Dustin Bowen came home from the Marines with the bones in his left hand so shattered they would fracture again when the Iraq combat veteran tried to open a door knob.

He underwent more than a dozen surgeries in a decade before finally deciding to amputate the hand last year.

He tried to adapt to civilian life while in fierce pain from the injury suffered in a mortar attack. No one would hire him once they got a look at the hand and the way his arm hung uselessly to the brace that supported it. He lost his home to foreclosure, his truck and car to repossession. 

Bowen, his wife Whitney, their young son and newborn had to move in with her family. One night the others came back to the house to find Bowen deranged and fighting them off, tearing a cabinet from the wall and flinging it at the hallucination of a dead friend, screaming to leave him alone.

"I have issues," Bowen said simply.

He's not alone. Today's veterans struggle with more than previous eras — everything from finding a job to multiple physical and psychological traumas. The social and health aids for them have struggled to keep up and staffs are grappling for ways to coordinate services.

More of the veterans have been deployed multiple times. With new technology and gear, more are surviving wounds that would have killed them a generation ago but are left without use of limbs and otherwise disabled. One veteran in every 10 is now female and one in every four of them has experienced military sexual trauma, according to Disabled American Veterans.

The strain on the vets and their families can be horrific.

Treating veterans today is like peeling an onion, the saying goes. As they are seen for one problem, others emerge.

"You can't have someone come in here and treat one thing," said Hugh Myrick, who directs mental health services for the Ralph H. Johnson VA Medical Center in Charleston.

The struggle to provide and coordinate services for this new age of veterans is the point behind Gov. Henry McMaster's recent support for a current legislative move to elevate the state's Division of Veterans Affairs to a Cabinet level position.

It would clear the way for the administrator to work closer with other state and national services and find ways to fund efforts.

Will it make a difference?

"I hope so," said Jordan Watkins, a Medical University of South Carolina therapist who co-chairs the Lowcountry Veterans Engagement Team, a multi-agency group working to coordinate local services.

Catch-up

More than 400,000 veterans now live in South Carolina — one of every 10 people in the state. Nearly half of them are veterans of the recent Gulf War era, according to VA statistics.

Veterans in South Carolina

They are a small percentage of the nearly 20 million veterans nationwide. But as those numbers continue to decline, the numbers in South Carolina won't, for at least the next 10 years.

The region is becoming a relocation destination for veterans, and is among a handful of areas where population growth continues to be expected, according to a 2019 Rand Corp. demographics study.

For newly discharged veterans who need help, it's "sep and tap," — separate from service and tap into resources to adapt to civilian life.

But that's something they haven't been trained for — details such as how to find the right form and get the right signature on it to keep your home from being foreclosed while you transition to a civilian paycheck, Bowen said.

There's no one-stop guide, no one-size-fits-all for individuals with individual needs. Veterans end up turning to other veterans they know for advice.

"I don't think (veterans) don't seek help because they don't want to," Watkins said. "They don't know where to go and what questions to ask."

The community isn't as welcoming as the "thank you for your service" memes would have you believe. Bowen's home was foreclosed on after the first missed payment, the lenders using a contingency in his VA loan.

"People hear 'wounded veteran' and they think, here's a person who is unemployable and homeless and probably has an alcohol problem," said Watkins about the problem in general.

In a 2019 military appropriations bill, U.S. Senate staffers noted that while 44 percent of Gulf War veterans exhibit illnesses including chronic, multi-symptom illnesses, only 26 percent receive benefits and only 17 percent of claims are approved by the VA as a whole, according to the most recent VA data.

Accustomed to a system where an older veteran turned up to be treated for a specific condition, VA centers and other medical services weren't really prepared to deal with the host of symptoms a younger veteran would exhibit. 

"Females in combat is new," Watkins said. "My experience has been that females in particular find the VA hospitals not to be catering to their needs as much, fertility (issues) and women's health in general."

At the Ralph Johnson center and other VA clinics, though, the services are coming together and the coordination improving. A group like Watkins' Lowcountry Veterans Engagement Team is a prime example. The VA is one of the agencies on that team.

Departments in the Ralph Johnson center now move patients from service to service in the same visit without the formerly lengthy referral process, said mental health services director Myrick. There's more focus on identifying suicide risk factors and getting those people help, and on individualized treatments such as women's health.

There's more outreach and referral among VA and outside helping agencies.

"Me personally, I think we're playing catch-up. (But) good work is being done," Watkins said.

There are moves underway on the state level besides elevating Veterans Affairs to the governor's Cabinet. Among other measures, the legislature has agreed to cover about $40 million that grants won't pay for an $87 million project building three new nursing homes for veterans in the state.

Dozens of bills crop up in every session, calling for everything from specialty license plates to free higher education tuition for the families of war veterans.

"In 2008 it was very different for me as a young woman," said Stacy Pearsall, the renowned combat and now veterans photographer who was seriously injured in Afghanistan in 2004 when a roadside bomb blasted under her convoy.

Now, "I think we're headed in the right direction," Pearsall said. "They're working hard to improve and predict where needs arise."

'Jenga stick'

The former Sgt. Bowen is now 35 years old, living in Beaufort. He's at the gym regularly, to work off the emotions pent up in him, and is solidly built. He speaks with an intensity in his eye.

After police Tasers finally subdued him during the incident in the family home, he found a VA social worker who had dealt with the same issues herself. Working with her and others he has managed to put himself back together.

Partly as therapy he now speaks to veteran groups.

Turned down for job after job, Bowen kept finding new ways to try to show employers what he could do. He pursued specialized federal training to drive semi rigs and now works for J.B. Hunt Transport Services.

He isn't cured. The arm might need further amputation. He takes medications to sleep at night without thrashing violently during the nightmares.

"I still fight it. But I've found some peace," he said. "There are a lot of veterans who couldn't recover like I have."

Services for discharged service people have improved immeasurably since the first day Bowen stepped into a veterans clinic, he said. The coordination among the services still lags. Something as simple as automatic enrollment in disability benefits would help.

But "the VA today is almost like a new hospital," Bowen said. "If I got out today it would be a smoother transition into civilian life."

Definitely, though, services for veterans could be better, he said.

Bowen is a little leery of making veterans services a state cabinet position. Putting it in terms of the Jenga stick balancing game, he said, if you put too much weight at the top the pieces at the bottom can't keep up.

"If you put veterans in charge of veterans," he said, "that would work."

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Reach Bo Petersen at @bopete on Twitter or 843-937-5744.

Science and environment reporter. Author of Washing Our Hands in the Clouds.