BlackFive

at...It's harder for enlisted soldiers to return to the front lines after losing a limb, Army officials say. Very few even try. Yet today, the unthinkable has at least become thinkable. About 300 soldiers and Marines have lost limbs in Iraq and Afghanistan. Technological and medical advances are allowing these amputees to perform at levels that would have seemed impossible just a few years ago. In recent months, the Army has found two enlisted front-line soldiers -- both of whom are below-the-knee amputees -- fit for duty and ready for a return to combat.

Sgt. McCaffrey and amputees like him are raising tough questions for a military eager to encourage these soldiers, but also worried they could put colleagues at risk. "Andy is a real asset and the Army has made a considerable investment in him over the last 14 years," says Maj. Thomas Leitch, his commander. "But I have 82 other soldiers in the unit I am responsible for."

His superiors have pushed Sgt. McCaffrey to think about a job training Green Berets at Fort Bragg, or a position with a Special Forces unit that does reconstruction and relief work. In either post, he'd be eligible for full salary and promotions.

Other soldiers, confronted with similar situations, have relented. Capt. Lonnie Moore, an infantry officer who lost a leg to a rocket-propelled grenade in Iraq, began his rehabilitation determined to return to battle, commanding tanks. That front-line job requires less walking than the infantry.

As time passed, however, he began to have doubts. Although he could run and jump on his new leg, the prosthetic broke frequently. A fellow officer, under whom Capt. Moore had served in Iraq, asked him what would happen if his tank were hit. Could he scramble out of the burning vehicle as quickly as a soldier with two legs? Could he pull fellow soldiers to safety? The questions haunted the 29-year-old officer.

"A leader's job is to mitigate risk," Capt. Moore says. "With my prosthesis the way it is today, I would be creating risks for my soldiers."

Now, he plans to take a civilian job with a small defense company. He's hoping to convince the Army to put him on the "temporary disabled retirement list." If a soldier's condition improves while on that list, he can return to his military job. "That way if prosthetics continue to improve, if they become more reliable, I could go back," Capt. Moore says.

By contrast, Sgt. McCaffrey says his best chance at a return to active duty is now. "I didn't bust my hump for two years to get this close to achieving my goal only to give up," he says.

"This is a mission for Andy," says Lt. Col. Jeff Gambel, Sgt. McCaffrey's physician. "For him it is a way of being whole again."

Sgt. McCaffrey, a native of Massapequa, N.Y., speaks in a rapid-fire cadence that stands out in an Army full of southern drawls. When he greets someone, he thrusts his prosthetic arm out to shake hands, almost as if it were a challenge. "A lot of people see this hand when they first meet me and nothing else," he says.

His father, a track cashier for the New York Racing Association, served in Korea. He lost both legs in a car accident in 1965. "I never knew my dad with two legs," Sgt. McCaffrey says. His experience with his father lessened the shock of losing a limb and gave him an insight into the challenges he would face. "There is a thick line between people who have lost a body part and those who haven't," he says. "As an amputee you always have to prove and re-prove yourself."

In 1990, after graduating from high school, Sgt. McCaffrey joined the Marines because he thought they were the "toughest thing out there." But he says he grew bored and when his contract was up after four years, he left. Three days later, he enlisted in the Army, convinced it offered more challenge. "The recruiter thought I was nuts," he recalls.

Shortly after joining the Army, he married his wife, Irma Ortega, who had a 10-year-old son. They had two more children, a boy, then a girl. About the time his daughter was born, he started getting restless, Sgt. McCaffrey says.

He signed up for the U.S. Army Special Forces qualifications course. Only about one-third of those who start the course become Special Forces soldiers, also known as Green Berets. In training at Fort Bragg they learn how to survive for weeks in unforgiving conditions, stage ambushes behind enemy lines and fight alongside rebels as well as foreign armies.

"It was a lot more than just manual labor. You had to think," Sgt. McCaffrey says. As part of training, he learned French and studied African culture. His first deployment was to Mozambique, where he spent six weeks training African security forces.

In March 2003, his unit deployed to Afghanistan to train its fledgling security forces. Three months into the tour, Sgt. McCaffrey was disposing of Chinese-made hand grenades at an ammunition dump outside of Kabul, Afghanistan. He pulled the pin on a grenade and prepared to throw it. But the faulty grenade exploded prematurely, taking off his right hand and most of his forearm below the elbow. Sgt. McCaffrey remembers almost every detail of what came next.

"It is etched in your skull for the rest of your life," he says. He reached down to grab his wounded hand and quickly realized it was gone. A buddy threw him to the ground and kneeled on what remained of his arm, in an attempt to stem the bleeding. Sgt. McCaffrey remembers reaching up with his good hand to pick grenade and bone fragments from his friend's face before the medics arrived.

