RUTHFULLY YOURS

 Six months after the blast in the mountains of southern Afghanistan, Pfc. Matthew Leyva rolls into the rehabilitation center at the Center for the Intrepid in a mechanized wheelchair.

His left arm is encased in a cylindrical cage, metal rods plunging into a forearm that is withered and discolored. He has just three fingers on each hand, empty spaces where the pinkies and ring fingers used to be.

His shorts spill over his lap, his legs gone except for a few inches of femur that jut out below his midsection. A colostomy bag is tucked under his shirt.

He is 21 and had been married less than a year when he stepped on the pressure plate. The blast took more than his legs: It left him unable to have children and dependent on testosterone treatments.

Pfc. Matthew Leyva tries to stretch out his back and take a break after spending a couple of hours working out and going through physical therapy Feb. 7 at the Brooke Army Medical Center in San Antonio. He stepped on an improvised explosive device in August in Afghanistan
With his good arm, Leyva pulls his torso onto the mat from his wheelchair and practices rolling on his back and pushing himself up. If he falls and nobody is around, he will need this skill.

After 12 rolls, he struggles to get back into his chair, and a wide smile spreads across his face. “Rehab is the best,” he says. “I’m not going to let this take me down at all. I’m still here, and that’s a gift.”

Even as the decade-old U.S. war in Afghanistan enters its final stages and the American public focuses on troop withdrawals and end dates, the Center for the Intrepid at Brooke Army Medical Center is increasingly filling with service members who have suffered what some are calling the new signature wound of the Afghan conflict: dismounted complex blast injury.

The clunky name describes some of the most catastrophic injuries ever survived by humans on the battlefield, caused by troops stepping on improvised explosive devices.

Injuries from those blasts, which increased after military planners called for more walking patrols in Afghanistan, can and often do result in amputations of legs and arms and hands. Less discussed but more debilitating in the minds of many soldiers are the genital and pelvic injuries — urinary tracts, genitals and bowels can be injured or destroyed in an IED explosion. It’s become so common that some soldiers reportedly visit sperm banks to store their sperm before deploying.

The amputation rate for American troops reached a record number last year — averaging 20 per month, which outpaced even the most violent years of the Iraq war. And in 2010, 17 service members survived triple amputations, compared with just eight in the previous seven years combined, a sign that the severity of the injuries is increasing and that battlefield care is improving.

Dr. Kathryn Waggoner, a clinical psychologist at the San Antonio Military Medical Center at Brooke Army who has counseled several service members wounded in Afghanistan, said that not much work has been done on the psychological fallout of such injuries.

“I researched the psychological literature, and to be honest, it’s very sparse,” she said.

Waggoner said much of her work involves helping wounded service members come to grips with their new realities. “Many are infantrymen or special forces; a lot are fairly young, just married or in steady relationships,” she said. “The idea of not having everything they were born with seemed to say something about their identity as men. … To have any of that compromised is a big deal.”

The rise in blast injuries coincided with a tactical shift in Afghanistan, which in recent years has taken troops out of heavily armored vehicles and put them on foot patrols. As part of the U.S. military’s counterinsurgency strategy, leaders wanted soldiers and Marines to get to know the villages and villagers in an attempt to gain better intelligence and reduce sympathy toward Taliban and al Qaeda fighters. The mountainous terrain and rocky paths of Afghanistan also make travel in armored vehicles impossible in some areas.

In Iraq, IEDs were also lethal, but more often aimed at vehicle convoys, resulting in different kinds of injuries, said Dr. Ronald Glasser, author of the book “Broken Bodies, Shattered Minds,” which examines the changing nature of battlefield injuries in recent American conflicts.

In Afghanistan, smaller IEDs, usually made of fertilizer smuggled from Pakistan, are aimed at troops on foot. They explode upward, producing a shock wave that can separate skin from muscle. But the worst damage comes from the fragments of rock, metal and sand that are hurled upward, penetrating skin and embedding in tissue and organs, resulting in wounds that are very difficult to treat and infections that require amputation.

“If your body is hit by a shotgun, it is often more devastating than being hit by a bullet,” said Dr. James Ficke, a colonel and head of orthopedic surgery and rehabilitation at Brooke Army Medical Center. Its Center for the Intrepid, built in 2007 with $50 million in private donations, is one of three military medical centers dedicated to rehabilitating service members who have suffered blast injuries.

Military leaders are still scrambling to find and implement ways to reduce the carnage, including greater use of pelvic protection units made up of so-called blast boxers and Kevlar overgarments that may protect against infection and injuries to the midsection.

Officials are calling for other changes. In June, an Army task force studying the dismounted blast injuries recommended that urologists be stationed at trauma centers in Afghanistan to give quicker treatment to genital injuries, including reconstruction. Officials with the U.S. Army surgeon general’s office said they could not reveal how many Army urologists have been deployed to Afghanistan since the report’s release, citing operational security.

The injuries have become so notorious among soldiers that according to Glasser, some troops have begun storing their sperm before deploying to Afghanistan, although the practice is not official military policy.

“The (unwritten) general recommendation is that if you’re going to be sent to Afghanistan, you store your sperm,” he said.

