Something Tom failed to mention about his guest columnist...Associated Press story from April. At the time Koch said the program was "doing good work."
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Noel Koch Ousted: Pentagon's Head Wounded-Soldier Care Official Forced To Resign
LOLITA C. BALDOR | 04/25/10 04:26 PM |

WASHINGTON — The Pentagon official in charge of the wounded warrior program said Sunday he has been forced to resign, as the military continues to struggle with how best to care for troops injured in combat.

Noel Koch said in an e-mail that he was asked to step down by Clifford Stanley, the undersecretary of defense for personnel. Koch had been serving as the deputy undersecretary of defense for wounded warrior care and transition policy.

Pentagon press secretary Geoff Morrell said Defense Secretary Robert Gates had asked Stanley to do a full review of the Pentagon's personnel and readiness office. He said this is not the first nor the last change to take place.

"He was given wide latitude to make needed changes so that our men and women in uniform are better served," said Morrell. "What you're seeing is that the overhaul of that vitally important office is under way."

Koch said he believes the decision was unjust and that he resigned "under duress" after Stanley told him he had no confidence in him. The Pentagon had no comment.

"No explanation was given, although I pressed for one," he said. "No prior indication of dissatisfaction with the work of this office was cited."

Koch said the wounded warrior program has done good work during the past 11 months since his appointment to lead the new office.

Nearly nine years of war, in Afghanistan and Iraq, has physically, mentally and emotionally battered the military, sending thousands home with severe injuries and spawning spikes in suicides and post-traumatic stress issues.

Officials have scrambled to set up transition units to help wounded troops recover and return to society or even the military, but the flood of patients and the complexities of their injuries have often overwhelmed the system.

Mr Koch says: "You don't hear that, "I love them" a lot up front in the U.S. military, but that summed up much of what we heard from the cadre in the WTU's."

I say: In most places such sentiment flows easy, and if it doesn't they are doing it wrong. My Dad made it clear to me that my most important job was to "love your soldiers" and when that time was up it was time to move on.

I confess I have a tough job, but it is far from thankless--it is very rewarding and I am honored the Army asked me to do it.

Yes, 84% of Soldiers in a WTU have deployed at least once.

The Army does comply with the Recovery Coordination Program and exceeds the standards of that program. The Army did not accept contracted Care Coordinators offered from Mr Koch because we already had personnel (Nurse Case Managers and Army Wounded Warrior Program advocates) that had been doing that mission for two years and four years respectively.

Surveys: Done by an independent company (Synovate), they contact about 2500 Soldiers (25% of our program) each quarter. These surveys have 32 questions about leadership (by name), care providers, medical care, non-clinical services, and special interest areas. They include Soldier comments. Feedback is consoldiated to give an overall approval rating based on Soldier input. Some specifics. Care providers/leaders: Nurse Case Managers get the highest marks (92%), followed by NCO leaders (88%), then Primary Care Managers (82%). Soldiers satisfaction for medical issues are: Satisfaction with Therapists (90%), Doctors (85%), meeting Mental/Emotional needs (84%), and Pain Control (72%). Non clinical satisfaction rates: Quarters (95%) Transportation (90%) Finance (85%) and Orders (82%). Based Soldier feedback, we have changed transfer policies, added pain therapies, worked a number of changes to medical evaluation board processes (lots more work to do here), and medication control (more work to do here as well). These surveys are also be sorted by installation, so we are able to share areas of low performance with those particular WTUs.

Other inspections: Our Command Sergeant Major and I visit these units personally and we also have an inspection team that inspects about two units per month looking at over 100 inspection areas. The Inspector General has independent inspections of living spaces and periodic reviews as well. There is a significant amount of scrutiny of WTUs and assistance from installation and garrison commanders.

