In mid-July, at a meeting with the senior civilian and military leadership, I was briefed on statistics that I thought proved my point about tiering. I was told that, as of that date, 1,754,000 troops had been engaged in Iraq and Afghanistan. Thirty-two thousand had been wounded in action, half of whom had returned to duty within seventy-two hours. Ten thousand troops had been medically evacuated from Iraq and Afghanistan, not all of them for combat-related injuries, and a total (as of July 15) of 2,333 had been catastrophically injured or wounded. In short, the number of troops wounded in combat at that point in the wars represented a small fraction of all those being treated.
I felt a great sense of urgency in addressing these issues, in no small part because I assumed I had only six months remaining as secretary. I knew that if I didn’t make progress in these areas, and if my successor was not as committed as I to fixing these problems, very little would happen. I knew one of the chief obstacles to proper treatment of wounded troops and veterans was the bureaucratic territoriality of both the Defense and Veterans Affairs Departments. A wounded soldier had to go through two separate disability evaluations, and getting health records from one department to the other was always a challenge. The secretaries of veterans affairs whom I worked through most of the Bush and Obama administrations (respectively, James Peake and Eric Shinseki) were committed to working out these problems. Unfortunately, if there is one bureaucracy in Washington more intractable than Defense, it is VA. Only when the VA secretary and I personally directed an outcome was any progress made at all. Unless successor secretaries are equally committed to change, whatever progress we made will be lost. And again, as far as I was concerned, a big part of the problem was the system’s unwillingness to differentiate in the process between someone wounded in combat and someone retiring with a hearing problem or hemorrhoids.
Wounded warriors and their families would often mention how difficult it was to get information on what benefits were available to them. When I raised this at the Pentagon, I was sent a two-page list of Web sites where wounded warriors could go to find all they wanted to know about support and benefits. But the effort required to access and read all that material—and the assumption that every wounded warrior family had a computer, especially when assigned to medical facilities away from home—seemed to me symptomatic of what was wrong with the system. In January 2008, I formally asked the personnel and readiness organization in the Pentagon to prepare a paper booklet for wounded warriors that could serve as a ready reference for benefits and care. I received a response a month later in the form of multiple brochures and handouts, a list of more Web sites and 1-800 call centers, all developed to address the needs of the wounded warrior community. I wrote back, “This is precisely the problem. We need one, easy to read, tabbed and indexed comprehensive guide. Like I originally asked for months ago.” Two weeks later I received a memo laying out plans for the handbook and all that would need to be included in it, and I was informed that it would be available on October 1. I hit the ceiling. I wrote back on the memo, “Strikes me that if it takes six months to pull all this together, we have a bigger problem than even I thought.” And we did.
Many of these matters came under the purview of the undersecretary of defense for personnel and readiness (P&R). For that office, it seemed the status quo was satisfactory. Virtually every issue I wanted to tackle with regard to health affairs (including the deficiencies in Tricare, the military health insurance program, which I heard about continuously from those in uniform at every rank), wounded warriors, and disability evaluations encountered active opposition, passive resistance, or just plain bureaucratic obduracy from P&R. It makes me angry even now. My failure to fix this inert, massive, but vitally important organization will, I fear, have long-range implications for troops and their families.
Beyond the Defense and Veterans Affairs bureaucracies, there were two other obstacles to reforming the disability system for wounded warriors. The first was Congress, which has over the years micromanaged anything dealing with veterans and responds with Pavlovian reliability to lobbying by the veterans service organizations (VSOs, including the Veterans of Foreign Wars and the American Legion). Nearly any change of consequence requires new law—a huge challenge. In October 2008, I directed development of a “stand-alone” legislative proposal that would give us the authority to create an express lane for catastrophically and severely wounded warriors.
In December, Mullen and I met again with the people in Defense working on the wounded warrior problem to discuss what initiatives we might suggest to the new presidential administration. I said that I had reached out to the new veterans affairs secretary, Eric Shinseki, who was eager to work with us on the disability evaluation issue. There were two choices: either Defense and VA worked this problem out together or we would go the legislative route. Mullen noted that we needed to improve support for families of the wounded, and I responded that we needed legislative relief to reduce their financial burden. Finally, I said we needed to make sure the National Guard and Reserves were provided for in any legislation. We knew that the legislative path would be tough because of the veterans organizations.
I greatly admire the VSOs for their work on behalf of veterans, for their patriotic and educational endeavors, and for their extraordinary efforts to help military families. That said, again and again they were a major problem whenever I tried to do something to help those still on active duty—for example, my attempt to bring about the changes in the disability evaluation system as described above. The organizations were focused on doing everything possible to advantage veterans, so much so that those still on active duty seemed to be of secondary importance, especially if any new benefits or procedures might affect veterans. The best example of this was their opposition to legislation implementing some of the excellent recommendations of the Dole-Shalala commission. That was unforgivable.
Another example: Senator Jim Webb authored a new GI Bill that was immensely generous in its educational benefits for veterans. I felt the benefits were so generous they might significantly affect retention of those on active duty. I wanted Congress to require five years of service to qualify for the benefits so we could get at least two enlistments out of troops before they left the service. When I called House Speaker Pelosi to press for this change, she told me, “On matters such as this, we always defer to the VSOs.” (When I visited Fort Hood in the fall of 2007, a soldier’s wife suggested to me that a service member ought to be able to share his or her GI Bill education benefits with a spouse or children. I thought it was a great idea and suggested it to President Bush, who included it in his 2008 State of the Union Address. There was little enthusiasm for it on Capitol Hill, but we were able, ultimately, to get it included in the final GI Bill—a benefit I saw as somewhat offsetting our inability to require five years of service to qualify for the education benefit.)
I found it very difficult to get accurate (and credible) information from inside Defense about whether we were making progress in helping wounded warriors and their families. The bureaucrats in the personnel and readiness office would regularly tell me how well we were doing and how pleased our troops and families were. Meanwhile I was hearing the opposite directly from the wounded. I insisted that we get more comprehensive and accurate feedback from the wounded, other troops, spouses, and parents. “I want an independent evaluation of soldiers and families and a list of programs where you need money,” I said.