United States Anny Inspector General Agency

. Inspection of the Warrior Care and Transition Program

Table of Contents

. COVER l-ETTER 1. EXECUTIVE SUMMARY 2. Summary of Observations and Recommendations

TAB AD POLICIES AND PROCEDURES

TAB B - SUPPORT SYSTEMS FOR SOLDIERS AND FAMILY MEMBERS

TAB C -MANAGEMENT OF "MEDICAlLY NOT READY "SOLDIERS

TAB D - OTHER MATTERS

TAB E co POSITIVE NOTES

TAB F - METHODOLOGY

APPENDIX 1 • Directive

APPENDIX 2 - Stakeholder Briefing

APPENDIX 3 • Acronym List

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UlJited States Army. Inspector General Agency

Inspection.of the Warrior Care and Transition Program

Table of Contents

COVER LETTER 1. EXECUTIVE SUMMARY 2. Summary of Observations and Recommendations

TAB A· POLICIES AND PRPCEDURES

Observation 1.1: No single synchronized source document outlining governing policies. A·1 guidance. 'and regulatory requirements

Observation 1.2: Warrior Transition Unit (WTU) fosters a focused environment of healing and transitioning. however WT personal motivations may drive transition decisions

A·17

Observation 1.3: A mixture ofcombat wounded, injured and ill Soldiers In the WTU has created perceptions leading to leadership, medical management, public relations and small unit cohes.i?n challenges

A·20

Observation 1.4: Challenges exist to Implement rapidly issued/changIng policy without A-23 the-requisite resources

Observation 1.5: Subordinate commanders and some healthcare providers consider A-25 Fragmentary Order (FRAGO) 3 WTU entrance criteria to be vague and inconsistently

. applied

Observation 1.6: Medical Command's (MEDCOM) accountability processes for \ A-27 Soldiers evacuated out of theater result in Immediate acceptance into the WTU without meeting FRAGO 3 screening criteria

Observation 1.7: Most WTU cadre are concerned with inconsistencies in determining A-29 ,the Medical Retention Decision Point (MRDP)

Observation 1.8: Selection ofWTU cadre shifted from "best qualified- to "good and A·31 . first available"

Observation 1.9: The current WTU classroom-centric and theory-based instruction A-33 ",wcrY'Ii'loIuately prepare the'cadre to perform their duties

RJR OFFiew. lfSE ONLY. This documellt contains Infomnllton which hi Exempt from Mandatory Disclosure under the Fl"iIItdom CIf IlIfo""l!dIon Act. Bi8IIemln&1ion Ie proIdbltiad Me.... wUlDFlzed bJAR 20 1.

Observation 1.10: Most MUs visited are not meeting the intent and implementation A-35 of the Comprehensive Transition Plan (CTP)

Observation 1.11: Most Warrior Transition Units have not implemented the Transition 14:-37 Review Board (TRB)

Observation 1.12: Army-wide specialty care shortages exist.in Behavioral Health, 14:-39 Occupational Therapy, and Physical Therapy and contribute to delays in Soldiers treatment and healing

Observation 1.13: Army is failing to properly document Line of Duty (LOD) for A-.41 Reserve Component (RC) Soldiers - critical to the follow-on care and transition for the RC Soldier

Observation 1.14: Perception that Warriors in Transition are not held to same A.043 standards of dlscip6ne as required in other Army units

TAB B - SUPPORT SYSTEMS FOR SOLDIERS AND FAMILY MEMBERS

Observation 2.1: Soldier and Family Assistance Centers (SFAC) are underutilized, B-45

however they provide WTs with a level of personal ~ce ahd an environment .

conducive to their medical and transitional needs. Most SFACs encounter near-term

resource challenges (facilities, funding, and staffing)

Observation 2.2: Providing services for Component (COMPO) 213 WTs and Families 8-47

is challenging due to the dispersion ofstate resources

Observation 2.3: Communities outside the gate are beginning to selectively support 8-48

onlV combat-wounded WTs with incentives resulting in non-standardized practices

across installations

TAB C .. MANAGEMENT OF "MEDICALLY NOT READY "SOLDIERS

Observation 3.1: The Army does not use common terms of reference to accurately C-49 determine statUs of "medically not readY', -medically non-deployable", and -not . available" Soldiers

Observation 3.2: Army medical fitness determination processes have not kept pace C-52 with Army Force Generation (ARFORGEN) requirements

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Observation 3.3: Army medical capabilities do not support the needs of the C-S5 Medlcany Not Ready (MNR)/Me9ically .Non-Deployable(MND) in units

Observation 3.4: C;:urrent medical priorities do not assist commanders In maintaining a fit fighting force that Is medically ready to deploy.

e-57

Observation 3.5: Leaders are concerned abOut Soldiers that Permanent Change e-g of Station (PCS) with known or unknown medical issues, particularly behavioral health Issues (Traumatic Brain Injury (TBJ}and Post-Traumatic Stress Disorder(PTSD»

Observation 3.6: Soldiers in the Medical Evaluation Board (MEB)lPhysical Evaluation C-59 Board(PEB) process that are not assigned to a WTU are disadvantaged from a lack of information, lower priority In access to care, and length of M'ea I PEB process

Observation 3.7: Individual Ready Reserve (IRR) Soldiers are often not identified C·SU as non-deployable until they reach a mobilization pla~onn, approximately 42 days or more after recalled to active duty . .

TAB 0 ·'OTHER MATTERS

Other Matter 1: Leaders. health care professionals. and Soldiers stated that MEBIPEB 0·1 inefficiencies affect the Army's ability to mee~ the needs of Soldiers and the Army in a timely manner

other Matter 2: Umited and/or no interoperability between DoD Armed Forces Health 0·3 Longitudinal TeChnology Application (AHLTA), Department of Veterans Affairs (VA) Veterans Health Information Systems and Technology Architecture (VISTA). TRICARE network, and civilian provider information systems

Other Matter 3: COMPO 213 are not longer astrategic reserve; current Army resources D-4 appear to be insufficient to medically sustain RC in an operational environment

Other Matter 4: The majority of medical management staff have some level of concern 0·6 for personal safety in managing increasing numbers of Soldiers with behavioral health .issues

Other MaHer 5: Most healthcare providers interviewed(Primary care Managers (PCM). D·7 Nurse case Managers (NCM) estimate 25-3S% of WTs are dependent on or addicted to dl'llgs .

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TAB E .. POSITIVE NOTES

. Positive Note 1: Some units Implemented pain and prescription management E·1 programs to assist in the reduction of medication dependency.

Positive Note 2: Fort Bragg's Focused Transition Review (FTR) is a multidiscip6nary E·1 platform that combines features of the Comprehensive Transition Plan (CTP) with the Transition Review Board (TRB) .

Positive Note 3: Eisenhower Army Medical Center's In-patient substance addictionE-1 program provides for more effective Command and Control (e2) and Medical Management (M2) of Soldiers with addiction diagnoses

Positive Note 4: 4th Infantry Division (IO) "Building The Soldier Athlete" fitness E·1 program motivates Medically Non·Deployable (MND) Soldiers; focuses on abilities instead of disabilities

Positive Note 5: Evans Army Community Hospital, Fort Carson established robust E..1 Mobile Behavior Health Team (MBHT) as a single point of contact to improve mission readiness

TAB F .. METHODOLOGY

APPENDIX 1- Directive

APPENDIX·2 • Stakeholder Briefing

APPENDIX 3 • Acronym List

7'1-' ~: . . -. 7 'Q"••mE FOR ornetAL USE ONLY.

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DEPARTMENT OF THE ARMY OFFICE OF THE INSPECTOR GENERAL

1700 A1fIIV PENTAGON

WASHINGTON DC 2031G-t700

SAIG-ZA SEP 22 2010

MEMORANDUM FOR SECRETARY OF THE ARMY

SUBJECT: Results of the Warrior Care and Transition Program Inspection

1. The U.S. Army Inspector General Agency conducted an Inspection of the Warrior Care and Transition Program from 27 January 2010 to 30 June 2010. Three objectives were assessed (further discussed in paragraph 3).

2. Background. In February 2007, the Army established the Army Medical Action Plan (AMAP) now known as the Warrior Care and Transition Program to effectively manage Soldiers receiving outpatient care. A~ its heart, the Warrior Transition Unit (WTU) Is an organizational and cultural shift In how the Army cares for its wounded. ill, and injured Soldiers.

a. There are currently 29 WTUs on Army installations and ninecpmmunity-based warrior transition units (CBWTU). These units are designed to provide support to Soldiers who are expected to require at least six months of rehabilitative care and the need for ·complex medical case management" for active component (COMPO) or -definitive heaHhcare" for reserve component Soldiers. The units have dedicated phYSicians, nurses, behavioral health professionals. and military leaders. These leaders and healthcare professionals are charged with ensuring Soldiers' needs are met, their care is coordinated, and their Families' concerns are addressed. .

b. Since June 2007. the WTU returned 12,956 Soldiers to duty with an average stay of seven months. During that same period, 13,504 $Oldiers transitloned from the Army with an average WTU stay of over 14 months as cited in a report by Plans, Analysis, and Evaluations (PA&E), Office of The Surgeon General (OTSG) on Warrior Transition Status, dated 14 June 2010. The current combined WTU and CBwru population Is approximately 9,500. .

c. There is a misperception that all or most Warriors in Transition(WT) were wounded In combat OTSG Status Report statistics show only 10% were wounded In combat; 37% were evacuated from a combat zone due to disease and non-battle injuries; and 53% had illnesses or injuries not associated with combat (COMPO 1 Soldiers command-referred and COMPO 2 and 3 Soldiers in mobilization and de-mobilization).

FOR OFFICIAl: USE ONLY. This Document contains information Oisseminmn is prohibited expect 8S EXEMPT FROM MMlDATORV authorized by AA 20 1. . DISCLOSURE under FOIA;

Eemptioo 5 applies.

SAIG-ZA SUBJECT: Results of Warrior Care and Transition Program Inspection

3. Inspection Summary. The inspection team visited 17 installations with WTUs or caWTUs to assess their policies, procedures and support systems. Additionally, the Inspection team assessed brigade and below unit procedures in managing Soldiers considered "medically not ready" (MNR) or "medically not deployable" (MND). Inspectors contacted over 2,100 individuals during the inspection which included senior/unit commanders, healtheare profesSionals, cadre members, WT, and Family members. "rhe inspections determined that. while the WTU leaders and staff are dedicated to supporting ourWTs, there remained issues that must be improved. This report outrrnes 24 observations, 5 other matters and 56 recommendations.

a. Inspection Objective #1 (Assess Implementation and oversight of policies and

procedures for the US Army Warrior care and Transition Program).

