Colonel John L. Mayer
Chairwoman Buerkle, Ranking Member Michaud, and distinguished Members of the Health Subcommittee, on behalf of the United States Marine Corps, thank you for this opportunity to provide testimony on interaction between the Marine Corps’ Recovery Coordination Program (RCP), which is executed by the Wounded Warrior Regiment (WWR), and the Department of Veterans Affairs Federal Recovery Coordination Program (FRCP), which is overseen by the DoD/VA Wounded, Ill, and Injured Senior Oversight Committee. Many severely wounded, ill, and injured (WII) Marines are unable to return to active duty and the Marine Corps WWR works to ensure these Marines are postured for success as they reintegrate to their communities. We fully recognize that reintegration success is largely dependent upon the programs and services offered by the Department of Veterans Affairs. As such, the WWR welcomes opportunities to increase collaboration between the Department of Defense and Department of Veterans Affairs and to integrate efforts where appropriate.
The Marine Corps Wounded Warrior Regiment: Background and Assets
To provide the Subcommittee context on interaction between the Marine Corps’ RCP and the VA’s FRCP, it is important to provide background on the mission and scope of the WWR. Established in 2007, the WWR was created to provide and facilitate non-medical care to WII Marines, and Sailors attached to or in direct support of Marine units, and their family members in order to assist them as they return to duty or transition to civilian life. Whether wounded in combat, suffering from an illness, or injured in the line of duty, the WWR does not make distinctions for the purposes of care. The Regimental Headquarters element, located in Quantico, VA, commands the operations of two Wounded Warrior Battalions located at Camp Pendleton, CA and Camp Lejeune, NC, and multiple detachments in locations around the globe, including Military Treatment Facilities and at Department of Veterans Affairs Polytrauma Rehabilitation Centers.
In just a few years, the WWR has quickly become a proven unit providing WII Marines, their families, and caregivers coordinated non-medical support. Some of the Regiment’s primary care assets include: a Resource and Support Center, the Sergeant Merlin German Wounded Warrior Call Center, which extends support to Marines and families through advocacy, resource identification and referral, information distribution, and care coordination; Clinical Services Staff that provide immediate assistance and referral for Marines with psychological health issues and / or post traumatic stress or traumatic brain injury; a Job Transition Cell, manned by Marines and representatives of the Departments of Labor and Veterans Affairs; and District Injured Support Cells (DISCs) located throughout the country to conduct face-to-face visits and telephone outreach to WII Marine and their families who are recovering or transitioning to their assigned region.
Care Coordination: The Importance of Recovery Teams
The complexity of WII Marines’ care requires a heightened level of coordination between various medical and non-medical care providers. There is no “one size fits all” approach to care and the Regiment responds to this requirement by delivering a cross-section of services and resources tailored to meet the specific needs of WII Marines and their families. We determine the specific requirements to meet these needs through the coordinated efforts of medical and non-medical care providers who are part of our Marines’ Recovery Teams. The Recovery Team includes, but is not limited to, Marine Corps leadership; Section Leaders who provide daily motivation and accountability; non-medical care managers; medical case managers; and Recovery Care Coordinators (RCCs). Recovery Team participation may be expanded depending on the acuity of the Marine’s case or the needs of the Marine and family and may include the Primary Care Manager, mental health advisors, and the Federal Recovery Coordinator (FRC).
Marine Corps Recovery Care Coordinators
The Marine Corps’ RCCs are highly qualified and dedicated individuals who serve as a point of contact for our WII Marines and families, and they work hand-in-hand with the WWR’s support staff. Typically, our RCCs have case management experience, have college degrees (some with master’s degrees), prior military experience (the majority are prior Marines), are combat veterans, and have military leadership experience. We have found that this combination of credentials provides our WII Marines and their families a high level of support. For example, the WWR’s 2010 Recovery Care Coordinator Survey showed 81 percent of WII Marines and their family members were either satisfied or very satisfied with the attributes pertaining to their RCC (i.e., timeliness, availability, frequency of communication, advocating for needs and goals, coordinating and monitoring medical and non-medical care, and facilitating reintegration back into the community). Moreover, of the respondents that stated they had an RCC, a very high percentage (96 percent) reported that their RCC satisfied their explained roles and responsibilities. This is particularly important, as we know recovering Service members and their families can be confused by myriad of case managers who may become involved in their recoveries.
