One civilian's perspective, for what it's worth: I'd assumed that the Army and Marines had done over a year ago what Noel Koch is calling for them to do now.

Revelations about substandard care (or at least post-operative care) at Walter Reed in the Washington Post are what inspired the services' increased attention to wounded veterans' issues in the first place. It was a major public relations disaster, and frankly I'm surprised that either the Army or Marines would take any chances on another one.

I have no strong views about the specifics involved in "wounded warrior" care. It's just not a subject about which I know enough to judge. I understand politics pretty well, though, and the perception that the military is not treating men wounded or injured in combat as they ought to be can't be anything but damaging to the services. Is the "Wounded Warrior" program in the Army and Marines, as it is now being run, heading toward recreating that perception?

I have to say it sounds like it to me. If I'm wrong, fine, but otherwise the DoD leadership had better revisit this issue.

Until recently, the separation authority (at least at Fort Drum) was the CG. Giving separation authority back to the BN CDRs might help eliminate the problem children that get lost in the bureaucratic shuffle. (This may have already happened, though)

Many commanders have second thoughts about initiating separation paperwork, knowing every page will be scrutinized by the entire chain of command up to the GO-level. This is one reason why you see so many obese and out of shape troops--the paperwork requires so many stipulations, you risk making a fool of yourself in front of the CG.

At least in the Army, is their lack of legal counsel. SJA resources are generally installation-applicable, which normally means GO officer level. To drop separation authority to a battalion is to invite problems with administrative shortcutting that violate regulations and statutes designed to protect service members who are sought to be "gotten rid of" by a disappointed commander. That's also why things like rehabilitation transfers are required when the proposed separation is performance-related.

If I am not mistaken, the Wounded Warrior Barracks at Camp Lejeune, N.C. are buildings quite a distance away from the base hospital - how the hell does that work out for someone with a physical mobility problem or a brain injury making land navigation a challenge, especially if one is on meds?

I’ll leave the above paragraph, though an e-mail just came in telling me the Corps is building a new complex near the base hospital (as well as reminding me about logistics and appropriations, etc. - I do like this delete key).

Well anyway, we are describing something in print as the Wounded Warrior Program. This conjures up the vision it is for those wounded as a result of hostile action or injured in a combat zone. Not a facility for everyone with a some physical or mental malady, real/imagined or faked.

Let me say this again: young enlisted see what’s going on, they know BS when it’s peddled and because they are cunning and sly recognize when someone is peeing down their backside but telling them it’s raining outside. If they see this program also includes the sick, lame, and lazy some may be loath to come forward with legitimate problems, that over time, may worsen. At the least, those with a real reason to be there feel cheapened and may not get the attention and advocacy the need.

We simply must separate the wounded/injured in a combat zone from the others, but I suspect must also include those that have legitimate injuries documented while on active duty - after all, it would be a travesty to tell a four tour combat vet injured in a training accident preparing for his fifth tour, he didn’t qualify also (or one injured training for his first) - what’s fair is fair?

As concerns administrative discharges in the Marine Corps. Though now dated, my observation was that the biggest impediment to timeliness of the process was the command itself not following guidelines from the get-go, and trying to cut corners thinking they could speed up the process only to
find the package sent back, viewing it as a bureaucracy, which is now seen as a too time consuming endeavor for next time. Thus, the Wounded Warrior Program may become a tempting vehicle for dumping one’s problems into - which seem to be the perception of the majority if not the reality.

We need to do better. And yea, this Mustang is still agitated about this issue, because the sun is out at my house and my backside feels wet.