(1) The inspection team concluded that wru leaders and Cadre were dedicated and committed to assuring care and transition of Warriors back to duty or into Civilian life as productive veterans. Inspectors interviewed 786 wr and determined that most felt that being aSSigned to a transition unit was the best place for them to recuperate; however, it remains soiety on the Soldier's personal motivations as the driving factor to either return to duty or decide to transition out of the Army. Briefings and orientations provided by transition units help'educate WTs on medical disability entitlements and often influence Sordiers personal motivations. There is a noticeable sense of awareness about these entitlements among the wrs intervieWed. However, the lnspectof'$ noted that the Warrior Care and Transition. Program lacked a single synchronizing document outlining governing policies, guidance and regulatory requirements. There are numerous orders, messages .and policy memos that guide the program, creating varying interpretations and, in some cases, confusion at the unit level. rhe inspection team specifically assessed the eligibility criteria that was published in FRAGO 3/4 (July 2008/May 2009) and found it vague. The criteria of ·complex medical case management" and -definitive healthcare" are ambiguous and applied inconSistently to Soldiers seeking admission to a transition unit.

. (2) The Comprehensive Transition Plan (CTP) is the cornerstone of the WTs roadmap to healing and transitioning back to the force or to veteran status. This guidance was inconsistently applied a·nd misunderstood within the WTUs. The CTP sets Initial expectations for entering WTs and also guides medical providers and unit leaders to plan and assist WTs in the healing process.

(3) Lastly. the demand fQr behavior health services has increased as more Soldiers are diagnosed with PostTra\jmatic Stress Disorder (PTSD) and Traumatic Brain Injury (TBI). Most WTU cadre and WTs s~ted specialty care provider shortages contribute to delays in diagnosis and treatment and thereby increasing length of stays.

FOR OFFICiAl USE ONLY. 2 This Document contains information Dissemination Is prohibited expect as EXEMPT FROM MANDATORV authorized by AR 20·1. DISCLOSURE IInder FOIAo

Exemptien 5 applies.

SAIG-ZA SUBJECT: Results of Warrior Care and Transition Program Inspection

b. Inspection Objective #2'(Assess Warrior Care and Transftion support systems for Soldiers and Family members). The Army Installation Management Command (IMCOM) assumed the mission of establishing and operating Soldier and Family Assistance Centers (SFAC) as part of the Warrior Care and Transition Program. SFACs provide specialized Soldier and Family support services, including. but not fimited to, child care, legal assistance, pastoral care, travel claims. lodging assistance for non-Invitational Travel Orders (ITO) Family members. vehicle registration, and translation services. Although the services provided by the SFAC can be found In Army Community Service (ACS) and Soldier Processing Centers, it is focused to support a smaller population with unique requirements such as providing a higher level of service catering to each individuars time and attention and maintaining access to more tranquil environments. The team determined that the services may be underutilized on some installations.due to the small population that they support..

c. Inspection Objective #3 (Assess tools and processes Implemented by Commanders to manage Soldiers who are "Medically Not Ready (MNR)"). Tactical unit commanders are challenged by the increasing numbers of assigned Soldiers who are MNR but are not part of a WTU. Leaders face many challenges in managing Soldiers undergoing medical determination throughout the ARFORGEN cycle. There is a Significant amount of medical resources dedicated to treati,ng the WTU population; which represents only 'about . 26% of the MNR population. The rest of the MNR Soldiers compete for the limited amount of medical resource remaining. MNR SoldIers in tactical units undergoing medical determination processes. profiles. and board actions such as MOS/Medical Retention Board (MMRB), Medical Evaluation Board (MEB) and Physical Evaluation Board (PES), can take up to 24 months, nearly a full ARFORGEN cycle, as cfted in GEN(R) Franks Task Force Report rrhe Franks Report) in April 2009. These processes are not synchronized with the ARFORGEN cycle. The Army's medical resources are stretched and encumbered by an'increasing population of Soldiers that cannot deploy.

4. Other Matters. There were matters that did not fatl within the scope of our assessment butwere deemed appropriate for further discussion in this report. The most Significant was the MEB/PEBboard Inefficiencies which affected the Army's abilfty to meet Soldiers' needs. ,A majority of those Int~rvlewed stated that the processes are complex, disjointed. confusing, and lengthy. In The Franks Report, WTs stated that the board process is stow, reportedly taking a year or more to initiate, and an additional 1824 months to complete. Less than.1 0% of Soldiers In the MEB/PEB process retuf'l"¢ to duty Which Impacts unit readiness. In practicalfty. Soldiers pending an MEB should be considered a loss to the unit which allows for a trained and ready replacement to be requisitioned.. Delays in the board processes cause existing efforts to expire and thereby repeating themwhich further draws on already limited resources. Measurement of the board timeline is difficult when health care providers can stop, start and terminate board actions. tn some cases, Soldiers identify -new" conditions requiring initial evaluations or assessments. Most of the subjects Interviewed were concerned that medical staffing is

FOR OFFICIAL USE ONLY. 3 This Document contains InformatioA Dissemination is prohibited expect as EXEMPT FROM MANDATORY authorized 8)' AR 20-1. DISCLOSURE urlder FOJA.

Exemption 5. applies.

SAIG-ZA SUBJECT: Results of Warrior Care and Transition Program Inspection

insufficient to support timely MEBIPEB ·processing. A detailed discussion of this is In the written report.

5 .. Recommendations. The report contains 56 recommendations for implementation, as well as 24 observations and five other matters which should be considered by appropriate proponents as outlined in the body of the report. Upon your approval, the Director, Army Staffwill"direct execution on your behalf.

6. Follow-up. The deficiencies enclosed in this report will be entered into the USAIGA Corrective Action Oversight System. Designated responsible entities will provide bimonthly status updates. I recommend the Inspector General Agency conduct a follow-up inspection in 12 months upon approval of this report to determine the effectiveness of implementing the recommendations provided.

~e. WILLIAM H. MCC~ Major General, usY Acting The Inspector General

Encl

Reportof Inspection of the Anny Warrior Care and Transition Program '

CF:

UNDER SECRETARY OF THE ARMY

CHIEF OF STAFF, ARMY

VICE CHIEF OF STAFF, ARMY

APPROVE.D0~ ".11"'\\DISAPPRO~-\______ SEEME~__~~_____

FOR OFRCIAl USE ONLY. 4 This Doetlment oontsins information e!sseminatfon is prehibited eKpeGt as EXEMPT FROM MANDATORY authorized by AR 20-1. DISCLOSURE under POIA;

Exemption 5 applies.

http:APPROVE.D0

Summary of Observations and Recommendations:

OBJECTIVE 1: Assess implementation and oversight ofpolicies and procedures for the United States Army.Warrior care and Transition Program

OBSERVAnON 1.1: No synchronized source document outlining governing policies, guidance, and regulatory requirements

RECOMMENDATIONS:

a. OTSG/MEDCOM: Publish a single, synchronized document to govem the Warrior Care and Transition Program. Warrior Transition Command Is developing a single source manual for Warrior Care and Transition Plan.

b. MEDCOM: Publish DA PAM in support of single source document standardizing WTU procedures. '

'OBSERVATION 1.2: Warrior Transition Units (WTU) foster a focused environment of healing and transitioning, however, some WTs' abuse the system and manipulate it to maximize entitlements.

RECOMMENDATION:

OTSG/MEDCOM: Revise Warrior Care and Transition Program procedures to incorporate a sequential approach initially focusing on strengthening the incentives for Soldiers retuming to duty ahead of disability-based compensation.

OBSERVAnON 1.3: A mixture of combat wounded, injured and ill Soldiers in the Warrior Transition Unit has created perceptions leading to leadership. medical management. pubUc relations and small unit cohes,ion challenges.

RECOMMENDATION:

OTSGIMEDCOM: Detennine messages and strategies to educate the Army and public on the Warrior care and Transition Program.

OBSERVATION 1.4: Challenges exist to implement rapidly Issued/changing policy withoUt the requisite resources.

RECOMMENDATION:

OTSG/MEDCOM, ICW ASA(FM&C) and IMCOM: Ensure a cost benefit ana.lysis is conducted and appropriate resources are available for year of execution for WT policy requirements.

OBSERVATION 1.5;' Subordinate commanders and some healthcare providers consider FRAGO 3/4 WTU entrance criteria to be vague and inconsistently applied.

RECOMMENDATIONS:

a. OTSGIMEDCOM: Define acomplex medical care," "extensive and. clinical case management," "definitive healthcare," and standardize screening criteria for entry into the WTU to add.ress medical condition for all COMPOs. OTSG Is currentfystaffing EXORD that establishes a MEB referral formal reporting system and a General Officer requirement to approve treatment plans for WTUICBwrU wrs with a length ofstay greater than 12-months without.MEB start date.

b. ASA(M&RA)lG1: Consolidate Medical Retention Processing Evaluation (MRP-E), Medical Retention Processing (MRP). Medical Retention Processing 2 (lViRP2) and Active Duty Medical Extension (ADME) into one order similar to COMPO 1.

OBSERVATION 1.6: MEDCOM's accountability processes for Soldiers evacuated out of theater result In immediate acceptance into the WTU without meeting FRAGO 3 screening criteria.

RECOMMENDATION:

OTSGlMEDCOM: Develop a standardized process to evaluate Soldiers evacuated from theater to detennine if they meet WTU entrance criteria.

OBSERVATlON 1.7: Most WTU cadres are concerned with Inconsistencies in determining the Medical Retention Decision Point (MRDP).

RECOMMENDATIONS:

a.OTSGIMEDCOM: Redefine the MRDPto be m~re clear. concise and proscriptive; develop a standardized metric for assessing the MRDP; establish reporting requirements for Soldiers being treated for more than one year without reaching the MRDP. ·OTSG is currently staffing EXORD that establishes a MEB referral formal reporting system and a General Officer requirement to approve treatment plans for WTulcewru WTs with a length of stay greater than 12-months without MEB start date.

b. OTSGIMEDCOM: Develop and publish standardized elective procedure/surgery policy.

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c.OTSG/MEDCOM: Develop and pubfish ,policy regarding treatm.ent of additional medical conditions subs$quent to admittance Into the Warrior Care and Transition Program (WCTP).

OBSERVATION 1.8: Selection of WTU Cadre shifted from "best qualified" to "good. and first available."

RECOMMENDATIONS:

a. ASA{M&RA)lG1, ICW OTSG/MEDCOM: Add WTU Cadre eligibility requirements to AR 614-200, Enlisted Assignment and Utilization Management; AR 614-100. Officer Assignment POlicies. Details. and Transfers. .

b. ASA(M&RA)lG1: Implement a selection process for WTU cadre commensurate with other Special Duty assignments (Recruiter, Drill Sergeant) for all COMPOs.

OBSERVATION 1.9: The current Warrior Transition Unit (WTU) classroom-centric and theory-based Instruction does not adequately prepare the cadre to perform their duties.

RECOMMENDATIONS:

a. OTSGIMEDCOM: Implement training for cadre that is scenario-based; deals with behavioral health Issues; side effects of prescription medications and includes sensitivity training.

b. OTSGIMEDCOM: Require cadre training prior to assignment to WTU and implement sustainment training. Consider use of computer based training for cadre sustainment training.

c. OTSGIMEDCOM: Require WTU Primary Care Managers to attend cadre training within 3Q days of assignment.

d. OTSGIMEDCOM: Provide a leader's guide to address Warrior in Transition processes and policies.

