'No More Walter Reeds'

By Noel Koch

Interesting to note is that the U.S. Special Operations Command runs its own program, the Care Coalition, insisting on keeping special operators out of the WTUs. This is a source of annoyance to the Army for the invidious comparison it creates.

The substance of that comparison is much to the point here, as it throws a spotlight on the WTUs and illuminates the chronic problems that confront these units and that surface with increasing regularity to confound the intentions of the "No more Walter Reeds" pledge. While these occurrences are a political headache for the White House and the Office of the Secretary of Defense (OSD), the Army bears the brunt of the criticism and is held accountable for correcting them. What the administration sees as sporadic public-relations embarrassments are symptoms of a larger problem that is not amenable to patchwork. It requires a radical rethinking of national-security policy.

A line runs straight from the problems of the WTUs to the dysfunction of one of the nation's most sacred cows: the all-volunteer force. It is the Army's misfortune to be the national institution most aligned with the AVF, even as its present problems affirm the failure of that experiment. The U.S. Army is the service most heavily engaged in Iraq and Afghanistan. To be sure, the other services, especially the Marines, carry their considerable share of the burden, but by virtue of its numbers and roles, the Army is taking the worst beating. While the problems in the WTUs are mere symptoms, they must be addressed.

Secretary of Defense vs. Service Chiefs

An engendering difficulty lies in a long-running difference of opinion between Secretary of Defense Robert Gates and the service chiefs concerning who should populate the WTUs. Secretary Gates has wanted access to these units restricted to combat-wounded service members. The chiefs want the units to include those suffering combat- related wounds. It is a vexing distinction, best explained in a conversation with the Surgeon General of the Army, General Eric Schoonmaker. His argument follows, in my words: One Soldier is nicked in the calf by a piece of concrete from an improvised explosive device (IED). He is, by definition, combat-wounded and thereby eligible for a Purple Heart. His buddy falls through the bottom of a poorly-constructed watchtower and is paralyzed from the neck down. His wounds are only combat- related . He is not eligible for a Purple Heart. Were the Secretary's preference adhered to, he would be ineligible to be in a Warrior Transition Unit.

The chiefs see a failure of equity in this determination. It is difficult to argue the point. The debate thus far is restricted to the theater of war. If it could be left there, reasonable people might find a reasonable solution to the problem. Unfortunately, the issue of what is combat- related extends to the Soldier injured during training for deployment. Can we insist he is not entitled to the same benefits accruing to the soldier nicked by a fragment from an IED? Not to a Purple Heart, perhaps, but surely to care in a WTU. To this point we may agree that the Secretary's position is indefensible.

But the matter doesn't stop there. It extends to the case of the National Guardsman who is training to deploy to Afghanistan and who, at the end of the training day, is involved in a softball game, gets hit in the head, and suffers a mild concussion. Yet he (or she), too, has suffered a combat- related injury—an example of the blurred criteria for who should be included in the Warrior Transition Units. Secretary Gates' thinking thus becomes clearer, the service chiefs' more tenuous.

Without trying to parse the relative merits of the debate, it is sufficient to note that, pending its resolution, most of those involved do end up in a WTU. From here, we enter another dimension of the units, and this is one that begins to illuminate the problems of the AVF.

Along with my staff I visited WTUs from the European to the Pacific theaters, conducting hours-long meetings with commanders, cadre, and other caregivers and holding intensive "sensing sessions" with personnel in the units. Our findings were all carefully recorded, forwarded to the appropriate authority, and routinely ignored.

Life in the WTUs

The stated mission of the Soldier in the WTU is "to heal," with the goal of returning to active duty. If it is determined through the agency of a Medical Evaluation Board that the Soldier cannot be returned to active duty, then he or she begins the process of transitioning to veteran's status. On paper, this is all very straightforward and unexceptionable. In practice, the process breaks down. It is virtually impossible to be categorical about the issues involved here. For every Soldier whose interests one perceives are not being served in a WTU, Army spokespersons, from a defensive crouch, will offer up those who claim to be delighted in every way with their WTU experience. If the debate were left to proceed in this fashion, i.e., to be contained solely within the issue of the utility of the WTUs, little of value would be gained from it, because it would circumvent the critical issue of who is in the WTUs.

To address this, we must return to the debate between Secretary Gates and the service chiefs. To reprise, the matter has to do with combat-wounded versus combat-related. But these cohorts, in combination, do not represent the units' total population. Instead, a significant number are neither combat-wounded nor suffering combat-related wounds, injuries, or illnesses. They are service members who have not been deployed at all and are unlikely ever to be so, and many are physically and/or mentally unfit for deployment. In some instances, these disqualifying conditions combine with behavioral problems of a more malign nature, including demonstrated criminal tendencies.

