GPSolo Magazine - January February 2005
America’s Wounded Warriors
“Mom, I just got wounded. I think I’m going to be OK. They are taking me to the central hospital. Try to meet me there. I love you.” Conversations and casualty notifications like this are starting to take place on battlefields around the world from servicemembers with cell phones and other telecommunication devices. This is a far cry from earlier wars, when an impersonal telegram arrived and transportation realities made it unreasonable for “next of kin” (NOK) to be united with their wounded soldier.
Today, with the tremendous advances in telecommunications, as well as increasingly fast and inexpensive long-distance travel, the American public’s expectations have changed concerning what its government should do for the nation’s wounded soldiers and their families. In reaction, the military has made changes to keep the NOK informed of the status of wounded/injured servicemembers. (We speak of “wounded” in this article, but the same policies and procedures described below apply any time a servicemember is seriously injured—be it from a traffic accident, heart attack, disabling disease, or otherwise.)
As a lawyer or just a personal friend trying to help a family in your community, to whom do you turn for accurate, current information regarding administrative policies and procedures to ensure that families (1) get timely information from appropriate authorities on their wounded soldier and (2) are aware of all the benefit options available to them for medical care, potential disability processing, and reuniting with their loved one as soon as possible? Who will bear those transportation costs and other expenses? These are but a few of the reasonable questions you may be asked.
Perhaps you have followed how casualties are returned to the states. On the battlefield, including now in Iraq, the military tries to have a hospital or life-saving surgery capability within the “golden hour” evacuation distance from where a servicemember gets injured. Much of this evacuation is done by dedicated medical evacuation helicopters on standby, where the tactical situation permits a safe landing and pickup. If it is apparent the servicemember has an injury that is going to take more than a week or so to heal, or that definitive medical care is not available in the theater of operations, then the servicemember will be moved by medical transport to a U.S. military regional medical center as soon as his or her condition allows for safe transportation.
The Landstuhl Regional Medical Center in Germany receives casualties from Europe, Africa, and the Middle East. Tripler Army Medical Center in Hawaii covers Asia and the Pacific in many cases, and evacuations from Central or South America may be transported to a variety of designated U.S. military casualty receiving hospitals, including those of the Air Force and Army in San Antonio, Texas. Brooke Army Medical Center in San Antonio has the military’s only burn unit and often is the ultimate destination for any military personnel with significant burn injuries. Soldiers usually stay only a few days at the overseas regional hospitals, until transportation is arranged to a military hospital in the United States close to the servicemember’s home or where they are stationed. Sometimes, because of the specialized medical treatment that they may need, servicemembers are taken to one of the military’s large academic teaching hospitals, such as Walter Reed Army Medical Center in Washington, D.C.
By the time you as a lawyer become involved with a family, they probably will have already received information that something has happened to their loved one. This may come from official military channels, from the servicemember’s unit or perhaps a buddy in the combat theater, or in some cases from the servicemembers themselves.
Each military service designates a point of contact for a seriously injured servicemember. This is the “Casualty Assistance Officer” (CAO), who may be a commissioned officer, a warrant officer, or a senior non-commissioned officer. CAOs will provide up-to-date information about a wounded/injured servicemember to the appropriate NOK in cases in which the seriousness of the injury has been categorized as “seriously ill” (SI) or “very seriously ill”(VSI) by military medical authorities, usually the servicemember’s attending physician at the hospital where the soldier is currently being treated.
All servicemembers are required to have in their personnel records a current Department of Defense Form 93, Record of Emergency Data, which indicates the servicemember’s preference concerning whom to contact in an emergency, and how to contact them. CAOs normally notify one primary and one secondary NOK and recommend that other family members or friends use the appropriate NOK for sharing information.
Minor health problems or injuries in which the servicemember is expected to quickly return to duty may or may not make it to the casualty notification threshold. In these cases, servicemembers are expected to notify their family and whomever else they wish. They also may decide not to make any notification in these minor incidents.
The Department of the Army has recently established a Disabled Soldier Support System Initiative (800/833-6622; www.armyds3.org) to provide severely disabled soldiers and their families a system of follow-up and personal support as they transition from military service to the civilian community. (For a full list of Casualty Assistance Offices at the department level, see the sidebar at left.)
In addition to notification, CAOs will assist two family members of SI or VSI categorized servicemembers to travel to the bedside. The order of preference is to offer this benefit first to a spouse, then to the servicemember’s children, parents, and siblings. This authorization covers transportation and, in the case of combat injuries, meals and temporary lodging at government rates. At the locations where these servicemembers are receiving treatment, low-cost temporary lodging is frequently available, including at specially designated Fisher Houses. The Fisher Houses, created through the generosity of Zachary and Elizabeth Fisher of New York, usually charge about $10 per day.
In addition, the servicemember’s unit will most likely have a family readiness group remaining at its home station to help handle any number of issues that may come up while the servicemembers are away, including casualty assistance problems. Often they will have as much interest as the family in knowing where in the medical system the soldier is, and what is his or her condition. Units take a great deal of pride in caring for their unit members.
Families may need your wise counsel and judgment at times in dealing with the military chain of command and bureaucracy. For many years the American Red Cross ( www.redcross.org) has been charged by Congress with assisting military families. It has an extensive infrastructure, including in the combat theater, to receive information and pass messages. The Red Cross can often do things or provide assistance from its donations that the military is not authorized to provide.
After recovery is complete, the servicemember may be restored to duty or separated. If not restored to duty, the servicemember will be faced with the issue of disability processing. Each service has physical disability procedures. The servicemember will go before a physical disability board; there he or she will be represented by a military attorney or by civilian counsel (the latter at the servicemember’s own expense). If unable to be restored to duty, he or she will be permanently or temporarily medically retired if the disability is 30 percent or greater. Disability less than that usually involves separation with a lump sum severance. In cases of severance, the servicemember may still apply to the Veteran’s Administration for disability compensation.
These policies and procedures are very complex and are beyond what we can adequately cover in this article. If you are asked to provide advice or get involved in assisting a servicemember or family through a fairly long disability process from the military service, and subsequently with the Department of Veterans Affairs, we recommend you contact (or at least visit the websites) of organizations that help service-members and veterans in getting a fair, timely, and equitable disability rating.
Becoming a combat casualty is a life-changing event for soldiers and their families. This often can be a very emotional time for those involved, even with relatively minor wounds—at least until they can hear their loved one’s voice or feel their touch. It is at times like these that a family’s special friends, support groups, and trusted advisors—spiritual and legal—can make a real difference on the long-term impact this event may have. We hope this article will assist you in knowing where to seek accurate information and the right authorities who can make rational decisions—or exceptions to policy—in an effort to do right by America’s wounded warriors and their families.
|Casualty Assistance Offices|
Department of the Air Force
Department of the Army
Department of the Navy
U.S. Coast Guard
U.S. Marine Corps
Harold L. Timboe, MD, MPH, is a senior official at the University of Texas Health Science Center at San Antonio and a member of the Texas State Guard. He retired from the Army in 2002 as a major general with his last assignment as commander, Walter Reed Army Medical Center. He can be reached at Timboe@uthscsa.edu. Richard R. Timboe, MEngr, JD, is a former Army officer with Armor and Adjutant General Corps experience. He is an assistant vice president at the California State University at Long Beach and is known as an innovator in the use of information technology in academic institutions. He can be reached at email@example.com . The brothers are both graduates of West Point during the Vietnam era and have a keen interest in the well-being of military personnel and their families.