The authors of the VA study, Janet Kemp and Robert Bossarte, included many cautions about the interpretation of their data, though they stand by the reliability of their findings. Bossarte said there was a consistency in the samples that allowed them to comfortably project the national figure of 22.
But more than 34,000 suicides from the 21 states that reported data to the VA were discarded because the state death records failed to indicate whether the deceased was a veteran. That's 23 percent of the recorded suicides from those states. So the study looked at 77 percent of the recorded suicides in 40 percent of the U.S. population.
The VA report itself acknowledged "significant limitations" of the available data and identified flaws in its report. "The ability of death certificates to fully capture female veterans was particularly low; only 67 percent of true female veterans were identified. Younger or unmarried veterans and those with lower levels of education were also more likely to be missed on the death certificate."
"We think that all suicides are underreported. There is uncertainty in the check box," says Steve Elkins, the state registrar in Minnesota, which has one of the best suicide data recording systems in the country.
VA Secretary Eric Shinseki requested collaboration from all 50 states to improve timeliness and accuracy of suicide reporting, key to improving suicide prevention. At the time the VA released its last suicide report, at least 11 states had not made a decision on data collaboration.
Combat stress is just one reason why veterans attempt suicide. Military sexual assaults are another. Psychologist Craig Bryan says his research is finding that military victims of violent assault or rape are six times more likely to attempt suicide than military non-victims.
More than 69 percent of all veteran suicides were among those 50 and older. Mental-health professionals said one reason could be that these men give up on life after their children are out of the house or a longtime marriage falls apart. They are also likely to be Vietnam veterans, who returned from war to a hostile public and an unresponsive VA. Combat stress was chalked up to being crazy, and many Vietnam veterans did not seek help.
Even though more older veterans are committing suicide, it's difficult to predict what the toll of America's newest wars will be. A survey by the Iraq and Afghanistan Veterans of America showed that 30 percent of service members have considered taking their own life, and 45 percent said they know an Iraq or Afghanistan veteran who has attempted suicide.
"There's probably a tidal wave of suicides coming," says Brian Kinsella, an Iraq war veteran who started Stop Soldier Suicide, a nonprofit group that works to raise awareness of suicide. Between October 2006 and June 2013, the Veterans Crisis Line received more than 890,000 calls. That number does not include chats and texts.
President Barack Obama says there is a need to "end this epidemic of suicide among our veterans and troops." In August 2012, he signed an executive order calling for stronger suicide prevention efforts. A year later, he announced $107 million in new funding for better mental health treatment for veterans with post-traumatic stress and traumatic brain injury, signature injuries of the wars in Afghanistan and Iraq.