Medical Care for Soldiers Wounded in Iraq In 2007, a series of articles in The Washington Post exposed extremely poor care for some soldiers at the Walter Reed Army Medical Center. Have conditions improved? Joe Shapiro, NPR correspondent, and Brigadier General Mike Tucker talk about the medical services currently available for wounded soldiers.
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Medical Care for Soldiers Wounded in Iraq

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NEIL CONAN, host:

This is TALK OF THE NATION. I'm Neal Conan in Washington.

A year ago, The Washington Post reported on scandalous conditions and bad management at the Walter Reed Army Medical Center. Some wounded, ill and injured soldiers lived with mice and mold and peeling paint while they waited through endless red tape. Other challenges included disputes over disability ratings, understaffing, difficulties with difficult injuries like TBI, traumatic brain injury and PTSD, post-traumatic stress disorder. So a year later, what's changed?

If you're in the Army and received care in the military hospital, call and tell us your story - what's improved, what hasn't? 800-989-8255. E-mail us, talk@npr.org. And you can comment on our blog at npr.org/blogofthenation.

In a few minutes, Brigadier General Michael Tucker will join us from the Pentagon to take your calls. But we begin here in Studio 3A with our own correspondent Joe Shapiro who's been following the story.

Thanks very much for coming in, Joe.

JOE SHAPIRO: You're welcome.

CONAN: And let's go back to a year ago. What was the Walter Reed scandal all about?

SHAPIRO: Well, I think what angered Americans most - what we remember most of those about the stories is that injured soldiers were living, as you said, in these in a building that had all these mold and rotten - mice, cockroaches. But that was one building. It was called Building 18. I think that's worth pointing out because a lot of the other places that people live in at Walter Reed were actually fairly nice. Now, they were crowded because there were so many soldiers being treated, but, for example, the Malone House at Walter Reed is kind of like a Days Inn, like a small hotel and they got a bar in the lobby and the soldiers would in a small…

CONAN: Not necessarily the Ritz, but…

SHAPIRO: Right, not the Ritz but, you know, not bad. And they have a room where you have two double beds and you might have your father or you mother would stay with you to help you out or maybe there'd be another soldier there. But - and these soldiers lived there with their laptop computers and their Xboxes and food and microwave ovens. And they're there for months and months. Sometimes they're there for a year. And that's the other - I think that's the other problem that The Washington Post story…

CONAN: And we'd get to it in just a second.

SHAPIRO: Yeah.

CONAN: But what about Building 18? Has it been fixed up?

SHAPIRO: Building 18 - you know, that's something you have to ask General Tucker. You know, I actually asked the Army yesterday, they weren't sure if it's closed or have been fixed up. I know they have fixed up a lot of the other buildings in military hospitals around the country. I'm not sure what happened to Building 18.

CONAN: Then, the other thing that you just pointed out. That interminable time, even bad conditions are tolerable there if you're only there for a little while. But nevertheless, these soldiers were there sometimes for months.

SHAPIRO: Right. And that, I think, that's what the - was most valuable from The Washington Post series. It showed that there was a disability system that took way too long for these guys to get out. And before an injured soldier could leave Walter Reed or any other Army hospital, he or she needs a disability rating because that rating, depending on how high it is or how low it is, that's going to determine how much health care, how much disability pay they get when they leave. And that system is way too complex. That's what we found out. It was taking way too long to get the rating. There was concern that the rating system was seen in a low ball, the extent of the injuries. The system was seemed antagonistic as well.

CONAN: And amidst all of these, these very negative stories coming out of - in The Washington Post, certainly. There was a brand-new secretary of Defense just appointed. How did the Defense Department and the Army react to these reports?

SHAPIRO: Well, they reacted fairly quickly and they did change things around. They changed things at Walter Reed. They brought in General Tucker. They changed things in the Army's surgeon general's office. And one thing they did - they're trying to make change. They're doing more research, for example, on the PTSD and traumatic brain injury. And the thing that maybe most visible is that they restructured the way things are set up for injured soldiers.

There are 35 Army hospitals including Walter Reed, they now have things they call - a new brigades that they call Warrior Transition Units. And the idea is that these are for wounded soldiers who are getting care as outpatients. And the idea was to give them more attention and to hire extra staff to do anything that a wounded soldier or the family needed whether it was help getting through the bureaucracy or monitoring their medical care or just making sure they had the right transportation to get to a therapy appointment.

