Resources for Wounded or Injured Servicemembers & Families

This article is intended to give military families a basic understanding of available resources and the overall process if their servicemember is wounded, injured or becomes ill in the line of duty.

What is a casualty?
The word casualty can be a very frightening term for families to hear. It is good to know that the term actually has several meanings. A casualty is any person who is lost to the organization by reason of having been declared beleaguered, besieged, captured, dead, diseased, detained, duty status whereabouts unknown, injured, ill, interned, missing, missing in action, or wounded. (Source: DoD Joint Publication 1-02 http://www.dtic.mil/doctrine/jppersonelseriespubs.htm and Department of Defense Instruction (DoDI) 1300.18 http://www.dtic.mil/whs/directives/corres/html/130018.htm)

When a servicemember is killed, injured, gets sick, or is hospitalized, he or she becomes a “casualty.” The servicemember is then further categorized by and reported according to his/her casualty type and the casualty status. Casualty type is the term used to identify a casualty as either a hostile casualty or a non-hostile casualty. Casualty status is the term used to classify a casualty for reporting purposes. According to DoD Joint Publication 1-02, there are seven casualty statuses:

• Deceased
• Duty status-whereabouts unknown (DUSTWUN)
• Missing
• Very seriously ill or injured (VSI)
• Seriously ill or injured (SI)
• Incapacitating illness or injury (III)
• Not seriously injured (NSI)

Basic Definitions You Should Know:
A servicemember who has incurred an injury due to an external agent or cause, other than the victim of a terrorist activity, is classified as Wounded in Action (WIA). This term encompasses all kinds of wounds and other injuries incurred in action, to include penetrating wounds, injuries caused by biological or chemical warfare agents, or the effects of exposure to ionizing radiation or any other destructive weapon or agent. A person who is not a battle casualty, but who is lost to the organization by reason of disease or injury, is classified as Disease and Non- Battle Injury (DNBI). This category also includes servicemembers who are missing when the absence does not appear to be voluntary or who are missing due to enemy action or internment. When someone is wounded in action or has an illness or disease, they will be further categorized in one of the following statuses:

• Very Seriously Injured (VSI): the casualty status of a person whose injury/illness is classified by medical authorities to be of such severity that life is imminently endangered.
• Seriously Ill or Injured (SI): the casualty status of a person whose illness or injury is classified by medical authorities to be of such severity that there is cause for immediate concern, but there is no imminent danger to life.
• Incapacitating Illness or Injury (III): the casualty status of a person whose illness or injury requires hospitalization, but medical authority does not classify as very seriously ill or injured or seriously ill or injured; the illness or injury makes the person physically or mentally unable to communicate with the next of kin.
• Not Seriously Injured (NSI): the casualty status of a person whose injury or illness may or may not require hospitalization but not classified by a medical authority as very seriously injured (VSI), seriously injured (SI), or incapacitating illness or injury (III); the person is able communicate with the Next of Kin (NOK).
• Duty Status-Whereabouts Unknown (DUSTWUN): A transitory casualty status, applicable only to military personnel, that is used when the responsible commander suspects the member may be a casualty whose absence is involuntary, but does not feel sufficient evidence currently exists to make a definite determination of missing or deceased.

What is the process for notifying families of casualties?
Remember to keep in mind that each Service is responsible for notification of next of kin and has its own specific procedures for ensuring expeditious and personal notification. In the event of a servicemember injury or illness, only the primary next of kin (PNOK) will be notified and may be notified telephonically. All notified families will have ready access to information as it becomes available. In all death and missing cases, the PNOK and secondary next of kin (SNOK), and any other person listed on the DD Form 93 (Record of Emergency Data), will be notified in person. The notification will be made as a matter of highest priority, taking precedence over all other responsibilities the notifier has. Whenever possible, the notifier's grade is equal to or higher than the grade of the casualty. When the PNOK is also a servicemember, the notifier's grade will be equal to or higher than the grade of the PNOK. Personal notification will generally be made between 0600 and 2200 hours local time. The PNOK is always notified first.

Although each Service’s notification process is slightly different, in general the process works as follows:

• The Service will notify all PNOK and SNOK as soon as possible, generally within 24-48 hours.
• In injury cases deemed to be VSI or SI, the PNOK is normally telephonically notified. For minor injuries, notification generally comes through other channels (i.e., the hospital or directly from the servicemember).