Zathras makes a good point. If the conventional wisdom about WTUs and warrior care in general is that the Army or the services aren't taking care of this population, there will be hell to pay. The Army made a strategic decision in the wake of the Walter Reed scandal to establish a management system that accounted for--not just wounded soldiers--but all soldiers who couldn't deploy because of illness or injury. That may have been a mistake in terms of solving the perception problem about poor treatment of wounded warriors, but it did address the "ARFORGEN" problem that the Army faces after years of combat deployments. WTUs were a way to get non-deployables off unit books and provide them focused care so they are able to get back in the fight at some future point. Initially, deploying commanders did use the WTUs as a place to move non-deployables, and the WTU population ballooned to about 12,500--which was untenable for the WTU staffs and dilluted the care. Stricter criteria was then set so that only the complex cases were admitted. But that still left a widely diverse population--from purple heart earners to drug addicts. Despite that, tens of thousands of soldiers have moved through the WTUs without much ado--over half returning to duty. But because the public thinks these units are full of combat wounded heroes, every complaint gets front page coverage--which only emboldens the opportunists. So I would conclude that there's no going back for the Army--too much has been invested. But if the misperceptions about what WTUs are and who is in them persist--fueled by guys like Ricks and Koch--then political forces may end up dismantling them against the Army's will.

At one time, the Marines had CCC for misfits, which could include those awaiting non-medical discharge. Its like boot camp, but rather than classes they can work 12-hour days six days a week picking up trash and mess duty type work. The idea is to get some work out of them and make them miserable so they want to go back to their unit. Or if awaiting discharge, it will encourage them to desert so their pay can be stopped and we don't have to feed them. Then Marines are afraid of getting in trouble, cause they will be sent to the prison like CCC.

The Army also has/had a CCC, AKA Charley's Chicken Coup. Some of my best soldiers were CCC graduates. It was a motivational rehab program and was quite effective. I believe it went away with the drawdown of the 90’s as the military was reducing the force structure so motivational rehab became unnecessary.

The below comment is not targeted and anyone in particular but if the shoe fits, wear it.

Again, the WTU entrance requirement requires a medical condition that likely does not meet retention standards. As long as such individuals with diagnosed medical conditions are labeled misfits and malingerers by insiders and outsiders alike, we will get nowhere living up to the soldier’s creed. If you have credible evidence of malingering, refer UCMJ charges. Else, SHUT UP!!!!!!! False charges of malingering are not conducive to a healing environment.

The non combat disability equaling misfit, malingerer, unworthy is getting quite tiring. If a malingerer is sent to the WTU, then the chain of command that sent him is perhaps guilty of dereliction of duty. The sword swings both ways.

Mike

Dave Goldrich makes an important point that recruiters need to be judged not only for meeting their quota but also on the caliber of recruit they bring in. Giving recruiters credit for a successful accession when the recruit graduates boot camp is too early. Wait 6-9 months and see if the recruit becomes a productive member of the service. What's the harm? It provides recruiters a disincentive to encourage mentally or physically unsuitable candidates from signing-up and may result in a better quality of enlisted person.
Would a private-sector company continue using a specific headhunter if too many of their new hires prove to be incapable or unwilling to do the work? No. Stop believing that leadership can overcome the lack of health, talent and work ethic in poor quality recruits and give us people who actually want to work.

For each branch of service, the best thing to do with individuals no longer able to take up a full mission load is discharge them, wounded vets to the care of the VA (and clean up that interface so the transfer of responsibility is seamless) and the rest of the lot to civilian life.

Each Service is limited by law to a certain end-strenght - the number serving on active duty on the 30 September end-of-fiscal-year. Those not assigned to a unit or to a training billet go into a catch-all account (the Navy's was TPS&D - Transients, Prisoners, Sick, and Deserters) and the total tallied there is a significant number. I seem to recall something like 20,000 Navy in one year. That's a lot of potential contributors to mission who just aren't there to carry their load. Any in this account that can and should be discharged ... should be discharged and get them off the books.

The short version - Think outside the box.

If you want a few potential ideas....to at least get you thinking in a different direction, whether they be right or wrong, here's the long version.

Just curious...why do the wounded have to be under the supervision of military personnel? It seems to me that most everyone participating in these threads has two main concerns - care for combat wounded troops and identification and disposal of the malingerers.

I’ll let you figure out how to deal with the malingerers and how to positively identify them. With regard to the wounded, I believe they should be separated. Combat wounded resent being with the others. Perhaps it’s because they may be viewed as malingerers or perhaps they have a hard time feeling bad for the guy who had a bad reaction to a flu shot when they themselves are dealing with the loss of a limb or a brain injury. Either way, separating the two groups should be seriously considered. My combat Marine had serious issues about being grouped with the those dealing with non-combat related injuries. As well, another Marine I know, who was not injured in combat, but had previously been to combat, felt that the combat injuries (specifically invisible wounds of PTSD and TBI) were not given the attention they deserved because the staff seemed to be treating those Marines as if they were malingerers.

