Warrior Care and Transition Program Overview 21 Sept 2012 Soldier Success through Focused Commitment SGT Joel Tavera and Parents/Caregivers AW2 Veteran SSG (R) Shilo Harris and Family SPC Joshua Kerber with his Triad of Care-Dr. Mark A. Passamonti, CPT Lashon S. Duncanson, and SGT Candice L. Dawkins COL Catherine Mozden, Warrior Transition Command

Provide an overview of the US Army Warrior Care and Transition Program Purpose and Agenda Purpose: Provide an overview of the US Army Warrior Care and Transition Program Agenda: WTC Mission WCTP Command Relationships Unit Populations and Locations AW2 Program Medical Retention Processing (MRP) Entry and Exit Criteria for RC in WCTP Compo 3 PDHRA data

Our Mission WOUNDED ILL INJURED Provide centralized oversight, guidance and advocacy empowering wounded, ill and injured Soldiers, Veterans and Families through a comprehensive transition plan for successful reintegration back into the force or into the community with dignity, respect and self-determination. Mr. Mark Jackson (703) 325-1969

Warrior Care and Transition Program Relationships WCTP Oversight MEDCOM IMCOM Supporting Commands Senior Commander Warrior Transition Command Regional Medical Commands IMCOM Regions Warrior Transition Task Force Warrior Transition Office Army Wounded Warrior Southern Regional Medical Command *Triad of Leadership Senior Commander MTF Commander WTU Commander Community Based WTU Senior Commander Medical Treatment Facility Installation Garrisons Triad of Leadership* Warrior Transition Unit AW2 Advocate (Veteran) AW2 Advocate (OPCON) Community Based WTU Northern/Western Regional Medical Command SFAC Mr. Mark Jackson (703) 325-1969

Warrior Transition Unit (WTU) and Community Based WTU For all components Traditional Chain of Command (Squad Leader - Battalion Commander) Focused “Triad of Care” for each Soldier Army Wounded Warrior (AW2) Advocate for most seriously injured Best facilities on post; priority medical care Dedicated Family Support Family Readiness Support Assistant (FRSA) Soldier Family Assistance Center (SFAC) Primarily for Reserve Component Soldiers Modified Chain of Command (PSG - LTC) Focused “Triad of Care” for each Soldier Live at home; medical care available CBWTU allows wounded, ill, and injured Soldiers to heal at home Duty at approved Title 10 duty site Dedicated Family Support Virtual Soldier Family Assistance Center (VSFAC)

Warrior Transition Unit and Community Based Warrior Transition Unit Map WI OR MT ID NV WY ND SD NE CO AZ NM TX OK MN IA MO KS LA MI IN OH WV PA NY VT NH CT NJ MD NC SC GA MS TN KY ME Puerto Rico Ft Huachuca Joint Base Lewis-McChord Balboa Ft Irwin California Ft Bliss Ft Carson Utah Ft Hood Ft Sill San Antonio Ft Leonard Wood Ft Riley Arkansas Illinois Ft Stewart Ft Bragg Ft Gordon Ft Jackson Ft Polk Ft Benning Florida Alabama Ft Campbell Ft Knox Ft Drum Virginia JB Langley Eustis Ft Belvoir Ft Meade Walter Reed NMMC JB McGuire-Dix-Lakehurst West Point Massachusetts Elmendorf- Richardson Schofield Barracks Northern Regional Medical Command Western Regional Medical Command Europe Regional Medical Command Heidelberg Pacific Regional Medical Command Brigade (2) Battalion (16) Separate Company (11) Community Based Warrior Transition Unit (9) (color by Area of Responsibility) AW2 Advocate (201) Southern Regional Medical Command as of 6 Sep 12 Ms. Carolyn Spencer (703) 428-8228 6 6 6

Warrior Transition Unit/Community Based Warrior Transition Unit Population Over Time WTU/CBWTU Entrance Criteria Review WTU/CBWTU Manpower Study FRAGO 3 Publication: Entrance Criteria NCR TDA Realignment (EDATE Jun 11) Squad Leader Ratio Review Army directs movement of MEBs and Non-deployables to WTUs FRAGO 4 Publication RC Management CTP Enablers added to TDA (EDATE Apr 10) Remote Care Review OCONUS IDES EXORD 118-07 Publication: WTUs Established Active Component - 4588 Army National Guard - 3176 Army Reserve - 2121 as of 6 Sep 12 Ms. Carolyn Spencer (703) 428-8228

