Samuel Askins spent 545 days as an infantryman in the U.S. Army in Iraq, witnessing numerous firefights and suffering a concussion in an explosion that eventually ended with a diagnosis of post-traumatic stress disorder.
"It ruined my life," Askins said, adding that he tried to kill himself with alcohol and drugs because of the panic attacks and despair that followed him back to the United States and resulted in his retirement from active duty.
Today, at 35, he helps other vets as director of Camp Hope in Houston, but even he is having a tough week anticipating the loud fanfare that comes hand in hand with Fourth of July.
"Even with my recovery, the fireworks will kill me this week. The [fireworks] stands are all open," Askins said. "Just last week, I went fishing and I put the boat in the water when a cherry bomb exploded. I fell out of the boat.
"I will have to deal with this for the rest of my life," he said.
Fourth of July fireworks can trigger anxiety in people with post-traumatic stress disorder, or PTSD, according to the Department of Veterans Affairs.
It can cause anything from a startle to a full-blown panic attack or combat flashback in people who are vulnerable, VA doctors say. They even recommend noise-cancelling headphones as a way to mitigate the effects of sudden and loud noises.
"There's a fireworks stand at nearly every major intersection around here, sometimes two," said David Maulsby, executive director of the Houston chapter of the PTSD Foundation of America, which works with about 100 veterans a year.
About 30 percent of the more than 800,000 men and women from wars in Afghanistan and Iraq being treated at veterans clinics and hospitals have been diagnosed with PTSD, according to a 2012 report from the VA.
It can occur after any traumatic event: combat exposure, physical or sexual abuse and natural disasters. Most people have stress reactions right after exposure but, in others, the feelings of anxiety, panic and paranoia do not go away and disrupt daily living.
Symptoms can start immediately after exposure to trauma or might not appear until months or years later. PTSD can vary from reliving the event to avoiding situations that are reminders.
But many other veterans, with or without a diagnosis, also can be affected by the holiday, according to John E. Mundt, a clinical psychologist at the Jesse Brown VA Medical Center in Chicago.
"Many combat veterans may be rattled, unsettled and startled by fireworks this time of year," Mundt said. "... but there's quite a broad range as to how distressing or disruptive that reaction will be."
Working with patients, he said fireworks tend to be triggers for "re-experiencing episodes," as well as aggravating a person's hypervigilance.
"Most vets I know tend to be bothered less by the large firework displays, the colorful starbursts that are accompanied by patriotic music and 'oohs' and 'ahhs' by a crowd," Mundt said. "The bigger problem is all the smaller fireworks that start getting used weeks ahead of July 4th and continue getting used for weeks after the holiday sometimes."
M80s, bottle rockets and many other smaller projectiles that go off suddenly and create loud noises remind combat veterans of incoming mortars and small fires they experienced in Afghanistan, Iraq and even Vietnam.
"Nobody knows when one of these little loud blasts is going to occur," Mundt said. "I've had clients have flashbacks when kids threw M80s into their alley or backyard, or when somebody lights off a string of firecrackers in their mailbox."
Many anticipate the holiday and get defensive. "I used to know a Vietnam veteran who dealt with July 4th every year by saving up to be able to check into a high-rise hotel downtown in Chicago every July 2nd," he said. "Then he would spend three days and nights in a hermetically sealed room high above the street noise."
And it's not just July 4 that rattles veterans. New Year's Eve, Halloween and other celebrations -- even the recent Blackhawks hockey Stanley Cup victory in Chicago when guns went off -- can distress them.
Mundt makes sure he has "anticipatory" group discussions, especially among newly returned war veterans, to be prepared for the impact of such events.
PTSD sufferers in particular can feel fear, guilt or shame. In addition, they can have hyperarousal: being constantly anxious, looking out for danger and unable to sleep.
Such was the case in Houston with Askins, who served from 2004 to 2005 in operation Iraqi Freedom, working on a multinational convoy security detail for Gen. David Petraeus.
After a suffering a concussion in a vehicle-borne explosion, he had a headache for two weeks and was treated only with ibuprofen at the "sick hall" before returning to work.
Askins got married to another soldier, she got pregnant and he returned to the Army Reserves because of her higher salary and career potential. The delayed symptoms of PTSD began shortly after that, while the couple was living on a base in Missouri.
"I was real paranoid at first," he said. "I would notice around every street corner a potential for threats. I'd see gang members on the streets. I'd black out -- see BMWs and see Humvees and hear choppers flying overhead."
Depression eventually set in and suicide thoughts followed, even as Askins had full responsibility for the care of his now 2-year-old daughter.
"I'd lock myself in the closet obsessing about tornadoes," he said. "I was so bad, I had a bunker in the house."
He said things really fell apart when his wife was sent to Iraq on her fifth deployment. When she asked for a divorce, Askins said his drinking escalated.
"I fell completely apart and didn't get off the couch for two years," he said.
Knowing his family would never get death benefits if he killed himself, Askins said he tried to kill himself with alcohol and drugs.