This population mix creates an inherently unstable environment militating against the mission of those assigned to the units, i.e., "to heal." The combat-wounded are commonly determined to get back in the fight, while some part of the remainder are in no hurry at all to transition out of the unit. The inclination to game the system is facilitated by the Medical Evaluation Boards that will determine whether the individual is fit to fight or should be passed to a Physical Evaluation Board in preparation for the transition to veteran status. Insufficient numbers of medical personnel available to conduct evaluations result in lengthy delays in the evaluation process.

'Witch's Brew'

Gaming the system can include "discovering" or claiming maladies beyond those that got the individual into the WTU in the first place. In such cases the objective is to remain in the WTU as long as possible, as well as to increase the disability rating that will determine the individuals' benefits when they leave the military. The resulting witch's brew of attitudes and intentions has a variety of consequences, none of which is conducive to fulfilling the mission.

Combat-wounded Soldiers see themselves as diminished by being lumped with people they consider malingerers and, to quote one Soldier, "human garbage." This appellation may be ill-considered, but it illuminates one of the problems that infect the WTUs. The stresses among the disparate elements assigned to the WTU bubble up to the caregivers, most immediately the cadre. The Army claims that all NCOs assigned to this duty are trained for it, but this assertion is more a goal than a fact. Many are not trained to deal with the interplay of impatience, complacency, contempt, cynicism, anger, and hostility that characterize the unwieldy and transitory culture of their charges.

The results of these pressures include a debilitating range of physical and emotional effects on caregivers. These include the cadre, but they ripple out to include parents, medical personnel, chaplains, and senior leadership. My Office of Wounded Warrior Care and Transition Policy codified these effects in a series of articles in our newsletter, The Square Deal . While the problems were plainly and fully conveyed, little was done to alleviate them, because little could be done with existing resources and with the nature and scope of the prevailing problems. And this is the essence of the matter.

Virtually nothing can be solved within the framework of the existing paradigm. Ironically, the Army has conceived well-thought procedures for dealing with its wounded warriors. Every Soldier in a WTU is introduced on entry to a Comprehensive Transition Plan (CTP). This consists of a structured process of goal-setting guidance, milestones for measuring progress, counseling to strengthen self-discipline, a computer-based system for tracking each Soldier's progress to assure none falls through the cracks and to develop metrics to provide feedback that can further improve the CTP. It is the main line of resistance against another "Walter Reed," and it is permeable.

The plan assumes that each person in the WTU wants to heal ("the mission") and get back in the fight. It has no provision for those who don't fit this profile, even as it lumps them all in a confined space. It tries to fit its non-medical responsibility to the medical care Soldiers require, and the edges don't match up. Drugs are dispensed as a panacea, and Soldiers are over-medicated. The evidence is empirical: Soldiers appearing in a daze; Soldiers trading or selling drugs; Soldiers graduating themselves from prescription medicines to heroin and other controlled substances that WTU commanders complain are available outside the gates of the posts at known locations. These are de facto "Walter Reeds."

Post-Traumatic Stress

Threaded through all the other problems with the WTUs, sometimes combined with traumatic brain injury and sometimes suffered discretely, is post-traumatic stress (PTS). Service chiefs are passionately engaged with the problem, and the range of proposed solutions, both for diagnosis and treatment, grows exponentially. But the problem persists, and the effects are only partially apparent in an array of dysfunctional behaviors, from disciplinary problems that bring sufferers before the courts, accidents whose origins in PTS tend to be suggestive at best, and a suicide rate that in any given month exceeds battle casualties. These consequences are only partially measurable, because their concomitants among dependents and others are unrecorded. PTS can come as a result of the chronic accumulation of stresses resulting in trauma, as well as from exposure to a single event.

Post-traumatic stress uniquely separates the Army from other services, national and allied. The Marine Corps, whose leaders are no less concerned with the problem, nevertheless see in their troops a lower incidence of it. British forces also show a markedly lower incidence, for several reasons. British troops are older, deployments are shorter, dwell times are longer, and the British have evolved proven methods for reducing the incidence of PTS. They do not test for PTS when their troops rotate, as the United States does.

British troops, if they feel they have symptoms, report them for assistance. The U.S. practice is to actively inquire if the Soldier has PTS and then automatically assign a 50 percent disability rating for six months, with reassessment at the end of that term. The British provide an en-route respite period for troops redeploying home, rather than bringing them directly home from theater. Authorities in this country are belatedly exploring a method for doing this.

While these distinctions may be seen to represent failure on the part of the Army, they actually mask a much larger problem. The Army is a much larger organization, and it is fighting with constrained personnel resources. Because of this limited number, Soldiers are being deployed repeatedly, with insufficient dwell time, resulting in pressures on spouses and children that are destructive to the family and the emotional health of the Soldier. The correlation between frequent deployments and post-traumatic stress is well established.