How is the primary next of kin (PNOK) determined?
The person most closely related to the casualty is considered the PNOK for notification and assistance purposes. This is normally the spouse for married persons and the parents for unmarried servicemembers/individuals. The precedence of NOK with equal relationships to the casualty is governed by seniority (age). Equal relationship situations include divorced parents, children, and siblings. Minor children's rights are exercised by their parents or legal guardian. The adult NOK is usually the first person highest in the line of succession who has reached the age of eighteen. Even if a minor, the spouse is always considered the PNOK. The following order of precedence is used to identify the PNOK:

• Spouse
• Natural, adopted, step and illegitimate children
• Parents
• Persons standing in loco parentis (In loco parentis means a person who is charged with a parent’s duties and responsibilities in the place of a parent, normally someone who stood in the relationship of a parent to the deceased for a period of at least 5 years prior to the servicemember reaching 18 years of age.)
• Persons granted legal custody of the individual by a court decree of statutory provision
• Brothers or sisters, to include half-blood and those acquired through adoption
• Grandparents
• Other relatives in order of relationship to the individual
• If no other persons are available, the Secretary of the Military the individual
• SNOK is any other next of kin other than the PNOK.

What Causes Delays in Notification of Family Members?
The number one reason causing a delay in notification to families that the servicemember has been wounded/injured is incorrect phone numbers provided on the emergency information data card. It is IMPERATIVE the servicemember keeps this information updated. Precious time is wasted when military officials have to track down correct notification numbers for family members. Delays are also common when the family member leaves the area without notifying the unit Rear Detachment Commander or Family Readiness Point of Contact. The number one rule of thumb is to let someone in the unit know that you are leaving the area and to provide them with a working phone number where you can be reached should they need to contact you. How often will families be provided updates on their Servicemember?

The Service will pass information to PNOK as it becomes available. Since the PNOK will be notified of updates, families/friends should use the PNOK as a focal point for sharing information internally. In the first hours after the incident, information may be limited. If there is no solid evidence a particular servicemember was involved in the incident, but military officials have reason to believe the servicemember was involved, families will be given a "believed to be" notification. This simply tells the family that the military has good reason to believe their loved one was involved and that they will be provided updates as they become available. This type of notification will be delivered only when there is overwhelming reason to believe their servicemember was involved. If it is "believed to be killed" or "believed to be missing", PNOK and SNOK will be notified in person. If it is "believed to be injured," only the primary next of kin will be notified telephonically. All family members who have been notified originally will be kept informed of developments in their cases.

How do I get to my wounded servicemember? Who funds my travel?
For very seriously injured/ill (VSI) or seriously injured/ill (SI) patients, the primary next of kin (PNOK) can be issued Invitational Travel Orders (ITOs) if the attending physician determines it is essential to the recovery of the patient and it is verified by the hospital commander. The Services can provide transportation for up to three family members when a servicemember is classified as Very Seriously Ill/Injured (VSI) or Seriously Ill/Injured (SI), as determined by the attending physician and hospital commander upon injury. ITOs will be offered to immediate family members (spouse, children, mother, father, siblings (including step) OR those acting in loco parentis. The Service point of contact/notifier or hospital will provide information concerning travel regulations. Transportation and lodging is provided for up to three family members in two week increments. Wounded servicemembers cases are evaluated every two weeks and at the discretion of the attending physician, family members are authorized additional time at the bedside.

Where will I stay while I am visiting my wounded servicemember?
If the family members are traveling on ITOs, the Services arrange for family member’s lodging before traveling to be with the wounded servicemember. Families are housed in local hotels, guest lodging at a military installation, or, if available, a Fisher House, which is "a home away from home" for families of patients receiving medical care at major military and VA medical centers. The homes provide comfortable, temporary housing for families of servicemembers recovering from serious medical conditions. Families pay $10.00 per night to stay in a Fisher House; however, this fee is waived for families of wounded servicemembers. The homes are normally located within walking distance of the treatment facility or have transportation available. For more information on the Fisher Houses, go to: www.fisherhouse.org.

Is child care available for my children while I am with my wounded servicemember?
Hourly child care slots are often hard to access on military installations and so families should not assume there is child care available. Child care is an added expense for families and is not covered in the ITO reimbursement. The individual who notifies you about your servicemember’s injury can direct you to the installation child development center to help you determine if you can make child care arrangements. There may be community resources available to assist with child care. Do not forget to bring a copy of the child’s shot record as you will need this to register your child at any child care facility. Some medical facilities have Family Assistance Centers (FACs) that provide assistance to the families of wounded servicemembers once they arrive at the MTF. The FACs should be able to provide child care information.

