MILITARY HEALTH 

CARE

Army Needs to 

Improve Oversight of 

Warrior Transition 

Units

Report to Congressional Committees

July 2016

GAO-16-583

United States Government Accountability Office
United States Government Accountability Office

Highlights of GAO-16-583, a report to 

congressional committees

July 2016

MILITARY HEALTH CARE

Army Needs to Improve Oversight of Warrior 

Transition Units

Why GAO Did This Study

The Army established its WTU

program in 2007 after congressional 

interest and media coverage about

substandard care for soldiers at the 

former Walter Reed Army Medical 

Center. The program is to coordinate 

care for soldiers recovering from 

serious physical and behavioral health

conditions. As the WTU soldier

population has declined, the Army has 

reduced its WTUs--from 45 in 2008 to 

a planned total of 14 by August 2016.

The House Report accompanying a bill 

for the National Defense Authorization 

Act for Fiscal Year 2016 included a 

provision for GAO to review the WTU 

program. GAO evaluated, among other 

things, the extent to which the Army

has (1) assessed the effectiveness of 

the Triad of Care model; (2) 

established processes to oversee the 

selection of WTU personnel, assess

their training, and adjust staff levels;

and (3) assessed adherence to WTU 

admittance criteria and the impact of 

any changes to them. GAO conducted 

site visits to 5 WTUs, based on a mix 

of active and reserve component 

soldiers and other variables.

What GAO Recommends

GAO’s recommendations include that 

the Army assess the Triad of Care 

model’s effectiveness; track adherence 

to selection processes for WTU staff; 

assess the application of their training;

develop plans to ensure the ability to 

adjust staff levels, if needed; track 

exceptions to WTU admittance criteria; 

and compare the costs and benefits of 

expanding a WTU-alternative program

for Army Reserve soldiers. DOD 

concurred with each of GAO’s 

recommendations.

What GAO Found

The Army has not assessed the effectiveness of the Triad of Care model, the 

core structure of the Warrior Transition Unit (WTU) program, consisting of a team 

of three key staff that provide medical case management. The Army established

the Triad of Care model at a time when WTU soldiers’ diagnoses were primarily

for physical conditions. Since then, the composition of diagnoses has changed

significantly. Specifically, in 2008, about 36 percent of the 12,228 soldiers who 

entered the WTUs had a behavioral health diagnosis. In 2015, however, over half 

of the 2,628 soldiers who entered the WTUs, about 52 percent, had such a 

diagnosis. Despite the change in the composition of diagnoses, the Army has not 

assessed its approach for managing soldiers' care. Officials from the five WTUs 

that GAO visited stated that they have added social workers to the Triad as an 

ad-hoc measure to provide better case management and certain types of 

behavioral health services. These local adaptations represent efforts to meet an 

immediate medical need and support the need for analysis of whether the Triad 

model should change. Assessing the Triad in light of the changes in WTU 

soldiers’ diagnoses would position the Army to better determine how to meet 

WTU soldiers’ medical needs. 

The Army faces challenges in its oversight of the selection of squad leaders and 

platoon sergeants to staff WTUs, in the evaluation of staff training, and in the 

ability to adjust future staff levels if needed. Specifically, the Army has 

established selection processes and updated its selection criteria for these WTU 

personnel, but it is not exercising oversight responsibility to track full adherence 

to these policies, specifically the Army’s requirement to interview candidates for 

these positions. Candidates for these positions are drawn from a mix of Army 

occupations, and the selection process, including interviews, is intended to 

ensure the suitability of the staff selected for these sensitive positions. While the 

Army has taken steps to improve its training program for squad leaders and 

platoon sergeants, the program does not incorporate a post-training assessment 

of the application of training to the work environment. Without information that 

could be obtained from such assessments, the Army may miss an opportunity to 

incorporate information concerning the practical application of training. In 

addition, the Army has not developed plans for how it would increase WTU staff 

levels, if needed, to support any potential future increase in demand. The ability 

to reverse the decision to inactivate 11 WTUs by August 2016 was a key 

planning consideration for the Army. However, without a plan to address staff

level changes, the Army lacks assurance that it can select, train, and assign staff 

to its WTUs in a timely manner.

While the Army has implemented a process for reviewing the eligibility of soldiers 

to be admitted to WTUs, it does not track instances in which Commanders have 

made exceptions to these criteria. By not tracking this information, the Army does 

not know how frequently such exceptions are made and cannot ensure the best 

use of resources. In addition, the Army is planning to expand a WTU-alternative 

program to the Army Reserve, but has not examined the costs and benefits of 

such an expansion. Without comparing the costs and benefits of program 

expansion with the current system, the Army could incur significant costs without 

clearly articulated benefits.