WTC Population Map w/CBWTU AORs (Data Source: MODS WT, 10 SEP 2012) Heidelberg WA OR MT ID NV WY ND SD NE CO AZ NM TX OK MN IA MO KS LA WI MI IN OH WV PA NY VT NH CT NJ MD NC SC GA MS TN KY ME PR Ft Huachuca Joint Base Lewis-McChord Balboa Ft Irwin CA Ft Bliss Ft Carson UT Ft Hood Ft Sill San Antonio Ft Leonard Wood Ft Riley AR IL Ft Stewart Ft Bragg Ft Gordon Ft Jackson Ft Polk Ft Benning FL AL Ft Campbell Ft Knox Ft Drum VA JBLE Ft Belvoir Ft Meade WRNMMC JBMDL West Point Elmendorf- Richardson Tripler Europe RMC Western RMC MA Northern RMC Pacific RMC Southern RMC Brigade (2) Battalion (16) Separate Company (11) CBWTU (color by AOR) (9) 8 8 8

Army Wounded Warrior (AW2) Program On April 30, 2004 the Army introduced an initiative to enhance the care and support of severely wounded, injured and ill Soldiers, Veterans and their Families/ Caregivers. This system of support guides them along the paths to regaining their independence; from the onset of their condition through their eventual transition back to the force; or into the civilian community as a Veteran. SSG Jon Duralde, Continuation on Active Duty (COAD)

Army Wounded Warrior (AW2) Program Vision Wounded Warriors and their Families/Caregivers are self sufficient, contributing members of our communities; living and espousing the Warrior Ethos with the knowledge that the Army and the Nation remembers their sacrifice. Mission We assist and advocate for our severely wounded, ill and injured Soldiers, Veterans, and their Families/Caregivers; support and advise during medical treatment, rehabilitation and beyond to facilitate a Soldier’s return to duty or their transition to a civilian community as a Veteran.

To be considered an AW2 Soldier/Veteran Suffer from wounds, injuries or illness incurred in the line of duty after 10 September 2001 in support of Overseas Contingency Operations, and Receive or expect to receive at least a 30% rating from the Integrated Disability Evaluation System (IDES) for one of the conditions listed below: Severe Loss of Vision / Blindness Loss of Limb Spinal Cord Injury Severe Paralysis Permanent disfigurement Severe Hearing Loss / Deafness Severe Burns Severe Traumatic Brain Injury (TBI) Post Traumatic Stress Disorder (PTSD) Fatal / Incurable Disease with limited life expectancy OR Receive a Combined 50% IDES rating for any other Combat or Combat Related Condition

Services Provided Advocates assist wherever the Soldiers and their Families/Caregivers are located, as they progress along the path to independence. AW2 Advocates - 201 Personalized support for Soldiers and their Families Local Resource Experts Benefits Advisers – navigating the maze Military Transition Specialists Education and Career Guides Life Coaches – Empowering Soldiers and their Families/Caregivers to make informed and relevant decisions VA Integration Experts AW2 Support Experts - 21 Medical Eligibility Human Resources Finance Transition Employment/Career Dept of Labor Veteran Affairs Advisors IT Support Training

Veteran Population in our Communities AW2 Soldier / Veteran Status AW2 most severely wounded, injured and ill 11955** WTU Or MEB / PEB Complex Medical Needs 2% of AW2 204 1372 COAD / COAR / FIT / RTD Soldiers returned to Mainstream Army WTU / Unit 10354 Veteran Population in our Communities Veteran *AW2 as of 1 Sep 12 **Incl :25 Deceased

MRP Orders The Army has further delineated 10 USC 12301(h) into: MRP-E – 60/90 day orders intended for evaluation of medical condition and determination of MTP; normally a Soldier is coming from the demob site MRP - Orders intended for medical treatment or evaluation for PDES; the Soldier is in your AO MRP2 - Return to active duty for medical care subsequent to REFRAD ; Approved by a Medical Review Board ADME - ordered to active duty to complete medical care estimated to exceed 30 days due to an Inactive Duty Training (IDT) injury ; Approved by a Medical Review Board

WTC Medical Review Board WTC Medical Review Board Primary Care Manager Reserve Component Soldiers in the Warrior Care And Transition Program (WCTP) are on Title 10 12301 (h) Orders Soldiers In-Process through one of these four methods MRP RC on active duty (AD) MRP2 RC REFRAD from AD ADME RC WII in LOD during IDT AGR Soldiers (same process as AC) Eligibility Determination Primary Care Manager WTC Medical Review Board WTC Medical Review Board Primary Care Manager Triad of Leadership Triad of Leadership HRC HRC Entrance Approval Soldier is wounded, ill or injured PCM: definitive care needed Triad of Leadership Approval DeMob site or WTU submits RFO to HRC HRC publishes orders Soldier is wounded, ill or injured Soldier’s Unit submits request WTC MRB: definitive care needed; recommends approval HRC Approval HRC publishes orders Soldier is wounded, ill or injured Soldier’s Unit submits request WTC MRB: definitive care needed: recommends approval HRC Approval HRC publishes orders Soldier is wounded, ill or injured PCM: six mos/complex care mgmt Triad of Leadership Approval DeMob site or WTU submits RFO to HRC HRC publishes orders Process Steps

Entry Criteria Compo 2/3 Soldiers, except AGRs, must meet the following criteria: (1) Be in the Line of Duty and (2) Condition(s) require(s) *definitive care. Soldier is on a temporary Profile (3) Program is voluntary. Army determines care location. *Definitive care is defined as a specific treatment or sequence of treatments of at least 60 days duration, and requiring a significant commitment of the Soldier’s time, which, in the opinion of competent medical authority, will upon completion either return the Soldier to duty or will meet the criteria for Medical Retention Determination Point (MRDP) and referral to the Integrated Disability Evaluation System (IDES).

