Warrior in Transition
Warrior in Transition
Soldiers wounded in combat operations or suffering from wounds, illness, or injuries now make up a new populace within the Army. When a Soldier suffers a wound, illness, or injury he begins an unknown journey through the medical and disability systems and evaluation, compensation, and benefits programs. The Soldier becomes a Warrior in Transition (WT) and must go through recovery and rehabilitation phases before reintegration into the force, or back into society as a productive veteran.
A WT is a Soldier who is assigned or attached to a Warrior Transition Unit (WTU) and whose primary mission is to heal. Further, a WT is held on active duty, an active duty medical extension, or any other active duty Soldier who may require a medical evaluation board (MEB), or has complex medical needs requiring six months or more of treatment or rehabilitation. A WT's mission while assigned to a WTU is to heal and successfully transition.
WTs are currently admitted to a WTU with various wounds, illnesses, or injuries resulting from training, deployment, or operational engagement that require medical attention. The WT may arrive at a WTU from combat, a military treatment facility (MTF), a parent unit, or another WTU. Medical care must always be the first priority when a Soldier is considered for the WTU. The second consideration is where the WT must be transferred. The WT will be transferred to a WTU closest to his home of record (HOR) as long as the necessary medical services can be provided. The necessary services are not always close to the WTs HOR location; in this situation, adjustments with WT and his Family must be made.
Soldiers who meet the criteria for assignment to a WTU require a unique support system and the finest leadership the Army has to offer. A strong support system and high-quality leadership aid in the WT's rehabilitation so he is able to be returned to duty or gains the right knowledge and tools to transition out of the military.
The WTU is also a patient-centered organization which supports every WT and Family member with a triad of care (TOC) consisting of a squad leader (SL), a primary care manager (PCM), and a nurse case manager (NCM). The WTU's mission is to focus on the care, treatment, and compassionate disposition of its WTs. The MTF must have medical records and the WTU must have administrative documentation from the parent unit for a timely and complete transition process for the WT. While the Army reserve component (RC) has different documentation requirements than the active component (AC), the process is generally the same. This handbook does distinguish slightly between the AC and RC.
Orders. "My orders expired two days prior to my arrival at the WTU, which was a burden on my finances until I got paid." -A Warrior in Transition
Unfortunately, some RC Soldiers arrive at a WTU with expired or soon to expire orders. This situation causes a break in service and delays transition. It is essential for the WT to bring current orders with him to the WTU. It is the Soldier's responsibility to review his current orders and verify the expiration date. If a WT's orders will soon expire, he must promptly bring the impending expiration to the unit's attention to avoid a break in service. The WTU takes five to seven days to obtain a medical retention program order, which enables the WT to begin his transition and to acquire medical care and medications.
Travel and transportation orders. Before the Soldier travels to the assigned WTU, it is important to know and abide by the scheduled date and time of arrival and contact the point of contact (POC) at the WTU for verification. Soldiers traveling to the WTU must carry the necessary documentation for in-processing. This documentation includes two forms of identification, a copy of medical and dental records, travel and transportation orders (T&TOs) or other orders, profiles, medications, and a line of duty (LOD) investigation signed by the parent unit's commander. If WTs travel without T&TOs, they are responsible for their own lodging, food, and transportation. Failure to have the required documentation delays in-processing and transition and leaves the Soldier with unnecessary, out-of-pocket expenses.
Orientation. "The orientation is...very important for resources and knowing all the folks that are involved in my care and assisting my Family." -A Warrior in Transition
Every WTU has an orientation process that is different than traditional in-processing. The orientation familiarizes the WT with the WTU staff, services provided by the WTU, and how all parties interact throughout the entire transition process. Families are encouraged to be included in this process and are provided welcome packets. At this time it is also beneficial for WTs and their Families to identify a WTU POC whom they may contact with follow-up questions or concerns.
Evaluation reports. "I don't know if I need an NCOER [noncommissioned officer evaluation report] when I leave the WTU for promotion purposes or if retiring."-A Warrior in Transition
Usually, the time a Soldier spends at a WTU for recovery is non-rated. However, WTs who perform position-related duties during the recovery process may receive an evaluation at the WTU commander's discretion. WTs who are not assigned a duty other than recovery will have their time spent at the WTU indicated as non-rated time on their next evaluation.
