SELAH, Wash. -- On a recent warm spring day, a physical therapist pressed firmly on Evan Mettie's right shoulder, causing him to ever so slightly lift his head.

It's an intentional response from the 25-year-old, whose body is largely bereft of voluntary movement.

"These are the things that are going to reach Evan," says Robin Moug, a Spokane therapist in town to instruct his caregivers. "They're not huge but they're really important."

The job of reaching Evan Mettie, an Army specialist severely wounded more than three years ago by a roadside bomb in Iraq, has entered a new phase.

After more than three years in hospitals, nursing homes and rehabilitation centers, Evan returned home to live with his family in late March. He lives in a bright and roomy new addition with a front porch that opens up into the sun-splashed orchards and hills above Selah.

His days are a series of small victories and occasional setbacks, all set to the rhythm of a brain pierced by shrapnel from an improvised bomb -- the enemy's weapon that has defined much of the war.

His mother, Denise Mettie -- normally stoic and strong -- wasn't prepared for how she would feel that day at a military hospital when she asked to see the metal that had been removed from the left side of Evan's brain.

"I looked at it and I just lost it. I went running out to a waiting room," she recalled in a recent interview.

But knowing Evan, Denise kept the shrapnel.

"He'll want to make a belt buckle out of it someday," she quipped.

Humor was a hallmark of Evan's personality and his relationship with his mother. It may be one of the things Denise misses most as she lives with what she calls "the new Evan."

"A lot of my conversation is, 'Did you sleep well? Are you in pain?' The fun is gone," she said. "That is the big thing. We don't have fun."

Many historians have already observed that the Iraq war, now seven years long, will be defined in large part by the number of soldiers disabled by traumatic brain injuries from roadside explosions and suicide bombers.

According to the Department of Veterans Affairs, more than 1,800 U.S. troops suffer from traumatic brain injuries caused by penetrating wounds.

Like Evan, more men and women are coming home alive with these injuries because of what's been called a "revolution in military medicine" that has placed live-saving tools and skills in the hands of the medics who first treat the fallen.

But the same modern military was not prepared to offer the level of services these wounded veterans would need at home.

No one knows that better than Denise and Dave Mettie. After Evan's injury, they experienced firsthand the shortcomings -- indeed, the failings -- of the military's system for treating veterans with traumatic brain injuries.

Because of Evan, they became champions of wounded warriors, helping to make the system more responsive to other families and veterans.

Denise quit her job at U.S. Bank to become a full-time caretaker and advocate, while Dave continues to work for a local sign company.

Because of Denise's testimony before Congress, the Department of Veterans Affairs now considers treating brain-injured veterans at private rehabilitation clinics, which traditionally have more experience than VA clinics in head trauma.

The military also vows not to push injured veterans and their families into retirement, which reduces their medical benefits and family living expenses away from home. The Metties didn't know this when they consented to Evan's retirement just 17 days after his injury.

In hindsight, they say that Evan's retirement cost him first-class medical care.

The Metties have made a difference, but there is a long way to go.

"In all honesty, I don't think the system has improved that much," said Jeremy Chwat, executive vice president for policy and public affairs with the Wounded Warrior Project.

The Jacksonville, Fla.-based nonprofit was founded by veterans who were moved by the stories of the first wounded service members returning home from Afghanistan and Iraq.

Soldiers like Evan Mettie.

Evan has a neurological disorder described as locked-in syndrome, according to Denise. He can't move any of his muscles except his eyes and, occasionally, his big toe, an involuntary movement that signals he's in pain.

He can't speak, but he's thinking.

"He knows what's going on," said Denise.

She has had more than her fair share of doubters. Doctors and other medical caregivers have told the Metties that Evan can't communicate and will never recover.

But Denise recently found comfort in the findings of Dr. Geoff Greenberg, a Yakima pulmonologist and critical care specialist who runs the Sleep Center at Yakima Valley Memorial Hospital.

During a recent overnight study that measured the electrical activity of Evan's brain, Greenberg found an extended dream state, three times that of an adolescent or adult. It looked like the dream sleep of an infant.

"His brain waves are telling us he's still at a young, infantile age at least in terms of what his sleep looked like," Greenberg said. "It struck me that could be a metaphor. That he's really going to have to learn things over again."

