discharge based on his physical injuries and mental health injuries of posttraumatic stress disorder (PTSD) and major depression. He suffered second-degree and third-degree burns and a broken pelvis as a result of an improvised explosive device (IED) blast that killed two of his fellow soldiers.

Sgt. Arrozo lives with his 29-year-old wife of 10 years and his three young children—7, 5, and 2 years old—in a small city in North Carolina. After completing his high-school education focused on technical training, he enlisted in the Army, where he has served for the last 10 years. The family has a middle-income socioeconomic status. Maria Arrozo typically works on a part-time basis as a physical therapist. Both partners and their children are bilingual and speak Spanish and English interchangeably at home. The parents and children rely on their Catholic spiritual community as a source of hope, healing, and social support.

PRESENTING ISSUES

Individual

In the last two months, Sgt. Arrozo described pervasive anxiety, insomnia, nightmares, a fear of crowds, and flashbacks. One flashback occurred while he was driving with his wife to the grocery store. As they drove along a major highway in the middle lane, Sgt. Arrozo maintained his 60-mph speed until he saw a young adolescent boy leaning over the edge of a bridge that traversed the highway just 30 ft ahead. Knowing that the only thing he could do was continue forward, Sgt. Arrozo started to hyperventilate, sweat profusely, and increase his speed on the highway from 60 to 70 to 80 to 90 mph as he screamed to Maria to duck and take cover under the dashboard. As they sped frantically beneath the bridge, Maria screamed out in terror for Carlos to stop the car. Neither of them understood that this flashback was triggered by odors of gasoline and burning rubber, which were reminiscent of a traumatic incident involving a burning truck in Iraq. He fears remaining jobless and incapable of locating work in his field of communication. Worries about the possibility of a divorce from his wife plague him regularly.

Sgt. Arrozo also struggles with obsessional thoughts related to his guilt of surviving an IED blast that killed his fellow soldiers. He feels “dead to the world and deserving of death.” Deep feelings of shame overwhelm him as he recalls “accidentally killing a helpless young child”



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