The fundamental question seems to be--should entry into a WTU require being wounded in action? Having been evacuated from theater? Having been deployed? Or, should that 1% of Americans who have signed up to serve the Nation in a time of war be assigned to a WTU based on the acuity of their medical conditions? Should we have separate programs? Does an amputee from a motorcycle accident go to a different unit or receive different treatment than an amputee from combat? Should we segregate those with behavioral health issues? How would that affect the stigma associated with seeking behavioral health care? The Army's position is that the source of the injury does not predicate assignment to a WTU, only the severity of the wound, illness, or injury. I absolutely support that position.

Perhaps Mr Koch can give us his vision on how he believes this program should be run.

Tom - you need to highlight this from BG Cheek like you do the other "contributors." After 8+ years of war, you have to have a system that accommodates the entire force. Dealing with a few malingerers/losers on the margins, which the press exploits in pursuit of their pulitzer, is simply the price of doing business...

"The fundamental question seems to be--should entry into a WTU require being wounded in action? Having been evacuated from theater? Having been deployed? Or, should that 1% of Americans who have signed up to serve the Nation in a time of war be assigned to a WTU based on the acuity of their medical conditions? Should we have separate programs? Does an amputee from a motorcycle accident go to a different unit or receive different treatment than an amputee from combat? Should we segregate those with behavioral health issues? How would that affect the stigma associated with seeking behavioral health care? The Army's position is that the source of the injury does not predicate assignment to a WTU, only the severity of the wound, illness, or injury. I absolutely support that position."

I'll side with BG Cheek. Never really had much use for proof by anecdote, which seems to be what Mr. Koch is offering. Having said that, the obesity cases need to be moved elsewhere, as do the drug abuse and mental illness cases, provided those cases do not result from deployment. Remember what WTU stands for and why it was formed.

Be careful of the obesity equals not worthy position. I recently assisted a soldier who developed severe sleep apnea after entering service. He did a tour in Iraq after receiving a waiver to deploy with the condition. His condition worsened but he was able to complete his tour in Iraq. When his unit was preparing to redeploy for a second tour, his waiver request to deploy was denied. He opted for surgery to improve the condition and allow him to deploy but the procedure ended up making his condition worse. He was sent for his second MEB. His unit tried to terminate the MEB and chapter him out for weight and PT failure; problems directly related to the effects of his medical condition.

I was able to get the Pentagon officials to make a call to instruct his unit that DES processing takes precedence over administrative chapters. He was a mere 24 hours away from being discharged when his unit was informed they could not chapter him in the midst of DES processing.

His MEB was completed but the informal PEB deemed he was fit for sleep apnea even though his doctor specifically stated his sleep apnea made it unsafe for him to driving military vehicles, fire weapons, standing guard and deploy. The fatigue factor also made it unsafe for perform his MOS duties of repairing military aircraft. The "wink and a nod" fit finding opened the door for the unit to chapter him out of the Army. We demanded a formal PEB.

Over a several week timeframe, I was able to point out the errors of the fit decision based on the evidence and well established, but often ignored, regulations and policies. I relayed authoritative medical studies demonstrating that sleep apnea causes weight gain which also impaired his fitness. His doctor also weighed in and reemphasized the severity of his condition. It was one of the worse cases of sleep apnea he had seen.

On the morning of his formal board, the informal PEB “reconsidered” his case and granted him permanent disability retirement at 50%. He went from a chapter action without benefits to a permanent disability retirement. All it took was to doggedly demand his unit, MEB and PEB follow the rules; something they should do without asking.

