Reeling from PTSD, Issac Sims tried unsuccessfully to get help from the VA
By MARTIN KUZ | STARS AND STRIPES Published: November 3, 2014
Part two of a four-part series
KANSAS CITY, Mo. — The neighborhoods on Kansas City’s east side exist in various stages of entropy. Crime is commonplace, and residents accept without comment the sporadic pop of gunfire. Along Lawndale Avenue, shaggy lawns border houses that slump from weather and neglect, almost too exhausted to stand.
Patricia and Shawn Sims settled in the working-class area in 2000, buying a brown clapboard bungalow after years of moving around the country with their son and daughter in tow. They were drawn by the low cost of living and the proximity of the Veterans Affairs Medical Center two miles away. Then as now, Shawn traveled to the hospital several times a year for an array of physical ailments resulting from his combat tours in Vietnam.
Patricia believed war had affected their son’s mental health. Issac Sims sustained a traumatic brain injury from an explosion during his second tour in Iraq with the Army in 2010. The blast had fractured his genial nature.
“I was worried about how he’d been acting since he got hurt,” she said, dressed in a gray T-shirt with “Army” imprinted in black lettering across the front. She sat in the living room on a sagging leather sofa beside tote bags bloated with her son’s medical and military records. “I wanted to figure out what kind of help he could get.”
Sims drifted within himself after his return to Kansas City following his discharge from the Army in April 2013. He fell out of contact with his military comrades, perhaps to blunt the ache of what had slipped away, and avoided most of his old friends in town, whose experiences he found too removed from his own. He showed scarce interest in working. His marriage remained fraught.
His isolation and depression mixed with anxiety as his mind moved at the speed of war.
He “patrolled” Lawndale Avenue, walking the street as he scanned rooftops for snipers, dropping into a crouch when a car backfired or a door slammed. He sometimes carried a gun and military rations when heading out on a “mission” in the forest behind the neighborhood. Migraines stalked him, sleep evaded him.
At his mother’s urging, Sims visited the VA. Tests confirmed his traumatic brain injury and suggested he suffered from post-traumatic stress disorder. A clinician prescribed medications for his anxiety, headaches and insomnia.
Recent studies have documented a widespread pattern of VA providers overprescribing drugs. The reports bolster a perception that the agency emphasizes medicating patients over counseling them to hold down costs. For Sims, drugs proved ineffectual, even as the label of PTSD intensified his self-alienation.
“He wore that with shame,” Patricia said. His reaction typified that of combat veterans steeped in the military ethos of invulnerability. On occasion, holding up an old Army ID card or unit patch, Sims told his parents, “This is who I am. I’m not some crazy person.” Groping for purpose, he spoke of joining the French Foreign Legion.
America’s faraway wars come home in the form of the men and women sent to fight them. The actions of some veterans with PTSD can make them appear inscrutable and unsympathetic, and if tolerated by the military to varying degrees, they re-enter a civilian world that is largely unaware of and indifferent to their condition. Their families struggle to decode what goes unspoken.
Like many veterans, Sims was reticent with loved ones about his combat tours. After moving back to Kansas City, he never talked with his family about the bomb blast in Iraq that scarred his mind. He alluded to survivor’s guilt without sharing details.
Patricia hoped he would unburden himself on their long walks in the woods, when they amused each other by singing duets, switching from Sinatra to Nickelback to church hymns. Shawn, an electrician by trade and a handyman by nature, hoped for the same when he asked his son to help with small projects around the house and yard.
“He kept everything pretty much to himself,” Shawn said. “I understand that, but you could also see he had things that were bothering him.”
Shawn has withstood the internal ravages of war for more than 40 years. Combat trauma trailed him home after he served in Vietnam, and in bad moments when the memories return, he feels rage and despair anew. “That’s why I didn’t push him on anything,” he said. “With PTSD, you’re just trying to survive.”