Denise finds the comparison comforting, to a point: "He has all the basic needs of an infant, but he's also a man."

Denise and Dave have never bought a bleak prognosis.

They remember occasions during the first two months after his injury that Evan moved his head from side to side, opened his right eye, squeezed his mother's fingers and flashed a "thumbs up."

During one visit by one of his two sisters, Kira, at Bethesda Naval Hospital in Maryland, he opened both eyes, lifted his head and shoulders and reached out with his arms, as if he were trying to sit up.

"It was like an awakening," Denise said. "Evan was alert."

Denise saw it as a window of opportunity to develop Evan's "command responses" -- answering questions by blinking his eyes once or twice or raising his right hand for "yes."

But in the months that followed, Evan's treatment plan -- if there ever was one -- lacked focus, Denise said. Evan suffered physical setbacks, which impeded his rehabilitative progress.

The doctors at Bethesda advised the Metties they should return "to a more normal life" by putting Evan in the Veterans Affairs hospital in Seattle.

"We asked about rehab and were told he wasn't ready," Denise said.

At no point, she said, did anyone mention the VA's polytrauma centers, which specialize in intensive rehabilitative care for veterans with severe injuries, including brain injuries, and those suffering problems with more than one organ system.

At the time, Evan was still being weaned from a ventilator, although he had gone for a 24-hour-period breathing on his own. The VA hospital decided to transfer him to a nonmilitary nursing home until he no longer needed breathing assistance.

Denise said conditions at the nursing home, which she declined to name except to say that it's in Spokane, were substandard: Staff were inattentive and disregarded his pain. The Metties pressed the VA to investigate. He was moved back to the hospital in Seattle.

"He completely regressed at the nursing home. That regression is what we're still fighting today," Denise said.

Back at the VA, his rehab was more limited than Denise would have liked. He received 30 minutes of range-of-motion exercises five days a week. Nevertheless, the Metties say the overall care at the Seattle VA was excellent.

Finally, in November 2006, nearly a year after he was injured, Evan was admitted to the VA's Palo Alto Polytrauma Rehabilitation Center.

Denise had high expectations -- the Palo Alto center had a reputation as the crown jewel in the VA's system of four polytrauma centers.

But she said she was soon disappointed. Evan was only the second severely brain injured service member to be treated at the center. Denise said their therapists weren't prepared for the severity of Evan's case.

"They did not have very good therapy in place," she said.

It was later disclosed by a congressional oversight panel that Palo Alto's success rate stemmed from the fact that it had been cherry-picking patients, choosing those they knew would have better outcomes.

In May 2007, the VA discharged Evan from Palo Alto. Denise, who had by this time become a savvy, effective advocate for his care, persuaded the VA to send him to a private rehab center in New Jersey, called the Kessler Institute, where he spent about six months.

Chwat, of the Wounded Warrior Project, said it was a major breakthrough for the VA to consent to private rehabilitative care.

But he doesn't expect the practice to become widespread because the VA has been building up its own expertise as the extent of neurological injuries from the war becomes known.

"They've put a lot of time and energy into a system to care for these men and women, so if they're sending them to private facilities, doesn't that ultimately question their ability to provide care?"

Evan made progress at Kessler, but he continued to suffer medical problems, including setbacks from the surgery that replaced a part of his skull with a metal plate.

The VA decided to stop paying for private treatment.

"The VA said he wasn't progressing as rapidly as they would like," Denise said. "I agreed it would be better to continue his rehab at home."

For a year and five months, Evan was cared for at Garden Village, a Yakima nursing home where he was introduced to the Quadriciser -- a machine that exercises his arms and legs -- and other therapies.

In that time, the Metties were able to build a $123,000 addition to their home with help from a $50,000 VA grant and donations of money and labor from local builders, businesses and community organizations.

They are waiting for a wall-mounted therapy mat that will help build his core strength and balance.

Denise knows the hard work has just begun to try to bring Evan back.

"I asked myself the other day, are we going to fail at this? It's going to be a lot of work. But I know he can do it. Once he's done something, we know he can do it again."

* Leah Beth Ward can be reached at 509-577-7626 or lward@yakimaherald.com.