Michael Parker
LTC, USA (Retired)
Wounded Warrior Advocate

I am an injured soldier and was in a WTU at Fort Lee for over a year. I have also visited other WTU's. From my own first hand experience I can tell you it was a living hell at the WTU at Fort Lee. It has been well reported so I am sure it will not come as a shock to anyone. I had never been deployed. I was injured quite severely during a training accident. To say that someone who has not been deployed or to diminish their injuries in any way is ridiculous. Just because someone has not deployed does not make them any less a soldier. In the WTU I was in, many of the cadre had not ever deployed. They had no experience with injured soldiers and definitely had "no love" for them. I heard many of them making comments on how it would not even be worth being there except they were able to harass the soldiers and to be in charge of people who were a higher rank then they were. As a commissioned officer I found it highly offensive to say the least. Nobody knows the situation of every soldier and their injuries. To make comments or assumptions about such shows how ignorant people are and shows a lack of concern for soldiers who signed a dotted line and gave up much of their lives. Every WTU is not the same and all the cadre are not in these positions for the right reasons. As such, maybe some of the soldiers are not there for the right reasons either, but there was someone that made that decision to put them there. Do not put the stigma of a soldier being a slacker or trying to get over on the system beacuse there may be a couple that do. Unless you are that soldier, you have no idea what their problem may be and just because someone doesn't have an arm or leg missing doesn't mean they do not have a legitimate reason to be in a WTU.

As a Soldier who: has deployed twice, been evacuated from theater and has an intimate knowledge of our Army's Warrior Transition Unit(s), the Warrior Transition Command and the Officers, NCOs, and Civililian Caregivers who support our wounded, ill and injured population - I am absolutely appalled at the IRRESPONSIBLE, mis-informed and inflammatory remarks originally stated by Mr. Koch.

Further, I concur with BG Cheek's closing remark of "Perhaps Mr Koch can give us his vision on how he believes this program should be run."

It is both an unfathomable and disgusting notion that Mr. Koch (not only a former "Senior" DoD Official but also the man charged with the responsibility of overseeing the wellfare of our nations wounded, ill and injured Service Member population) would refer to our young men and women in uniform as misfits or unworthy of enlistment (simply because they have not deployed or dont have life threatening illnesses). Since the war, How many time have you deployed for over a year or stood guard at a gate or lead Soldiers into battle Mr. Koch? Would it have made you less effective or unqualified as a Pentagon if you hadn't?

Moreover, it is a MAJOR contradiction to indict the organization and personnel charged with supporting our sick Service Members but yet wonder why the Soldiers he refers to in his response seem to "question" what the Army thinks of them as a result of being in a WTU.

Erroneous and absoultely ignorant remarks such as those of Mr. Koch's, coupled with similiar irresponsible remarks from the former Company Commander, are exacty the types of things that contribute to mis-guided perception, predjudicial treatment and false stigmas.

Unfounded rants from former officials forced to resigned (for ineptness in leadership for the very program he indicts) seeverly exaccerbates the already numerous challenges our Soldiers (whether Combat Veteran or brand new PFC) face on a daily basis in the WTU as they recouperate from their injuires and the men and women who work diligently to support them.

So the fundamental challenge remains for both Mr. Koch and the former Company Commander: Rather than exhibit the antithesis of leadership and denograte our nations Military, step to the plate, outline inherit problems based on FACT (not conjecture, rumor or innuendo) and offer hard nosed solutions to ameliorate the problem (as you see it).

Our Army (much like our Nation as a whole) isn't exactly perfect and constantly seeks to improve itself. As leaders, WE (whether former or current) have a duty to improve upon it responsilbly and productively.

IRR Soldier:

Lets clarify some things as the logic contained in your argument is circular:

- The "ARMY" WTU Program is actually part of comprehensive and cumulative DoD plan that encompasees ALL of the uniformed Services. The Army has the proponderance of WT(s) and is leading the pack of all service(s) with respect to how it handles its wounded, ill and injured population. That stated, you are incorrect in saying that the program as a whole is run by the Army. The program as a whole is run by the DoD (which was formerly run by Mr. Koch before he was asked to resign).

- It is neither here nor there as to whether Mr. Koch stated "some" or "all." It still insults the service and integrity of the men and women who get up and serve daily that someone who was charged with leading our nations defense has reduced it to a media blog side show.

