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By Jeff Stoffer

A full year removed from Walter Reed’s dark cloud of 2007, military-to-veteran transition remains a top priority in Washington.

In early spring 2007, The American Legion’s 47th Annual Washington Conference buzzed with frustration and dismay. Unsanitary and rundown conditions had recently been exposed at Walter Reed Army Medical Center’s Building 18, portrayed in the national media as a moldy and insect-infested outpatient holding tank for recuperating troops, many of whom had been stuck there for months. The Washington Post investigative series that began Feb. 18, 2007, unleashed a torrent of public criticism and outrage directed at all arms of government – DoD, Congress, VA, the Army, the White House – responsible for compassionate care and smooth transitions for sick and wounded military personnel.

The article produced more than a Pulitzer Prize for The Washington Post. It drove the issue of military and veteran care to the forefront of the American conscience. A year later, the issue remains there.

That much was clear at The American Legion’s 48th Annual Washington Conference, March 30-April 2, where talk of seamless transition, wounded-warrior programs, economic opportunities for disabled veterans and VA health-care improvements flowed through the meeting rooms and reception halls of the 64,000-square-foot Renaissance Hotel. More than 1,000 members of The American Legion, American Legion Auxiliary and Sons of The American Legion heard from generals, doctors, politicians, business leaders and others about how the government is urgently trying to prove itself worthy of Lincoln’s ageless promise, “to care for him who shall have borne the battle.”

American Legion National Commander Marty Conatser of Illinois also drew upon the 16th president during the Washington Conference. “I am proud to be from the land of Lincoln,” he said at the April 1 Commander’s Call, a staging event before he dispatched Legionnaires to meet with their congressional delegations on Capitol Hill. “Like many of you, his memorable words – ‘a government of the people, by the people and for the people’ – resonate with me every time I come to Washington, D.C. This is where the opening line of the United States Constitution – ‘we, the people’ – literally comes alive and applies directly to you and me.”

The Commander’s Call attracted several national leaders, including Speaker of the House Nancy Pelosi, D-Calif.; House Minority Leader John Boehner, R-Ohio; VA Secretary James B. Peake; Secretary of the Army Peter Geren; Sen. Richard Burr, R-N.C.; Rep. Chet Edwards, D-Texas; Rep. Stephanie Herseth-Sandlin, D-S.D.; and Brig. Gen. Greg Zanetti, deputy commander of Joint Task Force Guantanamo Bay. American Legion Commissions on Veterans Affairs & Rehabilitation, National Security, Foreign Affairs and Economics also conducted forums, workshops and panel discussions on such subjects like traumatic brain injury and mental health, seamless transitions from DoD to civilian life, wounded warrior care at Walter Reed and beyond, detainee treatment at Guantanamo Bay, economic opportunities for disabled veterans and full accounting of POW/MIAs.

Pelosi focused on improvements to VA health-care funding passed by the 110th Congress – a record $11.8 billion increase budget increase. “Particularly when I travel abroad, to Iraq or Afghanistan, the question I get most often is, ‘What is going to happen to me when I come home?’ I tell them what you have told me – that in the military there is a saying and tradition, that on the battlefield we leave no soldier behind. And when they come home, we will leave no veteran behind.”

The Building 18 effect was confronted head-on during a joint session of The American Legion National Security and Foreign Relations Commissions. Brig. Gen. Michael S. Tucker, assistant surgeon general for warrior care and transition at Walter Reed, told Legionnaires how he is guiding a transformation that in less than a year has included training and certification for 2,428 care providers, elimination of more than 70 bureaucratic procedures in the transition process, improvements in doctor-to-patient ratios and greater compassion for families coming to visit their wounded loved ones. Tucker said Walter Reed’s outpatient rooms are more frequently inspected and better maintained now, families are now met at the airport and driven to the hospital, and soldiers are treated more like soldiers than patients. “Importantly,” he explained, “the wounded soldier has a mission: to heal.”

Among the tallest orders Tucker still faces is speeding up the decision process for those who are caught in a limbo between medical discharge and re-activation. “Today, we have 10,900 non-deployable soldiers,” he said. “We’ve got to return them to duty or release them to VA.”

The American Legion, in an agreement with DoD that was inked shortly after the Building 18 story broke last year, now has a staff service officer on post at Walter Reed to help troops in transition. Also in the aftermath of the Building 18 exposure, President Bush summoned former U.S. Sen. Robert Dole and former U.S. Health and Human Services Secretary Donna Shalala to lead a commission to recommend urgent changes in the readjustment process. Many elements of the Dole-Shalala Commission report released last fall have since been written into legislation or implemented as policy.

Gen. Tucker described the Building 18 exposure as a “perfect storm” that had been gathering nearly since the Global War on Terrorism began. He explained that battlefield survivability rates rapidly began to outpace long-term recovery resources at DoD hospitals. “Miracles were happening in inpatient care,” Tucker said, noting that combat survivability has soared from 22 percent to 94 percent for patients whose bodies are penetrated by metal. “Outpatient care was our problem. It wasn’t just a Walter Reed problem. It was an Army problem.”

At Walter Reed, however, it was a problem compounded by the medical center’s 2005 placement on the Base Realignment and Closure list. Walter Reed is scheduled to merge with an expanded National Naval Medical Center at Bethesda, Md., in 2011. Physical repairs and maintenance had lagged at the 13-acre Washington site after the BRAC decision, Tucker said.