Our Recovery Care Coordinators are located at Military Treatment Facilities, VA Polytrauma Centers, and are imbedded within the Regiment and Battalions to provide immediate, face-to-face support to our WII Marines and their families. Along with their unique ties to the Marine Corps, this close proximity to Regimental staff precludes logistical challenges, improves information sharing, facilitates care coordination, and enhances the quality of care provided. Per WWR policy, which comports with federal statute and regulation, RCCs are assigned to certain active duty (typically seriously ill/injured and severely ill/injured) WII Marines. RCC caseloads do not exceed the prescribed Department of Defense Instruction 40:1 ratio. Assignment priority is given to Marines who are joined to the WWR; however, the Marine Corps’ RCP is available to WII Marines and their families whether they are assigned to the WWR or remain with their operational units. A key attribute of the Marine Corps recovery care program is that it allows WII Marines to remain with their parent commands so long as their medical conditions allow and their parent command can support their needs. Accordingly, our RCCs allow our WII Marines to “stay in the fight” by providing assistance to WII Marines who are not joined to the WWR.
Whenever possible, the RCC is one of the first points of contact the Marine and family has with the WWR support network. Usually within 72 hours of assignment, RCCs engage their WII Marine and family and immediately begin development of their Comprehensive Transition Plan (CTP). RCCs help Marines with immediate needs and set goals for the long-term. RCCs perform comprehensive needs assessments with their Marines and families, which takes into consideration various recovery components such as employment, housing, financing, counseling, family support, the disability evaluation process, and more. The information derived from the needs assessment becomes the basis for the Marine’s CTP and is often referred to as a “life map” for the recovering Marine and family. It reflects their medical and non-medical goals and milestones from recovery and rehabilitation to community reintegration. The CTP is updated frequently to reflect changes in the Marine’s health, financial situation, or transition goals. A Marine’s outlook or goals for their future may be somewhat limited during the recovery phase and will improve and become more focused when they start rehabilitation, get involved in reconditioning sports, and begin to accomplish what may have at one time seemed to be impossible. The RCC, in coordination with the Marine Corps leadership and other Recovery Team members, will regularly reassess the Marine’s mental, physical, and emotional state to ensure that their transition plan reflects their progress.
For Marines who move to veteran status and require continued transition support, RCCs coordinate the transfer of their case to the WWR’s DISCs for continued support. Additionally, when a catastrophic WII Marine is preparing for transition to veteran status, the RCC may coordinate transfer of the Marine’s case to an FRC.
RCC – FRC Collaboration
The Marine Corps fully recognizes the potential of the FRCP and where appropriate, we engage FRCs to ensure our severely injured Marines who are approaching veteran status receive their support. Across the country, we have situations where RCCs are working with FRCs on behalf of our severely WII Marines who are approaching veteran status. Especially for our Marines who are at VA Polytrauma Centers, the FRC provides a valuable support resource to our RCCs.
As the Marine Corps continues to standardize its RCP, we look for opportunities to establish practices with external programs, to include the FRCP, to enhance the recoveries of our seriously injured Marines and their families. Additionally, we look forward to collaboration and leveraging best practices. The Marine Corps actively participated in the March 2011 Wounded Warrior Care Coordination Summit, which included a working group on Federal Recovery Coordination Program / Recovery Coordination Program Collaboration. We also regularly coordinate with the other Services’ wounded warrior programs to identify best practices and improve care. We will continue to work with VA, DoD, our sister Services and all other stakeholders to ensure care provided to our WII Service members and their families is complementary, not duplicative, and fulfills our missions to posture those we serve for recovery and transition success, free of unnecessary bureaucracy.
In his 2010 Planning Guidance, the Commandant of the Marine Corps, General James F. Amos, pledged to “enhance the capabilities of the Wounded Warrior Regiment to provide added care and support to our wounded, injured and ill.” This is in keeping with the Marine Corps’ enduring pledge to take care of their own. We are proud of our “Once a Marine, always a Marine” ethos and are grateful for the support of this Committee and its dedication to the well being of the Marines who have so proudly served our great Nation.