For Army Staff Sgt. Sterling Beair, the post-traumatic stress disorder, or PTSD, wasn't really noticeable until about five or six months after he returned from Iraq.

The 25-year-old Beair, who grew up in 'Ewa Beach, was a medic with the Hawai'i Army National Guard in 2005, patching up bloodied and sometimes dying Americans and Iraqis.

When he got home, he had nightmares and flashbacks. He had anger issues at work, and couldn't concentrate. He was eventually fired from his "very good job" in a lab at a local medical center. He lost his house and, for a time, lived out of his car.

Beair's doing better now. He lives in a fraternity house near the University of Hawai'i and wants to go back to school to be a firefighter or social worker.

Last week, Beair and nine other current and former service members graduated in an emotional ceremony from the Post Traumatic Stress Disorder Residential Recovery Program.

Beair credits the 7 1/2-week program run by Veterans Affairs at Tripler Army Medical Center with turning his life around. The program made a "tremendous, tremendous difference," he said.

"It's not a cure. I don't feel cured. I still have the same nightmares. I still have the same thoughts," Beair said. "It's just now I have the coping skills to deal with them and control it, instead of it controlling me."

Nearly 20 percent of military service members who have returned from Iraq and Afghanistan — 300,000 in all — report symptoms of PTSD or major depression, according to a study released in April by the RAND Corp., a nonprofit research organization.

Yet only slightly more than half of those with PTSD symptoms have sought treatment, partly as a result of the stigma associated with the disorder and career repercussions.

There are almost certainly others from the Hawai'i National Guard who returned from the 2005 Iraq deployment who have untreated PTSD and who suffer daily, Beair said.

"Looking back, I can see how bad it (the PTSD) was," he said. "But at the time, it was so unnoticeable."

SHARING HIS STORY

In Iraq, Beair was gregarious and went out of his way to help when he worked as a medic at bases including Logistics Support Area Anaconda.

At the time, Beair said, "Honestly, I see this as more spiritual fulfillment. Every man tries to find purpose in life, and I find purpose here treating the Lord's children and saving life."

Now that he has returned to Hawai'i, experienced PTSD and learned how to deal with it, Beair wants to tell his story in hopes other service members with PTSD will come forward.

The VA program Beair participated in started in 1993 in Hilo with Vietnam vets. In 2006, with the wars in Iraq and Afghanistan creating a new urgency for treatment, the program was moved to O'ahu. Fourteen classes have graduated since then.

Dr. Kenneth Hirsch, the program manager for the residential treatment, said it's one of relatively few VA programs that provides care to both veterans and active-duty service members.

"That's where the need was," Hirsch said.

Last week's graduating class had three Vietnam veterans and seven who served in Iraq or Afghanistan.

Up to 12 individuals can reside at the VA's Tripler facility at any one time. The program is intended for some of the more severe cases of PTSD. Separate outpatient treatment and counseling for service members with PTSD also is available.

Beair and another graduate, Chief Warrant Officer 2 Alan McIntosh, 37, both said the group therapy was a key aspect of recovery.

"They (officials) know, and I would agree, that group is what heals us because we're all coming together with the same problems," McIntosh said.

There are programs all day long, and even on weekends and the service members live at the facility in space rented from Tripler. Bio-feedback training helps control anxiety and the hyper-alertness that's often an advantage in war, but can't be switched off back at home.

"We spend a lot of time working, talking about the things they found most upsetting in the combat environment," Hirsch said. "You don't want them to try to deal with that during the day and then they're going home to their families."

Some of the combat veterans don't like to be in crowds because they worry that they could be hiding an enemy fighter. Part of the therapy involves doing things most take for granted — like going to a movie.

Beair had two particularly traumatic experiences to deal with — a "mass casualty" response to about 20 Iraqis injured in a bombing at a checkpoint, and the death of a popular soldier, Staff Sgt. Frank Tiai, who was wounded in a roadside bomb attack.

Beair treated Tiai, 45, who was with the 100th Battalion, 442nd Infantry, before he died.

Beair is still on active duty with the Hawai'i Guard, and his brigade of 1,700 fellow citizen soldiers is preparing for a Kuwait deployment.

'NERVES WERE ON FIRE'

McIntosh most recently was in Iraq as a Ch-47 Chinook pilot with a Schofield Barracks unit.

The Santa Barbara, Calif., man said it was the cumulative effect of being in two serious car accidents, multiple deployments, health issues with his wife, and losing close friends in a helicopter crash in Afghanistan — all while facing daily threats in combat, that led to his PTSD.

He had been in Air Force special operations before switching to the Army to fly the big Chinooks. There were deployments to Bosnia, Croatia, Zaire and two trips to Iraq.

When he returned most recently from Iraq, McIntosh said he was having nightmares and tremors. He was getting little sleep.

"The way I describe it best, my nerves were on fire," he said.

The one-time social drinker said he began self-medicating with alcohol — an all-too-common response for Iraq and Afghanistan veterans to the vestiges of combat stress.

McIntosh, who subsequently entered rehab, and the VA residential program after that, penned a letter to U.S. Sen. John McCain asking if he could attend the graduation.

"God only knows what is next for me, but in the meantime, I have just celebrated 90 days of sobriety and am finally able to deal with war stressors and their effects in a healthy way," McIntosh said in the letter.

Terri Tanielian, who was involved in the RAND study on PTSD, said there is a "major health crisis facing those men and women who have served our nation in Iraq and Afghanistan."

Many do not seek treatment because they fear it will harm their careers, RAND said. But even for those who do seek help, only half receive treatment the study said was "minimally adequate."

The study estimated that PTSD and depression among returning service members will cost the nation $6.2 billion in the two years following deployment, but investing in more high-quality treatment could save $2 billion within two years by reducing lost productivity and suicides.

The VA residential program's Hirsch said there are plans for a new PTSD building on Tripler's grounds that will house both residential and outpatient PTSD patients and increase the number of beds from 12 to 16.

The approximately $10 million facility is expected to be open in less than two years, he said.

"Good things happen here, that's for sure," McIntosh said of the VA program.

Now he's planning the next phase of his life, including leaving the military after 14 years, and possibly a civilian flying career.

He figures he's been with his kids only half their lives, and with his wife only half their marriage, because of all the past deployments.

"I could care less about (making military) retirement at this point, because my family comes first. And they come now," he said.