The day before 13 people died in a Nov. 5 shooting spree at Fort Hood, Texas, a familiar routine was playing out at Army posts across the country: Get home from war, prepare to go back.
At Fort Carson, Spc. James Bell carried his new orders over to join the 1st Brigade Combat Team, which had moved to Colorado Springs from Fort Hood over the summer. After three deployments to Iraq, Bell, 34, had spent a year in the post's Warrior Transition Unit, getting treatment for post-traumatic stress disorder. These orders were his third since leaving the WTU in August; he'd begged out of a transfer to White Sands, N.M., and his old unit at Fort Carson didn't want him back.
His greeting to his new unit came as a barked question from a sergeant major: "ARE YOU READY TO FIGHT?"
Bell, given to leaping behind his living room sofa when gunplay broke out on television, jumped before he choked out the obligatory "Yes, sir."
"They had no clue I was still on medication," Bell says. Or that he was still getting treatment for PTSD, and had pending tests for traumatic brain injury.
The sergeant major later apologized for startling him. But in his new unit over the next two weeks, Bell played a mental-health version of dodgeball as he tried to avoid trips to the firing range and steered clear of weapons in the brigade's motor pool. He worried one of his "freak-outs" at the wrong moment could prove dangerous.
On Nov. 19, a psychologist with the post's mobile mental-health squad put Bell back on a medical "profile," barring him from access to weapons and closing a communication gap that had opened when Bell was sent to a new unit that had no idea of his condition.
Says Bell, who is starting the process of going through a medical retirement: "They were completely blindsided."
'The trigger mechanism'
Two years ago, the Army started Warrior Transition Units at 32 posts across the country in an attempt to combat a flood of negative reports about injured veterans returning to dismal conditions and bureaucratic bungling. The goal was to guide soldiers and officers through the healing process in a space where peers and superiors wouldn't regard them as "shitbags" or "dirtbags."
After completing treatment, some would go back to active duty; others would transition to medical retirement.
Bell provides just one example of things not working out. More than a half-dozen soldiers and officers — many of whom, fearing consequences, requested their names not be printed — describe a pattern of tightening access to Fort Carson's WTU, pressure to reduce numbers already in the program, and retaliation against those who question either their care or the operations of the unit.
Seen in this light, the Army's solution to its wounded-soldier problem appears less a shining success than a public-relations smokescreen, behind which the Army continues breaking its promise to care for wounded soldiers. By shifting the medical-care burden to the Veterans Administration, critics argue, the Army is cheating soldiers who could return to active duty, and, worse, is ratcheting up the pressures that lead soldiers to take their own lives, or the lives of others.
Chief Warrant Officer Edward Quick, a pilot with 35 years of active and reserve experience in the Army, was in Fort Carson's WTU for about 10 months before he transferred to another WTU in Salt Lake City. He says he faced a hostile environment after questioning a decision made by commanders.
"It's the most screwed-up mess I've seen in the Army," says the 53-year-old.
He met with WTU commanders in May to highlight what he saw as a pattern of arbitrary and ill-considered decisions, fearing it was increasing pressure on those least able to bear it. Quick recalls telling them, "I believe you are the trigger mechanism for these young soldiers when they have nowhere else to turn."
Ironically, Quick says, the conversation was interrupted by a phone call that another WTU soldier had committed suicide.
WTU commanders recall the conversation, but say that call was actually in regard to an accidental death. In all, they report four suicides among members of Fort Carson's WTU since its formation in June 2007. The post as a whole had eight confirmed suicides in 2008, and six so far this year, with two more pending investigation.
Quick, who's having a smoother time with the WTU in Salt Lake City, says he's speaking out now because an officer still in the Fort Carson program is facing retribution for questioning WTU commanders.
"If they don't change their ways," he says, "they're going to have more suicides."
Closing an open door
Army Medical Command came under fire in November, when Nidal Malik Hasan, an Army psychiatrist, was charged with killing 13 people at a Fort Hood soldier readiness center. But the bad news actually started almost three years ago for Medical Command, the branch of the service that has the mission of caring for wounded and sick soldiers whether they are on American soil or deployed around the world.
