LOS ANGELES (Reuters) - His biceps steel hard, injured Iraq war veteran Ken Sargent is looking more like the career soldier who shipped out for his second tour than the severely wounded man who was evacuated from Najaf in August 2004. But his appearance only tells part of the story.
A bullet responsible for his wounds entered below his right eye, blowing off a chunk of brain, erasing most of Sargent's vision, the hearing in his left ear and portions of his memory and mental functioning.
After eight surgeries -- including one to put a metal plate in his head -- and countless hours of rehabilitation, the 38-year-old Marine master sergeant's chest and arms are buffed from workouts with weights. He's again walking, speaking and cracking jokes, but is dogged by fatigue, unable to work full-time and depends on his family for help with daily tasks.
Sargent and thousands of other soldiers with traumatic brain injury (TBI) -- the signature wound of the U.S. war on terrorism -- represent America's new war wounded.
Based on information in a recent report from the Government Accountability Office, an estimated 4,000 troops have TBI.
While many of their lives have been saved by advances in medical technology, a number of them will require specialized, long-term care from a military health system that has been under fire for losing medical records, pay mishaps and miring troops in bureaucracy and red tape as they transition from military to civilian life.
"My injuries can't be fixed. I can't get inches of my brain back. I can't get my hearing back. Doctors told me that the damage to my eyes can't be fixed," said Sargent, who joined the Marines at 18 and wants nothing more than to do another 20.
While he has regained day-to-day function and works on base a couple days a week, what remains of his vision is blurred or doubled. His brain also took a major jolt from the bullet, which has upset its wiring.
He is now obsessive about cleanliness and order, washing his hands often and even making the bed while his wife is still in it. He still has a hard time remembering things from one day to the next and uses notebooks to remember telephone numbers and his ever-changing physical symptoms, which include black spots before his eyes to headaches and fatigue.
He wears gloves while working outside or in the garage because his body doesn't register pain -- any cuts or bruises won't be noticed until hours later.
And Sargent is one of the lucky ones. His wife and family were there to support and fight for his needs. The Marines kept him on active duty after his injury so he can complete his 20 years and be eligible for fuller retirement benefits.
"I'm doing better than they thought I was going to do," he said. "I'm more of a joker and a funny man than I used to be."
While the experience has sharpened his sense of humor, it has also magnified his anxiety as his planned separation from the Marines looms in March 2008.
"I'm really worried about where we're going to live. Am I going to be able to make enough money to support my family? I feel bad because I can't take care of things like I used to," he said.
That role now belongs to Tonia, who is looking for ways to work and care for the man she married 20 years ago this week.
On top of that, she said her family is struggling to accept and make sense of their new roles and relationships.
"If you look at (Ken), the right side of his face from the side resembles the man that I was married to. The left side of his face is the man that I'm married to now," she said.
"What kind of relationship do I develop with this person that I am going to grow old with?"
For now, that takes a back seat to Ken's evolving needs.
"There is no finish line," said Tonia, who early on brought Ken back to Camp Pendleton, about 40 miles north of San Diego, rather than keeping him in a high-tech military hospital in northern California.
"I was assuming that the closer I got to home, the more structure and support I would have," said the 37-year-old, who also planned to join the Marines before getting pregnant with the first of their two daughters, Tasha, 19, and Alishia, 17.
She found the opposite, and has taken up the warrior role her husband left behind by fighting to get him the best care.
"I'm a very squeaky wheel and I'm still misinformed," said Tonia.
She is trying to remain in the family's home on base, close to other resources and friends, for the six months or more it usually takes from the time one is discharged until benefits kick in from the Department of Veterans Affairs, which oversees care for non-active duty soldiers.
"It's like having two sides and you're missing a bridge. I'm saying 'You want me to jump from this end? I've got a 50-50 chance of making it. No. I want a 100 percent chance of making it. Don't make me guess,'" she said.