Wounded Warriors

Wounded Warriors

New Programs, new technologies, and new attitudes support military personnel with disabilities

story By J.R. Wilson

The term “perfect storm” typically refers to a major catastrophe resulting from an unusual combination of factors. But for wounded warriors returning from Southwest Asia since 9/11, it has meant a culmination of new technologies, new attitudes, new diagnoses, new treatments, new prosthetics, and the rapid growth and expansion of adaptive reconditioning.

In the wake of every war prior to Operation Desert Storm in 1991, warfighters with disabilities were most likely to be seen in public on crutches, in wheelchairs, or using prosthetics whose technologies hadn’t advanced in 50 years. Implementation of the Americans with Disabilities Act (ADA) in 1990 and the rise of sports as part of warfighter rehabilitation began to change that in the quarter-century since. The past decade especially has seen the military services radically change their thinking concerning wounded warriors, encouraging those who have been disabled in military service to remain in the armed forces if at all possible, should they so choose. Much of this is due to a massive research and development effort by the Department of Defense (DOD) and Department of Veterans Affairs (VA) in medicine and technologies serving people with disabilities, from computer-enhanced prosthetics to brain and spinal cord injury research. But, more importantly, accompanying these medical advances has been a sea change in the way the military views its “wounded warriors” and what they can bring to the fight.

Kirk Bauer, executive director of Disabled Sports USA (DSUSA), called the change in attitude toward people with disabilities, by both the public and the military, “nothing short of revolutionary. The military has done a 180-degree turn, now working hard to keep highly trained personnel in the service, sometimes even returning to combat.”

The DOD estimates that nearly 1,600 service members have lost limbs since the start of the wars in 2001, where improvised explosive devices (IEDs) have often been the enemy’s weapon of choice. This peaked, according to a Congressional Research Service report, in 2011, when 240 deployed servicemen and women had at least one arm or leg amputated. More than 80 percent of amputations have involved injuries to a lower limb.

In the early years of the Iraq and Afghanistan conflicts, wounded warriors who had lost a limb were regularly fitted with prosthetics, rehabilitated, and medically retired. Prosthetics was largely the responsibility of the Veterans Health Administration (VHA), which, as the health care branch of the VA, saw its mission as helping veterans adjust and thrive as civilian amputees.

The VA and its partners still play a leading role today in prosthetics development, but now the DOD also plays a major part. In 2004, the Pentagon contracted with a prosthetics company to design a “military-grade” prosthetic knee that could enable skilled and capable service members to return to duty whenever possible, and these efforts, and the change in mind-set they reflected, have paid off.

A 1995 study found that only 11 of 469 U.S. amputee soldiers (2.3 percent) returned to duty in the 1980s with amputation levels that included partial foot, partial hand, and transtibial (below knee). Today, that has increased to 16.5 percent. According to statistics made available by the Pentagon in the spring of 2012, more than 300 deployed service members who suffered the loss of a limb returned to active duty – and of those, more than 50 returned to Iraq or Afghanistan.

Such numbers would not have seemed possible just a few years ago.

The change of attitude regarding disabilities and those seeking help is perhaps most definitive among 21st century wounded warriors, who not only seek but expect cutting-edge technology and medical care, including advanced, increasingly robotic prosthetics. Nor are they content to live out their lives as “disabled.” Instead, they push themselves and the technologies available to them to levels of recovery and activity never before seen – or possible.

After sustaining a traumatic brain injury during deployments to Iraq, U.S. Army Sgt. Nathan Martucci, pictured here in March 2013, was a Warrior Transition Unit (WTU) soldier at Joint Force Base McGuire-Dix- Lakehurst in New Jersey. Martucci worked to improve multiple facets of his life with the help of the WTU’s medical staff.

U.S. Army photo by Sgt. Manda Walters, 129th Mobile Public Affairs Detachment

Warrior Transition Programs

Wounded warfighters since 9/11 have been served through four service-specific programs: Army Wounded Warrior (AW2), the Marine Corps’ Marine For Life program and Wounded Warrior Regiment, the Air Force Wounded Warrior Program (AFW2), and the Navy Safe Harbor program. Due to the heavy ground combat nature of Operation Iraqi Freedom and Operation Enduring Freedom (Afghanistan), the vast majority of the current generation of wounded warriors has come from the Army.

