Another soldier spurned by Army dies of apparent suicide

For a U.S. Army where failures to treat soldiers with substance abuse problems have been linked to suicides, Georgia National Guard Spc. Stephen Akins was another tragedy waiting to happen.

Scans of his brain showed scars, and he had a history of seizures, combat blast exposure and suicide attempts. All were indisputable evidence that the soldier needed a medical retirement — despite erratic behavior that led to punishable infractions, his lawyer and psychiatrist argued. Such a move would offer a smooth transition from the Army to the care of the VA.

But the Army didn't see it that way. A two-star general with no medical background concluded that the 31-year-old soldier's behavior — drunken driving, speeding, missed appointments and urinalysis cheating — had nothing to do with traumatic brain injury or emotional problems and kicked him out of the Army.

On July 2, six months after he was expelled, Chrystal Akins found her son dead in the basement bedroom of her home in Austell, Ga., just west of Atlanta, victim of an apparent suicide by overdose, according to police. "It totally blew me away," she said about prying open his bedroom door and finding his body on his bed. "I'll live with this the rest of my life."

Akins' death is the latest to cast a light on the Army's struggles to adequately treat soldiers who suffer drug or alcohol abuse, often the result of emotional illnesses or traumatic brain injuries from years of combat. The Army's substance abuse program has declined in quality of care since it shifted to non-medical management in 2010, according to a USA TODAY report in March that led to an Army inspector general's investigation. Army leaders are weighing whether to shift the program back to medical supervision.

Since non-medical management took over, 90 soldiers have committed suicide within three months of receiving substance abuse treatment. At least 31 suicides followed sub-standard treatment, according to records obtained by USA TODAY from staff members critical of the program. The clinical staffers did not specifically link the deaths to poor care.

Army documents show that half of the service's 54 substance-abuse clinics around the world fall below professional standards. The clinic at Fort Gordon, where Akins was treated, is among the best in the Army.

Patrick Lillard, the psychiatrist counseling Akins, said the soldier was in desperate need of more help than the Army could provide, and that he tried to arrange hospitalization at Walter Reed National Military Medical Center in Washington shortly before Akins was to leave the military.

The Army issued a statement defending its actions, noting that Akins had been counseled about his substance abuse and undergone in-patient treatment in 2013 at a Fort Gordon hospital. Despite these efforts, the Army said, he continued to abuse drugs.

"Akins tested positive for drug use eight times between January and November of 2014," the Army statement said, adding that Fort Gordon health officials scheduled one appointment for Akins with the VA for a few days after his discharge. "We are not able to confirm whether he attended or not."

Lillard said Akins was in no condition to see after himself at that stage. His last days in the Army were in the hospital where he was treated for self-inflicted cuts from an attempted suicide. "Stephen was not at a stage in his illness where he could manage on his own as an outpatient," said Lillard, who has since resigned from the Army program.

He and other program critics say commanders without medical training fail to see substance abuse as a way to cope with war-related trauma. Instead of treating the soldiers, commanders punish them for abuse-related misconduct, such as drunken driving, and force some out of the Army.

"It's much easier to ... wipe their hands of it thinking the VA is just going to pick up the pieces," says Ryan Pavlu, national service director for the Wounded Warrior Project, which has assisted 75,000 Iraq and Afghanistan veterans.

Lillard said, "There's a continual lingering doubt among command-level people that, 'Hey this is the same kind of severe disability that would be associated when somebody gets their legs blown off.' "

Akins joined the Georgia National Guard in 2003 and was sent to Iraq three years later, where he was knocked unconscious by a roadside bomb that detonated under his vehicle, according to his medical records.

The wound occurred as IEDs — improvised explosive devices — were becoming the most lethal weapon used against American troops, and military doctors were just learning how the explosions could cause traumatic brain injury. At the time, many troops exposed to explosions were sent back into combat before their brains recovered, risking further and more serious damage from a subsequent blast.

Akins returned to duty without proper evaluation, according to his files. He later served two tours in Afghanistan and was exposed to other blasts.

Akins was in training at Fort Stewart, Ga., in 2010 when he suffered a seizure on the firing range and collapsed. It apparently happened again in his barracks later that day, only this time as Akins fell, he struck his head so hard that it caused internal bleeding and he was rushed to the hospital, according to his records.

The soldier was placed in a therapeutic coma to allow brain swelling to decrease and he nearly died. Lillard, who also is a neurosurgeon, said Akins should have received a medical retirement right then. But the soldier, who was also diagnosed with PTSD, was found fit for duty and sent on a fourth deployment to Kosovo.

"Was it predictable with Stephen Akins that something bad was going to happen to him? Yes, it was," said Lillard. "The Army says they never leave a fallen comrade, but if (soldiers) come home with brain injuries and PTSD, the Army uses that as a reason to abandon them."

Neurological scans later showed signs of lesions in areas of the brain that control impulsive behavior and decision-making, easily explaining erratic conduct that included drug and alcohol abuse, Lillard said. Twice, Akins attempted suicide.

"The TBI factors of concern include impaired judgment, dis-inhibition and very poor control of reactions to stress. He also has an ongoing significant mood disorder with recurrent suicidal ideation," Lillard wrote in a memo to Akins' lawyer last October, as the soldier faced involuntary separation. "This adds up to a very impaired soldier."

Despite the evidence assembled by Akins' lawyer, Capt. Colin Nisbet, and Lillard showing the soldier's emotional and neurological illnesses, a military medical evaluation board found him fit for duty last summer, according to an email drafted by Nisbet.

This cleared the way for the Army to kick Akins out. Then-commander of Fort Gordon, Maj. Gen. Lawarren Patterson, said his own "careful review" of Akins medical condition showed that it "was not a direct or substantial contributing cause of the (mis-)conduct," according to a memorandum the general wrote. A separation board last August validated that conclusion and Patterson's replacement, Maj. Gen. Stephen Fogarty ordered that Akins be kicked out of the Army.

Akins remained on active status for several days while doctors at Eisenhower Army Medical Center at Fort Gordon treated him for self-inflicted suicide wounds.

It was during this time that Lillard said he tried to arrange Akins' admittance to a Walter Reed brain-injury treatment facility last November. Lillard said he was told by a supervising doctor that the hospital had an opening the following week if Akins was still in the Army

A thrilled Akins called his mother. "He was all excited," she remembers about that day in November. "He said, 'Mom, I won't be home next weekend to see you and granny, because I'm going to Walter Reed Medical Center and I'm finally going to get the help I need.' "

But Akins was released from the hospital and processed out of the Army before any transportation to Walter Reed could be arranged, Lillard said.

The Army disputes some of this, saying that Walter Reed told Lillard that the VA could later arrange care for Akins at Walter Reed even if he were a veteran. Lillard denies he was ever told this.

In the six months that followed Akins discharge from the Army, he grew isolated from his family, yelled out during his nightmares and complained about constantly feeling overwhelmed. "He actually looked like he was a million miles away," his mother says.

As police investigating his death await a toxicology report to determine more precisely what killed him, Chrystal Akins says she struggles with how the Army handled her son.

"He wanted to go out there and do something for his country and this is what he gets in return," she said. "I just don't understand why people are like that. They just wanted to get him out."

Her son was buried with military honors on July 9 at the Georgia National Cemetery in Canton.