A former armor school instructor at Fort Knox, Tucker has now spent a year forging a new wounded-warrior program at Walter Reed. He said his superiors made it clear the mission was top priority. “If it wasn’t illegal, immoral or unethical, I did what I had to do and apologized later if I needed to,” Tucker told The American Legion commissions. The Army’s “Comprehensive Care Plan” soon emerged for soldiers requiring six months or more healing time. The CCP lays out a curriculum of treatment that engages body, mind, heart and spirit on a course that aims to end up with either “a successful soldier” who returns to duty or “a successful veteran” who returns to civilian life and the VA health-care system.

The relationship between VA and DoD was a cornerstone of most Washington Conference discussions related to wounded-warrior transitions. Many who spoke at the conference said the line is blurring between the Department of Defense and the Department of Veterans Affairs, by design. “I really want to erase those lines,” VA Secretary Peake told Legionnaires at the Commander’s Call. He said improvements in information sharing and VA involvement at the DoD hospital level are helping, especially with the Iraq and Afghanistan veterans, 800,000 of whom have separated, 300,000 of whom are now in the VA health-care system.

“It’s not a seamless transition, or a seam-ful transition,” said Kristin Day – who has pioneered VA social support programs for wounded and sick Iraq and Afghanistan veterans. “It’s a partnership, and it’s a process that lasts for a lifetime.”

In a panel discussion on DoD-VA transition before The American Legion’s Veterans Affairs & Rehabilitation Commission, Day joined Dr. Lucille Beck, who leads VA’s Audiology and Speech Pathology program; Dr. Lynda Davis, who heads DoD’s case-management reform effort for returning wounded and ill servicemembers and their families; and Operation Iraqi Freedom veteran Steve A. Clark, a program analyst for the Under Secretary of Defense for Personnel and Readiness; Clark knows the transition process well, having lost his right arm during combat in 2003. “As a patient, I was on the receiving end of these programs,” he explained. “Now, I am on the giving end.”

He described the enormous adjustment faced by severely wounded veterans. “I’m still transitioning,” said Clark, who works closely with The American Legion’s Heroes to Hometowns program. “My story was pretty typical. An IED, lost a limb. To Landstuhl, Walter Reed and occupational therapy. The commonality is the commonality of frustration, whether it’s losing a limb, career changes, cooking … Ultimately, success comes when you are no longer thought of as that guy with one arm or that injured veteran, and they just think of you as a good person, coworker, a friend.”

“Well over 90 percent of our wounded now come home,” Dr. Davis told the VA&R commission. “We can help them survive. We know how to keep people alive. What we don’t know yet is how to make them thrive.”

Panelists agree that the sheer number of programs available from the government, veterans groups, businesses and nonprofit organizations can be confusing. Patient-privacy laws often keep disabled veterans and wounded warriors separated from programs designed to help them. Federal recovery coordinators – Dole-Shalala Commission-recommended liaisons between the government and disabled veterans – are moving into place around the country “to make sure the right people are there to help at the right time … to leverage all the resources available,” Day explained.

Another strategy the panelists promoted is the creation of a national resource directory, so patients and their families can pick and choose support programs that best suit their needs.

Secretary of the Army Peter Geren said The American Legion has a vital role to play in communities when wounded troops come home and start their lives over. “There is no substitute for neighbors helping neighbors,” he said at the Commander’s Call. “The American Legion understands that supporting America’s military means supporting America’s military families. Today, while our nation is fighting two wars on the other side of the world, the Legion is as important as ever.”

During the seamless transition panel discussion, Drs. Beck and Davis called upon American Legion members to watch closely for signs of mental-health problems among newly returned combat veterans. They said programs effective programs are available to help them, if they are willing to be helped. “We need you to keep your eyes and ears open and get these young veterans to come forward,” Dr. Davis said. A challenge for many, she added, is that they fear mental health treatment will stereotype them and lead to lost security clearances if they are still in the service.

Sen. Richard Burr, R-N.C., told of a soldier whose leg was so badly wounded he had a choice – to repair it and walk with a limp or have it amputated. Burr said the soldier wanted to know which choice would leave him most likely to pass his physical and return to the war. He had the leg removed, was fitted for a prosthetic limb and returned to duty. “Their expectations are so drastically different from the past, from what the system was set up to produce,” said Burr, ranking Republican on the Senate Veterans Affairs Committee. “I am committed to make sure we change it in ways to recognize the needs of the future.”

Pelosi said the federal government – regardless of opposition or support for the war – has an obligation to those who have been sent to fight. “What is mostly unspoken is the cost to America’s families of our men and women in uniform, whether it’s the breakup of families, the mental challenges that some of our troops are bringing home, the issues that have some stigma to them, that people don’t want to talk about so much, we have to face the reality,” she said. “We have to face reality in public policy, funding and in making those concerns a priority, because when those troops ask me, ‘What is going to happen to me?’ I don’t want to have to tell them, ‘Well, you have an enrollment fee… what you have sacrificed is not enough.’

Rep. Herseth-Sandlin – who used most of her time at the Commander’s Call to promote the House version of a new GI Bill to better cover the costs and meet the needs of today’s veterans – said “whether it’s health care, education benefits, housing, job training or other services, we must stand up for the men and women who stood up for us and our country … These are moral promises that must be fulfilled, and they are just as meaningful as the promise of a young life we send out onto a battlefield. A lot of extra focus is on veterans returning home, who suffer from post traumatic stress disorder and traumatic brain injury. With this renewed focus, I believe we can make important strides in addressing veterans’ health care, the crises that we have at times faced, and the inadequacies in the military health-care system brought to light by the scandal at Walter Reed. We can inch closer to keeping the sacred promise we made to our servicemembers.”

Jeff Stoffer is editor of The American Legion Magazine.

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