Duty: Memoirs of a Secretary at War (23 page)

The difficulty in getting the Pentagon to focus on the wars we were in and to support the commanders and the troops in the fight left a very bad taste in my mouth. People at lower levels had good ideas, but they had an impossible task in breaking through the bureaucracy, being heard, and being taken seriously. The military too often stifled younger officers,
and sometimes more senior ones, who challenged current practices. In a speech I gave to Air Force personnel a few days after I established the ISR task force, I made it clear that I encouraged cultural change in the services, unorthodox thinking, and respectful dissent. I spoke of earlier Air Force reformers and the institutional hostility and bureaucratic resistance they had faced. I asked the midlevel officers in the audience to rethink how their service was organized, manned, and equipped. I repeated my concern that “our services are still not moving aggressively in wartime to provide resources needed now on the battlefield.” In a line about ISR that I penciled in on my way to the speech, I said, “Because people were stuck in old ways of doing business, it’s been like pulling teeth.”

At West Point the same day, I delivered a lecture to the entire corps of cadets with a similar message about military leadership, knowing that my remarks there would be read throughout the Army. I told the cadets,

In order to succeed in the asymmetric battlefields of the twenty-first century—the dominant combat environment in the decades to come, in my view—our Army will require leaders of uncommon agility, resourcefulness, and imagination; leaders willing and able to think and act creatively and decisively in a different kind of world, in a different kind of conflict than we have prepared for for the last six decades.… One thing will remain the same. We will still need men and women in uniform to call things as they see them and tell their subordinates and superiors alike what they need to hear, not what they want to hear.… If as an officer—listen to me very carefully—if as an officer you don’t tell blunt truths or create an environment where candor is encouraged, then you’ve done yourself and the institution a disservice.

Mindful of an article published earlier by an Army lieutenant colonel that was highly critical of senior officers, I added: “I encourage you to take on the mantle of fearless, thoughtful, but loyal dissent when the situation calls for it.”

Because of the ISR issue and other concerns I had with the Air Force (more later), my speech to them was generally seen as a broadside against its leadership. At a press conference soon afterward, I was asked if that was my intention. I said there had been a lot of praise for the Air Force in my speech and that I had criticized the military bureaucracy across the
board, particularly with regard to getting more help to the war fighter now. Everyone recognized that both speeches represented my first public assertion that supporting the wars we were already in and those fighting those wars, as well as preparing for future conflicts, would require cultural change in all the services. It was only the opening salvo.

W
OUNDED
W
ARRIORS

I believe that exposure of the scandalous problems in the outpatient treatment of wounded troops at the Walter Reed Army Medical Center mortified the senior military leadership of the services and the whole Department of Defense. I was always convinced they had been unaware of the bureaucratic and administrative nightmare that too often confronted our outpatient wounded, as well as the organizational, financial, and quality-of-life difficulties that faced our wounded troops and their families. The scandal prompted numerous reviews and studies of the entire wounded warrior experience, while the department and the services simultaneously began remedial actions.

During my entire tenure as secretary, I never saw the military services—across the board—bring to a problem as much zeal, passion, and urgency once they realized that these men and women who had sacrificed so much were not being treated properly after they left the hospitals. Senior generals and admirals jumped on the problem. I don’t think that was because I had fired senior people. I was always convinced that once the military leadership knew they had let down these heroes, they were determined to make things right for them. The established bureaucracies, military and civilian, in the Departments of Defense and Veterans Affairs, however, were a different story.

The Army was the service, along with the Marine Corps, that had suffered the overwhelming preponderance of casualties, physical and psychological, in the post-9/11 wars. I met with Army Chief of Staff Casey in early March and told him not to wait on the reviews or studies but to act right away to fix Walter Reed and look at the rest of the Army’s treatment of wounded warriors. With respect to evaluating soldiers for disability, I told him, “When in doubt, err on the side of the soldier.” Casey and Army Vice Chief of Staff Dick Cody leaped on the problem without further urging from me. On March 8, I was briefed on the Army’s action plan. Under Cody’s supervision, other personnel changes
had already been made at Walter Reed, a Wounded Warrior Transition Brigade was created (to give wounded soldiers an institutional unit to look after them while in outpatient status), a “one-stop soldier and family assistance center” was established, and all outpatient soldiers were moved into proper quarters. The Army was establishing a wounded warrior and family hotline, organizing teams to examine circumstances at the Army’s twelve key medical centers, and looking into how to improve the Army’s physical disability evaluation system. General Casey took the lead in aggressively tackling the problem of traumatic brain injury and post-traumatic stress. In June, Casey briefed me on a program to train every soldier in the Army on the causes and symptoms of post-traumatic stress in an effort not only to help them cope but also to begin to remove the stigma of mental illness. As he told me, “We’ve got to get rid of the mentality that if there are no holes in you, then you’re ready for duty.” The other services were not far behind the Army’s lead.

On March 9, I had sent a message to every man and woman in the U.S. armed forces on the Walter Reed situation. I described the actions taken so far, including establishment of the two outside review panels. I told them we would not wait on those reports before tackling the problems. I told them I had directed a comprehensive, department-wide review of military medical care programs, facilities, and procedures, and that I had told the senior civilian and military leadership that in dealing with this challenge, “Money will not be an issue.” I went on: “After the war itself, we have no higher priority than caring properly for our wounded.” It was a sentiment and an admonition I would repeat often over the next four years.