Who will work with our family during the servicemembers recovery period?
Wounded servicemembers have case managers assigned to work with them during their recovery period. The job of these individuals is to provide information and help assist the servicemember and family during the recovery period and the Physical Evaluation Board (PEB) and Medical Evaluation Board (MEB) process. These individuals also provide information on Veteran Service Organizations (VSOs). As stated above, many military hospitals serving wounded or injured servicemembers also have Family Assistance Centers. Families can also seek assistance from the installation chaplains, social workers, and family center: Army Community Services, Marine Corps Community Services, Air Force Family Support Center, Navy Fleet and Family Support Center, and Coast Guard Work Life Offices.

What is the transition process for my servicemember?
The shift of a servicemember to medical retirement, transit on to the Department of Veterans Affairs, or separation from the military is known as Transition. DoD has a mandatory Transition Assistance Program (TAP) for all transitioning and/or separating servicemembers. You can read more about transition at http://www1.va.gov/opa/fact/docs/tranasst.pdf.

What employment opportunities are there for spouses /family members of wounded servicemembers?
Spouses often ask how they can find work after their servicemember is injured. Military OneSource offers practical tips and includes information on Entering the Work Force When Your Spouse Has Been Severely Injured in the Special Needs section at www.militaryonesource.com.

What Legal Resources are available?
Families ask where to go for legal support for such things as Powers of Attorney, Wills, Advance Directives and other legal affairs affecting a wounded servicemember and their family. Information from the American Bar Association’s working group Legal Assistance for Military Personnel (LAMP) is available at: http://www.abanet.org/legalservices/lamp/home.html. Additionally, the U.S. Army Judge Advocate General’s Corp (JAG) provides an information portal at http://www.jagcnet.army.mil/legal. Both of these are valuable legal resources.

What is the Traumatic Injury Protection Insurance (TSGLI) Benefit?
The Traumatic SGLI (TSGLI) benefit is designed to provide financial assistance to servicemembers during their recovery period from a serious traumatic injury. The program is not disability compensation and has no effect on entitlement for compensation and pension benefits provided by the Department of Veterans Affairs or disability benefits provided by the Department of Defense. It is an insurance product similar to commercial dismemberment policies. On December 1, 2005, all members eligible for SGLI automatically became insured for traumatic injury protection of up to $100,000 unless they decline SGLI coverage. The benefit provides payouts of tax a free lump sum payment ranging from $25,000 to $100,000, depending on the extent of a servicemember’s injury, for servicemembers who have lost limbs, eyesight, or speech or received other traumatic injuries as a direct result of injuries received during operations Iraqi Freedom or Enduring Freedom.

Coverage is retroactive to October 7, 2001. The retroactive provision of PL 109-13 provides that any servicemember who suffers a qualifying loss between October 7, 2001, and December 1, 2005, will receive a payment under the TSGLI program if the loss was a direct result of injuries incurred in Operation Enduring Freedom or Operation Iraqi Freedom. The benefit does not apply to servicemembers suffering from disease. For more information about the program, servicemembers should contact their Service TSGLI Representative. The Air Force POC for TSGLI is the Casualty Assistance Representative (CAR). For the other Services, contact the Service Injured Support Program (Army AW2, Marine M4L, and Navy Safe Harbor). See the following section for information about these programs. To read about the TSGLI program, go to: http://www.insurance.va.gov/sgliSite/legislation/TSGLIFacts.htm.

What support agencies are available for wounded servicemembers and their families?
Several DoD, other government agencies, and non-profit organizations have programs in place to support wounded/injured servicemembers and their families. Here are a few of them: Air Force Palace HART: The Air Force Palace HART (Helping Airmen Recover Together) program follows Air Force wounded in action until they return to active duty, or are medically retired. It then provides follow up assistance for 5-7 years post injury. The Air Force works to retain injured servicemembers on active duty, if at all possible; however, if unable to return an Airman to active duty, work to get them civilian employment within the Air Force. The Air Force also ensures counseling is provided on all of the benefits to which an individual servicemember may be entitled within the Department of Defense, Department of Veterans Affairs, and Department of Labor.