Attached to a Warrior Transition Unit Soldier returns to Parent Unit Soldier Entry Process Soldier is Wounded, Ill or Injured Yes Is Soldier Evac’d from Theater Yes No NOTE: Determination is made as to eligible to remain in WTU or return to unit Soldier is evaluated by PCM Attached to a Warrior Transition Unit Does Soldier meet Entry Criteria No Yes Triad of Leadership Review Approved Not Approved Soldier returns to Parent Unit

Continuum of Care (Comprehensive Transition Plan (CTP)) “The CTP provides Soldiers and Families clarity, purpose, hope, and direction as they prepare to move forward with the next phase of their lives.” Lieutenant General Patricia D. Horoho, The Surgeon General COAD COAR Return to Duty Reset Train / Ready Available 204 11,955 Army Force Generation 1372 10354 WTU CBWTU Veterans “Path to Independence…One Step at a Time” Soldier and Family Assistance Center Social Workers Pharmacists Chaplains Legal Support Operation Enduring Freedom/ Operation Iraqi Freedom/ Operation New Dawn Care Management Team Transition/Career Counseling MEB Physician Career and Education Readiness Physical Evaluation Board Liaison Officer Federal Recovery Coordinator VA Liaison for Healthcare Caregiver Support Coordinators Employment Counseling Education Counseling Occupational Therapists Physical Therapists Transition Counseling Specialty Care Return to Duty / Release from Active Duty Triad of Care and Interdisciplinary Team Warrior Transition Unit/ Community Based Unit Family/Friends Army Wounded Warrior Advocate (Life Cycle Management Plan) Veterans Affairs Integration and Hand Off Medical Retention Determination Point Inprocessing Transition Review Rehabilitation Rehabilitation Integrated Disability Evaluation System Veterans Affairs Goal Setting Post Transition Reintegration Comprehensive Transition Plan (Domains – Career, Physical, Emotional, Social, Family, Spiritual) DD214 Mr. Mark Jackson (703) 325-1969

RC Exit Criteria RC Soldiers normally leave the WCTP in one of three ways: (1) Voluntary withdrawal (WTU Consolidated Guidance). Soldier must request in writing. (2) Meet retention standards FFD (DODI 1241.2) (3) Completes PDES determination (DODI 1241.2)

Takeaways Enduring mission…efficiently resourced Currently, the Warrior Care and Transition Program is an enduring mission funded in the Program Objective Memorandum primarily by Defense Health Program funds. The Army must take a cautious approach to any reductions to resourcing the program. Keeping faith with our wounded, iIl, and injured Soldiers Soldiers will willingly fight as long as they know there is an effective system of medical care available to save their lives if necessary. Conserving fighting strength through focused care management and transition planning The Warrior Care and Transition Program contributes to Army Force Generation by returning at least 50% of wounded, ill, and injured Soldiers to duty. Unleashing unlimited potential The patient-centered approach to care that comprises the Warrior Care and Transition Program focuses on each Soldier’s abilities not their disabilities. Through an effective program of adaptive reconditioning, Soldiers are learning that they can meet and exceed the physical and personal goals they set for themselves.

QUESTIONS COL Catherine Mozden Chief, CBWTU Remote Care Clinical Services Division Warrior Transition Command Catherine.a.mozden@us.army.mil 703-325-0371

Warrior Care and Transition Program Overview Soldier Success through Focused Commitment SGT Joel Tavera and Parents/Caregivers AW2 Veteran SSG (R) Shilo Harris and Family SPC Joshua Kerber with his Triad of Care-Dr. Mark A. Passamonti, CPT Lashon S. Duncanson, and SGT Candice L. Dawkins BG David J Bishop, Commander, Warrior Transition Command

Released from Active Duty (REFRAD) Medically Separated/Retired Yes Soldier’s profile Permanent (P) and Temporary (T) rated 1s or 2s COMPO 2/3 Soldier receiving care Yes Released from Active Duty (REFRAD) No A single T3 that will spontaneously resolve to a 1 or 2 rating in < 30 days Yes No MRDP reached? Not expected to meet retention standards? Fit for Duty? IDES Stays in WTU Soldier Exit Process Yes No No COAR? Eligible for and accepts non-medical retirement Retire Yes Yes No No Medically Separated/Retired ADMIN/UCMJ Separation Separate Yes No Yes Continuation of Care