Once separated into the groups that have been determined, the wounded need to be under the care and supervision of health care professionals. This is where the military needs to bow out and let the trained health care professionals do their job. Before you go crazy and tell me why the military can not just hand over their prized property, just think about some of these issues.

Billet - patient
Job description - Go to medical appointments. That’s it. Go to appointments.
Work Hours:
7:00 am - Formation (Gunny will scream at you.. thinks this is Parris Island)
7:05 -11:30 am sit around waiting for lunch (unless appointment is scheduled)
11:30 - 1:00 pm LUNCH
1:00 pm - Formation (Times vary depending on Gunny’s mood/temper)
1:05 - 4:00 - sit around waiting to be dismissed (unless appointment is scheduled)
4:00 - go upstairs and sit around in the barracks with the same guys you sat around with all day long.
Repeat every day for the next year, or two, or three

*Note - Appointments are few and far between because there are not enough health care professionals on staff.

Option 1: Get involved in the WAR Program....which has, until recently been all about physical activity..... Less than 10% participate (though you will be told the number is higher by the command) Lack of interest in the program is likely one of the side effects of numerous prescription medications being taken by patients.

Option 2: Cross days off the calendar awaiting the next visit by a VIP looking for a photo op to stop by for one of those “tours”.

Before I go further, remember that the malingerers have already been identified and separated from this group of positively identified combat wounded Marines.

Marines train for war, not health care. NCO’s and officers running these units are not trained to deal with patients in recovery. From the way some of them behave, it’s pretty obvious they have no desire to be in their job assignment. If they have been assigned to the unit as some sort of demotion or punishment, then transfer them to the Malingerer Unit.

If an officer is assigned to the unit because he was once wounded in combat, make sure he doesn’t have a chip on his shoulder or his own issues with PTSD. Just because one is wounded in combat doesn’t mean he is qualified to run a unit with hundreds of injured troops. Please don’t choose a leader for this unit just because he had an injury that made the news! Resilience in a long recovery process does not qualify anyone to run a civilian medical facility, so why should it be a qualifier for a military medical facility? Maybe the officer should have medically retired and found a job in the civilian world. My point....if these Marines are still able to serve in the Corps, find them a job somewhere besides the unit for combat wounded warriors.

You can still keep the Marines on base where they can be counted, but let the health care professionals run this area. They have been trained and if they aren’t stretched too thin, they probably like their jobs, and their patients. They will probably treat the wounded warrior with respect and the patient might actually think someone truly cares about their recovery. There is also a possibility that patients will recover more quickly and be able to return more quickly to their units.

I know everyone is worried about the accountability piece. I know you want to make sure everyone serves their full contract. If you are that worried about it, don’t count the time spent in the wounded warrior program as time served. The troops aren’t working anyway. Allow them to be paid, but with the understanding that they are either working through the med board process to get out, or they are working toward a recovery plan that allows them to come back in and finish out their contract.

There should be strict time periods determined where cases must be evaluated and documented, perhaps at 60, 90, 120 days. If trained professionals are working with these troops, and testing, rehab, etc is done in a timely manner, it should be fairly easy to figure out how long one will have to remain in the program. As soon as the Marine is capable of doing some sort of job, no matter how small, he is given responsibility as he moves toward the time where he is ready to move back to his unit or out with a medical discharge.

The main reason the troops are stuck in these units is because they wait for months and months to go through all the red tape. My marine spent over a year waiting for his med board. He would have given anything to go back to his unit permanently or at the very least to serve in another capacity until decisions were made about his future, but instead he was forced to sit around with no purpose for a total of 19 months and counting....as he is still not out. That’s a long time to have no purpose.

These are only ideas. I am a civilian. I don’t assume for one minute that I can tell any of you how to run the military. Once a Soldier or Marine becomes a patient, just let him be a patient....and let the people that are trained and educated in the health care field do their jobs. I could care less what you do with the malingerers. They deserve whatever you want to give them. In fact, if they are the cause for the stigma and the fact that my Marine has received such poor treatment, I’d like to help you take care of them!

