Michael Butcher has applied for at least 25 jobs since injuries he suffered in Iraq forced him to leave the Army three years ago.
"I was even turned down by McDonald's," said the 29-year-old San Diego native.
The military is known for developing leadership, adaptability, loyalty and teamwork. But Butcher said when he tells employers he needs time off to see therapists for post-traumatic stress disorder and a brain injury, they don't call back.
"They think you are mental," he said.
After nearly a decade of war, many U.S. military veterans have lived through extended periods of combat stress and the trauma of losing colleagues. Nearly a third of the troops returning from Iraq and Afghanistan report symptoms of PTSD, severe depression or traumatic brain injury, according to a 2008 study by the Rand Corp.
Many of these new veterans struggle to find and retain civilian jobs. Not only are they returning to the worst economy in decades, advocates say, but many employers do not know how to accommodate these invisible wounds and worry that they might "go postal."
"If you are a person with a lost limb, it's a little more straightforward what you might need," said John Wilson, assistant legislative director for Disabled American Veterans. "You might need a different kind of keyboard or voice-recognition software to do the typing."
But employers may not know what to expect from a person with PTSD or a brain injury. The symptoms can include severe headaches, memory lapses, poor concentration, slurred speech, loss of balance, a short temper and anxiety in a crowd.
"These elements can make it a challenge to do everyday activities in the workplace," said Raymond Jefferson, assistant secretary for the Veterans' Employment and Training Service in the U.S. Department of Labor. "But there are very reasonable accommodations employers can make to allow wounded warriors with PTSD and [brain injuries] to be high-contributing, high-performing members on the team."
When the Society for Human Resource Management surveyed its members in June, 46% said they believed post-traumatic stress and other mental health issues posed a hiring challenge. Just 22% said the same about combat-related physical disabilities.
Although media attention has helped make the diagnosis and treatment of PTSD and traumatic brain injury a government priority, veterans say it has also contributed to the stigma associated with these wounds.
"They hear so many stories on the news — this soldier got back from Iraq and killed his wife — which makes people a little reluctant to hire you," Butcher said.
Butcher deployed to Iraq in 2003 as part of a tank crew that repeatedly came under fire. One hot day he left a hatch open and the force of a grenade blast slammed his head against an iron shield.
Many veterans are using education benefits to improve their qualifications. But when Butcher enrolled in community college, the sight of Muslim students kneeling to pray triggered terrifying flashbacks. He left after one semester.
A friend helped arrange an internship at a computer manufacturing company, but Butcher said he got into frequent arguments with co-workers. After four days, he was asked to leave.
Butcher said he has since learned to walk away when he gets angry and uses weekly counseling sessions to relieve stress. But he said the flexibility he would need from an employer puts him at a disadvantage compared to job seekers who don't have special needs.
Officials with the U.S. departments of Veterans Affairs, Labor and Defense have worked to assure potential employers that the mental and cognitive disabilities of many veterans can be accommodated with little expense and minimum disruption.
Short rest periods — no longer than a smoking break — can make a big difference, said Ruth Fanning, who heads the VA's Vocational Rehabilitation and Employment Service. The department also pays for adaptive technology, such as electronic organizers to help keep track of appointments and white-noise machines to reduce distractions.
Denita Hartfield, a veteran now working from home, takes a digital recorder into every meeting, writes lists in color-coded notebooks and covers her workspace with Post-it note reminders. A striking woman, fashionably attired, with a master's degree in criminal justice and weapons of mass destruction, Hartfield struggled as dean of students at a business school because her disabilities were not immediately apparent.
"I'd get ridiculed every time I had to go to a medical appointment," she said. "I'm not what people think a disabled veteran should look like."
Hartfield's 17-year Army career was cut short by a 2005 ambush in Iraq. She spent the next two years in and out of the hospital to repair three crushed ribs and drain fluid from around her heart. She is now home in Bakersfield, but commutes several times a week to medical centers in Sepulveda and West Los Angeles to treat a brain injury and PTSD.
To compensate, she would work 13-hour days, which caused more stress. But she said her supervisor would still complain when she had to leave for an appointment. When she was asked to delay surgery to remove shrapnel from her back, she resigned.
"I need my appointments to live," she said.
Hartfield now wants to set up her own business advising veterans and employers how to work together. She says more open communication would have helped in her case, but at first she did not want to acknowledge her disabilities.
"One of the problems is so many folks aren't even talking about their invisible wounds," said Tim Embree, legislative associate for Iraq and Afghanistan Veterans of America. "The issues are different with every individual, so what I think matters is that the individual understands what's going on as well as the employer."
To help employers better accommodate the mental health issues veterans face, the Department of Labor has set up a web site, America's Heroes at Work.
Many veterans find civilian work with the U.S. government, which is one of the largest employers of former military personnel; they make up a quarter of the federal workforce. About 40% of the staff at VA medical call centers in Northern California are disabled veterans, many of them with PTSD or brain injuries, according to Project Hired, the nonprofit contracted to run them. Los Angeles Habilitation House is training 18 veterans with invisible wounds to provide contract management services to the government.
They include Ronta Foster, a 49-year-old father of two who has cycled between the Army and low-paying civilian jobs for years.
He was diagnosed with PTSD and traumatic brain injury after deploying to Iraq in 2003 but traces the symptoms back to a beating he received outside a German nightclub in 1982.
"The opportunities have been far and few for me," Foster said. "This here is going to give me an opportunity to start another career and take care of me and my family. That's all I have been wanting to do for 30 years."
Some companies also seek out veterans. Joshua Stout is one of 80 people recruited through Northrop Grumman's hiring program for severely wounded veterans from Iraq and Afghanistan. A former Marine who served in both wars, he now works as a project manager at a plant in San Diego that is developing an unmanned surveillance plane for the Navy.
The company consulted occupational nurses on how to help the 27-year-old manage PTSD and a brain injury. They showed him how to set reminders on his computer and arranged his cubicle so co-workers could not come up from behind and startle him.
Stout said he struggled to learn how to manage databases, but his supervisor worked with him until he could remember the steps.
"I get a lot of self pride out of working for this company," he said. "I'm still supporting the troops and I'm still defending freedom."
Although accommodations have to be made, Karen Stang, who manages the hiring program, said managers appreciate what veterans like Stout bring to the company.
"They bring loyalty, a great work ethic, commitment," she said. "It's been a real win-win."