His right forearm bears a blue “U.S. Army” tattoo dulled by the decades, and he wore a black baseball cap dotted with military pins and stitched with the words “Purple Heart Combat Wounded.” His injuries included a bullet wound to his right foot, and in March he had a partial amputation. When Shawn had trouble walking stairs, his son carried him. “Yeah, good kid,” he said, voice rustling. “Good heart.”
Clean-shaven and precise about his attire, Sims presented a calm, even carefree facade to strangers and acquaintances. He could don a soldier’s poise as he once put on a uniform. Those closer to him observed a man under siege from within. Josh Pacetti, a young homeless man whom Sims befriended in his final months, sensed in him an ineffable heaviness.
“It seemed like there was something dark weighing on his chest that he couldn’t express,” Pacetti said. Patricia and Shawn allowed him to stay at the house, treating Pacetti as a surrogate son, and as Sims spiraled, he watched the combat veteran succumb to wounds from a distant battlefield. “He had the war inside of him.”
Sims had stopped taking his prescribed medications by early this year. He blamed the jumble of drugs for his drowsiness and worsening headaches. Around the same time, Patricia discovered he had developed an addiction to aerosols, inhaling vapors from shaving cream cans and hair spray bottles. The effects of aerosols mimic those of alcohol and pot, the substances most often used by people with PTSD to self-medicate.
The unrest in his marriage deepened. In March, his wife called police and alleged he had struck her. Officers arrived at the couple’s house, across the street from his parent’s home, and as he later told his mother, the sight of their weapons provoked a flashback to Iraq. He ran down Lawndale Avenue as cops gave chase before tackling him.
Sims vented on Facebook about how officers handled him. He wrote that they “held me down then took turns hitting me as hard as they could attempting to snap my neck, stomped my already broken skull more times than I could count as well as diclocating (sic) my knee and then re-setting it while senior officers looked on and laughed. I have never been so disappointed in the so called justice system in my life.” Three neighbors who witnessed his arrest offered similar accounts to Stars and Stripes.
Authorities charged Sims with domestic assault. His parents and several neighbors asserted that his wife, a native Cambodian who speaks limited English, lied to police and instigated much of the discord in the couple’s household. Following his arrest, she moved into a domestic abuse shelter. (She could not be reached for comment.)
Sims moved into a spare bedroom in his parents’ basement, and in April he pleaded guilty in the city’s veterans treatment court. Six years ago, Judge Ardie Bland created the court, the second of its kind in the nation, to divert veterans toward support services for behavioral health, substance abuse, jobs and housing.
“We were seeing these vets with problems — mental illness, alcohol, homelessness — that you could pretty much connect to when they got out of the service,” he said.
“Their behavior could look pretty bad. But when you started to understand the root causes, and you thought about how they’ve served their country, it seemed like there was something more we could do — should do — than lock them up or just put them back on the street.”
Bland has learned that support services matter little unless a veteran with combat trauma commits to treatment. He considered Sims sincere in his desire to repair his mind. “I really felt like we were on the right path,” Bland said. “He seemed like he understood what was going on.” The judge directed him to seek counseling at the Veterans Affairs Medical Center.
Sims resented that he had to plead guilty to avoid jail, and he complained to his parents about the order to attend therapy. His inability to grasp the severity of his condition reflected a common symptom of PTSD. Attuned to his lack of insight, his parents and friends recalled, they accompanied him to the hospital at least five times in May in a series of failed attempts to enter him into a treatment program.
Pacetti joined him on one trip. He described Sims charging up and down a stairwell in the 10-story building to check for insurgents and bombs as he “cleared” the hospital. A short time later, Pacetti said, an intake worker told them no beds were available.
Claude Guidry runs the Kansas City VA’s case management program for veterans of the Iraq and Afghanistan wars. He explained the two-step process for starting treatment.
A social worker at the hospital meets with a veteran for an initial assessment and decides whether a psychiatrist or psychologist should conduct an in-depth evaluation that day. In most cases, he said, the evaluation is deferred at the patient’s request, with a follow-up appointment typically scheduled within five days.
