Witness Testimony of Colonel Gregory Gadson, USA, U.S. Department of Defense, Director, U.S. Army Wounded Warrior Care Program
Thank you, Chairwoman Buerkle, Ranking Member Michaud, and all members of the Subcommittee for inviting me to appear today. I am honored to be here. As a wounded warrior myself, I wish to thank all the members of the Committee for their interest in the health and well-being of wounded, ill, and injured servicemembers and Veterans.
The lead proponent for the Army’s Warrior Care and Transition Program (WCTP) is the Warrior Transition Command (WTC), under the command of Brigadier General Darryl A. Williams. The WTC supports the Army's commitment to the rehabilitation and successful transition of wounded, ill, and injured Soldiers back to active duty or to Veteran status and ensures that non-clinical processes and programs that support wounded, ill, and injured Soldiers are integrated and optimized throughout the Army. I am the director of the US Army Wounded Warrior Program, or AW2, an activity of WTC. AW2 supports severely wounded Soldiers, Veterans, and Families throughout their recovery and transition, even when they separate from the Army. We do this through more than 170 AW2 advocates who provide local, personalized support to the more than 8,300 Soldiers and Veterans currently enrolled in the program.
The Warrior Care and Transition Program (WCTP) also encompasses the 29 Warrior Transition Units, or WTUs located around the country and in Europe where wounded, ill, and injured Soldiers heal and prepare for transition. I have AW2 Advocates at each of these WTUs, and we identify the severely wounded as quickly as possible, so AW2 can begin providing support.
Each Soldier in a WTU is assigned to a Triad of Care consisting of a primary care manager, usually a physician, a nurse case manager, and a squad leader. In addition, the WTUs have a multi-disciplinary approach that includes a wide range of clinical and non-clinical professionals, such as physical therapists, behavioral health professionals, chaplains, social workers, and occupational therapists. AW2 Advocates work closely with each of these professionals in support of the individual Soldier.
A requirement for every servicemember in the Federal Recovery Care Program is a comprehensive needs assessment, or Federal Individual Recovery Plan. Within the WTUs we conduct this comprehensive needs assessment through the development of what is referred to as a Comprehensive Transition Plan or CTP. The CTP is not the Army’s plan for the Soldier—it is the Soldier’s plan for him/herself. Each Soldier completes a CTP within 30 days of arriving at the WTU, in coordination with the multi-disciplinary team. They set long- and short-term goals in each of six domains of life: Family, Social, Spiritual, Emotional, Career, and Physical. Our goal is to make sure each Soldier is well-prepared for the next phase of their lives, whether they return to the force or transition to civilian life. The AW2 Advocates are closely involved in this process, including the periodic Focused Transition Review meetings where the WTU commander gathers the Soldier, Family member or caregiver, and the health care professionals involved in caring for the Soldier, and they discuss the Soldier’s progress.
Families are closely involved with the CTP process, and Family is one of the six domains of goal-setting in the CTP. Family members and caregivers are invited to all of the Focused Transition Review meetings and to all medical appointments, therapy treatments, informational briefings, etc. AW2 Advocates and squad leaders also work closely with the Families to make sure that their needs are met. When an AW2 Soldier separates from the Army and transitions to Veteran status, an AW2 Advocate continues to support the Soldier/Veteran and Family just as they did when the Soldier was in the WTU.
Another key component of WCTP is the Soldier Family Assistance Centers, or SFACs. SFACs are operated by the Army’s Installation Management Command, and they are on-site at WTUs. They bring together many of the programs and experts the WTU Soldiers and Families need to provide assistance with everything from childcare and lodging to arranging for Department of Veterans Affairs (VA) care and benefits.
AW2 Advocates work closely with Federal Recovery Coordinators (FRC) where they are available. As you know, FRCs are currently located in 10 military and VA medical facilities. There are more than 170 AW2 Advocates on my staff, spread throughout the country, Germany, and five U.S. territories. They are present at 60 VA facilities and 29 WTUs, and those that are co-located with FRCs do coordinate closely with them. We have an open referral process where AW2 Advocates and the Triad of Care can refer Soldiers and Veterans to the FRC if we believe they may qualify.
The Federal Recovery Coordination Program (FRCP) has the potential to facilitate positive, quality integration across the various programs throughout the federal government that support severely wounded, ill, and injured servicemembers. It has the potential to be a critical resource for these servicemembers and their Families.
The AW2 Advocates on my staff report having positive relationships with the FRCs and indicate that these FRCs are well trained, proficient professionals. The FRCs are well-versed in the resources provided by the VA and the resources available in their regions. They are also very knowledgeable about policies that can support the needs of the wounded, ill, and injured population.
I also want to discuss GAO’s recommended actions for the FRCP. As you have read in the comments section of the GAO report, the Honorable John Campbell, Deputy Assistant Secretary of Defense for Wounded Warrior Care and Transition Policy committed the Department of Defense to continuing to collaborate with the VA on these issues. A Joint Department of Defense (DoD)/VA Committee has been formed to study how to combine or integrate recovery coordination efforts for wounded, ill, and injured servicemembers, Veterans, and Families.
Recommendation 1 of the GAO’s report discusses establishing adequate internal controls regarding FRC’s enrollment decisions. This is not a problem at AW2. While FRCs are afforded broad discretion in determining which servicemembers are admitted to the program, AW2 has very clear eligibility criteria. We accept and support Soldiers who receive an Army disability rating of at least 30% for a single injury since September 11, 2001, regardless of whether that injury was sustained in combat or not. In 2009, based on AW2’s understanding of the long-term needs of this population, we expanded that criterion. We now also accept Soldiers who receive a combined Army disability rating of 50% or greater for conditions that are the result of combat or are combat-related. All AW2 eligibility decisions are made at the headquarters level, by a team of nurses and a Masters-level behavioral health professional who closely review all eligibility requests. We often accept Soldiers before they receive their formal disability ratings, if the nature of their injuries makes it very clear that they will meet the AW2 eligibility requirements.