He was rushed to a field hospital outside of Kabul where his battalion commander came to visit him. Sgt. McCaffrey says he told him: "I don't want to be kicked out of the Army."

'Lonely Crusade'

It was the beginning of what he calls a "lonely crusade" to overcome both the loss of his arm and his commanders' deep doubts.

Two days after the explosion, Sgt. McCaffrey arrived at Walter Reed Army Medical Center in Washington, D.C. During his treatment, his wife and children shuttled between their home at Fort Bragg and Washington.

Rehabilitation was slow and frustrating. One day, Sgt. McCaffrey was in the hospital cafeteria, near a soldier who was complaining the Army sent him to Iraq even though he had a hernia. In Iraq, the hernia grew more painful and he was sent home, the soldier told his dining partner. After a few minutes overhearing the story, Sgt. McCaffrey says he couldn't take it any more. He pushed his stump, which had been sheathed in his sweatshirt, in the stranger's face.

"Stop bitching. A lot of people in this hospital have problems that are worse than yours," Sgt. McCaffrey recalls telling him. "While you were trying to get yourself evacuated from a combat zone, I was trying to get back there."

To some at the hospital, Sgt. McCaffrey was abrasive and impatient. "Not everyone shared his sense of urgency," says Col. William Howard, chief of occupational therapy at Walter Reed. Others, like Oren Ganz, his occupational therapist, found his obsessive determination challenging and went out of their way to help him.

Mr. Ganz joined Walter Reed just three months before Sgt. McCaffrey arrived. When he walked into his hospital room to meet Sgt. McCaffrey for the first time, the soldier was vomiting uncontrollably -- a common reaction to painkillers. Sgt. McCaffrey's 3-year-old daughter was in the room, hiding behind a chair. "She was quite scared," Mr. Ganz recalled. "I asked if he wanted me to come back" when the nausea passed.

Sgt. McCaffrey shook his head no, threw up again and then started telling Mr. Ganz, "OK, here is what I need to work on," Mr. Ganz recalls.

Sgt. McCaffrey asked his battalion at Fort Bragg to send him a rubber replica of an M-4 rifle and a model 9mm pistol. Such replicas, called "rubber ducks," are standard training tools. Sgt. McCaffrey had little interest in the therapy regimen developed for him at the hospital, which revolved around using his fake arm to stack blocks, eat and get dressed.

Instead, he spent his sessions working with the guns. Some on the hospital staff were concerned the fake firearms would disturb patients suffering from post-traumatic stress. So Sgt. McCaffrey and his occupational therapist retreated to a small, windowless room near the main therapy ward. He spent hours raising his rubber rifle and pretending to open fire. Then he'd let it fall around his shoulders, and draw his pistol.

Mr. Ganz had almost no experience with firearms. So he peppered Sgt. McCaffrey with questions: "Why do you hold the rifle like that? What if you slid your prosthetic hand a little further down the barrel?"

He began to do research on the Internet, searching Army and Marine Corps Web sites for firing tips. To get a better sense of the weapon's recoil, he took trips to the rifle range. "Andy was so determined. I found it extremely interesting to work with him," Mr. Ganz says.

Sgt. McCaffrey's drive has been made possible by big advances in the treatment of amputees and the technology of prosthetics. Army field surgeons have learned that if they administer nerve blockers immediately after an injury they can greatly reduce chances of "phantom pain" -- the debilitating pain amputees often feel in their stumps.

Doctors at Walter Reed Army Medical Center have developed new surgical techniques that allow them to preserve larger portions of amputees' stumps. Soldiers with longer stumps typically have better luck manipulating their prostheses.

And in the past few years, prosthetic devices have made huge leaps. Today's prosthetic arms boast microprocessors that are 250 times faster than ones in use just 12 months ago. Amputees manipulate prosthetics, which cost about $40,000 each, by contracting their bicep and tricep muscles. The muscle contractions send electronic pulses that cause the computerized fingers to move. The faster chips allow a more responsive hand.

Some improvements are the direct result of Sgt. McCaffrey's push. A team of prosthetists spent extra hours designing special arms and hands he needed to get into shape. The Army's physical-fitness test, for example, consists of push-ups, sit-ups and a two-mile run.

Sgt. McCaffrey knew push-ups would be the toughest, so he asked John Miguelez, a prosthetist at Walter Reed, to design a special push-up arm. Mr. Miguelez found a "sports hand," developed by a Colorado company. Although designed for catching a basketball, the hand had a flex at the wrist that made it good for push-ups. He modified the hand so it would better spread the weight of Sgt. McCaffrey's body across his stump when doing push-ups.

"For most amputees, the thought of putting any weight on their healing wound is really scary," says Mr. Miguelez. Sgt. McCaffrey did push-ups with such intensity that he re-opened the wounds on his stump. To get him to slow down, the staff threatened to take his fake arm away.

