The number of wounded soldiers has become a hallmark of the nearly 5-year-old Iraq war, pointing to both the use of roadside bombs as the extremists' weapon of choice and advances in battlefield medicine to save lives.
About 15 soldiers are wounded for every fatality, compared with 2.6 per death in Vietnam and 2.8 in Korea.
But with those saved soldiers comes a financial price — one veterans groups and others claim the government is unwilling to pay.
Those critics also say that the tens of thousands of soldiers wounded in Iraq are part of a political numbers game, one they say undermines the medical system meant to care for them.
The most frequently cited figure is the 29,320 soldiers wounded in action in Iraq as of Thursday. But 31,325 others have been treated for non-combat injuries and illness as of March 1.
"The Pentagon keeps two sets of books," said Linda Bilmes, a professor at Harvard and an expert on budgeting and public finance whose newly published book, "The Three Trillion Dollar War," was co-authored with Nobel Prize-winning economist Joseph Stiglitz.
"It is important to understand the full number of casualties because the U.S. government is responsible for paying disability compensation and medical care for all our troops, regardless of how they were injured," Bilmes said.
Veterans Affairs predicts it will treat 330,000 veterans from Iraq and Afghanistan in 2009 — a 14 percent increase over the 2008 estimate of 263,000 — at a cost of nearly $1.3 billion.
For the 2009 budget, the White House requested $93.7 billion for the VA, including $41.2 billion for medical care for all veterans — not just those from Iraq and Afghanistan. That's an increase of $2.3 billion over the current budget.
Will that amount be enough?
But critics say that is not enough for a system that has a backlog of about 400,000 pending medical claims and complaints, especially in mental health care.
The VA "will not request enough resources to care for the troops — and in fact this is precisely what has happened in the past three years," said Bilmes.
Cynthia Smith, a Pentagon spokeswoman, rejected accusations that the government is trying to hide or obscure the number of wounded soldiers by placing the total in two categories on its Web pages.
"Both of the Web sites have equal importance. They are just counting different things," Smith said. "Neither is more prominent than the other."
James Peake, secretary of the Department of Veterans Affairs, said that funding for VA medical care requested for next year is "more than twice what it was seven years ago" before operations in Afghanistan started.
Soldiers may have to pay
But Bilmes says the VA is hoping to offset some of the costs through increased fees and co-payments — putting more of the burden for health care costs back on soldiers.
"That is the thing that sticks in the gullet, the fact they're hoping to raise $2 or $3 billion through their fees, which is what we spend in Iraq and Afghanistan in about three days," she said.
"For three days of fighting, we could not charge these vets a higher co-payment."
Paul Sullivan, executive director of Veterans for Common Sense, an advocacy group based in Washington, said the VA's budget request for 2009 also does not pay adequate attention to chronic problems facing Iraq and Afghanistan veterans, such as drug and alcohol addictions.
Struggles with mental health
Earlier this week, a federal judge in San Francisco held the first hearing in a class-action lawsuit filed by two vet groups, including Sullivan's, against the VA alleging their neglect in treating suicidal soldiers. The lawsuit asks that the VA immediately screen and treat all potentially suicidal veterans.
According to VA research obtained last month by The Associated Press, 144 veterans from Iraq and Afghanistan committed suicide from the start of the war in Afghanistan in 2001 through the end of 2005. Statistics from 2006 and 2007 were not yet available.
Dr. Gerald Cross, a VA official, said during this week's lawsuit hearings that 120,000 vets from Iraq and Afghanistan using VA care have potential mental health problems, and that nearly 68,000 have potential post-traumatic stress disorder.
In November, President Bush signed legislation directing the VA to improve its mental health training for staff and do a better job of evaluating and treating veterans.
Peake, in a telephone interview, emphasized new efforts in mental health. He said the VA has "changed the access standard. If you present with a mental health issue, you'll be screened within 24 hours."
Peake said he recognized the need to make changes within the VA — particularly in the disability claims system which he said dates back to 1945 — saying that "it is time to review and simplify and modernize our disability system, but that will take work with Congress."
In response to the backlog in pending claims, Peake said, some 3,100 new claims-processing jobs have been opened. He acknowledged, however, that it takes "about two or three years to train somebody to be top notch in terms of being able to develop a claim and adjudicate it."
Going back to the battle
Not all wounded soldiers leave the battlefield for good.
A roadside bomb that sent shrapnel through Fred White's hands and legs did enough damage to require four operations and six months of physical therapy. White, then an Army specialist who was wounded early in the war while protecting a convoy, is now a chief warrant officer, piloting Black Hawk helicopters.
The wounds that left White missing most of his middle finger on his right hand, nerve damage and broken bones in his left hand and shrapnel that is still lodged in his legs and left wrist were not treated in a VA facility.
Once evacuated from Iraq, he got treatment at the U.S. military hospital in Landsthul, Germany, near the Ramstein air base. He then went to Brooke Army Medical Center on Fort Sam Houston in San Antonio because there was a hand specialist there.
Despite his wounds, White made it through pilot's school and passed a few extra tests to ensure the damage to his hands would not affect his ability to fly a Black Hawk.
White's mother, who made a career of the Army, was disabled in a non-combat accident while serving, and he witnessed her struggles in dealing with the system.
"My biggest thing for the VA is they need to remember what their purpose in service is. These vets, they've already served their country, they've already sacrificed," he said. "There is no reason they should have to fight twice."