In February 2007, the Washington Post published a series of stories about the nasty conditions and neglect facing wounded veterans getting care at Walter Reed Army Medical Center in Washington, D.C. Amputees and brain-injured soldiers languished in moldy, roach-infested buildings while struggling through a thorny, bureaucratic maze to get care.
Public outrage followed, and the Army launched WTUs as a way of keeping tabs on wounded soldiers and seeing that they received thorough and timely care. As one Army Medical Command general put it in an October 2007 news release, "It's about healing the entire soldier."
Over time, the new units were lauded for giving the soldiers a chance to recover before having to decide whether to return to active duty or take a medical retirement. Combat-oriented units benefited by having a place to unload their wounded and sick members.
Fort Carson's WTU opened in June 2007. Lt. Col. Andrew Grantham, who took command a year later, says the unit had about 950 soldiers spread among three companies when he arrived, with plans to add a fourth company that August. The Army's Warrior Transition Command, based in Arlington, Va., says the monthly average in the unit never got above 750.
Either way, the unit has now been scaled back to about 450 soldiers. Fort Carson's fourth company only existed for a few months before it was converted to a headquarters unit for troops transitioning in and out of the WTU.
"We were basically taking anybody with any type of illness whatsoever," says Grantham. "A lot of these soldiers really did not need to be in this particular unit."
His statement reflects a quiet shift at Army Medical Command about how WTUs would be used.
In June 2008, the same month Grantham arrived at Fort Carson, Fragmentary Order 3, referred to as "FRAGO 3," restricted WTU access to those who needed six months or more of complex, comprehensive medical care. Between then and now, national numbers have dropped from 12,500 participants to around 9,000, according to Robert Moore, strategic communications chief for the Army's Warrior Transition Command in Virginia.
"Prior to [FRAGO 3], we had opened the doors completely to soldiers," he says, "many of whom had much less demanding requirements for care."
FRAGO 3 also established an impressive-sounding "triad of leadership," putting control of each WTU in the hands of the unit's commander, and the commanders of the hospital and military base where it resides. (Those commanders at Fort Carson now are Grantham, Col. Jimmie Keenan and Maj. Gen. David Perkins.)
As the number of soldiers accepted into Fort Carson's WTU began declining, though, another issue naturally arose. Army units, whether logistical or combat-focused, only have a certain number of soldiers to accomplish their objectives, and some commanders view wounded and sick soldiers as dead weight.
Valerie Lira, 33, says she hurt her back lifting heavy equipment during her second deployment in Iraq. The pain intensified for the remainder of the deployment, and kept getting worse after she returned to Fort Carson. She got some treatment, but was denied entry into the WTU. When it came time for her unit to deploy again, she says she got what she describes as an ultimatum: Deploy, or get out of the Army.
Lira, who now walks with a cane, tested out what it would feel like hauling around 40-plus pounds of gear and body armor, and figured there was no way.
Her options were limited. Denied a medical retirement that would have let her keep drawing a paycheck, she took $18,000 severance pay for her 14 years of service and limped off into civilian life.
"I feel like I got shafted," she says. "They didn't give me a chance."
That money is long gone, and she's now getting by on unemployment benefits.
Lira got a 20 percent disability rating from the VA, which in theory should pay her about $230 a month to compensate for what she lost in Iraq. She's appealing that rating, which is based on 10 percent for PTSD and 10 percent for knee tendonitis, ignoring her back injury altogether.
One final surprise awaited Lira after getting her VA rating: She found out she won't see a penny of her disability money until it adds up to what she got in severance, which will take more than six years.
Soldier or veteran?
Tightening access to the Warrior Transition Units is just one part of the equation. In June 2009, Policy 09-037 started whittling at the other end, replacing the old standard for discharging someone from WTUs — reaching "optimal medical benefit" — with the even more arcane-sounding "medical retention determination point."
Lt. Col. Nick Piantanida, deputy commander for clinical services at Evans Army Community Hospital, which oversees the WTU, keeps a copy of the policy in his pocket so he can readily cite it.
"A Service member with one or more conditions failing to meet medical retention standards will be referred into the [Disability Evaluation System] by competent medical authority," Piantanida begins, speaking emphatically as he goes through a list describing stabilizing medical conditions and predictable recovery patterns.