“I hear about medical centers where you have to wait a considerable time,” Guidry said. “Here, that’s not the case.”
Federal privacy laws prohibited Guidry from discussing Sims’ medical record and efforts to receive counseling, and the VA’s acting inspector general in Washington has yet to release findings of a review of his case.
Yet Guidry’s time estimate contrasts with the apparent delays endured by Sims and other veterans. Pat Hinkle, a psychotherapist in the Kansas City suburb of Overland Park, works with retired servicemembers in his private practice. Some patients have arranged sessions with him after waiting as long as four months to meet with a VA clinician.
“The level of care there seems to be good,” he said. “But it’s getting in that’s a problem.”
Hinkle, an Army veteran, contends the agency should ease access to short-term services for patients in crisis and provide greater oversight for long-range care. “There has to be more help for the most severe cases,” he said. “The need is growing.”
‘I’m so frustrated’
Sims and his mother tried to enroll him in a counseling program at the VA hospital on May 21. Turned away, they went back two days later, and an intake clerk told them a bed might open in 30 days. Patricia recounted how in a desperate plea, and to no avail, she asked whether her son could bring a sleeping bag and stay on the floor.
“I didn’t know what to do,” she said. “It was like, ‘Can’t you all do something to help my boy not be so ate up and confused?’ ”
In his last days, Sims, who would have turned 27 in July, rarely slept and subsisted mostly on military rations. He took miles-long “speed hikes” in the woods to scout for enemy combatants. Standing by a window inside his parents’ house, he pretended to shoot cars and passersby with a wood sword. He shouted to neighbors, “I’m the best soldier in this troop!”
His bitterness over his arrest had hardened into defiance. One afternoon, sitting in the living room with his AK-47 bridging his thighs, Sims vowed that if police officers confronted him again, “They ain’t taking me alive.”
“He was out there,” Patricia said. She felt helpless as he receded further into an unseen war. “His mind was racing and he was talking nonsense most of the time. The one thing he said that made sense was, ‘I’m so frustrated right now.’ ”
The family had always kept a handful of guns in the home, and with a pair of veterans living with her, Patricia regarded firearms as a fact of life. Only in retrospect would she wish she had locked up the weapons.
On the morning of May 25, Sims argued with his father about which one of them should pick up Patricia from a friend’s house. Shawn refused to hand over the keys to his yellow Hummer H2, concerned about his son driving in an agitated state.
“I got angry when he got angry,” Shawn said. “That was my fault. I gotta remember he’s not there in his mind. Two guys living together with PTSD is not a good deal.”
Sims grabbed his AK-47 and fired five or six rounds while standing in the front yard. Shawn called 911. He told the dispatcher his son suffered from PTSD and requested that police bring him to the VA. He then called Rick Jackson, a friend of Issac’s who lives on Lawndale Avenue, and asked him to stop by to try to calm his son.
Jackson walked over and knocked on the front door. “Rick, is that you?” Sims yelled. Hearing Jackson’s voice, Sims invited him inside and said, “If it wasn’t you, I was going to shoot you and break your neck.”
The former soldier wore dark running shorts, and his torso was bare except for an infantry blue cord around one shoulder and a length of black parachute cord around the other. His appearance had changed with his manner. He chattered without pause while showing his friend how to dismantle and reassemble the AK-47. Jackson stared, bemused.
“It was an Issac I didn’t know,” he said. “It was like he was back in the military.”
He urged Sims to seek help and hugged him before leaving. Opening the front door, Jackson saw a handful of police officers standing at the edge of the yard, guns drawn. He raised his hands and said, “Don’t shoot!”
Officers reported hearing shots from inside the house. Sims ignored their commands to step outside. They ordered residents to evacuate and escorted Shawn away from the house to police headquarters, where Patricia met him. The next time the couple saw their son he was on a steel table beneath a white sheet.