Operation Recovery

The Fort Hood Testimony Report

Fort Hood Command

On behalf of those who are suffering and will continue to suffer from the adverse consequences of the Department of Defense, Veterans Affairs, and command policies addressed within the report, we recommend these changes be implemented immediately.

Ensure Respect for Soldiers’ Profiles

Violations of soldiers’ medically necessary work restrictions violates their rights to health and well-being. Commander discretion over soldiers’ profiles and access to treatment not only interferes with soldier well-being by impeding the treatment plan, but also perpetuates stigma against injured soldiers, and promotes a culture of fear whereby soldiers avoid seeking care.

 

Fort Hood should ensure that commanders and supervisors respect the work restrictions detailed in soldiers’ medical profiles as orders rather than recommendations, in accordance with its own command policy.

  • Establish immediate accountability mechanisms for all aspects of the standing III Corps and Fort Hood Command Policy SURG-05, including means for reporting command violations of soldiers’ profiles and investigation and monitoring by an independent third-party.
  • Stop the issuance of temporary profiles in serial fashion when a permanent or longer-term profile would ensure continuity of care and medically necessary work restrictions.
  • Confirm the validity of all profiles which are recorded electronically by providers. Establish accountable means to ensure all supervisors and commanders consistently monitor e-Profile and abide by its profile restrictions, in accord with Army regulations on e-Profile.[1]

Institute exemptions in soldier and NCO evaluations for sections that cannot be completed due to medically necessary work restrictions, e.g. PT tests. Ensure that no soldier is made to complete a PT test if their profile restricts them from any of its exercises.

 

Eliminate the Culture of Stigma

Fort Hood should employ extensive resources to actively reduce the perpetuation of stigma against soldiers with physical injuries and mental health issues. Fort Hood’s command policies aimed at reducing stigma (SURG-01) must be accompanied by strong enforcement and accountability efforts.

  • Expand existing policies (SURG-01) to include the elimination of stigma toward all soldiers on profile or experiencing medical issues, whether due to physical or mental health concerns.[3]
  • Implement pro-active medical and mental health care, to be offered periodically to all soldiers.
  • Install reporting procedures and enforcement mechanisms against commanders and others who contribute to the stigmatization of soldiers experiencing medical and mental health concerns. These accountability mechanisms should be monitored by an independent authority, working in partnership with relevant military leadership.
  • Institute quality commander and NCO training (levels E-7 and above) on issues and policies related to soldier care and profiles by hiring independent trainers from civilian organizations who are qualified to advise on medical and mental health care in institutional settings.

Ensure respect for the needs of disabled soldiers on-post and increase compliance with provisions of the Americans with Disabilities Act by planning for relevant facility accessibility upgrades, including disabled parking.

 

Stop Improper Discharge Procedures

The consequences of the draw-down should not be shouldered by injured soldiers and their families. The Department of Defense must ensure that no service-member is discharged improperly, outside of DoD separation regulations. DoD must enact immediate evaluation and monitoring of discharge practices in all departments. This must be followed by DoD instruction to address how the departments should drawdown their forces in an ethical manner which is aligned not only with DoD separation policies, but with service-members’ rights to the health care they were promised upon enlistment. Fort Hood command must act simultaneously to implement these changes, using all available resources, to cease the violations of soldiers’ right to health under its watch. These changes should be monitored by an independent body partnering with the military to ensure accountability.

 

Prioritize the provision of adequate medical and mental health care for all service-members as a military-wide commitment to implementing an ethical drawdown of the forces.

Cease improper screening and diagnostic procedures used to justify involuntary, disciplinary discharges and administrative separations, as well as inaccurate MEB disability evaluations.

  • Provide proper diagnostic assessment. When a diagnosis of PTSD or TBI is warranted, it should never be replaced by diagnoses such as Personality Disorders, Adjustment Disorders, Depressive Disorders, Bipolar Disorders, Attention Deficit Hyperactivity Disorder, nor any other diagnosis which would misrepresent the service-member’s condition by implying a pre-existing or characterological condition.
  • Fort Hood must cease any pressure on or instruction to providers to avoid diagnosing soldiers with PTSD. Such practices allow the military to eschew its duty to provide due benefits to soldiers, and adversely affect soldiers’ navigation of longer-term care.

Institute automatic mandatory comprehensive physical and mental health evaluations in all pending misconduct discharges and other involuntary discharges, especially as many behavioral infractions at Fort Hood result from soldiers’ psychological distress and/or treatment protocols, such as substance abuse, tardiness, and brief AWOLs.

Enact monitoring and enforcement mechanisms to ensure Fort Hood’s compliance with DoD Instruction on Enlisted Administrative Separations.[4]

 

Protect Service-Members’ Right to Medically Retire

Given the evidence of improper diagnostic procedures and involuntary discharge proceedings at Fort Hood, command should implement special protections to ensure soldiers their right to medically retire.
Reform all MEB practices which impede access to care by unduly prioritizing the disability rating process over medical treatment. A service-member’s access to timely diagnosis and treatment should never hinge on the proceedings of their MEB processing, for any reason.