Shortly thereafter I created the Wounded Warrior Task Force, charged with reporting to me every two weeks actions that were being taken across the Defense Department to address the needs of wounded warriors and their families. The goals of the task force were ambitious: (1) to completely redesign the disability evaluation system; (2) to focus on traumatic brain injury and post-traumatic stress; (3) to correct the flaws in case management of wounded warriors and their support; (4) to expedite Defense–Veterans Affairs data sharing; (5) to ensure proper facilities for wounded warriors; and (6) to reexamine the entire process for transitioning wounded warriors to Veterans Affairs. These were also the primary issues addressed by the West-Marsh independent review I had appointed and by the presidential Dole-Shalala commission. I was
in a hurry and was not concerned about the three efforts stumbling over one another; each had a somewhat different mandate.

I wanted to ensure that good ideas were being shared across the services and around the Defense Department. As with MRAPs and ISR, I intended to make clear from my personal engagement the priority I attached to this endeavor, and that I was going to make sure everyone was moving aggressively to fix any problems we found. Gordon England and I also reenergized a joint Department of Defense–Veterans Affairs oversight group—the Senior Operations Committee—cochaired by each department’s deputy secretary in an effort to make significant improvements in the process of transitioning from active duty to retired or veteran status.

I believe that at the outset of the Afghan and Iraq wars, neither Defense nor VA ever conceived of, much less planned for, the huge number of wounded young men and women (overwhelmingly men) who would come pouring into the system in the years ahead. Many of our troops would not have survived their wounds in previous wars, but extraordinary medical advances and the skills of those treating the wounded meant that a large number with complex injuries—including traumatic brain injuries and multiple amputations—faced prolonged treatment, years of rehabilitation, or a lifetime of disability. The Defense and VA bureaucracies, accustomed to dealing with older vets from Vietnam and earlier wars or retirees with all the ordinary problems of aging, seemed incapable of adjusting to wartime circumstances, just like the rest of Defense and the rest of government. There were three areas where I fought the military and civilian bureaucracy on behalf of the wounded, and all three stemmed from my strong belief that those wounded in combat or training for combat should be dealt with as a group by themselves and be afforded what I referred to as “platinum” treatment in terms of priority for appointments, for housing, for administrative assistance, and for anything else. I wanted them to have administrative staff for whom they were the sole “customers.” The Defense and VA health care bureaucracies just could not or would not differentiate the wounded in combat from all others needing care.

Wounded Warrior Transition Units were being created by all the services at posts and bases throughout the United States so the wounded would have a home unit to watch over them. The first fight was over who should be allowed into them. I was shocked to learn, only months into
the program, that the Army units of this kind were nearly filled to capacity. My intent in approving these units had been that they be reserved for those wounded or injured in battle or training, but the Army had allowed in those with noncombat injuries and illnesses as well. So a transition unit berth that I had hoped would go to a soldier wounded in Iraq might instead go to a soldier who had broken his leg stateside in a motorcycle accident. I obviously wanted the latter to get first-class medical care, but that was not why we created these units. In talking to wounded warriors at various Army posts around the country, I was told that deploying units would often transfer soldiers with behavioral or drug problems to these units. Eventually I persuaded the new Army secretary, Pete Geren, to be more faithful to my original intent but agreed it could be done through attrition, so that no soldier was forced to leave a transition unit.

The second fight was over bureaucratic delays in making disability decisions. In the case of those severely and catastrophically wounded, there was no need to take months to determine if they were entitled to full disability benefits. Similarly, a decision to transition wounded troops unable to remain on active duty to the VA ought not take nearly as much time as it took. I called this approach “tiering.” President Bush was supportive of giving wounded warriors the benefit of the doubt on disability evaluations, erring on the side of the soldier initially and then making adjustments later if needed. Because the number of wounded warriors in the system was such a small subset of all those needing medical care and evaluation, I believed even more strongly that the system should be tilted in their favor. “We need to look at this from the perspective of the soldier, not the perspective of the government,” I told a group of West Point cadets in September. We were able to get a pilot program going in the Washington, D.C., area to expedite the disability evaluation process, but it was always limited by legislation and bureaucracy. I pushed for these changes for years, but the unified opposition of the military and civilian bureaucracies—and the lack of support for my efforts from their leaders—largely defeated me. Any new approach, anything different from what they had always done, anything that might require congressional approval, and any differentiation between troops wounded in combat and others who were ill or injured was anathema to most officials in Defense and VA.

The third fight was over the disability evaluation system itself. To be considered for a disability retirement, a wounded warrior had to be
evaluated as at least 30 percent disabled. This seemed to me to involve a ridiculous level of precision. How can you quantify whether a person is 28 percent disabled or 32 percent? I knew there were rules and guidelines, and I knew some veterans tried hard to game the system to get more money. But when it came to wounded warriors, when it was a close call or there was doubt, I wanted to err on the side of the soldier, and generously. I argued that we could institute a five-year review process to reevaluate the level of disability and correct any egregious errors made initially. I had no luck.

I also pressed for more support of families of the fallen and severely wounded, in addition to advancing state-of-the-art medical care for the signature injuries of the current conflicts—post-traumatic stress, traumatic brain injury, lost limbs, and eye problems and sight restoration. I predicted that these injuries would “continue to be the signature military medical challenge facing the Department for years to come.”

In mid-July, at a meeting with the senior civilian and military leadership, I was briefed on statistics that I thought proved my point about tiering. I was told that, as of that date, 1,754,000 troops had been engaged in Iraq and Afghanistan. Thirty-two thousand had been wounded in action, half of whom had returned to duty within seventy-two hours. Ten thousand troops had been medically evacuated from Iraq and Afghanistan, not all of them for combat-related injuries, and a total (as of July 15) of 2,333 had been catastrophically injured or wounded. In short, the number of troops wounded in combat at that point in the wars represented a small fraction of all those being treated.