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Wednesday, September 17, 2008

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Additional Reference Material:   

LTC Mike Parker, USA (Ret.) Brief:




Wounded Warrior Forum Cites Progress Amid Continued Shortcomings


By David Wood

WASHINGTON—Better, but nowhere near good enough.

That was the consensus on the current continuum of care for wounded servicemembers and their families among the hundreds of military caregivers, Defense Department, and Veterans Affairs officials, family members, and veterans gathered 17 September for a day of high-powered panels, discussions, and networking.

The U.S. Naval Institute (USNI) and the Military Officers Association of America (MOAA) sponsored the one-day forum, titled "Measuring Success: Keeping Faith with Wounded Warriors and Their Families."

Even as progress is being made, the problems are becoming more acute as greater numbers of severely injured service members return from Operation Enduring Freedom and Operation Iraqi Freedom. Many of them, observed retired Army Colonel Jack Jacobs, who earned the Medal of Honor in Vietnam, would not have survived in previous wars.

"These young Americans have written a blank check that includes giving their life if necessary," said Thomas L. Wilkerson, chief executive officer of the U.S. Naval Institute and a retired Marine Corps major general. "And Americans write a blank check that we will care for them and their families for the balance of their lives."

"That is a moral obligation but also a practical one: if we allow the perception to go forward that veterans cannot return to a meaningful life that they can sustain, when we next ring the bell we might not find the volunteers we need to defend this democracy," Wilkerson said.

With the passage of the Wounded Warrior Act, part of the FY 2008 Defense Authorization bill, much has been done toward that goal, said Senator Carl Levin, Democrat of Michigan and chairman of the Senate Armed Services Committee. The legislation mandated reforms of the DOD and VA disability rating standards and required an increase in severance pay for members injured in combat or combat-related activity. It required the Defense Department to establish "centers of excellence" for traumatic brain injuries (TBI) and post-traumatic stress disorders (PTSD) and that DOD and the VA  jointly develop comprehensive policies on case management to achieve a "seamless transition" from military to veterans care.

But as Levin observed, "when it comes to implementation, there have been shortfalls."

"We can pass all the laws that we possibly can and should, but unless they are implemented fully, then we have not carried out our missions and we have not done our duty," he said.

The Pentagon has acted on many of these requirements and others, officials said. Army Brig. Gen. Loree K. Sutton directs the Defense Center of Excellence for Psychological Health and TBI. Among its initiatives, she said, are the establishment of a Defense and Veterans Brain Injury Center, a Center for Deployment Psychology, the Deployment Health Clinical Center, a Center for the Study of Traumatic Stress, a Center for Tele-Health and Technology to reach National Guard and reserve troops in remote locations, and the National Intrepid Center of Excellence, due to open next fall.

At a higher level, the  Wounded, Ill and Injured Senior Oversight Committee, chaired by the deputy secretaries of Defense and Veterans Affairs, is working to streamline coordination between the two agencies and to improve case management, said Dr, Lynda Davis, deputy assistant secretary of the Navy who supervises joint DOD-VA case management. The committee oversees the work of the services' Wounded Warrior programs with its own recovery coordinators who work at Walter Reed Army Medical Center, Brooke Army Medical Center, the National Naval Medical Center at Bethesda, and elsewhere.

Although many of these programs and initiatives had their genesis before 9/11 and the wars in Afghanistan and Iraq, there has been impressive progress since then.

"There are double amputees on active duty. That's profound," said Lieutenant General Ronald Coleman, deputy commandant of the Marine Corps for manpower and reserve affairs.

But even with these achievements came acknowledgements of shortcomings.

Many community-based organizations want to help wounded troops, but cannot find a way to do it. "We have an awful lot of families who call and want to help,'' an Army officer said. Individuals and non-profit organizations call to offer help, she said, but are bewildered by the number of acronymed offices within DOD and the VA. State agencies often have trouble integrating their services with military and VA programs.

One problem is a DOD ethics regulation that forbids the gift of more than $1,000 to any active-duty service member. Jerry Kerr is a 53-year-old disabled civilian who runs a nonprofit organization that provides the two-wheeled mobility platforms called Segways to injured service members. His organization, Segs4Vets, obtained a blanket waiver from the Pentagon allowing it to donate the Segways, which cost about $5,000 each.

If the ethics rule was amended to allow gifts to wounded troops, he said, "people would come out of the woodwork to help."

"There's a lot of guys out there who want to assist," said Marine Colonel Gregory A.D. Boyle, who commands the Marine Corps Wounded Warrior Regiment, but there is no organized way to include them. "There is a lack of command and control," he said.

Meredith Beck, a senior VA adviser on community reintegration, acknowledged that the VA had been "somewhat insular" in not reaching out to community organizations and individuals. She agreed that reforming ethics and other regulations is needed "not because the government is not doing its job, in many cases, but because these communities want to help."

There is a shortage of caregivers, acknowledged Army Colonel Jim S. Rice, director of the Army's Wounded Warrior program. His goal is to provide one case manager for every 30 patients, but currently he can only manage one for every 37 patients. One reason for the shortfall is high turnover among case managers, he said, and there is competition among Pentagon and VA agencies for experienced case managers. And the workload is growing: His program is absorbing 91 new soldiers per week and is currently caring for over 3,200 soldiers.

Among those not receiving help are tens of thousands of former service members who are not in contact with their former service or the VA. Colonel Boyle said there are an estimated 8,000 former Marines in this category, and his office is making an effort to reach each one of them by phone.

Families of wounded service members were not hesitant to speak up.

"I have to pester the VA" to get assistance, said Cynthia A. Lefever, whose son, Army Specialist Rory Dunn, was badly wounded by an IED blast in Iraq. "You have got to get rid of your big roll of red tape," she told a VA official. She said she and her son had not had any contact from their VA case manager since February, 2007. She said it took 18 months to arrange for automatic deposit of her son's checks.

"As far as getting contact with the VA, it's always, 'we're understaffed, we're understaffed!'  All these programs sound great, but we don't get access to them because of understaffing,'' she said.

She said VA staff, including receptionists, should be trained to handle patients with TBI or PTSD. "We need your staff to know how to de-escalate a confrontation, how to treat patients with dignity and respect—just those two things—please! Sometimes when I come into the VA, I want to hit somebody I get so frustrated!''

Andrea Sawyer, the wife of a soldier who served in Iraq in mortuary affairs, also sounded bitter about the VA. Her husband, Sergeant Loyd Sawyer, waited at Fort Lee, Virginia, for eight months to get a referral from the base psychologist for help with PTSD, which he says he developed after handling 40 to 50 bodies a day and "being mortared constantly." He is now being treated at the Portsmouth Naval Medical Center. The psychologist at Fort Lee, he said, "couldn't care whether I was alive or dead."

"There are so many people working so hard on these problems—and not talking to each other," said Beck, who has served as national director of the Wounded Warrior Project and who has a brother deployed as a Marine in Iraq.

"A lot of progress has been made but there is a long way to go," she said. "I know the worst thing you can say to the family of an injured member is to be patient. They have been patient!''

David Wood is the national security correspondent for the Baltimore Sun.


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