All the Way to the Top

These consequences are laid unjustly at the feet of the services. They are properly the responsibility of the Under Secretary of Defense for Personnel and Readiness (P&R), OSD, and ultimately, the Commander-in-Chief. Yet all escape accountability even as mounting evidence of the schism between civilian leadership and the military produces reproving gasps and concerns that the doctrine of civilian control of the military has been threatened.

The latest strategic-planning document from P&R begins with this cardinal objective: Maintain the health of the all-volunteer military . But the importance placed by the political leadership on the nation's military personnel becomes clear in the priority assigned to filling Pentagon positions. The positions of the Under Secretaries of Policy; Acquisition, Technology and Logistics, and Intelligence were filled immediately after the Obama administration took office.

The position of Under Secretary for P&R stood empty for more than a year into the new administration, laboring along with an acting Under Secretary. The office of Assistant Secretary of Defense for Health Affairs, arguably the most important post in the Pentagon for the well-being of military personnel and their dependents, remains unfilled. It, too, has a guardian in an acting capacity.

Personnel's twin responsibility—readiness—is a fiction easily exposed by asking how the United States will respond while it is bogged down in Iraq and Afghanistan, should any of a number of contingencies emerge (if North Korea resumes hostilities, China moves to recover Taiwan, or Israel attempts to degrade Iran's nuclear capability, for example). Any of these contingencies would stress the U.S. force structure beyond its current capacity. If senior leadership does not accept this reality, how can it justify massive expenditures on capital weapon systems, such as another joint tactical fighter or yet another aircraft carrier? If it does consider these potentialities realistic, how can it cling to an AVF that is demonstrably inadequate to the conflicts at hand? And if it aims to maintain the health of the existing volunteer force, how can it urge Congress to reduce the less-than-1-percent pay increase proposed for that force?

'Distress in the All-Volunteer Force'

The WTUs are part of a pattern of indicators that signal distress in the all-volunteer force:

Privatizing the War. We are spending billions on contractors to do jobs Soldiers once did. Security, intelligence, and other duties formerly executed by military personnel are farmed out to private contractors, many of whom are former military personnel recruited from trained ranks, making salaries in excess of what they were making on active duty and egregiously in excess of what their military counterparts are making.

Stop-Loss Orders. In Vietnam, Soldiers lived with the assurance of an end-stop. With the AVF, there is no terminus to a Soldier's service. The Soldier may be scheduled to rotate by a certain date but can be kept in place through the expedient of a stop-loss order. At this point, the Soldier is only nominally a volunteer.

Deployment of Reserve Components. The shortage of active-duty personnel has put an intolerable burden on reservists and National Guardsmen. Men and women approaching middle age, with all the attending infirmities, are deployed to battle zones to compensate for the deficit. Army Chief of Staff General George W. C asey put the case before the House Armed Services Committee: "Our Reserve Components are performing an operational role for which they were neither originally designed nor resourced," he testified.

The Recruiting Conundrum. Army recruiters are under enormous pressure to bring in fresh blood. We may assume many of these recruits are fit and able young people intent on serving our nation, and nothing here is meant to denigrate them. However, a visit to any WTU will show that recruiters are enlisting people who do not belong in the U.S. military. They can't be deployed, and commanders don't want them.

David Wood's 5 July article in Politics Daily quotes Brigadier General Gary Cheek, Commander of the Army's Warrior Transition Command, as stating: "In all honesty, a lot of our unit commanders have found a lot of guys that they perhaps didn't want to take with them [to combat]. There are probably some commanders who probably have transferred some guys that maybe should have had disciplinary actions taken." In the 23 January 2008 issue, Time magazine's Mark Thompson cites a grisly metric that illuminates the recruiting conundrum—the pressure to enlist Soldiers from a rapidly drying pool in which too many of those who are willing to join should not be allowed to enter. In Time 's 2 April 2009 issue, Thompson reports that this metric is the number of recruiting personnel committing suicide.

Soldier Suicides. Myriad studies and programs are explored to answer why unprecedented numbers of young Soldiers are killing themselves. Military medical personnel charged with addressing the issue appear to be too quick to seize on the easy one: e.g., personal problems, pre-existing issues, and so on. The role of the easy answer is to avoid some of the more obvious ones, including the pressures of repeated deployments associated with post-traumatic stress that lead to family collapse and produce despair and uncertainty over when it will all end.

What is remarkable about the number of articles in recent years focusing on the facts of "a broken force" is how little they produce in the way of correction. One of the constants linking the majority of them is their focus on the services as sources of solutions. But nothing is to be gained by demanding that the Army fix a problem that is not of its own devising or beyond its ability to fix. An inadequate military is not the services' problem. The Commander-in-Chief and his appointees are responsible for it.

