March 15, 2011: A decade of war has revealed a new pattern of combat losses. These days, most of the serious casualties (about half) are for physical (31 percent) or mental (19 percent) stress. Only 14 percent of the casualties have been from the direct effects of combat. This decade of fighting has killed 6,000 American troops, and wounded 45,000. But over 100,000 have been badly hurt by accidents, mental stress and disease. While most of the sick and wounded have been treated, and often discharged, there are now 15,000 active duty troops (over two percent of army strength) who cannot be sent to a combat zone because of injuries, illness or PTSD (post-traumatic stress disorder).

Even in peacetime, there are some troops who have a �profile� that makes them ineligible for certain types of duty. But because of the large number of casualties in the combat zone (including injury and disease), and the need to keep experienced NCOs and troops with technical skills, the number of those with a profile is more than three times what it normally is in peacetime.

For the U.S. Army, this is not unexpected. Over a million American military personnel have gone to Afghanistan and Iraq since 2001, most of them army, and as more of them came back wounded, sick or injured, the number of people with a profile increased. This was particularly true with PTSD, which has become the most common reason for a profile that keeps troops out of combat.

While the risk of getting killed in combat is now a third of what it was in Vietnam and World War II, the incidence of physical and mental strain appears to have more than doubled. This is largely because troops are in combat for so much longer than in past wars. This makes it much more likely for troops to eventually develop PTSD, and the kinds of stress injuries (often accompanied by chronic pain) amateur and professional athletes suffer from as they get older. The lower death rate came about partly because of much more effective, and heavier body armor. Then there was all the weight of additional equipment (medical, combat and so on) that made combat safer. But at a cost. And the cost will be paid for by the troops for decades to come.