The push-up hand was the first of at least five prostheses the staff designed for Sgt. McCaffrey. "Our relationship with Andy was way more than a professional relationship," Mr. Miguelez says.

Board Determinations

Soldiers like Sgt. McCaffrey who want to rejoin their units after a serious injury must have their cases reviewed by a three-person "Physical Evaluation Board." After evaluating a packet chronicling the soldier's career and recovery, the board declares the soldier fit or unfit for duty.

Most soldiers remain at Walter Reed until the board rules on their case. But in December 2003, Sgt. McCaffrey persuaded his doctor to let him leave the hospital before his case was reviewed, and return to Fort Bragg. There he hoped he could amass a record that would give the board no choice but to find him fit.

Just before Christmas 2003, he met with the U.S. Army Special Operation Command's senior physician, Col. Warren "Rocky" Farr, and plotted a strategy. Sgt. McCaffrey made a list of all of the tasks he would need to return to his job as a Special Forces engineer. Engineers are the Army's ordnance experts. They defuse bombs, clear booby-trapped rooms and rig bridges and buildings to explode. In Special Forces units, they must also provide basic medical care to injured soldiers, train foreign armies and be experts in urban combat.

Sgt. McCaffrey's list of tasks ran six pages and 77 items. It included everything from tying a "western union pigtail splice knot" to guiding an I.V. needle into a soldier's vein with his prosthetic hand. Each time he mastered a task, he had a senior Special Forces soldier watch him, then sign and date his list. By summer, he could perform most of the tasks. He met the Army's basic marksmanship standards, learned how to disassemble and reassemble an M-4 rifle in minutes and don a gas mask in less than 10 seconds.

Using a special arm that attached to his stump with a silicone suction seal, he proved to Col. Farr that he could do six pull-ups -- the minimum troops must do to qualify for parachute jumps. On a piece of scrap paper, the Army doctor scribbled a note clearing Sgt. McCaffrey to jump out of planes. In March 2004, he secured a spot in the Army's "Basic Airborne Refresher course" and jumped.

When Sgt. McCaffrey came back to Walter Reed to have his prosthetics adjusted, he was a hero to other patients. He broke wooden boards with his stump, like a karate chop, to amuse patients in the occupational-therapy wing. Physicians showed videos of him parachuting from planes, doing pull-ups and pushing an I.V. into a patient's arm. Frequently, they had him talk with patients who were struggling with depression.

While training at Fort Bragg, he regularly smashed his prosthetic hands. So on his return to the hospital, he huddled with the staff to build a sturdier model he could take to war. The prosthetists at Walter Reed encased fingers of a fake hand in carbon fiber. To protect the hand's small electric motor, they fashioned small steel plates that clamped on to the palm. Finally, they filled the pinky with an extra hard polymer.

In April 2004, Sgt. McCaffrey spent a month at Fort Bragg training with newly minted Green Berets. His new hand held up. "The environmental conditions were rain and temperatures near 100 degrees. At no time did SSG McCaffrey's [arm] malfunction. Nor did it hamper the detachment's operational mission," the instructor wrote in an evaluation. A few weeks later, Sgt. McCaffrey took his annual fitness test -- a combination of push-ups, sit-ups and two-mile run. He scored higher than he did before his injury.

Sgt. McCaffrey's unit returned from Afghanistan in June 2004. After the company got back to Fort Bragg, its commander and its senior enlisted officer left, as part of a normal rotation. They were replaced by Maj. Leitch and Sgt. Maj. Blake. Their evaluations would play a huge role in determining whether Sgt. McCaffrey was found fit for duty.

Sgt. Maj. Blake, 50, had spent 20 of his 28 years in the Army in the Special Forces. His current enlistment contract ends in 2007, at which point he hopes to retire. Decades of jumping from planes had taken a toll on his back and knees. He expected his unit's coming deployment to Afghanistan would be his last.

Maj. Leitch, the 39-year-old unit commander, joined the Army in 1991. He became a Green Beret in 1996. The two commanders had spent most of their deployed careers in Africa, working with local forces. Neither had seen combat.

Upon taking command of the company, both were surprised to learn they had inherited a one-armed soldier. They weren't pleased.

"Andy was testing himself, jumping out of airplanes and shooting rifles. I had no idea what he had been cleared to do," Maj. Leitch says. To Sgt. Maj. Blake, it seemed as if "people in Washington didn't want to make the hard calls." He says the Physical Evaluation Board should have reviewed Sgt. McCaffrey's case and found him fit or unfit before returning him to Fort Bragg to train.

Maj. Leitch became worried about Sgt. McCaffrey's ability to operate in the intense conditions Green Berets often encounter. "Decisions have to be almost instantaneous," Maj. Leitch says.