CONAN: But what about that other aspect, you know, again, living in those temporary, quote/unquote, "facilities" for months and months at a time, people got very good at playing videogames and memorizing "SpongeBob SquarePants."

SHAPIRO: Well, that's I think that's the thing that's been harder to fix. The Army has tried to make some changes in the way the disability rating system is done. They've made big cuts in the amount of paperwork that an injured soldier has to fill out. And there'd been several blue ribbon panels in the last year that have basically said, let's just scrap the Pentagon's ranking system and let the VA do it.

The Army started a yearlong pilot project just try to see if that works out. It's happening with soldiers at Walter Reed and some other local hospitals in the Washington area. But it's just a pilot program; it's going to take a year. So today, if those soldiers were still in Army hospitals, it can take months and months still to get that rating. They're still waiting around as outpatients to get the disability ratings. But they can leave, go home, go back to their families. And many of those injured soldiers, they say they're still getting ratings that they think are too low, that their physical disabilities are underrated or things like PTSD are getting downgraded to things like anxiety disorder.

CONAN: And this rating is incredibly important.

SHAPIRO: Very important.

CONAN: Tell us about it.

SHAPIRO: Well, if you get a rating of 30 percent or more, you get access to Pentagon health care, your family is covered as well. If you get less than that, you get a severance pay and you go home. And you do get care from the VA but your benefits are less, your health care coverage is less.

CONAN: And you've done stories about soldiers who have gone in and the Army gives them a disability rating of 10, meaning, they get very little, and then they go to the VA and they get either challenged by a lawyer or the VA does it and it's a 60, 70, 80?

SHAPIRO: Right. And there was a - one of these veterans commissions that was setup to look at this issue last year found that more than half of the soldiers were being rated as 0 percent, 10 percent, 20 percent, were then getting ratings of 30, 40, 50 percent or more.

CONAN: Does - we're going to ask General Tucker but the does the Army have an explanation as to why you get such a different rating from the Veterans Administration than you do from the Army.

SHAPIRO: Well, they look at slightly different things. The Army, the services are trying look up if somebody is fit to go back to duty. The VA is considering a broader list of injuries and disabilities.

CONAN: We're talking today about the Walter Reed scandal, a year later. And again, we're talking about military hospitals, not Veterans Administration hospitals. If you've been there, if you've had an experience there, call us, tell us your story. Have things improved? What's better and what isn't? 800-989-8255, 800-989-TALK. E-mail is talk@npr.org.

And everybody including Secretary of Defense Robert Gates said look, we have to find ways to improve the bureaucracy and get this moving a lot quicker. Then, well, militaries and Department of Defense is a - I think maybe the biggest bureaucracy in the world, nevertheless, blue ribbon panels don't seem like are licensed to improve things quickly.

SHAPIRO: Well, they were acting even before these panels came up with the recommendations. They listen to the panels as well but they were doing things before that. They did the restructuring, setting up these Warrior Transition Units. They did try to cut some of the paperwork, do more of the research.

Their congressional investigators were running focus groups with injured soldiers and to see what soldiers say has changed, and so this has came out of the Government Accountability Office. And they've done two studies in the last year, one is September and one just last month. And they find that, yes, the buildings are being painted, they're in better condition, there's more staff around and the soldiers who are the outpatients appreciate this. But these investigators also say they're still staff shortages in some of these military hospitals. And the GAO said, well, a big problem is that it's just really hard to get staff that's trained to deal with some of these trickiest injuries: the PTSD, the head injuries.

There's one other area that - where it's hard to come by and the GAO also pointed out that there hasn't been enough change yet in making these disability ratings (unintelligible)…

CONAN: Come quicker…

SHAPIRO: …quickly.

CONAN: Yeah. And who are these soldiers?

SHAPIRO: Well, it's not just guys who have been injured in Iraq. In fact, in these Warrior Transition Units, most of them are not combat-injured veterans. They can be anyone who sustained any kind of injury whether it's a training accident - it might be somebody who's…

CONAN: Or - you did a story about a woman who got leukemia.

SHAPIRO: Leukemia - right, and was treated at Walter Reed. She'd been flown back from Afghanistan, I believe, and she had leukemia. She's treated at Walter Reed. She's there, I believe, for over a year. They said that the leukemia was in remission. They discharged her from the Army. They gave her a 10 percent disability rating. She had two children who couldn't get health care as a result of that. She went back home and the leukemia was back within a month. Her name was April (unintelligible) Croft and she actually just died a few months ago, with the VA rated her and said she had a 100 percent disability after the Army said it was 10 percent.