Ensure the MEB process accommodates all qualifying soldiers and provides adequate diagnostic and treatment procedures for physical and mental health in a timely manner.

  • Provide easy access to civilian doctors and mental health providers to all soldiers in MEB, including communicating lists of TriCare network providers and issuing referrals. Soldiers have a right to fair access to diagnostic services and screenings during active duty. These should not be unduly deferred during a soldier’s transition out of the military for any reason, including during MEB processing.
  • Establish means of voluntary communication and medical records exchange between civilian providers and those involved in the soldier’s MEB process. Ensure confidentiality in such transactions.
  • Honor the diagnoses of qualified civilian providers for consideration in MEB, especially in cases where service-members encounter undue wait times when accessing military providers.
  • Maintain proper medical records for all servicemembers in MEB, and provide service-members unqualified and ready access to these records before and after discharge.
  • Provide accessible means for investigation and correction of missing medical records.

Stop Deploying Soldiers Against Medical Orders

Ensure that neither physicians assistants, nor any other medical or mental health personnel should be placed under any pressure or quotas for characterizing a soldier’s condition as ‘deployable’ when medically evaluating them.

Commanders and supervisors must be banned from any interference in medical and mental health evaluations during SRP and R-SRP.

 

Stop Over-Medicating Soldiers and Unethically Prescribing Psychotropic Medications

Increase non-pharmaceutical treatment options for traumatic injuries and mental health concerns, as well as for medical conditions which would benefit from non-pharmaceutical treatment—such as referrals to specialist care and further testing.

Per the instruction of the DoD Inspector General,[9] DoD must issue comprehensive policy to track and reconcile medication management in all departments and establish drug take-back programs.

Enhance medication management and oversight for any soldier prescribed multiple psychotropic medications.[10] Provide easy access to civilian psychiatrist referrals where additional medication management is needed.

Discontinue the issuing of prescriptions without the assignment of diagnoses for complex medical conditions and mental health treatment.

Institute medication evaluations at an enforced standard of every three months, at minimum wherever psychotropic prescription drug treatment is necessary.

Install means for closely monitoring any soldier prescribed multiple or off-label psychoactive drugs for the treatment of PTSD and other mental health conditions. Severely restrict the prescription of benzodiazepines, atypical anti-psychotics,[11] and other off-label drugs for the treatment of mental health conditions.

 

Provide Soldiers Adequate Physical and Mental Health Care

Increase the ratio of mental health professionals to soldiers both on base and in theater to ensure timely access to care and continuity of care, and expand referrals to civilian providers when necessary to meet soldiers’ needs for timely care and diagnosis.

  • Reduce reliance on physicians assistants and medics instead of physicians for the diagnosis and treatment of conditions beyond their scope of practice.
  • Ensure adequate civilian providers are covered under military insurance plans, emphasizing coverage for specialist providers.

Support service members in following through on treatment plans by providing child care during medical appointments and allowing passes to attend appointments during work hours, regardless of training schedules.

  • Commanders and NCOs should not be permitted to disallow soldiers from attending health care appointments. DoD, DoA, and Fort Hood command should issue new policy clarifying command adherence to soldier appointments, and devoting resources to facilitate soldiers’ attendance.

Ensure that every soldier preparing to deploy is proactively contacted by a mental health provider who is assigned as their provider before and after deployment.

Improve tracking, record-keeping, and communications between health care providers.

Provide consistent medical records to the service-member at all times and to Veterans Affairs immediately upon discharge, to ensure continuity of care and diminish long transition times to access proper VA treatment.

 

Ensure Comprehensive Treatment for Traumatic Brain Injury

Establish consistent pre- and post-testing protocols to properly diagnose instances of TBI.

  • The ANAM is not an adequate diagnostic tool—DoD should issue new policy specifying adequate diagnostic protocol for implementation in all departments.[12]
  • As the Army has itself recommended, unit leaders should “understand the requirements for concussive care” and be “trained to implement the policy” specified in the Military Acute Concussion Evaluation and Blast Exposure/Concussion Incident Report.[13]
  • Decrease reliance on service-member self-reporting in screenings for psychological trauma and traumatic brain injury. Increase reliance on proactive and periodic diagnostic inquiry.
  • Discontinue screening procedures which rely solely on questionnaires and paper forms.
  • Ensure that every screening and diagnostic tool used on US service-members meets established diagnostic guidelines and codes of practice published by the American Psychiatric Association and American Psychological Association.

On behalf of those who are suffering and will continue to suffer from the adverse consequences of the Department of Defense, Veterans Affairs, and command policies addressed herein, we recommend these changes be implemented immediately. The following recommendations are organized by policy area, and within each policy area, by the institutions relevant to the implementation of the recommended policy change.

 

Ensure Respect for Soldiers’ Profiles

Violations of soldiers’ medically necessary work restrictions violates their rights to health and well-being. Commander discretion over soldiers’ profiles and access to treatment not only interferes with soldier well-being by impeding the treatment plan, but also perpetuates stigma against injured soldiers, and promotes a culture of fear whereby soldiers avoid seeking care.