Civilian Control of the Military

Civilian control of the military is one of the enviable jewels in the crown of the American republic. It is regularly cited yet little understood, and least understood by those who have not served in the military. The concept is not a one-way street. The American military accepts the supremacy of its civilian leaders, but that acceptance comes with an expectation: leadership.

When the civilian leadership decides on a course of action that takes the nation to war, the military leadership obeys. But that leadership has a right to expect, and does expect, that the course chosen is well-reasoned, prudent, and essential to national security. Military leaders also have a right to expect that their civilian overseers take responsibility for the results of their decision.

The complication arises when we substitute the word "political" for "civilian." Ill-conceived political judgments regarding national security have degraded relations between the civilian leadership from the Vietnam War to the wars in Iraq and Afghanistan, with deleterious consequences for the relationship and, ultimately, for the concept.

Just as it is the province of civilian leadership to take the nation to war, it is also the responsibility of that leadership to prepare the nation for war. Finally, it is the responsibility of the civilian leadership to prepare the military for war. Civilian leaders in recent years, having no direct experience in military affairs and thus having no understanding of the needs of the military, have failed this responsibility. The convenience of an all-volunteer force fosters this failure of responsibility.

It is by now commonplace to note that the civilian leadership has asked nothing of the American people in defending their nation. No leader in recent times has asked for, or expected, Americans to go to the recruiting station.

When anyone suggests a return to conscription, a hysterical minority begins shrieking about unfairness, "slavery," and similar objections. This outcry is taken as an expression of the national will, and politicians from bottom to top solemnly agree that a restoration of conscription is politically, and therefore practically, infeasible. Thus, the compact between the civilian and the military leadership is broken.

What the Military Thinks

Before we begin to conclude the argument, we should address the attitude of the military toward reinstating a draft. When ending the draft was first proposed, military leadership opposed it. More recently, and emphatically, they have embraced it. President Richard Nixon himself later wrote in The Real War that the end of conscription was a mistake and that, in the interest of the nation's security, it should be restored.

Opposition to conscription must be seen in the first instance not as a political dilemma, but as an issue directly connected to national security in its broadest sense. Such opposition is pacifist at its heart and isolationist in its consequences. The United States cannot be a global power and at the same time a nation unwilling to call on its full personnel resources for the purpose of asserting that power. There is a distinction here, and we must decide on which side we wish to come down. The responsibility for making this decision rests with the civilian leadership.

If service to the nation is to be considered slavery, then the civilian leadership needs to invite a political consensus on the point and embed that consensus in our national security policy. Protection of the tribe is an atavistic instinct; if it can no longer be awakened in the American nation, then we need to know it. What is clear is that the responsibility for leadership toward a conclusion on this account rests with the civilian leadership, not the military.

If we are to be a global power, with concomitant responsibilities for projecting American power into the global environment, then we must have sufficient manpower for the purpose. Securing that manpower is not the responsibility of the military, but rather of the civilian leadership to which the military is constitutionally subordinated.

Selective Service and "No More Walter Reeds"

The connection between the Warrior Transition Units and having insufficient manpower available to fight the war on terrorism can no longer be ignored. The war will end at some point determined by the political leadership. It is not the purpose here to discuss the wisdom of this war.

What we can assert, and what is affirmed by the evidence, is that the all-volunteer force does not provide adequate manpower to confront the current demands of our responsibilities as a global power, and that the inadequacies are illuminated in the WTUs.

Opponents of conscription insist that this resort will bring in as many unfit personnel as the current recruiting process now brings in. Here it is advisable to put aside the pejorative terms "draft" and "conscription" and repair to the more useful concept of "selective service." Selective is the operative word here. It addresses the capacity to enlist men and women who are physically, mentally, and emotionally fit to serve their nation. If it should prove impossible to find a sufficient number of such Americans, then we must rethink what we mean when we talk about this nation as a global power. This is not the responsibility of the military services, but of the civilian leadership. It is they who must accept responsibility for assuring there are "no more Walter Reeds."

Mr. Koch served for 11 months as Deputy Under Secretary of Defense for Wounded Warrior Care and Transition Policy in the Obama administration. He also served as Principal Deputy Assistant Secretary of Defense for International Security Affairs, Deputy Assistant Secretary of Defense for Africa, and Director of Special Planning with responsibility for anti-terrorism and counter-terrorism as well as the restoration of special operations forces during the Reagan administration.
 

Mr. Koch served for 11 months as Deputy Under Secretary of Defense for Wounded Warrior Care and Transition Policy in the Obama administration. He also served as Principal Deputy Assistant Secretary of Defense for International Security Affairs, Deputy Assistant Secretary of Defense for Africa, and Director of Special Planning with responsibility for anti-terrorism and counter-terrorism as well as the restoration of special operations forces during the Reagan administration.

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