Addendum I: Warrior Care and Transition

The Nation has a moral obligation to provide the best possible care and treatment to the men and women who have served our country and defended our Nation’s freedoms. The Army must also offer its support and appreciation to the Families of these Soldiers who have also sacrificed. It is the duty of every Soldier to care for their fellow Soldiers in time of battle and in time of healing. It is the duty of every wounded, injured, and ill Soldier to focus their energies on healing just as they dedicated themselves in battle.

The Army has implemented numerous initiatives and programs dedicated to the care and healing of wounded, injured, and ill Soldiers.  These programs heal Soldiers and Families while sustaining the force with a return to duty rate in excess of 70 percent within the first 12 months after initial treatment.  Since 2001, nearly 90 percent of this group fell in grades E4-E7, whose collective experience is invaluable, necessary, and irreplaceable.  To oversee this critical mission, the Army is forming an Office of Warrior Care and Transition to guide this revolutionary effort.

Elements of the Army’s Warrior Care and Transition program are:

The Army Medical Action Plan:  The Army Medical Action Plan set in motion  historic changes to its health care delivery system.  These changes extend far beyond the immediate fixes at the Walter Reed Army Medical Center and focus on the goal of providing a continuum of integrated care and services from point of injury, illness or disease to return to duty or transition from active duty. 

During 2007 the Army took unprecedented action in transforming the old “medical hold” and “medical holdover” system with the creation of 35 new Warrior Transition Units (a patient-centered command and control organization), and Soldier and Family Assistance Centers to facilitate the Warrior in Transition (WT) mission of healing.  These institutional changes require new facilities to enable a unique environment and culture that centers on healing:  WT Barracks; Soldier and Family Assistance Centers (SFAC); and Operations/Command and Control Facilities – ideally located in close proximity to the Medical Treatment Facility.  The Army is requesting $138 million in the FY08 Supplemental request to build Warrior in Transition complexes.  The Army is requesting $806 million in the FY09 supplemental request for Warrior in Transition complexes.

Warriors in Transition are active or reserve component (wounded, injured, or ill) Soldiers (who meet the appropriate criteria to fall under the provisions for medical hold, medical holdover or active duty medical extension, and Soldiers assigned or attached to community-based health care organizations. Active Army Soldiers who require a medical evaluation board or have complex medical needs requiring more than six months of treatment are included.  Warriors in Transition do not include initial entry training, advanced individual training, or “one station unit” training Soldiers except in extraordinary circumstances.  Exceptions to this definition must be approved by the local military treatment facility and the Soldier’s unit commander. 

The Army Wounded Warrior Program:  The Army Wounded Warrior Program (AW2), which was formed in April 2004, pre-dates the Army Medical Action Plan. The AW2’s purpose is to respond to the needs of seriously-wounded Soldiers returning from Operations Iraqi Freedom and Enduring Freedom (OIF/OEF).  AW2 eligible Soldiers include those who have suffered injuries or illnesses incurred on or after Sept. 11, 2001 and have been awarded (or are expected to receive) an Army disability rating of at least 30 percent for at least one qualifying injury type.  At any given time, the AW2 population includes Soldiers who are undergoing recovery and rehabilitation; awaiting medical evaluation board/physical evaluation board results; have been returned to duty, declared fit for duty, or returned to duty in a “continuation on active duty” or “continuation on active reserves status; or have been medically retired. 

Thus, in some cases, a Soldier may be simultaneously, a Warrior in Transition and an Army Wounded Warrior. 

Mental Health Initiatives: The Army is making great strides in treating soldiers with Post Traumatic Stress (PTS) and mild Traumatic Brain Injury (mTBI) while challenging the stereotypes and stigma associated with mental illness with progressive and innovative awareness and training programs for Soldiers, Civilians, and Families: 

The Secretary of the Army and Chief of Staff of the Army initiated a chain-teaching program to educate all soldiers and leaders about PTS and mTBI so they can help recognize, prevent and treat these health issues.  The Walter Reed Army Institute of Research (WRAIR), a part of the AMEDD’s US Army Medical Research and Material Command (USAMRMC), developed the Post Deployment Health Assessments, administered immediately after redeployment, and the Post Deployment Health Reassessments, administered three to six months later, to help identify soldiers with behavioral health problems.  They continue to refine it as our knowledge of preventing and treating behavioral health problems evolve. It is imperative to help Soldiers address their health concerns before they develop into more serious problems.  Five Mental Health Advisory Teams (MHATs), which was also the work of WRAIR, evaluated threats to the mental health of deployed Soldiers and resources to counter those threats.  The MHAT is now assessing for both Army and Marine units and warriors. 

The Army is also working on erasing the perceived stigma associated with receiving mental health care.  As a result of a program initiated by the AMEDD called Respect.Mil, soldiers who are concerned about this stigma can access behavioral health care privately through the normal sick-call process at health clinics. Soldiers and their spouses receive preventive training before and after deployments which we refer to as “Battlemind Training”.  Our mental health provider teams also developed two age-appropriate video programs to help children cope with the deployment of their parents.

Summary:  The Army pledged never to leave a fallen comrade – not on the battlefield nor lost in a bureaucracy.  This pledge applies directly to our wounded, injured, and ill Soldiers.  The Army has made dramatic changes in medical care and continues to pursue innovative and unprecedented ways to provide for the needs of the All-Volunteer Force.  These changes represent the Army leadership’s commitment to fundamental change.