OBSERVATION 1.10: MostWTUs visited are not meeting the Intent and implementation of the Comprehensive Transition Plan (CTP).

RECOMMENDATION:

OTSGIMEDCOM: Provi~e policy and guidance to support automated CTP and enforce/re-enforce the Implementation and execution. WTU started implementation of the automated CTP and have over 6000 WTs In the program with plan to have all WTs in the automated program in the next six months.

OBSERVATION 1.11: Most Warrior Transition Units (WTU) have not implemented the Transition Review Board (TRB).

RECOMMENDATIONS:

a. OTSG/MEDCOM: Enforce the implementation of the TRB and consider conducting the TRB for every WT at each 180 day period.

b. OTSG/MEDCOM: ICW ASA(M&RA)lG1, establish reporting requirements of TRB resufts.

c. OTSGiMEDCOM: .Assess· the feasibility of combining the TRB and the CT?

OBSERVATION 1.12: Army-wide specialty care shortages exist in Behavioral Hearth, Occupational Therapy. and Physical Therapy and contribute to delays In Soldiers treatment and healing.

RECOMMENDATIONS:

a. Army G3/SI7: ICW OTSGIMEDCOM, validate manpower requirements criteria for healthcare services.personnel.

b. ASA(M&RA)lG1: lew G3I5f1, and OTSGIMEDCOM review "rOA structure/staffing requirements for the specialty care providers (BH. OT, PT) and develop staffing actions to address shortages.

c. ASA {M&RA)lG~: ICW G3/S17, and OTSG/MEDCOM, confirm salary competitiveness amongbehavforar specialists.

OBSERVATION 1'.13: Army is failing to properly document Line of Duty (LOD) investigations for Reserve Component Soldiers - critical to the follow-on care and transition for the RC Soldier.

RECOMMENDATIONS:

a. ASA{M&RA)lG1: Publish message to commanders emphasizing required completlon.of LOD for RC Soldiers prior to REFRAD.

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b. ASA(M&RA)/G1: ICW ARNG, OCAR and TJAG, ensure education and training tools for LOD administrators are available to units prior to and during deployment.

c. ASA(M&RA)/G1: Determine feasibility of presumptive LOD for RC Soldiers on Title 10 active duty orders in 'support of Contingency Operations.

d. OTSGIMEDCOM: Adopt LOD module in MODS as the Anny's dedicated line of duty tracking system.

OBSERVAnON 1.14: Perception that Warnors In Transition are not held to same

standards ofdiscipline as required of other Soldiers.

RECOMMENDATIONS:

a. OTSGIMEDCOM: ICW TJAG. Emphasize the importance of maintaining good order and discipline and ensure WTs are herd to the Army standards of discipline.

b.OTSGIMEDCOM: Implement cadre training that Is scenario-based; deals with behavioral health issues and includes side effects of commonly prescribed prescription medications.

. OBJECnVE 2: Assess Warrior Care and Transition support systems for Soldiers and Family members

OBSERVATION 2.1: Soldier and Family Assistance Centers (SFAC) are underutilized; however they provide Warnors in Transition (WTs) with a level of personal service and an environment conducive to their medical and transitional needs. Most SFACs encounternear-tenn resource challenges (facilities. funding. and staffing).

RECOMMENDATIONS:

a. IMCOM: Conduct cost-benefltana/ysls to detennlne if SFAC services can be made available to all Soldiers in the MEB process.

"

, b. IMCOM ICW OTSGlMEDCOM and ASA(FM&C): Ensure resources are provided for year of execution policy requirements (zero sum game).

OBSERVATION 2.2: Providing services for COMPO 213 Warriors in Transition (WT)

and. Families is challenging due to the dispersion of state resources.

RECOMMENDATION:

OTSG/MEDCOM and ASA {M&RA)/G1, ICW IMCOM, ARNG, OCAR, and Army PAD: Establish a steering committee to detennlne most effective methods to deliver Information and servloo$ to COMPO 213 WTs and Families.

OBSERVATION 2.3: Communities outside the gate are beginning·to selectively support only combat-wounded WTs with incentives resulting in non-standardized practices across installations.

RECOMMENDATIONS:

a. OTSG/MEDCOM: Determine messages and strategies to educate the Army and public on the Warrior Care and Transition Program. .

b. OTSG/MEDCOM: Establish policy standardizing acceptance of community Incentives.

OBJECTIVE 3: Assess tools and processes implement~d by Commanders to manage Soldiers who are "Medically Not Ready"

OBSERVATION 3.1: The Army does not use common.terms of reference to aCcurately determine status of "medically not ready,II "medically non-deployable and "not available" Soldiers.

RECOMMENDATION:

OTSG/MEDCO~. ASA(M&RA)/G1, G3/517. ICW FORSCOM: Standardize termin

OBSERVATION 3~3: Army medical capabilities do not support the needs of the Medical Not ~eady (MNR)lMedical Non-Deployable (MND) in units.

RECOMMENDATIONS:

a. OTSGlMEDCOM, ASA(M&RA)lG 1 , and OCAR: Conduct feasibility assessment to determine requirements and implementation strategies for a temporary increase in medical assets to mitigate current limitations.

b. OTSGIMEDCOM: Establish Installation Medical Management Center (IMMC) pilot site for a next deplOying RC brigade to assist in managing MNRlMND Soldiers. The Integrated Disability !Evaluation System, currently in pilot program phase, may

enhance visibility of the system for·the Soldier,the Army, and the Veterans

Administration.

OBSERVATION 3.4: Current medical. priorities do not assist commanders in maintaining a fit fighting force that is medically ready to deploy.

RECOMMENDATION:

OTSGlMEDCOM, ASA(M&RA)lG1, and G3I517: Conduct a comprehensive MNRlMND support needs study to determine If medical priorities are correctly synchronized and applied. Installation Medical Management Centers, recently instituted by the Army, may assist commanders in managing their MNRlMND Soldiers.

OBSERVATION 3.5: Leaders are concerned about Soldiers that PCS with known or unknown medical issues, particularty behavioral heatth issues (Traumatic Brain Injury and Post-Traumatic Stress Disorder).

RECOMMENDATION:

ASA(M&RA)/G1, ICW OTSG/MEDCOM, FORSCOM, TRADOC: Enforce compliance

with AR40-501 11-48 (3) updating of MEDPROS; commanders must emphasize

medical In-processing to capture profile limitations and acknowledge Soldiers' recent

past deployment hiStory.

OBSERVAnON 3.6: Soldiers in the MEBIPEB process that are not assigned to a WTU are dIsadvantaged from a lack of information, lOwer priority in access to care, and length of MEB/PEB process.

.. RECOMMENDATIONS:

a.IMCOM: Conduct cost-benefit analysis to detennine if SFAC services should be available·to all Soldiers in the MEB process.

b. OTSGlMEDCOM: Make all MEa Soldiers same priority in access to care as WTs.

c. OTSGIMEDCOM: Clarify the Medical Retention Decision Point (MRDP) in order to enable the MEBIPEB process to begin sooner. Installation Medica/Management Centers, rer;ently instituted by the Army, will assist in providing information to MNRlMND Soldiers undergoing the MEBIPEB process.

OBSERVATION 3~7: IRR Soldiers are often not identified as non-deployable until they reach a mobilization pJatfonn, approximately 42 days or more ~fterrecalled to active duty.

RECOMMENDATION:

ASA(M&RA)/G1, HRC, ICW ARNG and OCAR: Ensure that IRR Soldiers receive a theater-specific SRP within 25 days of mobilization, prior to attending WIT, MOS training. and assignment to a deploying unit.

OTHER MAnERS:

OBSERVATION 1: Leaders, health care professionals. and Soldiers stated that MEB/PEB inefficiencies affect the Army's ability to meet the needs of Soldiers and the Army in a timely manner.

RECOMMENDATIONS:

a~ OTSG/MEDCOM: Continue implementation of reoommendations provided by GEN(R) Franks' Task Force.

b. OTSG/MEDCOM: Develop and publish standardized .elective procedure/surgery policy.

c. OTSGIMEDCOM: .Re-evaluate MEB physician ratios and ensure local MTF recruits. hires, and trains new PEBLOs to meet requirements.

d. OTSG/MEDCOM: Determine the laws that need to be changed in order to expedite . the MEB/PES processes and improve effICiencies between the Army and VA.

OBSERVATION 2: limited and/or no InteroperabiJitybetween DoD (AHLTA), VA (VISTA). TRICARE network, and civilian provider infonnation systems.

RECOMMENDATION:

OTSG/MEDCOM: .Improve the interoperability between DoD (AHLTA). VA (VISTA) and TRICARE network infonnation systems.

OBSERVATION 3: COMPO 213 are no longer a strat~ic reserve; current Army

resources appear to be insufficient to medically sustain RC in an operational

environment

RECOMMENDATIONS:

a. OTSGIMEDCOM and ASA(M&RA}/G1,ICW IMCOM, ARNG, and OCAR. and Army PAO: Establish a steering committee to conduct gap analysis and provide recommendations to addfl!ss RC medical care requirements as an operational force.

b. OTSGlMEDCOM ICW ASA(M&RA}/G1, G3/517. ARNG and aCAR: Resource annual medical screening for National Guard and Army Reserve Soldiers identified for deployment.

OBSERVATION 4: ·The majority of medical management staff have some level of concern for personal safety in managing increasing numbers-of Soldiers with behavioral health issues;

RECOMMENDATION:

IMCOIVI, ICW OTSGIMEDCOM, OPMG and USACE: Identify threats to personnel safety (facilities and operations) and implement safeguards as necessary, including awareness training.

OBSERVATION 5: Most healthcare providers Interviewed (Primary care Man~gers,

Nurse case Managers) estimate 25-35% of WTs are dependent on ot addicted to

drugs.

RECOMMENDATJONS:

a. OTSG/MEDCOM: Evaluate procedures for prescribing meetication and consider expansion of aHemative medicine programs.

b. OTSG/MEDCOM: Expand residential dependency/addiction programs. and pain management programs to M"rFs.

TASA·

FfNDINGS AND OBSERVATIONS

OBJECTIVE 1: AsSess implementation and oversight ofpolicies and procedures for the United States Army Warrior care and Transition Program

OBSERVAT10N 1.1: No synchronized source document outlining governing policies, guidance, and regulatory requirements

DISCUSSION: Most leaders (212 of 242) interviewed stated inconsIstencies In policies, guidance, and regulations and a lack of a single synchronized document create challenges in command an~ control and medical management in the Warrior Transition Units (WTUs). These leaders opined that a single source document would shorten the amount of time spent researching information on a daily basis and enhance unit efficiency.

Beginning with Department of the Anny Execution Order (EXORD) 118-07. "Healing Warriors,- with four Fragmentary Orders (FRAGOs), continlling with the Medical Command (MEDCOM) Operation Order (OPORD) 07-55 (MEDCOM Implementation of the Anny Medical Action Plan (AMAP») and its 46 FRAGOs, a plethora of All Army Activity (ALARACn messages, MEDCOM memorandums and poliCies, and Army installation specific memorandums. the inspection team .found over 109 different documents that leaders must use to manage WTUs. Below is the MEDCOM Warrior Care and Transition Consolidated Reference list.