CONAN: Well, joining us now is Brigadier General Mike Tucker. He's the U.S. Army's assistant surgeon general for Warrior Care and Transition, and he's with us from our studio at the Pentagon.

And, General, thanks very much for being with us today.

Brigadier General MICHAEL TUCKER (U.S. Army; Deputy Commanding General, Walter Reed Army Medical Center; Assistant Surgeon General, Warrior Care and Transition): Thank you. I'm glad to be here and I appreciate your interest.

CONAN: And we want to remind listeners, again, we're talking about the Army's medical system and not the Veterans Administration - we'll do that another day - but we're talking about the Army medical system today. We can't answer questions about the VA for you today.

But Gen. Tucker, you've created - Joe Shapiro was just telling us these 35 warrior transition units - what do they replace, why are they better?

Brig. Gen. TUCKER: They're replacing what was normally known as medical hold arenas which were active duty and reserve component soldiers, respectively. And so now there are Warrior Transition Units, and we took the term hold out of their title, hold means stagnant not moving. We want them in transition, moving on in life and getting better. And they're in transition because they were soldiers on the line who were deployable and now they're transitioning either back to the line - what we call return to duty - or they're going to transition to be a successful citizen of society, so they're warriors in transition in Warrior Transition Units.

CONAN: And about what percentage of them actually go back to active duty?

Brig. Gen. TUCKER: Around 70 percent.

CONAN: So most of them that you see in these WTUs, as I'm sure they're called, are going back to active duty?

Brig. Gen. TUCKER: Correct. In fact, 88 percent of that 70 percent are in their - are corporal to sergeant first class which is an important return on investment in terms of getting people back to the line that you'd have to go out and assess a staff sergeant. You can appreciate how long it takes to create or raise a staff sergeant or a sergeant first class - it takes years and years, decades. So now, we're able to return these soldiers back to the line about two brigades worth a year.

CONAN: And I neglected to ask you a question that came up earlier in my conversation with Joe Shapiro, and that's about the notorious or then notorious a year ago, Building 18 at Walter Reed Medical Center. Has that been fixed up, improved, closed, what's happened to it?

Brig. Gen. TUCKER: Well, we've - building - we moved the soldiers out of Building 18 about - within actual days of 18th of February last year when the article came out in The Washington Post. And so what we did then was move on concentric circles across the Army to improve the facilities for all soldiers in the Army.

CONAN: So Building 18 is no longer being used?

Brig. Gen. TUCKER: Building 18 is no longer being used for housing soldiers. I believe there are some office space being used over there.

CONAN: The military will find a space to - a use for almost every space they can come up with. As you look ahead though, a lot of the questions are about this disability rating system - I think you may have heard Joe talking about that just before you were able to join us - and the idea that you get one rating from the Army then another, sometimes much higher rating from the Veterans Administration, why the discrepancy?

Brig. Gen. TUCKER: Well first of all, I'm in the business of healing soldiers not rating soldiers. That's the preponderancy of the Physical Disability Evaluation System. However, the Army by law is required to rate you for your retainability(ph) for further military service and we rate you for the single disability that is keeping you from staying in the Army, so to speak; where the VA is going to rate you for the whole person, the quality of life, so to speak. So they'll give you ratings for anything that's wrong with you, where the Army - or the services, so to speak, will only focus on that disability that is keeping you from further service.

CONAN: And that pilot program that Joe was talking about where the VA would do the rating by itself, how is that working out so far?

CONAN: Yeah, I think it's working out well. It's too early to really pass judgment on it and I know that the - Secretary Peake of the Veterans Administration's taking a very close look at the metrics they were using and is drawing a lot of attention from - for Secretary Gates as well because they want it to be a very good product when we're done.

CONAN: Our guest are Joe Shapiro, NPR correspondent, and Brigadier General Mike Tucker, assistant surgeon general for Warrior Care and Transition. You're listening to TALK OF THE NATION from NPR News.

And we're asking listeners who have experience with the military hospital system either as inpatient or an outpatient, have things gotten better in the past year, have they gotten worse, what's changed, what's better, what's not, 800-989-8255, e-mail us, talk@npr.org. And Lyn(ph) joins us on the phone from Phoenix, Arizona.