The GAO’s next recommendation discusses the FRCP’s efforts to manage the workloads of individual FRCs based on the complexity of the services needed. At AW2, we pay very close attention to the caseloads of AW2 Advocates. The average caseload is 1 to 50, but each Soldier requires a different level of support, depending on where he or she is in the recovery and transition process, to include Veterans.
For example, AW2 Veteran Kortney Clemons is a severely wounded Veteran who no longer requires a significant level of AW2 support. He was a combat medic in Iraq, and he stepped on an IED just five days before his enlistment was up. He lost his right leg above the knee. Kortney has been out of the Army for more than five years. He’s gone on to become the national Paralympic champion in the 100 and 200 meter dash and is training for the Paralympic Games in London next year. He is currently enrolled in a Masters Degree program through the AW2 Education Initiative, a partnership between my program, the US Army Training and Doctrine Command, and the University of Kansas. He no longer requires the same level of support from an AW2 Advocate as he did when he was first injured.
AW2 recognizes that many of the Soldiers and Veterans we support become more independent as they heal and transition to the next phase of their lives. We developed the Lifecycle Case Management Plan, or LCMP, to help AW2 Advocates identify the level of support each Soldier needs. There are four phases. When the Soldier/Veteran requires a significant level of support, AW2 calls them at least once a month, sometimes more, if their personal situation requires it. As they progress and become more independent, we call them less frequently, every 60 or 90 days in the next two phases. In the last phase, where Kortney is, we only call them every 180 days. I am proud to say that I personally “graduated” to the last phase of the LCMP in March.
Soldiers and Veterans can always call their AW2 Advocate or the AW2 call center if they need support and we will be here for them. This initiative allows the AW2 Advocates to focus on those with a more immediate need for their support, such as the most recently injured, those going through the Medical Evaluation Board, or those facing significant personal or medical challenges.
GAO’s third recommendation addresses the FRCP’s decision-making process for determining when and how many FRCs the VA should hire. AW2 faces some of the same challenges as the FRCP on this issue. It is difficult to predict how many additional Soldiers will qualify for our program in the future. In 2010, we accepted more than 2,000 new Soldiers into the program. On average, that means we added one additional Soldier to each AW2 Advocate’s caseload every month. We are increasing our staff levels as quickly as possible. This fact makes it even more important that we ensure the AW2 program is run as efficiently as possible. The LCMP allows us to manage the rate at which additional Advocates are required.
One way we have dealt with the need for more advocates is to strengthen the communication between AW2 Soldiers, Veterans and Families so that they educate and support each other. We have launched peer-to-peer tools to enable the AW2 Soldiers, Veterans, and Families to communicate with one another. We have established a blog and a Facebook© account to facilitate a conversation among the population online.
GAO’s final recommendation calls for the FRCP to develop and document a clear rationale for the placement of FRCs, including a systematic analysis of data to support these decisions. At AW2, we evaluate our staffing on a quarterly basis. We make Advocate assignments by zip codes and place them where we have the greatest populations of AW2 Soldiers and Veterans. We have reassigned some of the contract positions based on the locations of the population we support. As I mentioned before, we have 170 AW2 Advocates. Sixty of them are at VA facilities and at each of the 29 WTUs, to provide local, personalized support to AW2 Soldiers, Veterans, and Families where they are. I would submit that aligning FRCs in a similar manner regionally would better serve both them and the servicemembers for whom they are responsible.
There are a couple of other items in the GAO report that I want to acknowledge. One is access to office space and technology at various VA facilities. Many AW2 Advocates on my staff have experienced similar challenges finding a private space to conduct sensitive conversations and getting access to technology. AW2 now has a designated liaison with the VA and this has significantly helped the situation. There are still individual challenges but by facilitating that relationship and proactively talking to regional VA facilities before the new Advocate arrives we have been able to mitigate this problem.
The GAO report also highlighted the challenges in information sharing between the DoD and VA. We recognize the importance of this challenge. For over a year now, the Warrior Transition Command has been developing automated systems that are part of an integrated system for tracking and managing the care of Soldiers and Veterans. The CTP mentioned previously is a fully automated process which provides managers at every level the ability to thoroughly analyze, in real time, the performance of staff in the development and updating of these plans. Currently being completed for implementation later this year is the central module of the system referred to as the Automated Warrior Care and Tracking System; the automated CTP will interface with this module which contains the history of each Soldier and Veterans care.
The Executive Director of the FRCP and the Deputy Undersecretary of Defense for Wounded Warrior Care and Transition Policy are co-chairing an information sharing initiative (ISI) to support coordination of non-clinical care for seriously wounded, ill and injured Operation Enduring Freedom and Operation Iraqi Freedom (now Operation New Dawn) servicemembers, Veterans, and Families. The Army has been an active participant in this joint DoD/VA ISI. The ISI will enable sharing of authoritative data electronically between DoD, VA, and the Social Security Administration case and care management systems. This will eliminate resource-intensive and error-prone work-arounds. A pilot for this initiative is underway for the bi-lateral sharing of benefit and case manager information. Further efforts will include such items as select care plan information and appointment and calendar functions. These efforts will significantly improve the challenges to information sharing between the agencies.
In closing, I again thank you, Madam Chairman and Ranking Member Michaud, for inviting me here today and for listening to my testimony about the Federal Recovery Coordination Program. I appreciate your attention to wounded, ill, and injured servicemembers, Veterans, and their Families, and I know that we share the same goal of providing the best possible services to these individuals who have sacrificed so much.