The biggest problem that you have, as military leaders, in my opinion, is that you think you know everything and you think the rest of us have no clue. I’ve never served in the military, but I’ve lived long enough to get a degree, raise three children, work successfully at my job for twenty years, begin another career starting up and running a successful business completely on my own, and I've managed to survive a lot of struggles in life that taught me important life lessons. You might be surprised to hear of some of the tough circumstances I have managed to survive.

There are a lot of us outside of the military that could bring perspective to your table. Perhaps you need to look beyond the professionals sporting so many degrees that they have never actually gotten out of the classroom. Maybe you need to hear from some people who have been long term patients. They might be able to tell you what it’s like to live through a long term recovery. Get the viewpoint of someone that is coming from a different, yet relevant perspective.

I know you like focus groups. Let some of the little people become a part of this process, and include family members. The family members are the ones who know what is really going on. Spouses are important, but don’t forget about the parents. There is a high percentage of single troops who basically have no advocate. A wise man is willing to trust the gut instinct of a mother.

Unfortunately, it is likely that you will ever consider these suggestions because it’s not the way things have always been done. Take a look around. Things are not running well in the military or in our nation’s government. Maybe we need to go back to the drawing board and listen to some fresh ideas from some people who think outside the box everyday....because we are allowed to do so.

Memory/retention, motivation and judgement/executive function suffer with both blast/impact injury and even relatively mild/moderate depression. TBI is associated with personality changes that emerge slowly. In civilian life, TBI is often misdiagnosed. The patient naturally wants to direct attention away from an acquired mental deficit. The injured party may be in self denial, and the symptoms can render them a poor judge of what changes have taken place.

A person who has suffered a stroke, or taken multiple blast-wave hits, or a crash concussion, or too long under anesthetic, is still a person with continuity to a past, and much future potential. He/she is a different self than they would have been without the injury.

Taking a serviceman that has lost part of his self, whether it's a foot or some mental function, and then stripping them of their service identity in short order, is adding insult to injury. But using that service identity to gain the best result from disciplined rehab in the first year after a serious injury, that makes sense.

I'm not saying there isn't a malingering problem, that servicemen are all heroes, or that WTU's aren't being misused for improper administrative purposes, as described here. The same sort of thing happens with speech therapy in public school systems, when language skills may be the real problem that is ruining somebody's scores.

But perhaps tactical adjustment and strategic patience, rather than knee-jerk reaction, should be considered. TBI and PTSD are real, and can be a very difficult diagnosis. The Defense Veterans Brain Injury Center and the clinic staffs are playing catch-up, but they have learned a great deal from the injuries they work with. Maybe someone with DVBIC or WTU contacts can get the human salvage pros to chime in here.

I'm just a sports therapy volunteer, trying to make surf kayaking a safe, exciting experience. Most of the servicemen I get to paddle with are post-deployment, require medical clearance to participate, and some are missing more bits and pieces than others. A casual observer might see a guy with no visible scars at the beach (when it doesn't conflict with other therapy), and draw the wrong conclusion.

Thoughts from a recently retired Army Captain.

Wounded Warrior units represent a classic case of "scope creep."

The original mission for the Wounded Warrior units was to provide treatment for Wounded Warriors.

The title begs the questions, "What or Who is a Wounded Warrior?"

I think there are two categories of Wounded Warriors: Mentally Wounded Warriors and Physically Wounded Warriors.

The units should be organized accordingly so that treatment can be specialized and so administrators who run the unit know exactly what their mission is.

In practice, Warrior Transition Units have become repository's for a unit's problem children. And that problem is due to the onerous paperwork required to chapter drug junkies and poor performers out of the Army.

What happens? Real combat heroes suffer from poor service and they are lumped with soldiers my men term - "turds." What a shame.

It is time to re-define the scope and criteria for what constitutes a Wounded Warrior. Once that is accomplished, specific goal oriented outcomes can be aligned with Wounded Warrior classifications.

This is a leadership and an organizational issue. I love the Army, but we are failing badly at this very important task.