like, ‘What the hell am I doing?'”

But some of his memory loss is a blessing. His last suicide attempt is too vague to haunt him, so Steff fills in the blanks.

One day at home in 2011, without Steff noticing, Tom made himself a cup of coffee. Then he told her he was going to take a nap.

“I went in to check on him,” she said, “and he was barely breathing.”

In the kitchen, Steff found an empty vial of 60 doses of morphine and the residue of the pills Tom had crushed into his coffee cup.

She drove him to the St. Francis Hospital emergency room.

His heart rate had dropped to nine beats per minute. But thanks to Steff and the ER staff, Tom is alive to express a feeling he feared had slipped away: “I’m more grateful for what I do have. I don’t take a lot of things for granted anymore.”

“For a while, I wasn’t even sure he wanted to live,” Steff said. “There still are things he would want to improve or change, but for him to say he’s content, that’s great. There were days I didn’t think we were going to make it to this point.”

To the point where they not only are surviving, but they are willing to help other caregivers and veterans.

Reaching out

Elizabeth Dole Fellow candidates apply and are interviewed to be selected. Steff was accepted in February.

“Steff stood out because of her personality and eagerness to advocate on behalf of other military veteran caregivers,” Carol Lindamood Harlow, executive director of the Elizabeth Dole Foundation in Washington, said in an email.

“We also chose Steff because her personal caregiving story reflects the stories of so many military and veteran caregivers, particularly those caring for those who served after 9/11. Her husband sustained a combination of physical and psychological injuries, which is a defining characteristic of the post-9/11 generation of caregivers. And though their path has not always been easy, Steff has persevered and now shares the knowledge she has gained with people facing similar struggles.”

Steff joined the Dole Fellows in Washington last month to lobby officials about expanding caregiver legislation to include more support services for more veterans.

“I have a friend who just posted the other day that they waited 24 months for a dental appointment at the VA,” Steff said.

She also is available to speak to groups or give one-on-one advice.

“By talking about it,” she said, “you can see that it’s OK to say, ‘We’re floundering. We’re going bankrupt.’ It’s OK to say that, and there are nonprofits and foundations that will help you.”


Tom sleeps only in spurts, 2 to 3 hours at a time. Sleeping pills don’t work for him. He needs to have a spinal cord stimulator implanted to help with pain management, another knee and a shoulder reconstruction.

As for Tom ever being healthy enough to be employed again, Steff said, “I would say that a job is only on the horizon, the distant horizon.”

“Believe it or not,” Tom said, “retirement sucks.”

“I think a lot of people envy the guys that medically retired in some way,” Steff said. “They’re like, ‘Oh, they got their disability and they don’t have to work.’ You don’t want this life. You don’t want it.”

“I’m used to going 90 to nothing nonstop, and all of a sudden it stops,” Tom said. “What the hell do I do now?”

He keeps busy with woodworking on the back porch and doing what he can to help around the house and with their three children at home, but he can concentrate on one task for only an hour or so.

“I get bored with what I’m doing,” he said. “I’ve got to do something else.”

He still takes 13 prescription medications, plus an aspirin regimen, for his chronic pain, anxiety, mood swings, panic attacks, insomnia and PTSD, along with recovery from a stroke he had in March. But the 60 medical appointments per month are down to around 10, giving Steff more time to be an Elizabeth Dole Fellow.

‘No pamphlet for this stuff’

Steff summons the energy to aid other caregivers and veterans “because I wish somebody had done this for me. It was trial and error, figuring it out, very much hit and miss, literally just sitting on the phone and calling people. For every call that panned out, there were 10 that didn’t. I can shortcut it for somebody.”

Tom added, “There is no pamphlet for this stuff.”

Even after he was medically retired, no one informed them of the resources available.

“The VA gives you a handbook,” Steff said, “but nobody says, ‘Hey, this is what relates to your situation.’ We’re lucky that we have a great case manager in Tuskegee, and I can go to her for anything, but that’s not the case across the country.”

As a VA caregiver, Steff is entitled to as many as 30 days per year of respite care. That means the VA would send a professional to take care of Tom and give Steff time to take care of herself. But she has tried the service only once.

“I got so frustrated and angry with the process,” she said. “They’ll say the respite program is more for people with physical needs. If he were a triple amputee, I could get a respite person. If it’s to make sure he doesn’t overdose or have a breakdown or a panic attack, no.”

About only 20 percent of caregivers use the respite benefit, Steff estimated.

“It’s almost impossible to get it,” she said. “I don’t know if they were just unprepared for the number of people that would need it. I know they weren’t prepared for the number of people that went into the program. We’re served out of Tuskegee. We have monthly caregiver meetings, and they serve Phenix City and Columbus, and there’s probably about 40 who regularly attend, but that’s probably a third of the number that’s in the program.”

Because of his PTSD and being wary of strangers, an hour is the longest period of time Steff will leave Tom alone.

“I probably hover a little more than necessary,” she said. “We’re together most days 24/7. We might be apart maybe four hours a week.”

Steff knows her situation isn’t a model for all veterans and their caregivers. That’s why she urges them to not bear their burdens by themselves.

“Ask for help,” she said, “and keep asking if you don’t get it.”

Mark Rice, 706-576-6272. Follow Mark on Twitter LEARN MORE

For more information about the Elizabeth Dole Foundation and a link to the RAND study, click on this story at www.ledger-enquirer.com.