Since its creation in 2004, AW2 has worked with thousands of soldiers, veterans, their families, and caregivers. To qualify for AW2, warfighters must have suffered wounds, illness, or injuries in the line of duty after Sept. 10, 2001, or have received or expect to receive a rating of 30 percent or higher from the Integrated Disability Evaluation System (IDES), using an expanded list of disabilities or a combined 50 percent IDES rating for any other combat/combat-related condition.

The expertise AW2 professionals gained helping the most severely wounded, ill, and injured warfighters was applied to policies and guidance for those recovering at Community Care Units (CCUs), and Warrior Transition Units (WTUs), hands-on components of AW2 offering a standardized framework of care and support as soldiers transition to the next stage of their lives, whether back to active duty or to civilian status.

Marine For Life is a nationwide program assisting Marines returning to civilian life, Marine reservists, and all Marine veterans and sailors who have served with Marine Corps units. It also is designed to help them remain part of the Corps family- an expression of the old ethos "Once a Marine, always a Marine"- becoming both members and beneficiaries of personal and professional networks of Marine veterans.

The organization’s headquarters at Marine Corps Base Quantico, Virginia, directs some 100 Corps reservists working throughout the nation to accomplish the Marine For Life motto: “Connecting Marines with Opportunity.” It also supports a component Marine for Life Injured program, providing information, advocacy, and assistance to injured Marines, sailors injured while serving with Marines, and their families. Support begins at the time of injury and continues through return to duty or transition to civilian life and care from the VA.

As with the other service programs for wounded warriors, AFW2 was established to ensure a smooth transition from military to civilian life for personnel with combat-related injuries or illnesses requiring long-term care.

In 2011, the RAND Corporation sent surveys to 872 AFW2 enrollees regarding their use of U.S. Air Force support services, seeking to better understand their needs, and found that 95 percent had received at least one AFW2 service and 20 percent used the more recently implemented Recovery Care Coordinator program. The majority from all three groups reported a high level of overall satisfaction.

U.S. Army Major Robert Eldridge, 2nd Battalion, 7th Special Forces Group executive officer, prepares to mount a Mine Resistant Ambush Protected vehicle in Kandahar province, Afghanistan, on May 7, 2012. Eldridge was injured while on a combat patrol in Shkin, Patika province, Afghanistan, on Dec. 17, 2004, when the vehicle in which he was riding was struck by an anti-tank mine. His left leg was soon amputated in order to save his life. According to Pentagon data from spring 2012, more than 300 deployed service members who lost limbs returned to active duty, and several of them returned to Iraq and Afghanistan.

Photo by Stg. Devin James

Navy Wounded Warrior-Safe Harbor (NWW-SH) coordinates nonmedical care of seriously wounded, ill, and injured sailors, Coast Guardsmen and women, Merchant Marines, and their families through proactive leadership to optimize individually tailored recovery, rehabilitation, and reintegration efforts. A voluntary component called the Anchor Program provides a support network that matches sailors and Coast Guard personnel with local volunteer mentors during the critical transition from uniform to civilian life.

“NSHF [Navy Safe Harbor Foundation] wants to ensure that every service member is given an opportunity for full recovery by providing financial assistance, respite care, special equipment, transportation, recreational opportunities, and other services,” according to the organization’s mission statement.

In 1992, Congress created the Defense and Veterans Brain Injury Center (DVBIC) as the TBI operational component of the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury (DCoE), with six lead centers at major military medical centers around the country. By 2014, those had grown to 10 military facilities and five VA hospitals in the United States and the Landstuhl Regional Medical Center in Germany.

All that is a reflection of the growing number of TBI cases diagnosed, including recognition that many patients from pre-9/11 conflicts had gone undiagnosed for years. DVBIC collaborates with military, government, and civilian researchers to develop state-ofthe-art treatment, innovative clinical research, and support for force health protection services.

DVBIC conducts pre-deployment screenings and briefings for warfighters and health care providers going into theater, and oversees data gathering and research programs. DVBIC also treats active-duty and veteran victims of mild to severe TBI, from the moment of injury to their return to duty or reintegration into civilian life.