The policy, which drew little if any media coverage, basically means that soldiers in the WTU shouldn't expect all their medical needs to be met; instead, their care should get them to the point where doctors can predict whether they'll meet the physical requirements to stay in the Army. Those who don't look like they'll meet those requirements will basically be taken to pasture, which means getting their care from the VA and accepting medical retirement benefits based on their disability rating.
That can be a difficult transition, given the physical and bureaucratic gulf between the Army and VA. At least one part is supposed to be getting better: In June, Fort Carson became part of a pilot program to unify the medical retirement process so the Army and VA rate a soldier's disability at the same time. It's supposed to shorten the process and eliminate a months-long wait that soldiers who left the Army could face before getting disability checks from the VA.
But it's too early to know if it will work, and Col. Harold Emick, a WTU participant, says that "what they are trying to do is shove everyone off to the VA real quickly."
Emick joined the Army in 1972 and has been on either active or reserve duty since then. He describes growing pressure from WTU commanders to retire even when he believes that, with appropriate care, he can continue serving.
"Everything I have wrong with me should be fixable," says Emick, who traces hip, neck and other injuries to a deployment in Iraq.
Another WTU officer, who asked that his name not be printed, gives a similar account.
The Army's promise to fix soldiers before deciding their future still seems to have gaps. Combined with a sour economy that has eased recruiting for the Army, Emick says, the feeling is that everyone is disposable.
"They changed the rules," Emick says. "The Army is doing what's best for the Army, not what's best for the soldier."
Two bad choices
Critics of Fort Carson's WTU who spoke with the Independent suggest a host of problems; Bell's story points to general incompetence.
He enlisted in the Army in 2000, and received several Army Commendation Medals for his work as a mechanic. He traces his PTSD to a handful of experiences during his three deployments, especially one in which he helped rescue a woman whose jaw got obliterated when a truck overturned in a convoy accident. Other times, he says, his vehicle got peppered with bullets, or he narrowly avoided explosions.
He also traces a possible brain injury to an embarrassing accident back during his first deployment in 2003: He bonked his head when he slipped off a "water buffalo," a tank trailer used to haul water.
In the WTU, Bell says, his PTSD was blunted through high levels of medication. Though he comes across as quiet and reserved, his wife Sheila says he can be a terror in the evening, after the meds wash out of his system. She points to holes he has punched into wood paneling at the couple's home in eastern Colorado Springs, and remembers times when he was startled and launched into a rage, one time pummeling her cocker spaniel.
In July, James Bell says, he worried he could be a hazard to others if given a weapon. But he still told his doctors he felt he could work as a mechanic or do something useful.
"I always felt [in the WTU], 'I'm letting my fellow soldiers down,'" Bell says.
An Army medical appointment log shows multiple visits for Bell in late June and early July, including two with Harry Rauch, a Fort Carson psychiatrist who took flak earlier this year after the news Web site Salon reported that Rauch had cleared one soldier for combat in 2006 despite of evidence he heard "voices" and had "schizotypal personality disorder."
That soldier was Robert Hull Marko, now charged in the October 2008 rape and murder of 19-year-old Judilianna Lawrence, whose body was found in the woods near Old Stage Road, west of Colorado Springs. He is one of 10 soldiers from the 4th Brigade Combat Team charged with or convicted of murder since returning from fighting in Iraq.
Rauch's assessments contributed to Bell's release from the WTU without restrictions on Aug. 13.
It wasn't until Nov. 19, two weeks after the Fort Hood shootings, that a psychologist finally thought better of that. Bell is still getting evaluated for brain injury. Though he'd planned to stay in the Army, his path now seems destined to lead him into medical retirement.
"I would like to have gotten more treatment before getting out of the unit," he says.
Perhaps Bell could have fought for more treatment, but four other officers in the program who talked with the Independent say commanders have penalized those who've spoken out.
"They turn around and retaliate against anyone," Quick says. "They harass anyone who questions what they do."
Quick, a reservist, is a commercial airline pilot when he's not on active duty. In late 2007 and 2008, he served two short tours in Iraq helping a shorthanded Texas-based unit by flying RC-7 spy planes. Though he'd injured his knee before leaving while doing physical training with the Army, and pinched a nerve in his neck in a car accident while deployed, he says neither injury interfered with his ability to fly.