Orders Publish Dale

~nmce'SubJec:ts

AJ.ARACT 135-2007 14-Jun-G7 Initial Personnel Policy Guidance for Assignment and Attachment to Warrior Transition Unl1s (WTU)

Al.ARACT 138-2007 15oJun-D7 Documentlng Blast ExposurellnJury In Theater Medical Records

ALARACT 139-2007 1s.Jun-D7 Applicable Processing ProcedUA!S for Military Orders Pertaining to Soldiers In a Palent Status WhO are Moved from Theater

ALARACT 141-2007 21.Jun-D7 ............. lnT - Family Escorts ALARACT 153-2007 11.Ju~ Announcement of Army.Mlld Traumatic Brain Injury (MTBI) /Post traumatic

StA!Ss DhIorder (PTSD) Awareness and Response Program

ALARACT 160-2007 1s.Jul-07 Interim Guidance· Army Mnd Traumatic BraIn Injury (MTBI) /Post Traumauc Stress Disorder (PTSD) Awareness and Response Program

ALARACT 172·2007 6-Aug-07 Transition Lea¥e ProcelSlna for AcIIYe Component (AC) (Medical Hold) and MoblllDd and Reserw Component (Re) (Medical HoldoVer)

ALARACT 175-2007 8-Aug.47 Commander NotifIca!lon of ArrIval and Departura of Medically Evacuated WantOl'8

A1N:tACT 185-2007 Z2·Aug..01 Transition Leave Processing for AdJw Component (AC) (Medical Hold) and Mobilized and Rase",. Component (RC) "Medical Holdover)

AI. 4R.lar.T 18i-2007 23-Aug-07 Unlfonn Wear Policy Changes for Soldiers Assigned to the warrtor Transition UnIt(WTU)

N.NW:fl......m ~/ ........... .......,.''''DIcabI.ty Al..ARACT 21J.2007 . Y Medical ActIon Plan (AJIMP) Aueasment ConfweI'Ica

ALARACT 228-2007 17.oct-C17 ubml8lllion of ReqUQts for Asslatancel Augmentation (RFAs)

fOR OFfiCIAL USE ONLY This dOCtlment contains llifolillation DissemlAatien is pmhlbitee ~MPf FROM ~1ANDATORY eMept as a.aFized by AR 20 1. DISaoOSUm: ulld. the FOIA ExemptiCll'l5.

ALARACT .......' ALARACT 0

,_ .4-Jan.oa

Combat - Retalad Injury Re~lItalion Pay (CIP) Policy Account ctasslflC2tlona for RC Ordens

ALARACT PRlC8durai Change for Tfl!II)Sfer of Health Recorda of Transitionlng Soldiers to VA

ALARACT 182-2008 2a.Jan-Ga Inspeclion of Military FaclllUes to House Recovering ServIce Members Assigned to Warrior Transition Units

AI..ARACT 205-2001 21-Aug.08 Retention·Beyond Scheduled Release or Discharge D_ Due to Medical Reasons for Sotcfl8l'S Assigned or AttacIIed to a WTU

ALARACT 224-2001 15-SelM'8 Implementation Guidance on the Anny Wounded Warrior Clothlng Support Program (wwcsPI

At.ARACT 295-2008 9-Dec-Oa MOD 1 to ALARACT 182-2008; Inspection of_Military Facilities to House Re~rlnl Serrice Members Assgnd to wru

ALARACT 006-2009

-

Wan-09 Policies and ProceduteS for the Handling of Personal Effects for Medically Evacuated Soldlens

ALARACT 022-Z009 23-Jan-09 Pay and Allowances Continuation Program (PAC)

ALARACT 068-2009 12-Mar~' Pay an!! Allowances Continuation Program (PAC) Corrections

MEDCOIVI MEMO 15.Jun.07 Im~~entation of Transition Policy for Wounded Warriors In Medical HoIdfHo1dOY8T and Their Families .

MEDCOMMEMO 21..Ju~7 FY 07 Training Guidance (Change 1)

MMEMO' Suicide Risk In Warrior Transition Unfts (WTU)5-SeJHJ7 COM MEMO 1a.oet~7 Suicide Screening In Warrior Transition Unfts (WTU)

MEDCOMMEMO 9-OctoOl Release of a Soldier's P~ HeaHh Infonnatlon to the Department of Veterans Aff;drs mv& .'

MEDCOMMEMO Holiday Guidance for wantors In Transition (W1)19-NOY-07

MEDCOMMEMO FY 08 Training Guidance1-Dec-OT

IIIEDCOM MEMO 11.Jan-08 Movement of SoIdIenoln Transition between WTUs andW'TlnlCBHCOs

MEDCOM WT Comprehensive care Plan (CCP) Memo I PolicyIIIEDCOMw:MO 25-Jan-G8 Provides initial guidance to all RMCs In reference to processing Reenlistment Eligibility ProhlbllionCode (ERUP) 9H to 10

MEDCOMMEMO 4-Feb-08

MEDCOM/WTO 22-Apr-D8 CBHCO Ombudsman GuIdance MEMO MEDCOM/HRC Updated poru:y IRT Transition Training for Soldiers assigned to WlUs MEMO MEDC9MMEMO

28-Apr-08

2O.OctoOa Holiday Guidance for Warriors In Transition (W1) and Cadra

1SoOac>OBMEDCPII MEMO FY 09 MEOCOM Command Training Guidance

WCTOMEMO 13-Nov-08 Support to Ute Amly Wounded Wantor Program (AM) Recovery Care CoordInation (RCC) Plan Implementation

MEOCOM Policy 5-Feb-07 IIEDCOM Conference Planning Guidance 0704104 MEDCOM Policy 3O-May-07 MEDCOM Military Treatment Facility (!\IfF) Access Standards for ActIve Duty

Services Members '01~7 MEDCOM Policy 24.JuJ.07 Ph)Slcal Evaluation Board Ualson Officer (PEBlO) Training and CertiflCation 07-021 BIEDCOM Policy 1~Aug.07 Ccmmander"8 CritIcaIlnfonnation RequlnJmenl$ (CCIR) 07.033 MEDCOM Policy 23-Aug-07 Escorts for Non-MedlcaJ careg1Yer8 and Families Traveling on Official Ordeno 07-1136 MEDCOM Policy 6-Sep-07 Ombudsman Program In Support ofWarriors In Transition (WT) 01-1136

FOR OFFICIAL USE ONLY This doaiment contains information Dissemination Is ~hlblt9d BEEMPT FROM MANDATORY exeept as aulhsftzed by AR 20-1. DISCLOSURE I;;/i'leer the FOIA Exemptieft 6.

http:1~Aug.07http:24.JuJ.07http:15.Jun.07

MEDCOII Policy 01-040

26-Sep-01 . Metrics and Procedures for Improving Medical EvaJuation Board (MES) and Physfcal Evalu8llOn Soard (PEB) Pn:Icesslng

MEDeOM Pollqo 07-041

2Wep.07 Patient Movement from OUtsIde Continental United States (OCONUS) and Reception ofWantors In Transition to ContInental United States (CONUS) Military Treatment Facllrtles (MTfs)

MEDCOM Policy 01-003

250Mar.. Exemption for WTU tadre to PROAS and YEO AUG Assignmenl$

MEDCOM Policy 0U14

Ntay-OB Wi. Hlgb Risk Medication Review & the Scle Provider Prognun

, MEDCOM Policy 01J.418

14-May-OS Accountability I Management of WT. ReceIVIng tare at Remote Facilities

MEDCOM PoII,y 08-028

WuI-08 MEDCOM.Mmtary Treatment Facility (MTF) Acces8 Standards for ActIve Duty' Services Mambare

MEDCOM Policy 08-030

9-Jun-OB Transfer C'.If~"!~~ In Transition (WTs) Assigned to ~de~~nentatUnited S1atea (OCONUS) Wamor Transition Units (WTUs) to CONUS MUs

IIIEDCOM Policy 08-038

23-Aug..(18 I Warrior Transition Unit (WTU) Rlak Anesamant and Mitigation Policy

MEDCOM PoDey 0g..11

1o.Mar-D9 Comprehensive Transition Plan (CTP) Polley

HQDA EXORD 051· 07

. 19-1111ar-07 ISO CSA Wounded Soldier Family Hotline

HQDAEXORD11IJ. 07

2..Jun-01 Healing Warriors

FRAG01 to HQDA EXORD.118-07

11-Aug-07 Healing Warriors

FRAOO 2 to HQDA EXORD 118-07

14-Dec-07 Healing Wamonl

. FRAGa 3 to HQDA EXORD 118-01

'1..JuJ.08 Healing Warriors

FRAGa 4 to HQDA EXORD 118-07

19-May.09 W1V Transition Review Board

OPORD09-22 27..JM-09 . Sulcfda and Accidental Death tnlerventlon-USAMEDCOM

OPORD09-12 15-Dec..(18 Virtual Family RaadII1QS Grvup (vFRG)

OPORD08-21 7.feb-Ol MEDCOM Soldler Transfer & Regulating Tracking Centll'

OPORDUT·55

~: MEDCOM lmpIamentation of the Army MedIcal ActIon Plan (MAP)

Annu A OPORD 07-55

Medical Hold &Medical Holdover Consolidation

Annex B OPORD 07-55

s-Jun.07 W1V Staffing

Annex C OPORD 07-55

5.Jun.07 Operatlonal capability BenctunarkB

Annex D OPORD 07-55

I 5-Jun.07 GIossaryJ

Annex E OPORD . 07-55

5-Jun-OJ nrnellnal Calendar

Annex F OPORe . 07-55

5-Jun-07 WT\I CDRI CSM/1SG OrIentation Schedule

Annex G OPORD 07-55

5-Jun-07 Quick Wins

-Annex H OPORD 07-55

s..tun47 Reports

Annex I OPORD 07· 55

5..Jun-07 RlHaslgnment or: Attachment of SoIdlens to the Wantor Transition Unit (W1V

MnuJOPORD OT-55

6oJUn-07 PatIent Admlnfstratlron

FOR OFFICiAl USE ONLY Thi' document eonfains irTfoIl1lation Dissemination is prohibited SEEMFT FROM MANDATORY exeept as all1herized by AR 20-1. DISClOSURE tinder the FOIA Exemplicn 5.

A-3

Annex K OPORO 5-Jurt007 Wanlor In Transition Program Standards 07-55 Annex L OPORD. 5-Jun-Q7 Strategic Communications Plan 01·55

Annex III OPORD 15-Jun-07 Facilltiel

07·55

Annex N OPORD 15-Jun-07 Establishing Community Based Health Care Organization - Puerto Rico ICBHCO OT-55 .~ '.