ADA, Vets with Disabilities, and Adaptive Reconditioing

Physical activity in which wounded, ill, and injured warfighters regularly participate to support their physical and emotional well-being is known as adaptive reconditioning, and it can play a significant role in service members’ rehabilitation, recovery, and reintegration efforts. One popular component of adaptive reconditioning has been the Warrior Games, in which the DOD and U.S. Olympic Committee Paralympic Military Program have partnered since 2010 to enable athletes with disabilities from all branches of the military to compete in seven sports: archery, cycling, shooting, sitting volleyball, swimming, track and field, and wheelchair basketball.

A new event debuted in September in the United Kingdom – the Invictus Games – where the U.S. team competed against 13 others from around the world. The United States sent 98 male and female athletes (22 Army, 20 Marines, 22 Navy, 22 Air Force, and 12 from U.S. Special Operations Command), 53 active duty and 45 veterans, the former ranging in rank from corporal to colonel. Their wounds, illnesses, and injuries ranged from post-traumatic stress disorder (PTSD) and TBI to spinal cord injuries, autoimmune diseases, and amputations.

Ed Rykard (left), chief of tactical gaming for the Joint Multinational Simulations Center, or JMSC, trains Staff Sgt. Ely Chagoya (right) on gaming simulations administration. Chagoya was participating in the Career and Education Readiness partnership between the JMSC and the Warrior Transition Battalion-Europe, Bravo Company. The Career and Education Readiness program partners Warrior Transition Unit soldiers who are separating from the military or re-classing within it with civilian and military employers to build or strengthen the soldiers’ skill sets in preparation for transition.

Photo by Capt. Cecilia Clark

The National Disabled Veterans Winter Sports Clinic, a joint effort of VA Recreation and Voluntary Services and the Disabled American Veterans (DAV) organization, will celebrate its 28th year by bringing nearly 400 veterans with TBI, spinal cord injuries, orthopedic amputations, visual impairments, certain neurological conditions, and other disabilities to Snowmass, Colorado, from March 29 through April 3, 2015. More than 200 certified ski instructors for people with disabilities – including several current and former members of the U.S. Disabled Ski Team – will instruct participants in Alpine and cross-country skiing, as well as rock climbing, scuba diving, kayaking, and snowmobiling.

“For over a quarter-century, this exceptional physical rehabilitation program, held in the mountains of Colorado, has transformed the lives of America’s most severely wounded, injured, and ill veterans. Often referred to as ‘Miracles on a Mountainside,’ it helps severely injured veterans rebuild their confidence, compensate for their injuries, and regain balance in their lives,” DAV National Commander Joseph W. Johnston told Senate and House Veterans Affairs committees in February 2014. “Veterans from all eras have attended our clinics, including many who were wounded and injured in the Iraq and Afghanistan campaigns.

“Often, this seminal event offers some veterans their very first experience in winter sports and gives them motivation to take their personal rehabilitation to a higher level than they may ever have imagined. Participants have included veterans with multiple amputations, traumatic brain and spinal cord injuries, severe neurological deficits, and even total blindness. For anyone who has attended ‘Miracles on a Mountainside’ and observed our participants and their efforts, it is an inspiring sight, unlike anything you will see anywhere in the world. I can assure you, miracles do still occur.”

Implementation of the ADA began removing physical access barriers just as the national and international sports programs for athletes with disabilities began to attract public and media attention – and, through the Paralympics and events still being created 25 years later, opened new opportunities for veterans with disabilities. Radically advanced prosthetic feet and legs, faster and more accurate diagnosis and treatment of TBI and PTSD, and a commitment by DOD, the individual services, the VA, and athletes – combining to emphasize and explore the rehabilitative benefits of sports – have changed the lives and prospects of thousands of veterans, as well as those who declined medical discharge and remained on active duty.

“In 2003, we began increased involvement with the VA and other hospitals for disabled veterans and their families. The veterans from this war have really driven a lot of the demand for high-activity, high-risk sports,” DSUSA’s Bauer said. “The resources DOD has put into developing the latest prosthetic devices has given greater independence to veterans, but also affected the entire field of wheelchair sports. The Paralympic team [that] went to the winter games in Russia – about 80 Americans – comprised about a quarter wounded warriors, so they are making up an increasing percentage of participants.”