Ombudsman. "I can always talk to my SL and ombudsman about anything." -A Warrior in Transition
The local ombudsman is another resource if questions or concerns arise that are not addressed by the WTU. An ombudsman is assigned to or near a major military or Veterans Affairs (VA) medical facility to further assist with the transition by helping WTs connect with local agencies and community groups. The ombudsman will assist with unresolved issues and policy updates. The ombudsman program is for WTs. It provides family advocacy and acts as a mediator, communicator, and facilitator for problem solving. It is not unusual for WTs to voice concerns to state officials, not knowing they can have issues resolved internally by the ombudsman at the WTU.
Line of duty report. "My parent unit has not provided the WTU or me with the LOD and now there is a delay in the MEB process." -A Warrior in Transition
WTs have experienced ongoing challenges in obtaining LOD reports from parent units. The WTU staff consistently encounters problems with incomplete or missing LOD reports. If at all possible, it is important for the WT to request the LOD immediately after the wound or injury occurs or the medical condition is identified. The LOD must be complete and signed by the unit commander.
Equipment and property."Don't wait to the last minute to try and find all your stuff, it will cost you." -A Warrior in Transition
WTs do not always come to the WTU with their organizational clothing and individual equipment (OCIE) or other equipment received via hand receipt. The WT is responsible for his own personal property as well as all Army-issued and WTU property hand-receipted to them. Keeping track of all WTU-issued equipment is vital when discharge orders are issued unexpectedly and the WT must gather the property immediately for turn-in to the logistics (S-4) section. Soldiers who are evacuated from Operation Iraqi Freedom (OIF) or Operation Enduring Freedom (OEF) theaters of operation to an MTF due to a wound, illness, or injury are authorized to receive a gratuitous issue of uniform items. OCIE and clothing issues can also be discussed with the S-4. It is important to address equipment and property issues as soon as possible after arriving at the WTU.
Alcohol and drugs. "Those WTs who break are morale busters to the rest of us." -A Warrior in Transition
All WTUs have an alcohol and drug policy prohibiting the WT from illegally using, possessing, and selling alcohol or drugs while assigned to the WTU. WTs must also comply with any alcohol-or drug-related stipulations in their profile. For example, a WT on a no-alcohol profile is prohibited from consuming alcohol. WTUs enforce this policy for the WT's safety. This is a serious safety concern because alcohol and/or drugs may have adverse affects when combined with pain medications and other treatments. Further, the combination of alcohol and prescription medications may result in death. WTUs conduct drug testing and take action following positive test results. The drug and alcohol policy is mandatory. If a WT fails to follow WTU policies, the consequences are Uniform Code of Military Justice (UCMJ) actions or loss of benefits.
Transportation. "I depend on the WTU transportation system due to my disability." -A Warrior in Transition
The WTU may provide transportation for WTs who cannot transport themselves or who do not otherwise have transportation. WTs should contact their WTU chain of command to discuss their individual situation regarding transportation. Modes of transportation offered by WTUs include shuttle, bus, or other vehicles. WTU-provided transportation is for WT use to and from the WTU for medical appointments and must be scheduled in advance. The WT can also request an escort for minor surgeries or because of disabilities. It is important to note that other WTs use the same transportation system and that sometimes WTs must wait for transportation to and from appointments. For example, there are three WTs with appointments scheduled on the same day, at three different locations, and at three different times. Because there is only one vehicle, it may be necessary for any or all of the WTs to wait to be dropped off or picked up depending on the locations and times of the other WT passenger appointments.
Appointments. The WT will have numerous medical-related appointments such as minor or major surgeries, rehabilitation or therapy sessions, and regular medical appointments. The WT must make every effort to make scheduled appointments or contact the NCM as soon as possible. Families and caregivers must also be aware of the policy. Completed appointments result in a timely and complete MEB process and transition.