LYN (Caller): Hi, good afternoon.

CONAN: Good afternoon, Lyn.

LYN: Well, my son was stationed at Madigan Army Medical Center for two years and he was - dropped back from Korea for a non-combat injury that he acquired while he was in service. And he was stationed and received great care at Madigan Army Medical Center that was they couldn't care for - they did refer him out to civilian to take care of. The conditions at Madigan at the time were changed and he did go through as part of this transition that you're speaking to your guest about…

CONAN: Mm-hmm.

LYN: …and because of that change, it was a very positive change for my son and for his family that was there to care for him during this time.

CONAN: What was the biggest and most important change do you think?

LYN: Two things are most important. I can't actually - just one. First of all, the doctors were very proactive (unintelligible) to his needs at the time. The second was once they identified that they needed to make changes at Madigan, they were proactive in making that happen. And the effect on the soldiers and the morale improved. And I think the Warrior Transition Unit is a positive step in that direction for the soldiers.

CONAN: And from your perspective, is there anything left to improve?

LYN: And for my perspective on what, sir?

CONAN: Is there anything else you would like to see improved?

LYN: Well, I'd like to see them continue with the program and also to bring the assistance that the soldiers are getting with their managed care brought to a better ratio of soldiers to manage care.

CONAN: Gen. Tucker?

Brig. Gen. TUCKER: Well, thank you Lynn for your comments. We appreciate that. We continue to review the ratios that we do have. You know, every soldier now has a triad of care which is like the soldier's home team: it's a primary care manager, it's a registered nurse case manager and it's a military squad leader who hold the soldier in their caring hands throughout the process to provide clinical care and benefits and leadership throughout the process. We review that ratio every 90 days to ensure that it's the proper amount. And we also have a massive study looking out across the entire Army, across all 35 Warrior Transition Units currently to determine what the manpower ratio should be. So we're continuously trying to sharpen us all and make ourselves better.

CONAN: And as Joe Shapiro was saying earlier, are there still questions about understaffing in some of these facilities?

Brig. Gen. TUCKER: Well, the understaffing is in relation to the rapid population of the warriors in transition. We're growing at a - our numbers are growing at a rate faster than we can man the cadre, and so we're having to rely on what we call borrowed military manpower from the units out there at our camps and stations until we can get the TDAs to catch up with the population.

CONAN: And how big is the population now?

Brig. Gen. TUCKER: Around 10,600.

CONAN: Thanks very much. Lynn, thanks very much for the call.

LYN: Thank you very much for taking my call and good luck gentlemen.

CONAN: Thank you.

Coming up, we're going to hear more from our guest. Again, a year after the reports of poor conditions at the Army's Walter Reed Medical Center Service, we're getting an update on improvements in care for wounded veterans and we're taking your calls. If you've received care at a military hospital, tell us your story, what's improved, what hasn't. Again, not VA hospitals, military hospitals, in fact, Army hospitals since our guest is a brigadier general in the United States Army and an assistant surgeon general of that institution. 800-989-8255. E-mail talk@npr.org.

Stay with us. I'm Neal Conan, it's the TALK OF THE NATION from NPR News.

(Soundbite of music)

CONAN: This is TALK OF THE NATION. I'm Neal Conan in Washington.

Today it has been five years since the U.S.-led invasion into Iraq, one year since The Washington Post broke a story of difficult conditions at Walter Reed Army Medical Center, a renowned hospital that serves the wounded from Iraq and Afghanistan. We're talking today with NPR's Joe Shapiro. He's a science correspondent. He covers issues of disability and aging. And with Brigadier General Mike Tucker, he's the Army's assistant surgeon general for Warrior Care and Transition.

And we want to hear from you if you were in the Army and received care at a military hospital in the past year in the hospital or as an outpatient, join the conversation. Tell us your story, 800-989-8255. E-mail is talk@npr.org. And let's go right to the phone. Hope(ph) is with us. Hope calling from California.

HOPE (Caller): Hi.

CONAN: Hi.

HOPE: My husband is a physician or was a physician at BAMC, Brooke Army Medical Center in San Antonio, Texas. We (unintelligible) to another installation but the care, I think, was outstanding at BAMC, state-of-the-art facilities, the new Intrepid Rehabilitation Center, a world class burn unit. But I think something that isn't being addressed is the extra stress this has created for the physician. It's unbelievable, the workload change in the last two-and-a-half, three years, and my husband works 12 to 15-hour days, alternate weekends off, on call…

CONAN: And what does your husband do?