Bauer emphasized that while most media attention has gone to those who have acquired disabilities in combat since 9/11, DSUSA and other organizations also are reaching out to – and finding a receptive audience in – older veterans from earlier eras.

Cpl. Justin Gaertner of the Special Operations Command team celebrates his first place finish in a hand cycling event at the 2014 Warrior Games at Fort Carson, Colorado, Sept. 29, 2014. Adaptive reconditioning and events like the Warrior Games can play a significant role in service members’ rehabilitation, recovery, and reintegration.

DOD News photo by EJ Hersom

“A lot of attention has been given to veterans injured in the wars in Southwest Asia – and rightly so. But the numbers are actually a quite small percentage of the total disabled population we serve – about 3 percent. If you look at the totality of injured coming out of the wars in Iraq and Afghanistan, we’re talking about 50,000 wounded, about 15,000 of whom have severe life-changing injuries. The total number of amputees is less than 2,000, visual is under 600, and there are about 7,500 with severe TBI,” he said.

“I’m an amputee from Vietnam and there were three times the number of amputees from that war than from Iraq and Afghanistan combined. But I have never witnessed so many multiple amputations because of the large IEDs the enemy used in Southwest Asia – hundreds of double and triple amputees.”

Ann Cody, a member of the International Paralympics governing board and a winner of four silver medals at the 1988 Paralympics Games in Seoul, South Korea, then a gold and a bronze in Barcelona in 1992 – all in wheelchair racing – says efforts to help veterans with disabilities provided the spark for the modern Paralympics.

“The credit for creating the Paralympics goes to the UK, with the whole concept coming about as a result of World War II and severely injured British and American soldiers,” she explained. “There were a lot of spinal cord injuries from that war, but the use of drugs such as penicillin also increased the number of survivors and greater efforts were made to heal those individuals, including using sports as part of their rehab.

“After 9/11, U.S. Paralympics and VSOs ensured our wounded military personnel had access to competitive sports opportunities to incorporate those into their rehabilitation effort. It was a much more coordinated effort and focus than in the past. As a result, injured veterans from Iraq and Afghanistan competed in Beijing, more in London, and quite a number in Russia. The UK and other nations also have been developing similar programs for their disabled veterans.”

Col. T. Shane Tomko, commanding officer of the Wounded Warrior Regiment, addresses the Warrior Games All- Marine Team at the Olympic Training Center in Colorado Springs, Colorado. The Marine team is comprised of both active duty and veteran wounded, ill, and injured Marines who are attached to or supported by the Wounded Warrior Regiment, the official unit of the Marine Corps charged with providing comprehensive non-medical recovery care to wounded, ill, and injured Marines.

Photo by Patrick Onfre

This generation of wounded warriors are the product of war with an historically low level of combat fatalities, but with onethird of those injured unlikely to have survived in any previous war. They bear a higher-than-usual percentage of disabling wounds, but due to new surgical and treatment technologies, advanced prosthetics seemingly taken straight from science fiction, and a vast change in mind-set on the part of those who command them, they are wounded warriors who refuse to be labeled or live as “disabled.”

An example is former Marine Gunnery Sgt. Brian Meyer, who lost his right leg above the knee, his right hand above the wrist, and three fingers on his left hand while disarming a bomb in Afghanistan in 2011. The then- 29-year-old underwent multiple surgeries, was outfitted with cutting-edge prosthetics, and learned to walk again, ride his motorcycle, and go hunting with both rifles and bows and arrows.

He refused to have wheelchair ramps installed in his home and only reluctantly accepted a handicap parking permit.

“I focus on what I have left, not what I lost,” he told the Associated Press (AP).

One of his doctors, Cmdr. Peter Shumaker, chief of dermatology at Naval Medical Center San Diego, told the AP it was a privilege to work with warfighters such as Meyer, “because they’re young and motivated and healthy and they can go farther than we ever thought. They don’t want to just walk; they want to do things that their colleagues are doing, their friends are doing.”