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The mental health of alleged terrorist sympathizer Ikaika Kang, a U.S. army sergeant from Waimanalo, is under scrutiny at a time when the deep psychological wounds of war are getting more attention across the country.

During a preliminary hearing at the federal courthouse in Honolulu on Monday, Kang pleaded not guilty to charges that he attempted to provide material support to the Islamic State.

His face was blank and stoic during the hearing and afterward. As he left the courtroom, he did not meet the eyes of his family members, a number of whom were sitting in the front row.

“The first thing I’m going to do is the first thing the military should have done — get him a full mental evaluation,” Kang’s attorney, Birney Bervar, said in an interview with Civil Beat. Bervar was appointed to represent Kang because the court determined he didn’t have the money to pay for his own defense.

Kang converted to Islam while deployed in the Middle East. According to an FBI affidavit, he attempted to give military documents to undercover agents representing themselves as officers of the Islamic State, tried to provide videotaped combat training instruction to ISIS soldiers and maintained a collection of ISIS recruitment information — including a video he called his favorite that showed people being beheaded by ISIS soldiers.

Bervar said he is making the mental-health examination request to federal prosecutors because of what he learned from a brief meeting with Kang in prison, from reviewing court documents and from speaking with members of Kang’s extended family in Hawaii.

, Kang’s father said his son was behaving oddly and that he believes he may have had untreated PTSD.

“It’s very unclear what, if anything, was done” to provide Kang with medical care after his behavior at work became increasingly disturbing to co-workers, Bervar said.

Little information about Kang’s combat history has been released. He’s been an active-duty soldier for 16 years. He joined up soon after the terrorist attack on Sept. 11, 2001, a few months after his graduation from Kaiser High School in Hawaii Kai.

He served two Middle East deployments of about a year each — in Iraq in 2010 and 2011 and in Afghanistan in 2013 and 2014.

‘Sense Of Urgency’ In DC

Questions about PTSD — who has it, and how serious it may be — are increasing, not just in Hawaii but around the country. The United States has been at war for 16 years now, a grueling, bloody, confusing conflict with no resolution in sight.

On Tuesday in Washington, the day after Kang’s hearing in Hawaii, members of a U.S. House subcommittee among active-duty military personnel and veterans, particularly those who served in those two countries.

“PTSD has been labeled the signature wound of the conflicts in Iraq and Afghanistan,” said Gerardo Avila, an American Legion official who specializes in disability issues. Avila and others described a worsening crisis, with PTSD sufferers receiving inadequate care both during and after their service.

The number of veterans who have been diagnosed with post-traumatic stress disorder, a mental health ailment that comes from coping with life-threatening situations, has more than doubled since 2008, climbing from 345,000 veterans to 940,000 veterans, according to congressional testimony provided by Department of Veteran Affairs.

It’s estimated that 11 to 20 percent of American soldiers who served in Middle East war zones from 2001 to 2014 are suffering PTSD in any given year, according to the National Center for PTSD at the U.S. Department of Veterans Affairs.

Symptoms include sleep impairment, disturbed judgment, exaggerated response to loud noises and stress, dark thoughts and volatile, even violent behavior. Many who suffer PTSD are unable to hold a job after they leave the service. Some find life not worth living: each day commit suicide, according to the VA.

At a  hearing, U.S. Rep. Jack Bergman, a Minnesota Republican and retired Marine Corps lieutenant general, asked the panel of expert witnesses how many have “a sense of urgency” in dealing with the problem. All four panelists raised their hands.

The extent of the mental health crisis in the military has come up in other forums in Washington recently as well. Both David Shulkin, secretary of Veterans Affairs, and Air Force Gen. Paul Selva, vice chairman of the Joint Chiefs of Staff, have been questioned in Congress in the past month about their efforts to help soldiers cope.

“If reconfirmed, I will do everything in my power to continue the Department’s progress in encouraging service members to seek mental health care when they are in crisis,” Selva said in prepared remarks.

Bad Behavior Escalated

While Kang’s mental health is being raised as a defense by his attorney, the FBI affidavit in the case presents a long list of allegations of troubling behavior by Kang.

According to an FBI affidavit, Kang provided military documents to an undercover agent he believed to be a member of the Islamic State. He demonstrated combat techniques and suggested the training should be videotaped and distributed to ISIS fighters to make them more effective killers, the affidavit states, and he paid for a drone that he said would help enemy fighters defeat American tanks.

He made pro-ISIS comments at work and on-post, according to the affidavit, and he received what the Army calls “negative counseling,” or disciplinary action, for threatening behavior toward other soldiers. He told people that if the U.S. went to war without proof of the provocation, it was terrorism.

The Army revoked his security clearance in 2012, but reinstated it the next year. In 2015, Army officials decided that Kang had become radicalized and referred him to the FBI, which conducted an investigation and used a rotating group of about half a dozen undercover agents to engage with Kang in activities that they told him would aid terrorism. They found Kang eager to cooperate, according to the affidavit.

The day before he was arrested, he spent some hours with the informants, watching ISIS videos, including one he called his favorite, which featured beheadings, the affidavit stated.

On July 8, he swore a pledge of loyalty to ISIS in Arabic. That same day, he was arrested by the FBI. He waived his Miranda rights and admitted he had transferred classified information to people he believed belonged to ISIS.

PTSD Is Often Concealed

If Kang did have PTSD or other pre-existing mental health issues, he may have been trying to conceal it at work. For a variety of reasons, as Gen. Selva indicated in his congressional testimony, many people serving in the military fail to obtain the psychological assistance they need.

Military experts have long noted that the stigma attached to acknowledging mental health problems causes many soldiers to believe they will injure their careers by divulging what they view as personal weakness. Untreated, their behavior problems can get worse, leading to violence or suicide. There is increasing evidence that military officers have not yet come to grips with the extent of the problem or learned how to cope with it.

In 2010, the Army adopted a policy requiring PTSD and brain injury screening for service members who had been deployed overseas, but recent reports by the U.S. Government Accountability Office have found that military officers who disciplined or penalized their soldiers did so without having first obtained and documented that screening.

A   in May, for example, found that 62 percent of the 92,000 service members kicked out of the military for misconduct from 2011 to 2015 had been diagnosed with PTSD within the previous two years. The misconduct described in the report included drug use, insubordination and criminal actions, according to the GAO.

But in a number of other cases the GAO reviewed, the Army had failed to document whether the soldier in question had been adequately screened for brain injury or PTSD. In one sample of 46 cases where soldiers were separated from the service dishonorably, about one-third contained no paperwork showing the mental-health examination had occurred.

When soldiers are separated from service with “other than honorable” discharges, they have also, historically, been barred from access to health benefits that are available through the Department of Veterans Affairs. In other words, some people who had been damaged by witnessing or experiencing violence in combat have been unable to obtain the medical care they need to recover.

In an effort to solve that problem, VA Secretary Shulkin  that the agency would begin allowing any veteran, even those with a dishonorable discharge, to obtain mental health care at VA facilities nationwide. That policy took effect July 5.