A repaired ear and injured knee pose challenges for Lara, but nothing like the migraines, mood swings and nightmares that caught her by surprise months after she left the bloodshed of Iraq in December 2004.

Yet in one way she's luckier than other Nevada veterans. Now a student at the College of Southern Nevada, Lara, 30, thinks she's getting much of the health care, schooling and compensation and pension she earned in the military. Many veterans don't.

She got those benefits only through the intervention of the Nevada Office of Veterans Services, an understaffed agency wrestling the behemoth U.S. Department of Veterans Affairs. Without that help, she said, she would be either "homeless" or "crazy."

That mortar blast caused a traumatic brain injury that wasn't diagnosed until months later. And battlefield memories haunt her, she said in December.

"You look at me on the outside and I look normal, but on the inside I am falling apart," Lara said. "I have nightmares about the patients I had over there; the patients who died in my hands and the soldiers I wasn't able to help; the innocent kids who weren't supposed to get killed."

With an estimated 339,235 vets in Nevada, it means a staggering one in nine residents is a veteran, and that Nevada is among the top five states in the percentage of veterans in its population.

However, it is 48th in the percentage of its veterans receiving compensation or pension benefits, and 48th for the per capita cash value of those benefits, according to the Nevada Office of Veterans Services.

Meanwhile, Clark County's figures are in the bottom half for Nevada's 17 counties. The national average for monthly compensation and pension of $1,453 is 60 percent higher than the Clark County average of $910.

And, with the Las Vegas economy in what some characterize as a depression and legislators pressed to balance the state budget, many expect things will get worse.

As a result, even fewer veterans may access their benefits at a time when: soldiers, looking for an education, are returning home from Iraq and Afghanistan; Vietnam-era veterans are retiring here along with other baby boomers; and veterans of World War II and Korea need care in their twilight years.

One reason for the dismal ranking is that the Nevada Office of Veterans Services has few service officers compared to the number of veterans.

This handful of state-paid advocates identify veterans and shepherd them through the bureaucratic labyrinth that is the federal VA, as they apply for benefits or appeal the VA's routine rejections.

The state office has one Veterans Services officer for every 20,000 vets. That is half the national average of one for every 10,000 veterans, and far below the average of one for every 2,000 or 3,000 vets as is the case in some California counties, said Tim Tetz, director of the state Office of Veterans Services.

"In many cases, we promised to take care of them (veterans) for life, and then we abandon them," Tetz said. "The VA makes the vets jump through so many hoops that many people give up, and that is why we need the veteran service officers. Everything is tied to the veteran service officer, whether it is PTSD, the education benefits, the health care benefits or changes to your home or your car if you've been injured."

States with more service officers go beyond helping veterans get financial benefits from the VA. They are better equipped to assist with job-related problems and veteran access to medical and mental health services.

Lara, who the VA classifies as 80 percent unemployable, receives medical care and collects $1,400 a month. She is waiting to hear if she qualifies for more given the extent of her service-related injuries.

Lara says a friend told her to seek help from state's Veterans Services in leveraging her federal benefits. Lara said Veterans Services Officer Tom George navigated for her the extensive documentation required just to be considered for benefits.

"They are very necessary. I would probably be going crazy right now. I wouldn't know where to go because they (the military) never told me where to go (for VA benefits)," Lara said. "The only income I have is from the VA, and I am having trouble finding a job right now."

The Office of Veterans Services is a small state department. It operates two cemeteries and a nursing home for veterans, and employs nine Veterans Services officers. It has limited influence in Carson City at a time when Gov. Jim Gibbons, also a veteran, has ordered all departments to slash budgets more than 20 percent.

Tetz has cut costs at the vets' nursing home and trimmed his budget elsewhere to avoid reducing the number of service officers in the state. Their services to Nevada veterans are too vital, he said. Furthermore, every $1 spent by Nevada to employ a service officer generates about $735 in additional federal payments for Nevada veterans to spend in their communities, he said.

Jeanette Rae, program manager for the Office of Veterans Services, said the agency has four service officers in Las Vegas and another at the state-run, veterans nursing home in Boulder City.

Adding those to veteran advocates from the VA and from nonprofit groups such as U.S. Vets, the Veterans of Foreign Wars and others, the ratio shrinks from 20,000 to 14,000 veterans for every vets' advocate, she said.

"With the huge number of veterans down south, we have a ratio that is rather astronomical," Rae said from her Northern Nevada office.

Unlike other state agencies, Veterans Services spends taxpayer money to access federal money that can make some veteran, who might have been a financial liability to his community, an asset instead.

Rather than have veterans frequenting emergency rooms, county jail cells or homeless shelters, they might own homes, pay taxes and send their children to college if they are identified as veterans and qualify for compensation, health coverage, a pension or other service from the VA, Rae said.

In August, a Vietnam-era veteran won a lengthy battle with the VA in which the agency forced him to appeal claim after claim before he received the benefits he had earned, Rae said.

He came to the state agency for help eight years ago, and might have given up hope but for the experience and knowledge of the service officers on his case, she said.

The benefits that veteran earned included years of retroactive compensation and a monthly stipend. Given his medical condition, it is likely his death will be "service related" and his widow will be eligible for his monthly compensation, Rae said.

"We have changed a family forever," she said.

If the number of Nevada veterans receiving their VA benefits -- and the value of the benefits -- were equal to national averages, Nevada's veterans would receive $173 million more than they do now, said Jay Hansen, a professional lobbyist and guest speaker at the Nevada 2008 Veterans Summit held in December.

That would be new money, which would continue coming to the state year after year until a veteran died and no longer received his benefits, he said.