The task force report calls on the Department of Defense to offer what are often expensive fertility services to any service member with combat-related infertility. The report also calls for research into the psychological health of service members who have suffered genital injuries.

Waggoner, the Brooke Army psychologist, said therapy essentially consists of helping service members shift their thinking about their injury. “Does this really mean I am less of a person? You really have to work on those thoughts; that’s what’s driving the depression and anger,” she said. “How do you dispute those dysfunctional thoughts about yourself and get to the point where you feel great about yourself and what you did? As you can imagine, that takes some time.”

Thanks to advances in battlefield medicine — including improved use of tourniquets and whole blood transfusions — more war fighters are surviving injuries that would have been fatal in previous American wars. That’s most likely the case with Leyva, who was given his last rites on two occasions before he finally made it to San Antonio.

About two years after graduating from high school in Cicero, N.Y., where he played football, Leyva joined the Army in October 2010.

“I like the whole kicking-down-doors and whatnot, the weapons, all that,” Leyva said. “I just looked for the rush really. Also that real camaraderie. I only have a sister, so I was looking for some brother-type figures.”

He was deployed to Kandahar in southern Afghanistan three months after he finished basic training. The flight over came after his wife suffered a miscarriage; his deployment had been on hold while they awaited their first child.

“My guys were all there for me,” he said. “It was a tight bond.”

His unit was stationed at a bare-bones combat outpost where soldiers slept on cots inside tents. During the unit’s many missions, the fear of IEDs loomed large for the soldiers.

“They are hidden so well,” Leyva said. “It’s not like when you get in a fire (fight) where you know where to take cover. With these IEDs, they’ll put them anywhere, follow your tracks and put one in there.”

A few soldiers in his unit had stepped on some smaller IEDs and suffered minor injuries, but nothing like what happened on Aug. 9.

That day, Leyva and his unit went on a walking mission to gather intelligence from the villages surrounding the compound. As he often did, Leyva took the point, at the head of his unit’s formation.

He remembers little from that day but knows the unit was walking back to the compound when it happened. “I think we walked a different path,” he said, his voice growing quiet. “I stepped on one.”

The blast that followed tore out chunks of his legs and sent fragments into his pelvic section and as high as his chest. But Leyva survived the wounds after receiving quick care from combat medics and trauma surgeons.

After his comrades brought him into the compound, he was flown out of the area and eventually arrived at the Landstuhl military hospital in Germany, where the most grievously wounded troops from Iraq and Afghanistan are treated before being sent to the United States.

He would remain in a coma for nearly two months.

His 20-year-old wife, Raelynn, remembers getting a call a few days after the blast from Army officials telling her she was being flown to see her husband, who they said was in critical condition.

“I just thought, ‘Look what they did to my husband.'” she said. “I had to walk out a couple of times. Even though he was in a coma, I didn’t want him to see me hurting. … I was so scared to touch him. I was scared I was going to hurt him.”

Soon Leyva was brought to San Antonio, where he underwent what seemed like an endless string of surgeries. When he finally woke up, he thought he was still in Afghanistan. He had dreamed that he was still on his cot.

“He wanted to know why we were there,” said his mother, Rene Scochia. “I told him something had happened in Afghanistan. I told him he stepped on an IED and now he was in Texas. He kind of rolled his eyes and went to sleep.”

He made his mom take a picture of what remained of his lower body, “so I could know exactly what happened to me,” he said softly. “It was horrible at first, but now I’m getting used to it, kind of.”

Despite the injuries, his family soon learned that Leyva’s infectious personality remained. He told his first joke after his mother cut his fingernails one afternoon shortly after he awoke. When she finished, he raised his hand with its missing fingers and deadpanned, “Aren’t you going to get the rest?”

It was a huge relief to Raelynn Leyva. “When I first saw him I had a lot of doubts, but anyone would when they see that. It’s a shock,” she said. “When he finally woke up, his attitude was phenomenal. It felt like I had my husband back. He has surprised so many people.”

Leyva is hopeful about the future: He wants to get prosthetic legs, but with such a small amount of femur left, it’s not clear yet whether that will be possible. Leyva is unable to father children after the blast, and he will need to take testosterone for the rest of his life, he’s been told. But he said his injury won’t stop him from being a father. He and his wife are looking at the possibility of working with a sperm bank.

“Yeah, it’s a big downer, but there are ways around it,” he said. “There are still ways to have a kid. I was so excited when Raelynn was first pregnant; I wanted to be a dad so bad. Now I’m even more excited because I’m going to be home.”

He’s also excited about his future career plans. He’d like to help other wounded soldiers, perhaps as a case manager or representative.

“I’m still living my life to the fullest,” he said. “There’s no point in beating myself down about this.”

Like many of his fellow soldiers, Marines and other gravely wounded service members, he hopes his battlefield sacrifices don’t go unnoticed by a public that sometimes seems all too ready to move on from the horrors of war.

“We’re over there fighting for them to be over here living their lives,” he said. “I gave my limbs for this country. I did the unthinkable. I’m not asking for some golden toilet or something; I’m asking for some respect because I was over doing what I could to help this country.”

jschwartz@statesman.com; 912-2942