Occupational therapy. "Occupational therapy is helping me get back to my original MOS [military occupational specialty], and hopefully I can return to my parent unit." -A Warrior in Transition
WTs have the opportunity to rehabilitate with an occupational therapist (OT). The OT is a health and rehabilitation professional who uses purposeful activity to promote independence in the life areas of work, self-care, and leisure activities. They help WTs attain optimal occupational performance and gain a sense of mastery as they transition back to independent and productive living. With the WT fully engaged, the OT can establish rehabilitative short-and long-term goals that will reflect the WT's vocational interests. The OT also supports reintegration by helping the WT identify occupational goals and instill a mindset in the WT to achieve them. Other services provided to the WT can be life skills training such as relaxation techniques and sleep hygiene, pain management and medication safety, driving skills, time management, communication skills, and other topics in the area of work readiness.
Medication. "I am on several medications and hope to get off some of them someday." -A Warrior in Transition
WTs may suffer from medical conditions requiring medications. Proper medication management is vitally important during the transition process. Limited amounts of prescribed medicine are provided by the PCM to the WT. The WT must become educated about the side effects; dosage; and interactions with other medications, foods, or supplements. This information is available to the WT from the pharmacist, NCM, and/or PCM or other physician. WTs should exercise caution when conducting Internet research about their medications because not all Web sites are reliable. When in doubt, the WT should always consult a pharmacist.
Medical evaluation board process. "The MEB process is so long, and they don't reschedule or wait for you to get everything complete." -A Warrior in Transition
The MEB process is an informal process conducted by at least two physicians who compile, assess, and evaluate a WT's medical history to determine if a WT's medical status would impact his duty performance to an unacceptable degree. The process is designed to evaluate a WT's medical condition(s) to determine if he does or does not meet the medical retention standards according to Chapter 3 of Army Regulation (AR) 40-501, Standards of Medical Fitness, September 2008, while documenting the WT's medical condition(s) and duty limitation(s).
Physical evaluation board liaison officer. The WT may not understand the function of the physical evaluation board liaison officer (PEBLO) or the responsibility they have to the each WT. The PEBLO may be a civilian, an officer, or an NCO whose job is to guide and assist WTs and their Families through the MEB/PEB process and answer questions. The PEBLO will advise the WT of the results of the MEB.
Department of Veterans Affairs. The WT has the opportunity to interface with the VA regarding healthcare services and future benefits while assigned to a WTU. Currently, the VA and the Department of Defense are working diligently on solutions to improve the WT's transition to VA medical care and services. While assigned to a WTU, a VA representative or liaison is available to WTs to discuss benefits, disability, compensation, numerous VA-offered services, or ongoing research programs. Family members are also encouraged to visit the VA and become familiar with the services provided.
Veterans Benefits Administration. In order to expedite benefits delivery, veterans seeking a VA benefit for the first time must submit a copy of their service discharge form (Department of Defense [DD] Form 214; DD 215, Correction to Certificate of Release or Discharge Form; or for World War II veterans, Military Record and Report of Separation Certificate of Service) documenting service dates and the type of discharge or providing the veteran's full name, military service number, branch, and dates of service.
Education. "When I first arrived at the WT, I had many appointments, but now I have time on my hands and take advantage of the educational resources." -A Warrior in Transition
Every WT and his Family have educational opportunities in the WTU. The Social Worker (SW), education director, Soldier and Family Assistance Center, and social services assistance coordinator, all of whom serve on the WT's transition team, can provide information regarding education programs. Educational opportunities are available online and through vocational, technical, and occupational means. Counseling provides educational opportunities in areas such as personal finance, nutrition, marriage, tobacco-use cessation, alcohol abuse, and suicide prevention.
Mandatory training. "I know it is required so I get it done." -A Warrior in Transition
A WT is required to complete mandatory training just as when he was assigned to the parent unit. Each WT is individually assessed to determine if he meets mandatory training requirements. WTs should speak with their SL about specific training requirements. Sometimes medications and medical conditions make this training difficult or impossible. On a case-by-case basis, the TOC will consider waivers of mandatory training.
Rehabilitation. Some WTs require rehabilitative services; to qualify for these services, the WT must meet established requirements. These services are not always available at the MTF or at the WTU. In this situation, the PCM and NCM will order and make appointments for necessary rehabilitative services in the civilian community. If questions or concerns arise for the WT, he should consult with the rehabilitative services representative; open communication is key to a successful rehabilitation program.