Changing Hands

Watching Sgt. McCaffrey at the rifle range, he noticed it took him two or three seconds longer than other soldiers to reload his 9mm. A former right-hander, his accuracy with his left hand was good enough to meet Army standards, but not great, Maj. Leitch says. "Andy lost his right hand and it seemed to me he had not completely become a switch hitter."

If his pistol jammed, Sgt. McCaffrey couldn't grasp hold of the slide and unjam it. Instead, he bashed it with his prosthetic arm until it worked, Maj. Leitch says.

In October 2004, the Army started the review that would determine whether he was fit for duty. His folder, now in a file cabinet at the Army's Physical Disability Agency in Washington, contains his medical records, along with letters from his doctor and occupational therapist. "Sgt. McCaffrey is the standard bearer for upper extremity amputee rehabilitation. He consistently challenges and overcomes obstacles," wrote Col. Howard, chief of occupational therapy at Walter Reed.

Sgt. McCaffrey made sure the packet included the six-page list of tasks he had learned to do with his prosthesis -- each signed and dated by a superior -- as well as videos of him inserting an I.V. needle into a patient's arm and parachuting.

A five-paragraph letter from Maj. Leitch countered all that.

"SSG McCaffrey's performance in staff areas has been exceptional.... But his ability to employ his individual weapon systems needs more work. He cannot effectively change magazines and reduce stoppages," Maj. Leitch wrote in September 2004. "SSG McCaffrey no longer possesses all the skills required to serve in a front-line unit."

In January, the board found him unfit. In standard procedure, it offered no explanation. Sgt. McCaffrey says, "That letter [from Maj. Leitch] didn't do me any favors," he says.

Sgt. McCaffrey applied for a special waiver from the Army's Physical Disability Agency to stay in the service. While waiting for a ruling, he continued to train with his unit for a deployment back to Afghanistan this summer.

In March, Sgt. McCaffrey went to a remote, mountainous corner of Montana for a month of intense training. For the first few days, the soldiers did nothing but fire weapons. Then they began elaborate mock missions. In the middle of the night, Maj. Leitch would get orders to seize a cache of missiles or a prominent terrorist. Typically, they would have 24 to 36 hours to plan and execute a mission. Other soldiers would play the enemy. Sgt. McCaffrey was treated like any other member of the company.

In Montana, he received a fax telling him his waiver had been granted. This meant he could stay with unit -- doing as much as his commanders would allow.

After the unit's return from Montana, Sgt. McCaffrey and Maj. Leitch stayed after work to discuss his future. It was 11 p.m. and the battalion headquarters had emptied out, both men recall. Over beers, Maj. Leitch told him he belonged in the Army and even in Special Operations -- but he couldn't hold his own in a front-line combat unit with just one arm. "What if your pistol jams?" he asked. "What if you get injured again?"

Sgt. McCaffrey recalls telling him none of the problems were insurmountable. "What drives me crazy is the 'what ifs'. Just give me a standard and I will figure out a way to meet it," he said.

These days, Sgt. McCaffrey is the first to work and the last to leave, says his boss, Sgt. Maj. Blake. "I've got the utmost respect for him. He will bust his ass," says Sgt. Maj. Blake. "He's here at 5:30 a.m. every morning working out. He'll spend hours trying to figure out how to use his hand or come up with new ways to cock his pistol or shoot his weapon."

After the sergeant major criticized him for re-loading his pistol like a wounded guy, Sgt. McCaffrey figured out another way to do it. Instead of wedging the gun between his knees -- a move Sgt. Maj. Blake said could lead to an accidental discharge -- he shoves the gun in a holster on his belt, pops in a new clip and then withdraws it again.

Maj. Leitch and Sgt. Maj. Blake watch these efforts with a mixture of admiration and frustration. They were hoping, says Maj. Leitch, "that Andy would accept that he does have limitations. I understand he is looking for answers. But that doesn't change the fact that the limits are there."

Sgt. McCaffrey's wife initially asked him to consider retiring or taking a position that would allow him more time with their children. But she has relented. "Andy feels like his career got cut short. I think he needs some closure on the whole thing," she says.

Others in the battalion have tried to convince Sgt. McCaffrey that the example he has set for other amputees is a tremendous achievement in itself. But he dismisses such praise. "I didn't do this for other amputees. I did it for me," he says.

Earlier this month, Sgt. McCaffrey returned to Afghanistan with his unit. He is scheduling aircraft in and out of the unit's base camp and serves as the battalion-retention manager, helping soldiers re-enlist. He likely won't get to leave the base much, or go on patrols or raids. "They offered me a job I can basically do with no hands," he said just before deploying.

Typically, commanders stay with a unit for 1½ to two years before being reassigned. Sgt. McCaffrey says he hopes his next commander will have the "intestinal fortitude" to let him back into the fight.

"I just want an opportunity to fail," he says.