Bob Monroe survived the rigors of being in an Army Ranger battalion and later getting shot at as a helicopter pilot in his 22-year military career.

What finally brought him down was a slippery step on a CH-47 Chinook at Bagram Air Base in Afghanistan and the "steel beach" decking he landed on — while fully loaded up with combat gear.

The Mililani man shattered his left elbow. Bits of bone that he says were not removed by Army doctors later sawed at his ulnar nerve.

Four years afterward, he still experiences chronic, debilitating pain.

On bad days, which leave him bedridden, "it's pretty much as if somebody took a white hot screwdriver and jabbed it into your funny bone," the 42-year-old Monroe said.

As the Pentagon and Veterans Affairs scramble to deal with an increasing number of post-traumatic stress and traumatic brain injury cases from Iraq and Afghanistan, chronic pain from injuries of all types also is coming to the fore as yet another consequence of war that isn't being fully addressed.

"We need to voice our concern, especially when it comes to pain management, because what's happening now is there are very high suicide rates in the Army and Marine Corps," Monroe said. "Part of that is because of pain. When you have pain, especially chronic pain, there's depression and suicide, especially when you have pain that's not under control."

The VA estimates that every year, 6,500 veterans from all eras kill themselves. According to a RAND Corp. study, 300,000 service members have reported post-traumatic stress or major depression.

More than 33,000 U.S. service members have been wounded in action in Iraq and Afghanistan. The American Pain Foundation said pain is a leading cause of disability among veterans, with nearly half returning from combat reporting pain-related problems.

AKAKA INTRODUCED BILL

The Defense Department does not have an adequate pain care program to access and treat them, and wounded troops returning from Iraq and Afghanistan will likely overwhelm pain clinics, according to the foundation.

U.S. Sen. Daniel K. Akaka, D-Hawai'i, is among the advocates for veterans who have initiated legislation to counter shortfalls.

The Veterans Pain Care Policy Act, introduced in the Senate by Akaka, along with the Military Pain Care Act introduced by another lawmaker, were signed into law by President Bush in October.

The Military Pain Care Act requires the Pentagon to implement a comprehensive pain-care program for active and retired military, and the Veterans Pain Care Act calls for the establishment of a similar program within all VA facilities, and for VA to provide the necessary pain management for vets with long-term chronic pain disabilities.

"It levels the field for the Defense Department so that all of the agencies are looking at pain the same way," Monroe said. "Because the Air Force is looking at it one way, the Marine Corps and Navy are different, and the Army is looking at it another way."

Monroe said a recent study showed how the same injury rated varying disability pay levels among the services.

"Whereas the Air Force and Navy would give somebody 60 to 80 percent disability, the Army would give them 10 or 20 percent," Monroe said.

The chief warrant officer 4, now on a temporary disability retirement list, said he was rated at 20 percent pay for pain and 20 percent for loss of the use of his arm, but he actually receives 55 percent of his former pay because of the 22 years he served.

He holds another job as a maintenance manager for a Defense Department contractor at Schofield Barracks. There is the highly unlikely possibility he could wake up in the next couple of years, the pain would be gone, and he could fly helicopters again, he said.

PAINFUL BONE SHARDS

Monroe, who's from Southern California, was in an Army Ranger battalion for four years, and then flew Army helicopters for the next 17. He deployed from Wheeler Army Airfield with a Chinook unit to Afghanistan in 2004, and was injured 2 1/2 months later.

At first, Monroe didn't know the extent of his injury, and he told a doctor, "I need to fly again, I've got missions going on."

Instead, he was evacuated out of Afghanistan, and doctors later told him they considered amputating his arm before putting in two 7-inch rods and a wire bundle in place of his shattered bones.

Monroe said Army doctors never removed bone fragments for reasons he's still not clear about.

"For nine months, every time I moved the arm, those bone fragments would slice into the ulnar nerve," he said.

A 6-inch scar snakes its way across the back of his freckled elbow. Monroe said he remains "on a lot of meds."

Monroe said part of the problem is that the Army wants a healthy, capable force, and as soon as a serious injury occurs, "you are not our problem, move, let us get somebody else who's capable and healthy."

"The problem is, guys like me who don't want to retire are getting passed to the wayside" and are transferred to the care of the VA, he said.

There are a few "trophy cases" where the Army lets seriously injured soldiers stay in, but that's generally not the case, Monroe said.

The Defense Department, for its part, said it has made "enormous efforts" to transform and restructure the way it provides healthcare to wounded soldiers, including establishing 36 Warrior Transition Units in the Army to provide care, counseling, rehabilitation and training.