Here is the MOAA report on the forum. Note, I am a retired Army LTC, not a retired Air Force Lt Col.
Mike
On Sept. 17, MOAA, in conjunction with the U.S. Naval Institute, sponsored a day-long symposium highlighting progress and continuing challenges in meeting the needs of severely wounded warriors and their families.
Senate Armed Services Committee Carl Levin (D-MI) kicked off the day, recapping the Committee’s long list of initiatives to address the problems exposed at Walter Reed last year, when the “sprawling overlap of bureaucracies left the wounded and their families confused, overwhelmed, and too often without adequate care…There has been some progress,” he said, “but a lot more needs to be made, because we’ve seen some implementation shortfalls. The wounded troops aren’t complainers, so that makes your involvement [in measuring progress] all the more critical.”
“Problem, Progress, and Prescription” discussion panel highlights
- COL Jim Rice, Director of the Army Wounded Warrior Program, said his chief challenges are the rising numbers of returning wounded and finding and training new case managers, as those high-demand specialists have many other opportunities.
- Col Greg Boyle, Commander of the HQ USMC Wounded Warrior Regiment, said his job is to ensure regular, caring leadership contact and personal assistance to every wounded Marine, and his people also are in the process of reaching out to contact the 8,000 who left active service before his program came into being.
- Sam Retherford, head of the DoD/VA disability evaluation system pilot project, focused on “adding transparency, advocacy, and speed to the process. There’s still too much passing of paper and files and we’re working to resolve conflicts in DoD vs. VA regulations, but we’re working to expand the pilot to 13 DoD sites.”
- Lt Col Mike Parker (USAF-Ret), a disabled advocate, said the services aren’t following DoD guidance in all cases, and DoD doesn’t always follow the VA rating guidelines, which still leads to inappropriately low disability evaluations. He also emphasized the obligation to review cases of those separated or retired before the new rules took effect.
- Meredith Beck, Special Assistant to the VA Secretary and former policy director for the Wounded Warrior Project, emphasized that the intent has to be to ensure the wounded are able to live their lives to the fullest possible, and that the VA needs to make more use of civilian and community-based programs to do that. “An ongoing problem,” she said, “is that so many people are working so hard, they sometimes don’t take time to talk to each other.”
“How Can Leadership Institutionalize the Seamless Transition Process?” discussion panel highlights
- Moderator Geoff Deutsch of the Veterans Innovation Center emphasized that the wounded warrior problem “won’t go away. We will find continually evolving problems and technological capabilities. And those who have disabilities today at age 25 are still going to have disabilities when they’re age 75.”
- Melinda Darby, Executive Director of the DoD/VA Senior Oversight Committee (SOC)Office, emphasized the intensity of commitment of the leaders of both departments, highlighting that they worked out a joint interagency agreement in only 30 days. She also said the committee is planning a transition to a permanent structure this fall (the statutory authority for the SOC expires at the end of the year).
- Dr. Lynda Davis, a Deputy Assistant Secretary of the Navy who co-chairs the DoD/VA case management effort, said an essential part of helping the wounded not just survive, but thrive, is ensuring their families are included as a key part of their recovery team. Her group is about to produce a national resource directory of all benefits, compensation, health care, family support, education/training, and other support, searchable by geographic area, military service, and diagnosis.
- Keith Pedigo, Associate Deputy Under Secretary for the VA, expressed confidence that the joint efforts of the new departments will continue into the new Administration, citing the statutory requirements and memorandums of understanding signed by both departments. “As long as the conflict continues,” he said, “we have a built-in stimulus.”
- LtGen Ronald Coleman, USMC, Deputy Commandant for Manpower and Reserve Affairs, highlighted top military leadership’s commitment to addressing the problems, emphasizing that only the best leaders are being assigned to the Wounded Warrior Regiment.