After returning, and in spite of the tightening entrance requirements, he received orders to report to the reserve component of the WTU in October 2008 for treatment.
The first six months in the program went well, Quick says, but the atmosphere soured in the spring, when he sought temporary leave from the unit. Improved after months of physical therapy, he wanted 10 days of leave to join his aviation unit flying missions with the RC-7, this time in the relative safety of Colombia.
"It would keep me current and qualified," he says.
Basically, putting in the time would allow him to continue flying RC-7 planes and to deploy during the holidays this year, as he did in 2007, allowing pilots on long deployments to come home to see their families. But WTU commanders said no, Quick says. So he went up the chain of command, as the Army allows. He asked permission from the command staff at Fort Carson, and eventually received it.
But that decision was doomed.
In April, a flight surgeon from the Texas unit wrote an e-mail asking for clarification on Quick's medical condition; his opinion was that Quick appeared fit to fly. The response from Lt. Col. Joel Tanaka, the WTU's chief physician, seems openly contradictory: At first, Tanaka questions the need for Quick to be in the WTU, and suggests treatment in an aviation unit. But then Tanaka dives into Quick's medical record, outlining his treatment for neck and knee pain, and says, "From the orthopedic perspective, he doesn't sound like he's fit to fly to me."
Though he'd flown without difficulty before joining the WTU, Quick says, the e-mails and a phone call to the Texas unit closed an opportunity to stay current with his flying hours.
Back at Fort Carson, he continues, the back-and-forth launched a period of retaliation. He was transferred between companies in the WTU and shuffled between doctors. Accustomed to doing much of his treatment from his home in the Denver suburbs and commuting to Fort Carson when necessary, he started getting last-minute orders to drive to the post to check in or attend less-than-vital events.
"Allowing the Soldier to live and work in Denver has been counterproductive to his Mission as a Warrior in Transition," a June message from Maj. Michael Ciaramella reads. "That mission is, of course, to heal." Ciaramella goes on to recommend that Quick be ordered to stay on post.
Driving home from Fort Carson one evening in July, Quick got a call requesting he come back the next day just to attend an equal opportunity training session. Though he complied with the order, he says, he bristled at its seeming senselessness. He ended up receiving two counseling statements, for allegedly disobeying an order and leaving without proper dismissal.
He believes those statements were meant to lay the groundwork to get him in trouble, and he's now pushing for an official apology.
"It's setting me up for failure," Quick says. "In my case, all I was trying to do was my job, and I got kicked in the face for it."
Two other reserve officers on active duty who went though the WTU describe similar experiences, but request that their names not be printed for fear of retaliation. They, along with Col. Emick, say the commanders are apt to withhold medical treatments as punishment for those who step out of line, or to order they undergo psychological evaluations on Evans Hospital's fourth floor.
Quick says they tried something similar with him, and he put his foot down.
"I didn't ask for any mental-health treatment, and I don't need any," he recalls saying.
Grantham and Tanaka decline to discuss particular cases, but deny that any decisions made in the WTU amount to retaliation.
"We don't want to make the mistake of assuming someone's OK," Tanaka says.
Grantham says the role of WTU commanders can be like that of parents.
"We wrap our arms around these guys," he says. "Sometimes it's a tough-love situation."
Maj. Gen. Mark Graham, who joined U.S. Forces Command at Fort MacPherson, Ga., in August, was an outspoken advocate for improved care for soldiers while he led Fort Carson from 2007 to mid-2009, particularly when it came to dealing with PTSD and other mental-health issues. He did not respond to a request to discuss his experience working with the WTU or his impression of changes to the program.
Nor did U.S. Sen. Mark Udall, an Armed Services Committee member, despite repeated calls to his press secretary.
Last summer, a new policy went into effect requiring that the following groups receive special permission from a general to get into the WTU: officers ranked major or above, enlisted soldiers ranked master sergeant and higher, and chief warrant officers grade three and higher.
The way Quick sees it, the burden placed on officers is similar to what junior enlisted soldiers have to carry. The difference is that officers may raise more questions, and they "know how to fight within the system."
He muses about what it would be like for a young injured soldier to face such pressures alone: "They're basically pulling the trigger for these young kids."