.Annex 0 OPORD 15-Jun-07 Access to.the MODS Warrior Transition and Soldier Patient Tracking

07-55. AppDcatlons

i Annex P OPORD 15-Jun-07 Memorandum of Agreement (MOA) Between HQDA, InstaJlation Management . 07-55 Command ("COM) and USAMEDCOM Concemlnll Com",and & Contnll of

Warrior Transition Units (WTU) and Medical Retention Processing Units (MRPU)

Annex Q OPORD 2.Ju1-07 Ombudsmen 07·55

1Q.JuJ.07Annex R OPORO Staff Assistance Visits 07-15 Annex S OPORD 5-Nov-07 Resource Management

07·55

Annex T OPORD 1-Feb-08 WTU Training Requlntmen1S 07-55

FRAGa 1 OPORD USAMEDCOIVI conducts an assessment as to RMCs wlll meet the required

07-55

&oJun-07 suspense dates

FRAGa 2 OPORD 15-Jun-07 ProvIdu updated Information ntganfing MyIVIEB and SFACs

07-55

Add an additional specffted task to NARMC

Add two edditlonaispecHledta8ks to SERMC ",

Add three additional tasks to aU RMCs

Provides updated WIIb links for several WTU-related. handbook templates and the latest edition of MEDCOM NOW

Provides factlitieH9lated guidance to the RIIICs Provides guidance and reporting requirement for MODS·WT and Soldier Patient Tracking ProvkIea the MEDCOIVlIIMCOM Memorandum or Agreement regarding MHlMHO consolidation

FRAGa 3 OPORD Provides an upuate on WTU lOA

07-55

2-Jul.or

Provide. guidance In the design and processing or flags for wrus Add a spec:lfled task to AMEDDC&S ntgardlng a leadership study

Modify spedfied task to ERMC ntg1Irdlng SFAC Handbook

Modifyspecified tasks to GPRMC lIIod"1fy specified tasks to NARMC:

Modify specified tasks to PRMC

Modify epselfied tasks to SERMC Modify spec:lfied tasks to WRIIIC Modify specified task to AC5. Operations Add opacified tasks to ACS. HPU regarding standardized Triad training

Modify !i!pClCIfteCI tallm to ACS. HR Add 8 specified task to AC$, IEFM regarding facility maintenance processes Add a specified task to DlR, PASoE f8IJlIIrd'lng WT surges

FOR OFFICiAl USE ONLY This document contaiIlS InfOrmation Oissemiftatiools prohibited EXEMPT FROM MANDAToRY except as etRheri!ed by Nt 2Q 1. DISClOSURE under the FOIA EKempIiOft-&

http:2-Jul.orhttp:1Q.JuJ.07

Modify specified tasks to Wanior TIillISH:Ion Oftice {formerly MHO

Modify coordinating Instructions to ERI\IIC, GPRMC, HARMC, PRMC, SERMC, and WRMC

1o.JuI'()7FRAGa 4 OPORD Provides guidance on AMAP.,.lated staff _Istance visits, which will occur

07-55 throughout Phase III, beginning with a Beta assistance vISIt from 24-28 JUL 07 at

Walter Reed Army Medica! Center and lroob Army Medical Center

24-JuI'()7FRAGa Ii OPORD Provides "UPDATE" guidance on MAP·refated staff uslsta.nce visits, whh:h will 07-55 occur throughout Phase m. beginnIng' wfth a Bata uslstanca visit from 24-21

JUL 07 at Walter Reed Army Medical Center and Brooke Army Medical Center

FRAGO 15 OPORD 2T.Jul-07 Add appl"CMld WT mission statament by the Secretary of the Army 07·55

Provides updated guidance to tha gap a.naIysls I personnal report In order to streamline and standardize personnel reporting

FRAGa., OPORD 31-Ju1.Q7 Provide updated guidance to mTBIIPTSD training for Nrny Aetlve Duty and 07-55 ReaerveSoc11l Workers, Nurse Case. Managara, PsyI:hlatl1c Nurses, and .

Pay.:hlatrlc Nurse Practitioners who are not PT$D trained

Cbanga updated mTB~D guidance and requirement to all MSCS In order to report statu8 ofmTBIIPTSD training

Add updated guldm:'ce and requirement to all RMCs In order to report status on phase I metrlce

3-Aug.07 Provides additional guidance to RMCs integrating Anny National Guard Medical 07·55 FRAGO 8 OPORD

LNOa Into thalr respective MecflCal Treatment FacDItIe8 ProvideS updated guidance on AMAP.,.lated _ assistance visits. which win occur throughOut Phase DI, beginning with a Beta asaIlIance visit from 24-21 JUL 07 at W'aItGr Reed Army Medical Canter and Brooke Anny Medical Center

Provides updated guidance to rating color (Green, Amber, Red) definition I crtterla for the MAP Tracker

ProvIdea upc:lated guidance to all RM~ ordering procechns forWTU Rags and' 07-55 FRAGO 9 OPORD 13-Aug.07

Guidons Provides initial guidance to NARMC and SEAMC to support a Visit offhe Warrior Transition activities at Fort Benning and Fort KnCIX by e program analyst from

I the OIftco of Budget &l8anagamant COMB), Vaterana.AffaIIS & Deftnse Health In order to ensure that Army health care ac:ttvIty requIrementS 111'9 matched against the PresIdent's naIIonai dllfunse budget requirements

Provides updated guidance to the gap analysis I personnel report In order to streamline and standilU'Cllu personnel reporting

. ProvidM updated guidance and requirement to a" RMCs and staff In order to report status on phase I metrfca

Pl"OYid89 initial guidance to an R,MCs on asslgnlnent criteria to sarva as a gUide for the ..Ignmant manage.. that select the Soldler8, regardless of component or corps, to aerve as wru cadre Provides updated guidance to all RMCs on weekly OmbudsmenlPatI8nt Advocate WT ~ SPT access status

14-Aug.07'FRAG010 OPORD Provides updated guidance to NARMC and SI:RMC to support a visit of the 07·55 Warrior Transition activities at Fort Benning and Fort KnCIX by a program analyst

from the OfI'ice of Budget & lIIanalJemant (OMB). Veterans AffaI.. & Defense Health In order to ensure that Army health care activity requirements are matched against the Prasldent'a national defense bl.lclgat, requirements. Due to other obllgatfons, the program analylt from OMI wfll not be able to visit Fort Banning and Fort Knox. Currently there Is no tantatfva re-scheduled visit date planned

Pl"OYides updated guidance to MEl Status Report requlramants .

FOR OFFICIAL USE ONLY This dOCUlliellt co-utah is ilifollilation ' OieeemiAatien Is pmhiblteEi EXEMPT FROM MANDATORY . 8)(f38I't as authedzed by AR 20 1. DISClOSURE under the FOIA Exemptioo 6.

http:14-Aug.07http:13-Aug.07http:3-Aug.07http:31-Ju1.Q7

FRAGa 11 OPORD 07-55

Z30Au9'

ProvIdes InHJai gultlance and requirement to aD RMCs In reference to havlng MTf WTU Case Manage... aasIat USMC Wounded Wantons. tracking In MeanT to acquire Defense Knowledge Online accounts 80 that the Martne can view hlsfher MyMEBpage

Provides updated guidanca to all RMCs on Warrior in Transition definition change and wre assigned as duty drtvara I cadre (Annex I(Re-assignment or Attachment ofSoldiers to the Warrior Transition· Unit (WIU). Provides initial guidance to all RMCa In reference to the Warrior Transition Office hosting·. Case Manager OrIentation and Training Conference at Walter Reed

FRAGO 18 OPORD ONi5

28-Sep-07 Provides updated guidance to all RMCs in refw8nce to the Wantor Transition Offlce hosting a case Manager Orientation and Training Conference at Walter Reed

Provides Initial guidance to all RMCa on COMPO accuracy to ensure that all COMPOs ant staffed with the equlVBIent COMPO as stned In the DA G-3 appl'OVlld TDA

Provides InWai guidance to aU RMCa In reference to the .WarrIor Transition OffIce launching a new website on AKO for MCa to tile best practices, local peDcy and procedures, and standardized local forms

Provides initial guidance to HP&S and Reserve AffaIre in reference to conducting analysis Of all celRs regarding lata notlfIcatJon (beyond 24 hours) to Main Body and Rear Detachment Commanders upon arrival and departure ofWTs to MTFs lAW ALARACT 17512007

Provides InWai guidance to HPU In refurence to updating OTSGJMEOCOM Policy Memorandum os.G15, Release of Protected Health hlfonilatlon (PHI) to WTU Commands

Provides lnltJal gufdance to HP&S In mwence to updating Annex I to MEDCOM OPORD07-55 ProvIdes Initial guidance to·a11 RMCs In order to direct W1Us ~ Issue WT mls&ianlchaln of command contact Information cards to WTs

~des initial guidance to all DCs In reference to submitting wru HOWling Inspection Report and Medical FKIIIUes ~.nt Report to MEDCOM ACSIEFM

FRAGO 17 OPORD. 07.s5

15-Oc:l-tJ7

I

Prvvfdes updated guidance to all RMCs In ntferenee to requirement to submit a Commander's Crftlcallnformation Requirement (CClR) when a Medical TreatmentFacllIly (MTF) falls to notIfydeployvd and rear detachment commanders for all arriving and departing Wantore In Transition

, ..

Provides updated guidance to all RIIICs on MTFs providing current wru cadre rosters to U1e Warrior Transition OftIce

Provides ~pdated guidance to Ifl RMCs in order to directWTUs to Issue wr mission I chain of command contact Information cards to WTe

Pn:wJdes.lnltlal guidance to all RMCs In order to direct WT\Js to standardize cadre I unit voice mall greeting me8118g9S on all official mRltary phone answertng machJnn and govemment ceD phones I blackberries voice man

Provides updated guidance and requirement to all Mes In order to report added taskS to the MAP Tracker Report

ProvIdeS updated guidance to all RMCs on asslgntng WTs as duty drivers I cadre

Provides InWaI guidance to all RMCs In reference to revlewtng the attached document tltJecI."Lesaons L.aarned"

FRAGO 18 OPORD 07

Provides updated dinK:tlon to all RMCs and MTFa to conduct 100% baseline medication review and reconciliation

Provides updated guidance to an RMCs In order to direct the conduct of Suicide Risk Asnssments Provides Initial guIdance to all RMCs In order to direct WTUs to conduct wr ac:covntabillty

Provides Initial guidance to all RMCs In order to,direct WTUs to ensure that WTa complywittl the Anny Urinalysis Program

Provides Initi.aI guidance to all RMCsin order to direct WTUs to provide emergency contact information to the wr FamiDes. ProvIdes Initial guidance to all RMCs in order to GnSUn1I that WTU cadre mambena have proper leadership and communicative aldlls to lead the WTs

ProvIde. Initial guidance to all RIIC. In order to ensure the Intltgration of all specialty care, to Include medication and prafile reconciliation

ProvIdes Inlttalguldanclt to all RMCs In order to dIrect WTU commande.,. to property align teSOUn:8S and report shortfalls

FRAGO19 OPORD

J5-Nov-01

07-55 ProvIdes updated guldance and requirement to all RMCs and staff In order to report status on phase 1, II. 10, & IV matrlcs

Provl~ updated mlBlIPlSD guidance and requirement to an MlCs in order to report status of mTBIIPlSD training ProvIdes updated guidance, to all DCs, In order to decrease rvport requirement tasb to the AMN" Tracker Report