Comprehensive transition plan. "Every WT should know about his CTP [comprehensive transition plan] because it is about you." -A Warrior in Transition
Each WT has a personalized Comprehensive Transition Plan (CTP) developed with assistance from the WTU team. The CTP serves as a personalized guide for each WT to increase the WT's feeling of ownership of the transition process. The CTP contains key items for success such as establishing weekly goals, building a strong base, creating weekly affirmations, developing daily to-do lists, and conducting periodic after action reviews (AARs).
Job assignments. The WT has a lot of free time between medical and rehabilitation appointments; staying engaged and productive with a job makes the transition seem to go faster. WTUs encourage WTs to take advantage of opportunities to return to a working environment as long as they are capable of it. WTs can often contribute to the workplace with knowledge and expertise, possibly in their MOS and from experience with the parent unit. The WT can request job placement through the SL, NCM, SW, and OT. The WTU contacts the parent unit to initiate job placement. WTs assigned to a WTU may have work assignments in the parent unit, but this work cannot take precedent over the WT's therapy and treatment. The WT is on temporary loan to a work site and is still required to fulfill duty requirements scheduled by the WTU.
Army Warrior in Transition Program. "The AW2 [Army Wounded Warrior Program] advocate has assisted my Family and me to understand some of the challenges we encountered." -A Warrior in Transition
The AW2 serves severely wounded, ill, and injured Soldiers and their Families. This program is available to the AC, RC, and retired veterans. The WT must have or is expected to receive an Army disability rating of 30 percent or greater in one or more specific categories, or a combined rating of 50 percent or greater. The AW2 manages the Soldier or veteran throughout a transition lifecycle. An advocate is assigned to every Soldier and his Family throughout the lifecycle, from the time of the wound or injury or inception of the illness into the future. The advocate is available and helpful during the MEB process as a resource. These advocates come from a variety of backgrounds, and some are Family members of former or current WTs or are WTs themselves. A unique service offered by the AW2 is the ambassador program that recruits WTs and military spouses who had an AW2 advocate to become advocates. These advocates with personal experience assist other WTs and their Families. The AW2 contact center provides information and referrals and investigative outreach to WTs. It will also provide information on federal benefits to AW2 WTs and their Families.
Communication. "If you don't speak up and ask, you won't get answers and someone else will manage you; you just have to get involved." -A Warrior in Transition
WTs must communicate with the WTU. Many times the WT feels that the WTU must initiate all contact, and WTs feel left out when they are not informed of certain issues or events. WTUs respond to WT questions and concerns, but the WT must be willing to ask questions. WTs are not always familiar with all the WTU staff members and their responsibilities. Keeping a planner, taking notes, and including the Family in interactions with the WTU are some ways the WT can effectively engage with the WTU. WTs should use some of their spare time to plan and execute targeted engagements with the WTU to obtain the information they need to help them in their transition. Squad and platoon leaders, other members of the TOC, or others identified in this handbook may be the best resources when questions arise; who the best resource is will often depend on the nature of the issue or question.
Family. Family and/or caregivers sometimes do not understand why the WTU provides them with so much information during orientation and throughout the WT's transition. WTUs often do not understand why the Family or caregivers do not use or take advantage of all of the resources available to them. Most WTs do not want to burden their Families with activities or with too much information. The Family is under stress as well, and WTUs should afford Families opportunities to explore and inquire about WTU services or about particular questions or concerns. WTUs should also provide Families with all of the information given to the WT. Giving the Family/caregiver a WTU welcome packet or providing them a WTU POC is always a good idea.
Escort/Attendant travel. The WT may need an escort for medical appointments or surgeries because he is unable to drive due to medication or a particular medical condition. Guidance for obtaining an escort for travel is contained in operation order 07-55, MEDCOM Implementation of the Army Medical Action Plan and EXORD 118-07, Healing Warriors. The WTU staff is the WT's first resource for questions about escorted travel. Family members, caregivers, or another Soldier may be invited to travel with the WT to the WTU or to appointments or surgeries. Travel, lodging, and per diem are for a pre-determined amount.