HOPE: Physician, a critical care physician, so it's the ICU, an intensivist.

CONAN: I see.

HOPE: And Brooke is - if Brooke is where people go instead of Walter Reed, depending on their injury. They have - if they need prosthetics or if they're severely burnt, they go to BAMC, they don't go to Walter Reed.

CONAN: Mm-hmm. Gen. Tucker, is the workload on physicians getting too much?

Brig. Gen. TUCKER: Well, Neal, it's our number one priority in terms of hiring right now. We are - we've got authorizations to hire the proper amount of physicians that we need for the population but it's just difficult hiring people. I can tell you that we've invested a great deal of money in recruiting and retention and signing-up bonuses and the Army Medical Command is very actively out there trying to hire as many doctors as possible, but it's a shortage across the United States in all sectors.

CONAN: Mm-hmm. And, Hope, how does this increased workload affect, well, the morale of your husband and the others who are affected by it?

HOPE: Well, I don't know, Neal. How would you like to work 12-15 hours a day, six days a week, alternate weekends off? You tell me.

CONAN: Well, I have a union contract.

HOPE: Yeah. Well, yeah, there's - the, yeah, the military doesn't have that union thing going on. I think it affects a lot. I mean, it's had - it's certainly had an impact on our relationship, it's had an impact on home life. And I mean, during in deployment to Landstuhl, actually, I got a call…

CONAN: That's in Germany. Yeah.

HOPE: Yeah, that's the - that's where they go from Iraq or (unintelligible) if they're (unintelligible) for the state. And he had been there about two weeks and I got a call and he was crying. He was like, I can't see one more brain-dead 20-year-old today.

CONAN: Mm-hmm.

HOPE: And that's what this war is creating - this ongoing occupation - and it is affecting military families and we're less than one percent of the population. And if (unintelligible) people can be to this occupation into the war, they're not really doing anything about it. And…

CONAN: Hope…

HOPE: …they keep serving and dying.

CONAN: Thanks very much for the call and hang in there, okay?

HOPE: Thanks.

CONAN: All right. Appreciate it. Let's see if we can go now to Brandon, and Brandon's calling us from Fort Drum in New York which is near the City of Watertown, New York and right on the banks of Lake Ontario. I bet it's pretty chilly up there today, Brandon.

BRANDON (Caller): It's raining. It's pretty miserable overall but it'll get better come May or April.

CONAN: Okay, what's your question?

BRANDON: Okay. I'm a lieutenant. I was injured in Iraq and sent back in January of this year. I'm now part of Fort Drum's Warrior Transition Unit. One thing that they try to do for us who are warriors in transition is give us jobs. Obviously, we've got a lot of doctor's appointments and physical therapy. Anyway, they give me a job. I'm a speech writer for the generals up there. And my question is why we can't get evaluated doing these jobs, like we're not allowed to get OERs, Officer Evaluation Records, we're a part of WTU even though we're doing the job. And it looks bad for a lieutenant to have a year where it looks like I didn't do anything.

CONAN: Mm-hmm. General Tucker, what do you think?

Brig. Gen. TUCKER: Well, first of all, Brandon, thank you for your service to the country and the sacrifices that you've made for the great 10th Mountain Division up there, climbing to glory. I'll tell you that we're looking at ways that we can account for this time that you are recovering and so that we can appropriately assess your performance and give you credit for the great work that you're doing. And we are running some pilots here at Walter Reed to fill that void in your performance portfolio. So I suspect that within the next month or two, we'll have some procedures out there so that we can get that documented.

BRANDON: All right. Thanks, sir. That's good to hear.

CONAN: Brandon, how are you doing?

BRANDON: Good, thanks.

CONAN: Oh, good. All right. Glad to hear that. Good luck to you Brandon.

BRANDON: Yeah. Thank you.

CONAN: Bye-bye. Let's see if we can get Joe on the line. Joe's calling us from Indiana.

JOE (Caller): Yeah. Thanks for taking my call, Neal.

CONAN: Go ahead please.

JOE: This question is for the general. I'm an hubster(ph) in the Army as well. In 2003, I spent a few months in a medical hold unit at Fort Knox. And the biggest problem that I saw in my short stint there with the soldiers was more of the mental health, the depression. It was - I'm pretty good at managing those feelings, but the other soldiers that were around me, it was really difficult and challenging for me to witness it. I saw some soldiers on the brink of suicide. What is the military doing to address those issues in these warrior transition programs today in the Army hospitals?