For immediate, 24-hour response, the Military Severely Injured Center can direct you to an Air Force point of contact. It can be reached toll free at 1-888-774-1361 or you can e-mail severelyinjured@militaryonesource.com

U.S. Army Wounded Warrior (AW2) Program (formerly the Army Disabled Soldiers Support System (DS3)): Through the U.S. Army Wounded Warrior Program (AW2), the Army provides its most severely disabled Soldiers and their families with a holistic system of advocacy and follow-up with personal support and liaison to resources, to assist them in their transition from military service to civilian life. AW2 links the Army and other organizations that stand ready to assist these Soldiers and families, such as the Department of Veterans’ Affairs and the many Veterans’ Service Organizations, to the Soldier. One key goal of AW2 is to provide a network of resources to severely disabled Soldiers, no matter where they relocate and regardless of their component: active, Reserve or National Guard. The goal is to ensure Soldiers, families, and communities receive responsive support services that meet their needs. The AW2 toll free number is: 1-800-833-6622. To read more, go to the current Army website: www.armyds3.org.

Navy Safe Harbor Program: The Navy Safe Harbor Program has a coordinated and tailored response for its men and women returning from Iraq, Afghanistan and other areas of conflict with severe debilitating injuries. Information can be found at http://www.npc.navy.mil/CommandSupport/SafeHarbor. For immediate, 24-hour response you can call 1-877-746-8563 or email safeharbor@navy.mil. Additionally, families can read up to date information on the DoD Military Homefront website. Go to http://www.militaryhomefront.dod.mil, and click on the Troops and Families link and then Military Severely Injured Center in the left column. Marine for Life Injured Support Program (M4L): The Marine For Life Injured Support program provides information, advocacy and assistance from the time of injury through return to full duty or transition to the Veterans Administration, up to one year after separation. The program is currently being introduced by Marine for Life staffers to Marines, Sailors, and their families at National Naval Medical Center at Bethesda and Walter Reed Army Medical Center in Washington, D.C. with a plan to expand to all major Naval hospitals as soon as possible. Marines who have already been medically discharged are being contacted telephonically. Injured Marines, Sailors or family members needing assistance can call toll-free: 866-645-8762 or e-mail: injuredsupport@M4L.usmc.mil. For more information about the Marine for Life Injured Support Program, go to: https://www.m4l.usmc.mil.

Military Severely Injured Center (MSIC): The Center is a central Department of Defense (DoD) resource available to offer support services to seriously injured servicemembers and their families. The Center works with and compliments existing Service programs such as the U.S. Army’s Wounded Warrior (AW2) Program, the Marine for Life Injured Support System, and Military OneSource. Support services are provided as long as seriously injured servicemembers and their families require quality of life support. Services are tailored to meet individual’s unique needs during recovery and rehabilitation. The Center offers counseling and resource referral in such areas as financial support, education, and employment assistance, information on VA benefits, family counseling, resources in local communities, and child care support. For immediate, 24-hour response, the Military Severely Injured Center can be reached toll free at 1-888-774-1361, or you can contact severelyinjured@militaryonesource.com

Additionally, families can read up to date information on the DoD Military Homefront website. Go to http://www.militaryhomefront.dod.mil, and click on the Troops and Families link. Deployment Health Support Directorate: DoD established the Deployment Health Support Directorate to see that the medical lessons learned from previous conflicts and deployments are integrated into current policy, doctrine and practice. The Directorate addresses deployment-related health threats to servicemembers. Part of the Deployment Health focus is on outreach. Current information on deployment-related health issues is published on an interactive web site, Deployment LINK: http://deploymentlink.osd.mil. The Directorate operates a toll free, direct hotline number where staff members assist callers in finding the answers they seek in relation to current and past deployments, helping them locate lost medical records, and providing contact information in the Department of Veteran Affairs. That number is 1-800-497-6261.

Other Useful Resources: If you do not have access to the Internet, or have further questions, contact NMFA at 1-800-260-0218. National Military Family Association (NMFA) www.nmfa.org 1-800-260-0218

American Legion http://www.legion.org/

TRICARE http://www.tricare.osd.mil/

Disabled American Veterans http://www.dav.org/

Department of Veterans Affairs www.va.gov

Military OneSource www.militaryonesource.com 1-800-342-9647

Veteran Center Readjustment Counseling and Bereavement Counseling www.va.gov

The Military Coalition (TMC) http://www.themilitarycoalition.org

National Center for PTSD (VA Sponsored Center for PTSD) http://www.ncptsd.va.gov/

Tragedy Assistance Program http://www.taps.org/

Veterans Service OrganizationsLists Organizations Chartered by Congress and/or Recognized by VA for Claim Representation http://www1.va.gov/vso/index.cfm?template=view

Veterans of Foreign Wars http://www.vfw.org/

United Spinal Association http://www.unitedspinal.org/pages.php?catid=205

Veterans and Families www.veteransandfamilies.org

Fisher House http://www.fisherhouse.org

Military Order of the Purple Heart www.purpleheart.org

Information courtesy of NMFA