The fact of the matter here is that he has made a blanket statement (QUITE IRRESPONSIBLY) that the WTU happens to be a "dumping ground" for misfits etc, et. al. That infers that the men and women who support it daily, the Soldiers who struggle to heal in it and the potential Soldiers who may (for whatever reason end up in it) are in fact being written off by the Army. Statements like these (from a Senior Official) do unwarranted damage. .especially when they are founded on little fact...mostly conjecture.

- To answer your question as to whether I was in any meeting or plenary with Mr. Koch attended? Let me counter by asking does he (or YOU for that matter) actually know (to the degree necessary) the medical reports, illnesses and injuries, pains etc that every WT in a WTU faces or endures? Were you or Mr. Koch apart of the medical boards and INTRICATE layers of decision making processes involved for a Soldier to even enter a WTU? Did you even know that there is such a process (complete with comprehensive testing and documentation from the Soldier chain of command or "Triad of Leadership?"

- Before you reduce me to a "bully," re-read my remark regarding Mr. Koch's service in the last five years. It was purely anectdotal and served to highlight the ultimate question of whether HE felt his service or lack thereof made him any more or less qulaified to perform his job or make the statements he is making now. . . so please save your insults until AFTER you have fully read and understood what I wrote.

Again, we can go back and forth, but the PROPER thing to do is suggest ways of remedying the "so called" multitude of documented cases. I welcome the opportunity to read his recommendations to the Army. Thanks.

There's that circular logic again IRR Soldier. . .

You have offered recommendations that are void of solutions (i.e. "Blow up the whole WTU bureaucracy and start over.") How do you propose we start over? Under what construct or business model would you use to make the "multitude" of issues you spoke about earlier..

The "combat arms cadre" you speak of have absolutely NOTHING to do with the medical care and rehabilitation of the Soldiers in the WT. They are in fact there to ease the added administrative strain burden from the medical professionals so that they CAN in fact concentrtate on the medical care and rehabilitation of the WTs hosued in the WTU.

It is abolutely absurd to suggest that the DEPARTMENT OF DEFENSE is catching up with the Army with respect to the WTU program when in fact that directive to establish the program (and the construct yb which to use ) came from DoD. .so the facts here are FAR from loose.

It is a shame that BG Cheek has the time to go tit-for-tat on a blog about the WTU and AW2 Programs with Mr. Koch. I would assume because BG Cheek will departing the WTC within the next few weeks, he has time on his hands to do so. BG Cheek or his minions will claim that he is so passionate about the mission of warrior care and the AW2 Program that he makes the time to defend the programs. Others may say, he is attempting to right the ship through hard core defensive tactics prior to his departure. Having served in BG Cheeks command, I tend to believe that he is doing what AW2 and the WTC have done from its inception, focus on the press and not focus on what’s doing what’s right for wounded warriors. When the AW2 Program and WTC have a staff of strategic communications (Public Affairs) folks that is larger than that of Army Division or Corps Public Affairs offices, what is the real mission? Take care of wounded warriors or package the message that we do take care of wounded warriors?

There is no doubt that the WTU’s were formed out of the overblown negative publicity from the Walter Reed debacle. Of course, when the BRAC Commission slated Walter Reed for closure, funds were not used to keep the facility up to standard. That made sense. When the war wounded needed space at Walter Reed, the decision not fund improvements for a closing hospital and the placement of wounded warriors in the crumbling facility, became an issue. The press had a field day and our noble members of Congress all did what they do best, they did the old duck and cover, letting the military take the fall. No one should have been placed in those facilities, however if Army leadership was at fault, it should have been because they didn’t go back to Congress and demand Congress provide additional funding for improvements prior to placing anyone in those facilities. They didn’t and I doubt Congress would have supported it anyway.

Have the WTU’s been abused. Absolutely. Has Army policy on who gets into the WTU and who doesn’t been changed and changed again. Absolutely. Was it easy for pregnant Soldiers to leave their unit and get into the WTU, receiving all the benefits of intense care management, low ratio doctor to patient care, special facilities, tickets to sporting events, and other benefits that other Soldiers don’t get? Absolutely. Was the WTU a dumping ground for Commanders of deploying units who needed to remove injured, ill or wounded Soldiers from their books so they can deploy with all the troops in boots they need to fight and service in the war zone? Absolutely, as the commanders needed to and as they should do. If they hadn’t, how many more dead Soldiers would we have had because the unit went to war without the manning they needed?