CONAN: General Tucker?

Brig. Gen. TUCKER: Well, first of all, we've established a risk assessment that we do in every soldier coming in to Warrior Transition Unit within 24 hours. We conduct a risk assessment on the soldier to identify whether or not that soldier would be what we term as high risk for perhaps self-defeating behavior. Some of the things that we consider are any prior substance-abuse issues, any former discipline issues, does the soldier have solid relationships, does he come from a stable family, the nature of their wounds, et cetera. And then based on that assessment, we will customize a care plan for that soldier that addresses these issues and provide support for them to include a sole provider for any medications whether that'd be narcotic or otherwise, chaplain support and social work services. And so we have learned and matured a great deal over the last year in regard to treating these soldiers who need extra care for those wounds that you can't physically see.

JOE: Well, sir, that's an excellent, excellent change from - back in 2003. That's incredible and I'm glad to hear that.

CONAN: Joe, thanks very much for the call.

JOE: Thank you.

SHAPIRO: Well, that's an interesting question. I know the Army surgeon general's office right now is looking about 11 deaths of soldiers who were outpatients in these new Warrior Transition Units. And some of them were the result of accidental overdose of prescription drugs. We've got soldiers who were on multiple potent medications, methadone, morphine and powerful pain relievers. So there've been these overdoses including some of these deaths. And the Army is trying to figure out what - how to prevent some of these. In addition to the risk assessment that General Tucker talked about, there's also new rules trying to prevent access to liquor by some of the soldiers who are on some of these drugs.

But there have been some really pretty horrible deaths including one of a soldier at Fort Knox, Gerald Cassidy, last September. It took about three days before someone checked on him and it was like he was alive but unconscious for a few days before people at the Warrior Transition Unit - and this was in Fort Knox actually - found him. And as a result some people lost their jobs there.

But so the number of suicides is up. There was a suicide attempt at Walter Reed that got some attention of a psychiatric outpatient named Elizabeth Whiteside(ph) who's an Army lieutenant that got some attention this year. And that's the problem. And there's concern about these increases of suicides or accidental suicides.

CONAN: General Tucker, is that what you were talking about earlier this program to address situations like what Joe is just talking about?

Brig. Gen. TUCKER: It is. About - we've done a tiger team and looked at every one of those unexplained deaths, Joe. Since June - and you right, we've taken that to heart and issued some pretty draconian measures across our Warrior Transition Units so that we as military leaders should never find ourselves regretting not having taken an action that have prevented a soldier's death because any one suicide or any death is one too many. And in creating alcohol-free zones over these building facilities is one of those measures that you mentioned in addition to restricting for high-risk soldiers, narcotics risking, I mean, breaking it so that they don't get more than seven days at a time, dedicate chaplain support, requiring leadership to see them physically twice a day, assigning room mates, et cetera.

There's another 18 things that we're doing so that we don't have to find ourselves second-guessing what happened, and of course, Sergeant Cassidy case was a tragic case that we learned a great deal from.

CONAN: Just to follow up on another point to some of the reporting that our correspondent Danny Zwerdling did from Fort Carlson. And it's one thing to, as you say, instruct - to have send out orders and to speak with, you know, training sessions for officers and that sort of thing, commanders. When it gets down to the level of sergeants and corporals, Danny found a lot of people belittling soldiers for their what they perceived to be exaggerated psychiatric problems and harassing them.

Brig. Gen. TUCKER: Well, I think that's part of the entire issue of stigma that's associated with traumatic brain injury or post traumatic stress. And we've done a lot to address that. Two major issues that we created a leader teach program back in the fall. We trained over 800,000 Army soldiers and leaders in what we call Battlemind. And what it is, is number one, junior leaders need to be able to understand the conditions and the manifestation of these conditions as the symptomatology begins to surface itself; and then secondly, they need to understand what their responsibilities are in getting these soldiers referred to help. And that in itself has helped us an enormously with trying to get these soldiers to care because we can heal these wounds if we can get them the care. But it is a strong stigma. And many soldiers don't want to come forward. So we're working very hard to help them with that decision.

CONAN: Brigadier General Mike Tucker, the assistant - Army's assistant surgeon general for Warrior Care and Transition; also with us, NPR's Joe Shapiro.