ProvIdes updated guidance to NARMC and ERMC on AMN"-reIa1ed statf assistance visits

, Provides initial guldance~ to all RMC., In order to ensure the Integratton of Resource ManagementAnnu

ProvIdes updatad guidance and requirement, to all RMcs. In nrlerence to having MTF PAD as&ist USIIIC Wounded Wanion; tracking in MEBnT. to acquire Defense KnDWIedge Online Kcounts 80 that the Marine can view llelr My Mea page

Provtdes upcialadguldance and requirement, to all RIIC.;ln order to report Intemal SAY comPliance and findings , Provtdes Inltta! guidance, to aD RMCs, in order to ensure Ihafsubordlnate MTFelWTUs are provtdlng escorts for wr. during In-processIng and out-processing

Provtdes Initial guidance to all RMCs for the issue of a government IMPAC Credit card to the WTUs

. Provides Initial guidance, to all RIIIICs. In order to direct currently assigned WTU personnel (Squad Leaders, Platoon Sergeants, Nurse Case Managers and Primary Care Managers) to complete ATTRS courses BE.f2, 61·f7300.FS5, and.6J. Ft3tJ0.F34I ~:'I:ltiaI guidance, to all RMC.,ln order to direct WTU Commanders to

an office call with their respective Senior Mission Commander

Provtdes InlUaI guidance. to an RMCs, in order to direct W1U Commanders to schedult? 1111 offIclat office call with their atata'u Veterane AffaIrs OffIcer

Provides InitIalguldattce, to all RMCs. In order to direct WTU Commande,. and CBHCOa to coordinate for sensftfYity training for WTU & CBHCO Cadre

ProvtdeS initial guidance, to all RMCs.I,n ordar to ensure MTFs validate that . Ombudsmen posters are posted In WTU area and MT:Fs and Ombudsmen bualnlSS cards are giftn to IMIry Incoming WT and family member

Provtdes lniUal guidance, to an RMCs,In Order to submit foIIOW'oup actions taken In (\'Isponae to the AMAP SAY. '.

FOR OFFICIAL USE ONLY This documellt contains infomation 9issemiAatien is prehibiteEi EXEMPT FROM MANDATORY exeept as al:ltheFlzed by AR 20 1. DISCLOSURE tinder ttle FOil. exemption 5.

A-8

FRAGO 20 OPORD 01-55

15-Nov-01 Provides Initial guldanca and requirements to an RMCs in order to SUpport the upcoming Warriors In Transition leadership and Training Conference

fRAGO 21 OPORD 07~55

~Dec-07 Provides Initialgufcfance to AMEDDC&S In order to provide asslstance to Behavioral Health in utiflzlng I tailoring the ProVider ReslUency Training (PRl) plan In order to support the Army Medical Action Plan (AMAP~ phaS81D task "Aaaes. Provider Fatigue"

Provides updated guidance to all RMCs, in order to traek mTBIIPTSD training for Army ActIve Duty and Raserve Social Workers, Psychlatrfc Nurses. and Psychlatrfc Nurse Practitioners who are not PTSD traIned

Provides updated guidance and requirement to all RIIIICa, in order to raport status on phase I. If, III. & IV matrics

ProvIdes updated guidance, to all RMes. In order to direct curreRUy assigned WIU personnel (Squad leaders, PlatoGn Sergeants, Nurse case Managers, and PrImary Care Managers) to complete ATTRS coursas BE-F2, 6J.f7300.F35, and 61F8301I-F34

. ProvIdaalnltlaJ guIdance, to all MCs, In order to ensure ihe Wamors In Transition Units (WTU) execute Personnel Accounting and Strength Reporting (PAl) (foeusing only on WTU Cadre and warriors In TranaHion (WT)) lAW AR SODU

Prvvtdes Initial guidance, to all RMCs, In order to ensure the Wantors In Transition Unlts(WTU) 4p[ecute Personnel Accounting and Strength Reporting (PAl) (focusing only on WTU Cadre and Warriors in Transition (WT) lAW AR SODU

FRAGO 22 OPORD 01-55

12-Dee-07 Provides updated guidance to all RMCs In order to report status on phase I, II, III, &lVmetrlcs

(

Provides Initial guidance to all AMCs In order to report comp!lance with the Holiday Guidance memorandum for warriors In Transi1lon(W1)

PrvvIde Inlt/alguidance to all RYe-In order to report Quartel1)' Training Brief (QlB) dates for all Warriors In Transition Units (W1'U)

FRAGO 23 OPORD 07·55

1Nan-08 ProvIdes initial guidance to GPRMCr NARMCr SERMC, and WRMC in order to conduct mission anatysIs to bring the CaHCOs located In their ruglons under C2 of cfosest wru commander In on:Ierto centrallzit C2.

Providea Initial guidance to AIVIEDDC&8ln order to dewlap tndnIng content fOr the Wantor In TnmsItIon concept for TRADOC to Integrate Into existing TRADOC leader clevefopment courses.

ProvIde8 Initial guidance to HP&S In order to c:onduct a pilot program utilizing existing technology to automata the ph)'Sicalprofile system In conjunction with G1. US Army Resel'V9, and ARMG.

ProvIcIes Inltlal ~!",ce to. HP&S In onIarto lItISIat the DA 61 wftb applyfng the Lean Six Sigma methodology to reduce the number of documents in the Medical Evaluation BoardII'hyslcal Evaluation Board process by 50 percent andIor establish these 88 a web-based process..

Provides Initial guidance to t:lP&8 In order to submit a rapid adIon ralllslon to AR 40-400 allowtng an MEB the authotfty to refer a service member to an ORB, If a sarvi!:e membar"s conditions ani detannlnad to be fit but the service member can no lOnger perform duties ccmmen&UT'8lD with their IIOS functional aptitude. .

ProvIdes Initial gulcfance to HPas In order to establish policies and procedures for the dlMlJopment of aCOR1pn1henslve rehabilitation plans for all WTL ProvIdes Initial guidance to HP&S In order to dewlap and Issue guidance requiring MTF Commandere to llB8iat the Solcller's chain of command by provIcllna neceuary m8CllcallnpUt for the R18k Mitigation Matrix..

FOR OFFICIAL USE ONLY This ckx;umenteontains information Dlseeminalioo 1& pmhlbited EXEMPT FROM MANDATORY EmGept as el#lOl'ized by AR 20 1. I>ISGlOSURE !;lAd. the FO'" EMmptioo 6.

A-9

Provides Initial guidance to HPIS In ord~ to assess ifSoldiers within WfUs have a pen:eption of In~nslsteney In the application of Anny disability standards. , Provides initial guidance to IE&fM In order to assess all WT billets, housing and lodging, and wru unit 111'888 lAW DoD 'and Amry standards. Provides Initlal guidance to IE&FM in order to lead II quarterly MILCON synchtonizatlon meeting JCW IMCOM and Department of the Army GR.

Provides Initial guidance to RM In order to dewlop and submit a funding request for WTs to receive specialtY uniform Items. replacement uniform Items, and allaratlon of existing uniform items.

Provides Initial guidance to the WTO In order to develop and Implement battle hand OWl' procedUJ8S to be,ueculBd each time a member of the WT's Triad or the wr. PESLO changes. i Provides Initial guidance to the WTO In order to qtabR$h a policy mandating reautlt coordination between the Triad and PESLO staff •

. Provides Initial guldartce to the HP&S In order to ~blish a training and counseling program for WT Caraglvel8.

Provide updat ... guidance to all RMCs In order to re'port status on phase \, II, Uf, & IV metrtcs.

FRAGO 24 OPORD Provides updated guidance, to AMEDOC&S, In referilnca to the consolidated 07-55

1·Feb-08 guIdance on WTU trainlngdewloprnent and coordination

Provides Initial guidance, to Ac.S Operations" In order to support the Wamors In Transition Unit (W'1U) staff training ntqutrements

Provides updated guidance, to all RMCs, in order to direct newly assigned wru personnlJl to complete ArrRS course 61f8.300F36 cwru Staff Support Orientation CoImlG) ¥Ice 61F6-300F34 cwru SIafJ Support Courae). and 61F7300F35 (WTU SUpport Course) and on ACEP Mobile Training Team (MTT) and loeaJly pnwlded training

FRAGO 25 OPORD 5-FIb-OI Provides initial guidance to GPRMC In order to suppoft the pnot program, 01·55 Automate the lIIedical Evaluation Board (liES) Process at Brooke Army Medical

Center

Provides updated guidance to aD AMCs In order to report status on phase I, II, m. &lVmeb1cs

Prvvtdes initial guidance to all RMes In ordarto direct all MTFalWTUs to validate 100% WT penlOl'lai phone number, address. and Nqlln MODS

Provides initial guidance to an AMCs In onter to direct MTF Caraer Counselors f Reenlistment NCOB to Include the WTU staff and ¥ITs In their ~pa of ruponslbillty .

PrcMdes initial guidance to aURMCs In order to d"rrect MTFs (WTUs to ensure that PEBLOs are aligned with wr ptatoons within each WTUs

Provides initial guidance to all RMCs Commanders in order to direct MTF Conunande~ to Include the WTUs (battalIon and company) In their scope of safety. reaponalblllty (MTF Safety OffIcers)

Provides Initial guidance to all AMes In reference to Wl'Us submitting monthly USR reports

Pn:lYldaa initial guidance to all RI'o'ICs In reference to processing Reenlistment Englbillty Prohibition Code (ERUP) IH to 10

FRAGO 26 OPORD 12-feb-08 Provfdeslnitial guidance to all RIIICs In reference to the Warrior In Transition 01-55 (WTl P8n;0nneI/8'f training Confantnce

FOR OFRCfAl USE ONLY ThIs docttment contains infom mOil Dissemination is prehiblted aEMPTFROM MANDATORY eJleept as atrtttGl'imd by M 2Q 1. DISCLOSURE under the FOIA Exempticn 5.

A-10

Provides Initial to an RIle. In order to enhance the C8HCO access standards In the natworIt are 21181Jable to all WTs nIgIII"dIess of ph)'BJeai location

FRAGO 27 OPORD 07-55

16-Fel>08 Provided Initial guidance to all RMCs IRT unexpected deaths from accidental drug overdoses and sUicides In WTUs continue to rise with 11 such Incidents .Ince JUN 07. Tasked RIICs to report on 18 WTU Tasks (Findings from the Tiger Team

FRAGa 28 OPORD OHi!.!

s.Mar-08 ProvIdes updated guidance to,811 RIICs, on h Nurse CUe Managers ATlRS course 6E-F2 and on Army Center Enhanced PerfOnnance (ACEP) Mobile

, Tralnln~Team (MlT)

ProvIcses updated guidance to all RMca. in reference to ~ SICretaJy of the Army and Chief of StaR of the Army nteently dlreded • comprehensive study to determine rtstc. mitigation antfll8aOClated controls to stem the n88 In these deaths

ProvIdes InlUaI guidance to all RYCs. in order to submit Ionnal After ActIon Reports (AAR) when the Department of the Anny InspectorGeneral (DAIG) or inspection General (16, YIsHs a warrior In Transition Unit (WTU)

........... lnlUaI gulcSance to NARIIIC, SERMC.and GPRMC, In order to support a Department of the Army Manpower AnalysIs Team. which wlR validate standiu'ds currently used to determine W1lJ staffing rsqulrements,'wIth particular emphlsls on WT acuity IIMII and location

ProvIdes updated guldanc;e to all RIles. on the rsqulrwnent to sul?mlt a Commander's CritIcal Inklnnallon Requil1llnent (CCIR) when a Medical Treatment Facility (MTF) falls to notify deployed and 1'881' detact)ment commanders for all arriving and departing Warrlora IrI Transition

FRAGO 29 OPORD 07-55

14-Mar.08 ProvIdes updated guidance to NARMC In order to support. Depatment of the Anny Manpower Analysis Team, which wiD vandate standards currently used to c1etennlnl!lwnJ stalling raqulrements. with particular emphasis on WT acUity lewl and location.