As stated earlier, the WTU has changed entrance standards time and time again. Sometimes it is hard to get in, other times, not so much. Do we have Soldiers in the WTU who have irritable bowel syndrome, chronic back pain, stress from fear of deploying (not fear from being deployed), flat feet, and a vast array of what most real wounded warriors feel are bullshit issues? Absolutely. Do these Soldiers eat up valuable resources that wounded warriors with combat or combat related injuries could use? Absolutely. Did many Soldiers many game the system? Absolutely.

What is sad is the actual problem is even greater. There are scores of wounded warriors who have combat or combat related injuries who can’t get into the WTU’s or don’t want to go to the WTU’s because of their own personal Esprit de Corps and don’t want to be stigmatized by being associated with the irritable bowel syndrome or chronic back pain type of Soldiers. They rather not get the treatment they deserve then be labeled one of those “profiles” or “broke dicks”.

BG Cheek is also being disingenuous when he says the WTC/AW2 Program is meeting the congressionally mandated requirements of the NDAA in supporting the Recovery Coordination Program and exceeds the standards of that program. The AW2 Program from the start rejected the program out of hand and along with it the additional RCC staff. Even to the point of undermining the RCC staff’s ability and qualifications with the existing AW2 Advocates. The AW2 Program felt they had the oldest and best program around and was not about to let Congress or DOD tell them differently.Comprehensive Care Plans (CCP) and Comprehensive Transition Plans (CTP) have not been instituted into the AW2 Program. AW2 is stalling in hope that Congress will defund the RCC Program so they can go back to their own processes.BG Cheek will point out that only the CTP is required by the NDAA, however, if BG Cheek was serious about Soldiers in the WTU getting help and getting better (the real mission of the Army Medical Care system) the CCP is the tool that identifies issues early and gets action taken to fix issues prior to them becoming problems.

BG Cheek stated “The Army did not accept contracted Care Coordinators offered from Mr Koch because we already had personnel (Nurse Case Managers and Army Wounded Warrior Program advocates) that had been doing that mission for two years and four years respectively.” Those are comments from someone who has lost touch with the realities of the field. AW2 Advocates (all contact and government employees) were originally assigned a case load of 1:30. It is not uncommon to have Advocates today with a 1:50 to 1:70 ratios. This is after BG Cheek rejected the additional “free” workforce. BG Cheeks comment that we already had Advocate doing the work is silly and is key in the very high turnover rates, frustration levels and burnout the Advocates have today. It is also key to lower productivity the programs are experiencing. As a combat commander, BG Cheek should know what he did was the same as rejecting reinforcements from another combat organization when you’re about to be overrun.

Fortunately, BG Cheek and COL Rice (the AW2 Director) will be departing very soon. Maybe with fresh eyes on the ball, a willingness to see value in the concept of working with the RCC Program will develop that will honestly serve the intent of helping wounded warriors get better and return to the force or successfully transition to the civilian life and the VA system. If not, the system will continue to be about building kingdoms and helping the lives of the Soldiers who work in the AW2 Program and Warrior Transition Command Headquarter and not the wounded warrior in the field they are charged to support.

As a commissioned officer I found it highly offensive to say the least. Nobody knows the situation of every soldier and their injuries. To make comments or assumptions about such shows how ignorant people are and shows a lack of concern for soldiers who signed a dotted line and gave up much of their lives. Every WTU is not the same and all the cadre are not in these positions for the right reasons.sazeni As such, maybe some of the soldiers are not there for the right reasons either, but there was someone that made that decision to put them there. Do not put the stigma of a soldier being a slacker or trying to get over on the system beacuse there may be a couple that do.