Fort Hood should ensure that commanders and supervisors respect the work restrictions detailed in soldiers’ medical profiles as orders rather than recommendations, in accordance with its own command policy.

  • Establish immediate accountability mechanisms for all aspects of the standing III Corps and Fort Hood Command Policy SURG-05, including means for reporting command violations of soldiers’ profiles and investigation and monitoring by an independent third-party.
  • Stop the issuance of temporary profiles in serial fashion when a permanent or longer-term profile would ensure continuity of care and medically necessary work restrictions.
  • Confirm the validity of all profiles which are recorded electronically by providers. Establish accountable means to ensure all supervisors and commanders consistently monitor e-Profile and abide by its profile restrictions, in accord with Army regulations on e-Profile.[1]

Institute exemptions in soldier and NCO evaluations for sections that cannot be completed due to medically necessary work restrictions, e.g. PT tests. Ensure that no soldier is made to complete a PT test if their profile restricts them from any of its exercises.

 

Ensure Proper Command Response and Comprehensive Treatment for Military Sexual Violence

Fort Hood Command must work to ensure comprehensive physical and mental health treatment for survivors of sexual harassment and violence, and institute consistent command response with a focus on victim protection in cases of sexual violence. Training and leadership on sexual violence must turn away from victims and instead focus on perpetrators and leadership accountability for eradicating sexual violence, and must work to reduce the prevalence of sexual violence on both male and female service-members.

Ensure comprehensive physical and mental health treatment for survivors of sexual violence by instituting further protections and bolstering existing programs.

  • Protect survivors of sexual violence from under-diagnosis of mental health conditions by instituting special treatment reviews for survivors within military treatment facilities, along with offering referrals to civilian mental health providers specializing in treating survivors of sexual violence.
  • Honor records and diagnoses when they are voluntarily submitted by civilian providers treating victims of sexual violence.

Install means for consistent, comprehensive command response to instances of sexual violence, that focus on supporting and respecting the survivor.

  • Implement protocols for victims to transfer units after reporting a sexual harassment or assault without approval from their direct chain of command.
  • Institute mandatory evaluation criteria for NCOs on how well they address military sexual violence.
  • Include commander and NCO evaluations on leadership climate for eradicating military sexual violence in regular performance and promotion reviews and make the results publicly available.

Ensure comprehensive medical and mental health treatment for survivors of sexual violence and dedicate resources that ensure proper access to treatment, including child care and time off to attend appointments. Commanders and NCOs should ensure soldiers’ access to appointments, and not be permitted to disallow soldiers’ attendance.

Eradicate stigma against survivors of sexual violence through specific measures at both garrison and unit levels. All training and leadership should emphasize enforcement and perpetrator accountability for both violence and associated stigma, and never reinforce victim-blaming.

  • Enhance Fort Hood’s sexual assault training curriculum by hiring proficient trainers from third-party civilian organizations, programming smaller class sizes, and ensuring more in-depth training for units with identified cases of repeated sexual assaults.
  • Establish periodic, anonymous surveys to capture sexual harassment and assault incidence at the unit level. Record and release this information, along with comprehensive sexual assault reporting statistics, to enhance oversight.
  • Implement specific training toward lessening stigma and ridicule toward male survivors of sexual assault and harassment.

Ensure Confidentiality and Adherence to Principles of Medical Ethics

Strengthen patient advocate services on-base[16] by pro-actively assigning a patient advocate to each service-member enrolled in care.

Maintain the privacy of soldiers’ medical records and private health information at all times, and disseminate into the chain of command on a strict need-to-know basis.

 

Strengthen Support for Spouses and Families

Ensure access to high-quality counseling services for families and pro-actively offer support to military dependents.

  • Ensure greater access to counseling and other mental health support for military spouses and families by increasing the provider to family member ratio and allocating more counselors to support positions for families.
  • Create mental health support programming specifically for the children of soldiers, with proactive outreach to military families.
  • Ensure that every family is offered mental health support proactively when the service-member is preparing to deploy.

 

Reinforce Soldier Care and Develop Leadership Accountability Mechanisms

Hold quarterly town halls in which soldiers, spouses, family members, and local community can address Fort Hood command in person, in a public forum.

General Milley should make unannounced visits to platoon battalion level to speak with lower enlisted (E-4 and below), without other leadership present.

Institute standards for soldier care a regular, binding, and enforceable component of the review and evaluation of leadership.

  • Subject commanders and NCOs to regular, periodic review regarding their promotion of health care and well-being for soldiers in their charge, including their ability to foster a unit culture which works to destigmatize these issues.
  • Include sections for adherence to profiles, promotion of health care, and destigmatization in NCO and Officer Evaluation Reports and make them integral criteria for promotion.
  • Institute anonymous evaluations of NCOs and commanders by junior enlisted which are also considered on NCOERs and other leadership evaluations.

 

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