ProvideS updated guidance to all RMC., In ontarto provide updated standards to the 8cc:e&8 to care

ProvIdes updated guidance to all RMCIIlnrvference to WJUIJ .ubmlttlng monthly USR reports

. Provides updated guidance to all RMCs, In order to submit formallUt2r ActIon Reports (AM) when the Department of Itte Army Inspector General (DArG) or Inspector General (IG) visits a Warrior In Transition Unlt(WTU)

Provides guidance to all RMCa,In reference to a dec:rease ofdocuments required fIom 32 to 19 for the submIasIon to the PEB, reformatting of the commander's letter, and the addition of the Commander's Performance and functional Statament •

PrcMdes updated guidance to all RMe., In reference to ellmlnalfng the requirement for PEBLOs to complete the distant learning orientation trainIng

FRAGO 30 OPORD , 07-55

. 28-Mar-08 . Provides updated guidance to GPRMC, NARMC, SERMC, and WRMC In order to conduct mlaalon analysis to bring the C8HCOs locat!td In their reglonll under the C2 of closest Wamor Transition Unit (WTU]commander In order to cenb'all:i:e C2

ProvIdea updated guicSance to all RMCs" In o~ to delete Itte report submlaslon requirement fotWamors In TransWon (WT) with und'rgraduateor graduate degraes In order to define tarpt.popuillfon In support of Army Inltiatfve , 5, which offens WTs the opportUnity to compata for gradumHeYe1 education scholarships and potential employment as faculty at Intermediate Level Education (ILE). military academies, Senior Service Collages (SsCa), and other· service schools

Provides updated guidance to an RIIICs, In reference to general order" 1 In support of the 18 quick wfns published In FRAGa %1

FOR OFFICIAL USE ONLY This docullient willalliS illfoml8tion OissemiAaticm is prohibited

. SEEMPT FROM MANDATORY elCeept as 8tJthoriEed by' AR 2()"1. OISGlOSURE tinder the FOIA Exemplion 5.

A-11

ProvIdes initial guidance to an RIlle., In reference to directing WTUs to review, distribute, 'and complywlth the uPdated Behavior Health care of Service lIIembers standing operating procedure (SOP). Social Work IlIIlsslon Statement. and White Paper

Provides Initial guidance to.a11 RMCs, In reference to dfrecting WTU& to submit Kn!en shots of all horne vruwn programs (determined by local WTU staff to be essential In managing WT) to the Warrior Trensltlon OffIce (WTO)

Provit.Iellnitial guidance to an RMCs, In order to determine dothlng modification requirements In support of WTs and estabnsll a supporting HQDA program for unifonn modlflcmtions

Pr0vide8 Initial guidance to all RIlle!, In refal'lnce to the upcamlng Warrior Transition Comprehensive Care Plan Workshop

Provides updated guidance to all RMCs, In reference to Guidelines for Eligibility. SeleCtion. and Acceptance Criteria for Referral to a WTU

FRAGO 31 OPORD 07-55

1o.Apr.oa . Provides initial guidance to GPRMC, NARMC. SERMC, and WRMCIn support of Human RQoIUC8S (HR) staff asalstanca yisrts In order to __ the effectiveness of 8ldstIn9 Hmnm Resource systems and provide training, guidance, and recommendations, for process Impl"lMll'/lents

ProvIdn updated guidance to all RMes, In order to delete the report submls$lon requirement for the AMAP Tra~r report

ProvIdes updated guidance to aD RIlICs In reference to MUs submltUng monthly USR reporta

ProvIdes initial guidance to all RMCs In reference to Special Duty Assignment Pay (SDAP) forWJU squad leaclere and platoon ~

FRAGO 320PORD 07·55

1~ay.08 Provide Initial guidance to AMEDDC&S In order to proYide assistance to Betiavloral Health (BH) In tile estabnshment vf a counseDng program In order to support the Army MedlcaI ActIon Plan (AMAP) phase IV task Establtsh a Training and Counseling Program for WarrIors In Transition (WI') careglve...

Provide updated guidance to all AMCs In order to raport status on phase I, II, m. &lVmetrics

Provide updated guidance to all RMCs in reference to WlUs submitting monthly Unit Status RsportB (USR) reports ProvIde Initial guidance to all RMCs in reference to the Human Resources Command (HRC) Memorandum, Revised Policy Regarding TransttlonTralnlng for Soidle... In WI'Us. dated 2t APR 08

FRAGO 33 OPORD 07-55

2O-Jun-08 Provides Initialguldance to NARMC In order to support addltlonal .. ___, requirement at Fort Drum MEDDAC In support of the Warrior In Transition Unit's mission

ProvIdes updat8d guiclanceto MEDCOM RM In order to support additional budget requirements at Fort Drum MEDDAC In support of the Warrior In Transition Unit's mission

FftIWO 34 OPOIW 07-55

27..Jun.Q8 ProvIdes Initial guidance to Army Medicel Department Center and School In support of the Provider ResIliency TreInlng Program.

Provides updated guidance to ACS, Operations In support of the ProvIder Resfliency Training Program

ProvIdes Inltlalguldanc:e to Health Policy and Services In support of the Provider ResfUency Training Program

P.l'O'IIIdes updil!lt8cl guidance to all RMCs In order to report status on phase I, II, III, aJVmetrtca

ProvIdes Initial guidance to all Rilles, In order to uecute SemI·Annual Training Brtefs to the MEDCOM Commander.

FOR OFFICIAL USE ONLY This dOCtllTlent colltains infel'l'fl8tion . 01ssemiAatisn 1& pl'9hlblted EXEMPT FROM MANDATORY exeept as euth8ftHd by AFt 29 1. OIS.GlOSURE ~nder the FOIA exemption 5.

A-12

ProvIda$ Initial guidance to aU RIles, In reference to wantor In Transition Units I

being authortzed to lssueBlackberrles to squad leader cadre In aupport of the WarTlor In Transition Unit's mlaalon

Provides Initial guidance to all RllCa. In rafentnce to the Implementation of the Provider Resmenc:y Training Program

Provfdes updated guidance to all RMCs, In orderto Implement the digital profile

FRAG035 07·55

ul-08 ProvIde updated guidance to all RMCs In reference to WTUs submitting monthly Unit Status Reports (USR} reports

Provide updated guidance to all RMCs, In.order to execute &emf-Annual Training Briefs to the MEDCOM Commander .

FRAGQ 36 OPORD 07-55

11..Ju1008 ..

Provide updated guidance and clarity to all RMCs on the optImaildantlflC8tion, screening. referral, and management of Wounded, ID, and Injured SoldlerL Warnor Transition Units (W1'U) are designed to meet the needs of Soldlens who were wounded, til or InJured In theater and/or require complex medk:al and case management through the Trtad of Care (primary care manager, nurse case manager, and squad leader).

Provide updated guidance to all RIICs on the requirements for ellby and exit of Warrlora In Transition (WT), ralnI'on:es cadre manning requirements and clarifies command and control.

Provides initial guidance toHeaJth Policy and Servtces In reference to developing a process to track permanent and te~raryprofiles.

Provides Initial guidance to Health Policy and Servtces In ref1mmce to Impn:Mng lhequality, validity, and rallab1lltyof Medlcal Evaluation Board IntomaJ Tracldng Tool data and developing 8 c:omputeriDd procen to forward Soldier signed MEB results.

ProvIcf~ Initial guidance to Human Resources In reference to streamline the reassignment Instructions/request for ardors process.

Provides initial guidance to Program Analysis and Evaluation In reference to dlrectfng Manpower Division to assist the DCS, G-315I1, In the davelopment of TDAs.

Provides initial guidance to the Ylanior Transition Office In rvfarence to prcMding command ..control and expeditious dl8pos1t1on ofWT SOldiers awaiting reassignment oraepandlon from the se!'¥lce.

Provides updated guidance to all RMCs on Wanior In Transition definition change.

ProvIdes Inldal guidance to all RIICs In reference to MTFsIWTUs coordlnatfng with Installation Senior Command.....

Provides initial guidance to all RMCs In reference to WTU requirements for the Pb)'SlcaI Disability Evaluation System Enhancement.

ProvIdes Initial guidance to all RAIIC. in refenmce to the establishment a MlC.

Provides Initial guidance to all RMCs In reference to UKutlng MEDCOI\IJ's standardized methods and tools for tracking WTU execution. Providea Initial guidance to all RMCa; In reference to Spac:ialDutyAsslgnment Pay.

FRAGO 37 OPORD 07-55

31..Jul-08 PnMdes initial guI~ to the MEDCOM Staff In support of the Warrior In Transition (WTU) Seml-Annual Training Brief (SATB) to the MEDCOII Commander. to Include the staft"a participation In both a staff rehearsal wtth the MEDCOII Chief ofStaff and the actual WTU SATB to the MEDCOM Commander.

FOR OFFIGtAL USE ONLY This document contains iliformation Dissemination is prohlbtted EXEMPT FROM MANDATORY e:xeept as atlthelii!ed by AR 20 1. DiSClOSURE tinder tfte FOIA Elcemplian 5.

A-13

Provides updated guIdance to all RMCs to raquest-reasslgnment for active component (AC) and Activa Guard and Reserve (AGR) Warriors In Transition

- (WT) classified 815 Retumed to Duty (RTD), to Include the publicatIon of an RTD Validallon Checldlst.

Provides updated guidance to all RMCs, In order to execute Semi·Annual Training Briefs to the MEDCOM Commander.

Provides initial guIdance to all RMCs to ensure WTUs use the ConsoUdaled RTD Submission Worksheet when submltllng requests for assignment Instructions (AI) to HRC.

FRAGO 38 OPORD 07-55

15-Sep-08 Provides Initial guidance to th9 MEDCOM Staff in support of the Warrior In Transition (WTU) Unit Status Report (USR) to the MEDCOM Commander, to Include the staffs participation In both a staff rehearsal with the MEDCOM Chief of Staff and Director, Wanfor Care and Transition OffIce (WCTO) and the actvaI USR brief to the MEDCOM Commander.

Provides updated guidance to all RUCs In order to report status on phase I, n, 01, .. IV metrlcs.

Provides updated guidance on required VA briefings 10 all WTs.