You're listening to TALK OF THE NATION from NPR News.

And let's see if we can get Joe(ph) on the line. Joe is calling us from San Antonio, Texas.

JOE (Caller): Yes, sir.

CONAN: Go ahead please.

JOE: Oh, okay. I'm a registered nurse. I'm contracted at Brooke Army Medical Center. I've been there almost a year. And I also have a son who's in the Navy and stationed in Japan. And I was kind of, like, trying to do my part and help out. One of the things that I have - I feel strongly about is that the - in the past year, the attention given to the soldier and to the warrior in transition has, in my opinion, has improved. The morale is better. The families, the (unintelligible) like the earlier person mentioned is an awesome rehabilitation center. And in my opinion, I think and I feel strongly that if a soldier is - every need is being (unintelligible) like the general had mentioned - they have an RN case manager, there's a primary care physician assigned to them. There's a lot of attention given, and it's been my experience that they're very appreciative of this.

And now I'll listen to the comments off line. Thank you very much.

CONAN: Okay, Joe. Thanks very much.

JOE: Yes, sir.

CONAN: General, I'm sure you're going to sharp disagreements.

Brig. Gen. TUCKER: Basically, (unintelligible) saying…

CONAN: I was joking.

Brig. Gen. TUCKER: Okay.

CONAN: No, I was joking there. I think you're going to be very pleased by that call.

Brig. Gen. TUCKER: I am. Thank you. Thank you, Joe. And thank you for your service as a registered nurse there in San Antonio.

CONAN: Let's go to John. And John's with us from Jacksonville in Florida.

JOHN (Caller): Good afternoon gentlemen.

CONAN: Go ahead please.

JOHN: I've been an Army nurse commissioned to officer for 30 years and have served during Vietnam and Dessert Storm, and I've been a leader in Army medical care around the world. And I would like to say that I don't think anybody could criticize the nature of the acute care provided to our soldiers and sailors and airmen and Marines at military hospitals. It's clearly the best in the world.

However, I think one of the reasons that the situation has developed as it has with the people after the acute injury is that unfortunately in any military system, we all follow the directions of the people above us. And at the start of this war, the administration was saying that all our warriors are going to be greeted with flowers and as heroes. And as a result of which, I really do not think that the military medical system geared up anywhere near for the amount of casualties that we were going to have and especially in terms of the chronic types of injuries because of our better protective gear that we see now. We're having a tremendously increased amount of people with traumatic brain disorders. Because of the nature of this particular conflict, we're seeing a lot of people with PTSD. Although they're taking care very well when the inpatients in the hospital, they tend to get lost in the shuffle as outpatients because they're really not, you know, the walking wounded who can manage their own self-medication and get themselves to clinics when they need to be. And I don't think that there was an adequate system set up to manage the great number of chronic casualties that we are going to see prior to them being out-processed from the Army.

CONAN: General Tucker?

Brig. Gen. TUCKER: Well, I think, John, you've identified pretty well what the situation was. I mean we did have unprecedented survivability rates. And to that, we can only say praise the Lord. And our docs are doing a terrific job of putting our soldiers back together and provide them a quality of life that's unprecedented in medical history. And to that, again I simply - we can always be happy about that.

The Army has reacted very quickly to the void and outpatient facilities and outpatient leadership that was necessary to deal with the large numbers of survivors. And by all accounts, we think we've got a solution set in play here that we're only going to continue to refine and get better.

CONAN: John, thanks…

JOHN: Well, I…

CONAN: I'm afraid we're out of time, John.

JOHN: Okay. Thank you so much.

CONAN: But we appreciate the call.

And general, thank you for your time today.

Brig. Gen. TUCKER: Thank you, Neal. Thank your for the opportunity. And…

CONAN: Brigadier General Mike…

Brig. Gen. TUCKER: I just like to say we have a wounded soldier and family hotline at 1-800-984-8523. You'll speak to a live operator 24/7, and they will help you with your problems.

CONAN: And we'll put that phone number up on our Web site, npr.org/talk. Brigadier General Mike Tucker, assistant surgeon general for Warrior Care and Transition for the U.S. Army with us today from our studio at the Pentagon. Our thanks also to Joe Shapiro, NPR correspondent with us here in Studio 3A.

Join us tomorrow on TALK OF THE NATION. Live music from singer/songwriter Tift Merritt.

This is TALK OF THE NATION from NPR News. I'm Neal Conan in Washington.

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