"That is a huge amount of money, and it is something that you can have a direct impact on," Hansen told veterans advocates at the Summit. "And, that is if we just got to the national average."

An investment in veterans services officers paid dividends in New Mexico, said Lou Helwig, deputy secretary of the New Mexico Department of Veterans Services.

Like Nevada today, New Mexico 10 years ago was ranked near the bottom of the 50 states in per capita compensation and pension its veterans collected. Now, it ranks first.

"We felt the state should be in charge of the grass-roots effort," Helwig said. "The importance of representing a veteran with power of attorney is significant in terms of the claims being more likely to be successful than if the veteran fills out the claim himself."

In addition to hiring more veterans services officers, New Mexico demanded the service officers be more proactive and it established a "collaborative" approach by enlisting the federal VA, nonprofit groups and other veterans services organizations, Helwig said.

"The Legislature (in Nevada) needs to think of veterans as an economic force," Helwig said. "The average income of a veteran in New Mexico is more than $2,000 a month."

Other states, including Maryland, have taken legislative steps to increase their role in veterans affairs. Maryland passed a bill this year requiring the state to help veterans who aren't getting timely mental health treatment from the VA.

Assemblywoman Kathy McClain, D-Las Vegas, and state Sen. Terry Care, D-Las Vegas, are the two state lawmakers on the state's Veterans Services Commission, which oversees state veterans services. Both are serving their last terms in the Legislature due to term limits, which means the commission will have new representatives in 2011.

During a committee meeting earlier this month, neither was optimistic about avoiding additional cuts to the veterans services agency during the upcoming legislative session.

"We have a big problem with the state budget and we are going to have to look at ways of enhancing our revenue," said McClain, chairwoman of the Veterans Services Commission. "This depression is not going to be over for some time and we can't keep cutting essential services."

For soldiers such as Lara, the Army medic, and Kenneth C. Evans, a lieutenant colonel in the Air Force Air Reserve, there is little room for debate or compromise when it comes to caring for veterans.

Evans, who owns a small development company in North Las Vegas, was stationed at Kirkuk Regional Air Base in Northern Iraq, where the bodies of dead soldiers were taken for transport back to the United States.

"I look at young soldiers in the Army and the young Marines and I think we need to do all that we can to get them the housing, medical, education and whatever other benefits they have coming to them," Evans said. "We should give the same level of energy and focus in delivering these benefits as these young men and women do when they go outside the wire to do direct combat missions."

Lara, who attends group counseling with other veterans at the Vet Center, said one member of her group committed suicide while waiting to receive his VA benefits.

Like other veterans, he had difficulty expressing his thoughts or fears to his civilian family and friends. He was subject to mood swings. He had trouble with his girlfriend, and in holding down a job, Lara said.

At one meeting, Lara told him she would help him in getting his benefits. Her friend didn't show up for the next meeting. Lara never saw him again, she said.

"In our group, we all agree that we (veterans) get the runaround and it is very upsetting," Lara said. "It was very disappointing to us. He served his country and this is how his country pays him back. ... It broke our hearts."

Contact reporter Frank Geary at fgeary @reviewjournal.com or 702-383-0277.

A last word from four interviewed during this series

DENISSE RAMOS WAS 18, AT TRAINING CAMP FOR THE NEVADA ARMY NATIONAL GUARD ON SEPT. 11, 2001.
Sergeants at the camp immediately told recruits, “This is why you’ve joined the Army. We’re going to war.”
Ramos deployed twice, both times to Iraq with the 72nd Military Police Company out of Henderson.
A graduate of Western High and its Air Force Junior ROTC program, Ramos visits local high schools to talk to students about whether to enlist in the military. She is not paid for recruiting.
“I won’t lie,” she says she tells teens. “I don’t get benefits from you joining. Do it because you like it . Not because you’re going to benefit in a different way,” such as receiving an enlistment bonus or college tuition.

PERNEATHA EVANS’ HUSBAND, AIR FORCE CAPT. KERMIT EVANS, WAS KILLED IN IRAQ IN DECEMBER 2006.
Evans said families of servicemen and women would benefit from learning on the front end about worst-case scenarios.
“I think (the military) needs to work more on families to make sure families have the support they need when loved ones are in the military,” she said.
“I think spouses sometimes underestimate what’s expected of them as spouses. I think it would help a lot if pre-deployment briefings were focused more on the families.”

SENIOR AIRMAN BRANDON BYERS WAS BADLY INJURED IN A ROADSIDE BOMB ATTACK IN IRAQ TWO YEARS AGO.
In addition to a grueling physical recovery, he’s battling post-traumatic stress disorder.
“PTSD means a lot of things,” he said. There are nightmares, flashbacks, paranoia. It just strikes, but there are ways to deal with it. There’s a group called Military One Source that provides counseling not only to military but to military spouses. ... Chaplains on the base offer marriage counseling.”
Byers’ wife, Megan, adds: “As a spouse, you have to understand you have nothing to do with it. Every spouse who’s dealing with a military spouse with PTSD really needs to have a separate counselor.”

BEFORE AND AFTER SERVING IN THE IRAQ WAR ZONE, SHARON DIXON HAS WORKED IN A WHITE-COLLAR CIVILIAN WORLD.
A former member of the Nevada Army National Guard — and recipient of a Purple Heart medal — Dixon, now 50, resumed her desk job in early 2004. She received a corporate welcome back, but believes all employers can do better at reintegrating workers after military service.
Job descriptions, vital tools such as computer software, and work procedures may change while a worker is overseas. Dixon thinks veterans would benefit if a specified person, beyond the immediate supervisor, visited periodically, to see if they need retraining and check for job fit and satisfaction.