Challenges and Handling of PTSD, TBI, and Depression discussion panel highlights
- Moderator Col Jack Jacobs, USA-Ret, Congressional Medal of Honor recipient and NBC/MSNBC analyst, noted that brain and nerve tissue aren’t so easy to heal. “People who have nothing wrong today are going to show up needing treatment years from now, and we need to be ready to care for them.”
- Terri Tanielian of RAND Corporation, co-director of a major study on the topic, cited institution barriers such as the fear that revealing these conditions will affect military careers and a shortage of health care providers. “We need to incentivize and reimburse providers to show we value quality care. Our study documented there’s a price tag for inaction. If we don’t provide specific kinds of care now to all who need it, it will cost the country billions more later on.”
- BG Loree Sutton, USA, Director of the Defense Center of Excellence for Psychological Health & TBI, said this is the time to use lessons from the past to transform for the future – that there are wonderful things being done in all kinds of institutions across the country that give great hope if we can bring them to bear.
- Dr. Steven Scott of the VA’s Tampa Polytrauma Center said TRICARE isn’t set up to deal with people with multiple injuries, and their doctors don’t have time to get multiple authorization numbers. Multiple tours in a long war dramatically increase exposures to trauma. He said even the severely wounded have high expectations and “want to stand, walk, think, and serve.” A crucial element is to get family members, including children, involved as part of their rehabilitation.
- BG Wayne Hoffman, AUS-Ret, former president of the Military Chaplains Association, emphasized the availability of military and civilian community faith leaders as experienced members of the rehabilitative team to help those who feel disconnected in any number of ways.
- Mrs. Jackie McMichael, spouse of a wounded warrior with TBI, reinforced the need for immediate and intensive involvement of family members in the treatment process, as they’re the only ones who see the member round-the-clock. She said TBI patients are often in denial in their communications with medical and other personnel, either because of their fears or their understandable wish to be as they were before.
Keynote speaker James Peake, Secretary of the VA (and a previous Surgeon General of the Army) was proud of the VA’s progress, noting that his department has added 4,000 mental health providers in the last 2 ½ years and will spend $4 billion on mental health in FY2009. But he acknowledged, “The VA needs to do a better job of communicating... We need to be ‘veteran-centric’. And you can’t make progress without change. 38% of veterans live in rural areas…and we have a 1945 disability system. We need to get to a paperless system, and we need to use technology to assist in adjudication of claims.”
Army Surgeon General LTG Eric Schoomaker graciously served as the event’s closing speaker on less than 24 hours’ notice when world events forced Joint Chiefs of Staff Chairman ADM Mike Mullen to extend his trip to Pakistan. He said the Army is working hard to standardize processes so that wounded and their families anywhere in the country get the same high level of care and support. One challenge is that the drawdown and facility reductions/closures of the 1990s meant “we’ve lost [a lot of] capacity to provide intermediate rehabilitation.” The bottom line, he said, is that “We want soldiers who aspire to serve and we want them to know they will get the very best care when they serve. Our commitment to this all volunteer force is that if you’re wounded in combat, we’ll take care of you.” One aspect of that commitment is that the Army has retained 20% of Iraq/Afghanistan-era amputees on active duty.
MOAA’s Bottom Line. Recurring themes we took from the day’s discussions include:
- The overriding need for a permanent, joint DoD/VA office, fully staffed by members of both departments with responsibility for oversight, implementation, and evolution of joint cooperation efforts by the services, DoD, VA, and civilian agencies.
- The overriding need for continuing personal involvement and attention by the most senior leaders in the two departments. That’s what it took to begin serious cooperation, and that’s what it will take to ensure it continues after the current leaders who got the ball rolling will depart – as many will in a very few months.
- The vital requirement for immediate and full involvement and education of family members in every aspect of the treatment, rehabilitation and transition process.
- Despite the continuing implementation and coordination problems that are inherent in changing the way these massive bureaucracies do business, there are thousands of leaders, administrators, and support staff at all levels who are sincerely doing their level best to provide our wounded and their families the kind of care and treatment they deserve. But it can be an overwhelming task, and continued oversight, reassessment, and constructive criticism is essential.