"I always kind of knew this day would come," his father, Steve Carlson, told an LDS Stake Center filled with mourners Friday. "It's a day I'd hoped would never come."
Carlson's body was found last Saturday in a rented room in Murray where he'd been staying for six weeks, waiting for a slot in an intensive treatment program at the George E. Wahlen Veterans Administration Medical Center in Salt Lake City.
His family does not know why or how he died but they know this: As fiercely as he fought in Iraq, his toughest battles were when he came home.
Carlson, a 2004 graduate of Skyline High, served as an Army infantryman in Iraq during some of the deadliest, most confusing battles.
He fractured his leg coming off a roof in the rain during an ambush in Fallujah. He came home, as well, with a traumatic brain injury, post-traumatic stress disorder (PTSD) and what psychologists call "moral injury" a haunting guilt over having to kill the enemy and for surviving when one's buddies didn't.
"The hardest part was dealing with the guilt," said his father, who hopes to raise awareness of young veterans' struggles by telling his son's story.
Young people "join the Army, they tear them down and build them up to kill. The problem is there is no reverse program to bring them back into society."
His father wouldn't be surprised to learn his son took his own life. At the funeral, he spoke of his son now being free of affliction, cravings and addiction.
There was no sign of struggle or violence when he was found. The only drugs he was prescribed were for anxiety, high blood pressure and to help him sleep.
If drugs killed him, his family may never know if it was accidental or suicide.
His stepmother, Susie Carlson, doubts he committed suicide, though the number of vets who do is high.
He had returned to Utah for treatment six weeks ago, while his wife and children stayed in Missouri, because he had rapport with staff at the Salt Lake VA.
"He said, 'I really feel like they can help me,'" she remembers.
Carlson was upbeat, talking of buying a car, laughing.
He told his family that the VA kept extending the wait for him to enter an intensive treatment program for PTSD. "They kept telling him, two more weeks, just two more weeks," Susie Carlson said.
"They (VA staff) were trying to get him help, but they have so very many soldiers that need help, just like James, that they simply couldn't get to him," Susie Carlson wrote in an email to The Tribune before the funeral. "He had lots of appointments with doctors and they would give him more meds to 'get him through.' In the end, he wasn't really living, he was just existing."
Scott Hill, chief of mental health for the Salt Lake VA, could not discuss Carlson's situation because of patient confidentiality rules.
But he said the Salt Lake VA does not have a residential PTSD treatment program, and instead sends veterans needing that level of care to Denver or Sheridan, Wyo.
Salt Lake's VA, instead, has an intensive treatment program for vets suffering from addictions, and that often means treating the underlying causes such as PTSD or getting the vet well enough to go to Denver or Sheridan, he said.
Vets often wait four weeks, or even six, to get into the substance abuse program, Hill said. " If somebody needs something right away we can get them into one of community partners (treatment programs)."
Carlson's father and stepmother believe he had been addicted to prescription drugs but had more recently stopped abusing them.
"I honestly think he was trying to put his best foot forward to try to get into that [program]," Susie Carlson said. "You've got to be clean for that."
Awarded two Purple Hearts for his injuries and rated as 100 percent disabled, Carlson was like a lot of Iraq and Afghanistan vets who struggle to return home.
He was happiest as a soldier. "He felt good about contributing to society, and he was good at what he did," said Susie Carlson. "He felt good about that."
When he came home, "nothing seemed as important," said his father, who will retire this fall after 28 years in the Navy Reserves. "There is no high like being in a firefight. … Everything they come back to is boring."
The American public needs to know and better support veterans who continue the battle back home, he said.
"The underlying problem is there are so many returning vets. … The system is overloaded, and they can't deal with everybody. So everybody waits and they wait. And you have nothing to do."
Recent Tribune coverage of veterans issues
U. study: Combat puts soldiers at high suicide, PTSD risk
Salt Lake VA adds five mental health staffers
Utah vets with mental health issues get new building at V.A.
Veterans' disability claims piled up fast in Salt Lake City