November 6,2008: The U.S. Department of Defense has been under a lot of pressure to do right by the most badly wounded veterans of Iraq and Afghanistan. While some 40,000 troops have been injured in those wars (and nearly 5,000 killed), about half the wounded were back on duty within a week, and only about a third required long term care. There are the troops who spend weeks, months, or even longer recovering. It's here that the army and marines have had problems when the recovering patients were overwhelmed with the bureaucracy, family issues, and medical problems they had to confront all at once.

To help deal with this, the U.S. Army has established 36 Warrior Transition Units (WTUs, plus nine similar organizations using non-military personnel). These look after the needs of soldiers requiring six months or more of medical care before they are well again. Most have combat injuries, but there are many with accident injuries, and a few recovering from diseases contracted overseas. Each WTU is staffed with a few officers and 15-20 NCOs (platoon sergeants and squad leaders). In addition there are nurses and other medical professionals. The WTU staff sees to it that those under their care receive the proper medical treatment on a timely and sufficient basis. The WTU deals with any paperwork problems, helping the patients cope with the many bureaucracies that come out of the woodwork. The WTU NCOs have the hardest jobs, because they are often combat veterans themselves, relate well to the patients, and they are the main problem solvers. This is particularly useful for WTU patients who are reservists, and are not familiar with a lot of the active duty paperwork and procedures. Because of the stress placed on the WTU NCOs, they will be special-duty pay of $225 a month. Sort of like combat pay, but given to any troops in particularly difficult jobs.

In a similar move, the U.S. Marine Corps established the Wounded Warrior Regiment. There are two battalions, one on the east coast and one on the west coast. This effort grows out of a marine innovation from 2006, of assigning wounded marines to units that could help them recover. That was simple solution for problems some wounded marines, recuperating in the United States, had in getting bureaucratic problems fixed. In the past, marines wounded overseas, and sent to hospitals back home for extended treatment, were still considered part of their units back in the combat zone. Two years ago, the rules were changed to make the wounded marines temporarily assigned to the hospital they were in, even though they still were, technically, members of their combat unit overseas. This didn't solve the problem, so Marines were allowed to temporarily join any nearby marine unit (active duty or reserve). This made it a lot easier to solve any problems with pay or benefits. Previously, such problems required communication with the marine unit overseas. Even with email and cheap phone calls, this was quite a chore, and a bit much for a recuperating marine to handle. By transferring these administrative chores to a nearby unit, it was much easier to clear up problems. About a thousand marines were eligible for this new procedure. Now, the new Wounded Warrior Regiment will have a staff that specializes in the kinds of administrative problems wounded marines encounter, and quick solutions for all marines that need them.

The army ran into problems this past Summer when they found their WTUs being overwhelmed with new patients. This didn't make sense, as the number of casualties had sharply declined since late 2007 (mainly because of the al Qaeda defeat in Iraq). What had happened was that, just as casualties began to decline, the army loosened the requirements of who could go to the WTUs. Thus the number of people doubled from late 2007 to over 12,000 by the middle of 2008. This made it more difficult to take care of those most in need of help. That was eventually noted, and the WTU admission requirements were tightened up. By early next year, WTUs will be handling about 8,000 patients. The concept now is to get everyone in who needs the services, no matter how severe their injuries were. Situations vary a lot according to the individual. A soldier with a large family, or just a sick wife or child, will benefit a lot from the WTU, no matter how bad is combat injury.

The army also wants to take advantage of the experience gained, and the declining casualty rate, to shut down about a third of the WTUs, and improve standards at the remaining ones.