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0-recruit
1-marine
2-veteran
3-nightmare (you get/start with soulcube here)
or ingame, open up console and tpye: g_skill x
"Nightmare" mode is recommended to go with a new game start, since it works different than other difficulty modes, for example there are no random medkits. Changing difficulty mid-game is actually kind of a twist, you may have halfway results.
I think that feature is intended, as your health constantly drops back down to 25HP while playing on Nightmare