Provides Initial guidance to RMCs reference the wru Cadre Resident Course to be conduc:tad by the AMEDDC&S.

Provides updated guidance to all RMCs In reference to wru. submitting monthly Unit Status Reports (USR) and briefing the USR to the MEDCOM Commander

Provides updated guidance to all RMCs reference acronym change from Community Based Haalthcare Organization (CBHCO) to Community Based Wantor TransiUon Unit (CBWTU).

Provides updated guidance to all RMCa reference CBWTU referrals of WTs from Nebra&ka and Kansas

FRAGO 39 OPORD 07-55

31.()ct-Ga Provides initial guIdance to Health Policy and Services (HP&S) to provide Wli HeDP code stamps to MTFa, WTUa, end CBWTUa In support of the new TRlCARE enroOment requirements for Warriors In Transition (WT).

Provides updated guidance to all RMCs In order to report status on phase I, H, III, .. IVmatrlcs

ProYidea updated guidance to all RMCsln reference to the Implementation of the Provider Resiliency Training

Provides Initial guidance to RBIICs on the assignment and use of special Defense Enrollment ERglbility Reporting System (DEERS) enroRment codes known as Health Car. Dclllwry Program (HCDP) Plan Coveragecocfes In order to more effIclentry manage the WII population

Provides Initial guidance to AMes and Staff on the execution of Warrior Ca,. Month

FRAGa 40 OPORD 07·55

5-Nov-08 Provides updated guidance to RMCs on the Army Warrior Healthcare Covenant

FRAGO 41 OPORD 07·55

2D-Nov-08 Provides updated guidance to RMCs on the assJsJnment and use of special Defense Enrollment Eligibility Reporting System (DEERS) enrollment codes known as Health Cara Delivery Program (HCDP) Plan Coverage c:odea In order to more efficiently ~nage the Wounded iii and Injured (WD) population

ProvIdes Initial guidance loRMCs on the required support to the DOD directed, - Army Wounded wantOr Program (AW2) Recowry Care CoOrdination (RCC)

Prognun bnplementatlon plan.

FOR OFFICiAl USE ONLY This document contains Infonnaflon Dissemination Is prohibited DEEMPT FROM MANDATORY exeept as autherized by AR 20-1. DISCLOSURE tinder the FOIA Exemplen 5.

A-14'\

FRAGa 42 OPORD 07-55

. D..feb-09 Provide updated guidance to RMCs on the wru OIP, Including the WTU OlP . FYDt Site VIsit Schedule and regional support requirements, In order to facilitate continuous opendionallmprovements, vandate WT program compliance With unifonn standards. and to both identify and share best practices among WTUs.

FRAGO 43 OPORD 07..s5

6-Mar.(19 ProvIde initial guidance to the AMEDDC&S and HPU on the requlmment to update, ICCntdH, and award continuing education creditS for the MEB Physldans CoU1"$4

Provide Initial guidance to the AMEDDC&S and HP&S on the requirement to dlrYelop a one week resident course for WTU Prfmary Care Managers (PCM,

Provide updated guidance to all RMCs In order to report status on phase I, II, IU,&rv mebtce

, Provide updated guidance 1.0 all RMC8 referance the W1U Cedi'll Resident Course to be conducted by the AMEODC&S

Provide Inillal guidance to all RIles In reteJ8nce to 0. reqllll1lment to perronn Independent and Impartfal nrvlew of I SoldIer's MEB ftndings or narratlw summary when such a review Is requested

Provide Inillal guidance to RMCs reference the DoD ComputerlElectronic Accommodations Program (CAP)

FRAGO 44'OPORD OT-55

12-Mar-09 ,

Deletes Updated GuIdance on the wru OfP Checklist Erroneously identified In Annex K to FRAGO 43 '

FRAGO 4S OPORD 07-&5

2T-Apr.()9 ..adCcrn implementation of the ANAP WTU right-sizing, develops comprahenslve plan to acc:ou~ for WTs and caregivers, W1U cadre and GoV'1 Equip_ closures and rualignments

FRAGO 48 OPORD 07·$5

2O-May.09 RC soldlenl wm move closer to home of record to heal, transfers between WTU and CBWnJ, Transition Review Board

As a result of the magnitude of issued guidance the Inspection team noted that individualWTUs execute the guidance in vastly different ways. Some leadership teams perceive the guidance as non-prescriptive and open-ended. For instance, the Consolidated GuIdance issued In late 2007 prescribed that the Triad of Leadership establish a process to review active component Soldiers against the WTU eligibility . criteria before determining disposition. The DAIG team observed several installations using a review panel to evaluate Soldiers for WTU entry eligibility, but the panels aiffered on composition, candidate selection, and unit notification procedures for Soldiers who were not accepted into the WTU. This is just one example of how the enormity of the guidance has caused the lack of standardization across the Army_ In addiUonto a lack of standardization, there is conflict between policies. In one instance, leaders were confused by the fact that. a policy Which called for additional support requirements for Warriors in Transition was seemingly in conflict with another policy issued by a different command that,required personnel reductions in the upComing years_ Although the Army attempted to field policy guidance via collaborative efforts, the unsynchronized issuance of guidance directly impacted the accomplishment of the WTU mission.

The Warrior Transition Command began an effort to consoHdate operational requirements into a Field Manuel (FM) for use by all units as a standardizing document, however this publication, DRAFT FM 4.XX-. is still ongoing by OTSGIMEDCOM.

FOR OFRCIAl USE ONLY This dOCtlment contains lllfollllation Dissemil'lation Is pmhibltOO EXEMPT FROM MANDATORY eeept as atJthefied 11)' AR 29-1. DISGU)SURE under the FOIA Exemptieft 5.

A-15

, . i

RECOMMENDATIONS: . .

a. OTSGIMEDCOM: Publish a single, synchroniZed document to govem the Warrior Care and Transition Program. Warrior Transition Command is developing a.single source manual for Warrior Care and Transition Plan.

b. MEDCOM: Publish DA PAM in support of single source document standardizing. WTU procedures.

STANDARDS: N/A.

(

FOR OFFICIAL USE ONLY This document contains ilifollilatioll Dissemination is prohibitedEXEMPTFROMMANOAVORY m;ept as auIIerizeEi by AR 29-1. DISClOSURE W'der the FOIA Exemption 6.

A-16

OBSERVATION 1.2: Warrior Transition Units (WTU) foster I focused environment of healing and transitioning, however, some WTs' abuse the system and manipulate it to maximize entitlements. DISCUSSION: Most (720 of 786) WarTiors in Transition (WT) interviewed active and reserve component stated that the Warrior Transition Unit (WTU)lCommunity Based WTU (CBWTU) Is the Ideal organization for them to heal and transition. The majority of these WTs are on track with their ·Comprehenslve Transition Plan (CTP). yet. some cadre and WTs strongly believe that some WTs are not focused on healing or transitioning. Rather, they are attempting to lengthen their stay in the wru because they have become accustomed to the Army's excellent services and support found In the WTU's abovewhat they wOuld receive in their units or out of the Anny, for example, with the Veteran's Administration. At every installation visited, cadre made statements in reference to some WTs' abusing the system and manipulating it to· maximize entitlements. Based upon their observations they expressed frustration with the WTs' ability to prolong their length of stay by sequentially bringing forth new medical issues.

The inspection team noted a "~ense of entitlemenr among some Warriors in Transition. Various programs, regulations, and poliCies entice Soldiers into a mindset to achieve personal gains.. The personal motivations to extend length of stay (LOS) may be financial, career, transition based anxiety. or a less than ideal family environment. During our interviews we leamed that some WTs are not only seeking to benefit from the system but also to delay the evaluation board process by bringing up additional iIInesseslinjuries at key points during the evaluation process.

.Once Soldiers enter the WTU, they gain access to perks and entitlements that are not . available to Soldiers that are not In a WTU. Examples include full time education options, internship programs, and services provided by the Soldier Family Assistance Center (SFAC). These perks and entitlements appear to lead to an actual or· perceived heightened sense of status which is reinforced by senior military/civilian leaders involvement in WTs concemslissues. With the status of 'Wr,t!. a Soldier has the ability to gain a Top Secret clearance in 45 days when tethered to an intemship Is a notable example. These factors may entice some WTslnto a Dmindser of -I'm in no hurty to leave."

Some WTs also leverage financial inCentives and career concerns to maximize length of stay in the WTU. For example, WTs "attached" as opposed to "assigned" to a WTU allows financial benefits such as combat pay (or other special pays), per diem, Basic Allowance for Housing (BAH), and Family Separation Allowance (FSA) to be continued.. When per diem and BAH based upon the WTs home of record/duty . assignment are factored into the equation the financial benefits become prominent and lucrative. .

FOR OFFICIAL USE ONLY This document coillaillS infolillatiOJl Diesemlnation Is prohibited EXEMPT FROM MANDATORY exeept as autheltHd by AR 29-1. DISOlOSURE tinder the rolA Exemption 5.

Additionally. some WTs were concerned that they would not be able to return to their . previously held civilian occupations due to their military wounds or Injuries and wanted to stay in the WTU until the Army "fixed" them. Although It Is understandable that a Soldier would want to be healthy enough to return to his previously held career, it is an unrealistic expectation in some cases that he or she would be able to do so. The Army stand~rds for medical fitness for dutY are contained within AR 40-501 and may not match the fitness standards for civilian career fields.

Another example of desiring to prolong the stay in a WTU Is the fear of losing health benefits for family members. While on active duty all Soldiers and ~ir family members are entitled to health care. If eligible, the veteran and his family receive benefits from Veterans Administration. Some WTs expressed fear of this transition. This fear creates a desire to prolong their stay In the WTU.

Anotherfactor Influencing'Soldiers motivations is the ubiquitous "barracks lawyer." A barracks lawyer is another Soldier that has been In the system longer and is perceived by other Soldiers to "know more." He or she, either for nefarious reasons or by genuine concern, becomes an adjunct chain of command, offering advice to new arrivals into the WTU. The majority (237 of 418) cadre members interviewed req:>gnized this as a serious influencer!n motivations. citing that new arrivals often come Into the system motivated to return to duty as soon as possible. But after a few. months of talking to other WTs, change their minds and start to seek ways to prolong their stay and maximize their benefits. .

Further lengthening the stay of a WT in a WTU is the Medical Evaluation Board (MEB) process and Physical Evaluation Board (PEB) process. The MEB is used by the Army to determine medical retention in the Army. AR 635-40, chapter 4-10. provides the following: .

The ~ed;calievaluati~n boards (MEB) are convened to document a Soldier's medical status and duty limitations insofar as duty is affected by the Soldier's status. A decision is made as to the Soldier's medical qualification for retention based on the criteria in AR 40-501 , chapter 3. If the MEB determines the Soldier does not meet retention standards, the board will recommend retenal ot the Soldier to a PEB [Physical Evaluation Board]. For MEB's rUles for documentation, recommendations, and disposition of the evaluated Soldier, See AR40-400. chapter 7.

Chapter 4-17 of the same regulation provides the following for PEBs:

a. Purpose. The PEBs are established to evaluate an cases of physl~1 disability equitably for the Soldier and the