View GAO-16-583. For more information, 

contact Brenda S. Farrell at (202) 512-3604 or 

farrellb@gao.gov.
Page i GAO-16-583 Warrior Transition Units

Letter 1

Background 5

The Army Has Not Assessed the Effectiveness of the Triad of 

Care Model despite the Change in the Composition of 

Diagnoses among WTU Soldiers 9

The Army Faces Challenges in Overseeing the Selection of 

Certain WTU Staff, in Evaluating Their Training, and in 

Adjusting Staff Levels if Needed 13

The Army Does Not Track Instances in Which Commanders Have 

Made Exceptions to WTU Admittance Criteria and Has Not 

Analyzed Proposed Changes to Criteria for the Reserve 

Component 24

The Army Cannot Ensure Full Oversight of Soldiers’ Complaints 30

Conclusions 33

Recommendations for Executive Action 33

Agency Comments 34

Appendix I Scope and Methodology 36

Appendix II Trends in Warrior Transition Unit Soldiers’ Separation from the 

Army and Lengths of Stay in the Warrior Transition Unit Program 41

Appendix III Comments from the Department of Defense 44

Appendix IV GAO Contact and Staff Acknowledgments 48

Related GAO Products 49

Tables

Table 1: Warrior Transition Unit (WTU) Program Selection Criteria 

for Squad Leader and Platoon Sergeant Positions before 

and after November 2015 16

Contents
Page ii GAO-16-583 Warrior Transition Units

Table 2: Admittance Criteria for the Warrior Transition Unit (WTU) 

Program and for the WTU-Alternative Program 27

Figures

Figure 1: Position Descriptions and Staffing Ratios for the Triad of 

Care Model 6

Figure 2: Trends in the Population of Army Warrior Transition Unit 

Soldiers by Component (June 2007 to February 19, 

2016) 7

Figure 3: Sources and Processes for Filling Squad Leader and 

Platoon Sergeant Positions 15

Figure 4: Percentage of Warrior Transition Unit (WTU) Soldiers 

Who Separated from the Army, by Year of Entry into the 

WTU Program (2008-15) 41

Figure 5: Warrior Transition Unit (WTU) Soldiers’ Average Length 

of Stay in the WTU Program, by Active and Reserve 

Component (2008-14) 42

Figure 6: Warrior Transition Unit (WTU) Soldiers’ Average Length 

of Time in the WTU Program before Reaching the 

Medical Retention Determination Point (2009-14) 43

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Page 1 GAO-16-583 Warrior Transition Units

441 G St. N.W.

Washington, DC 20548

July 12, 2016

The Honorable John McCain

Chairman

The Honorable Jack Reed

Ranking Member

Committee on Armed Services

United States Senate

The Honorable Mac Thornberry

Chairman

The Honorable Adam Smith

Ranking Member

Committee on Armed Services

House of Representatives

After congressional interest and media coverage regarding deficiencies 

related to medical care for Army soldiers recovering from serious medical 

conditions at the former Walter Reed Army Medical Center,1 the Army in 

2007 established its Warrior Transition Unit (WTU) program for activeduty, Army Reserve, and Army National Guard soldiers. The Army 

created this program to manage recovering soldiers’ complex medical 

needs using a uniform, Army-wide structure and approach to facilitate the 

soldiers’ transition either back to the force or to separation from the Army. 

The central structure of the WTU program is the Triad of Care staffing 

model for managing soldiers’ care, which comprises a primary care 

manager, a nurse case manager, and a squad leader or platoon sergeant 

who work together to develop a plan of care for supporting each soldier’s 

transition. According to Army data, the number of soldiers entering the 

WTU program has declined from a peak of 12,228 in 2008 to 2,628 in

2015,2 and consequently the Army has reduced the number of WTUs, 

from a high of 45 units in 2008 to the planned 14 units by August 2016.

 1 In 2011, the Department of Defense merged the Walter Reed Army Medical Center in 

Washington, D.C., with the National Naval Medical Center to form the Walter Reed 

National Military Medical Center in Bethesda, Maryland.

2 This includes WTU soldiers for the given calendar years for whom there was a recorded 

medical diagnosis. 

Letter
Page 2 GAO-16-583 Warrior Transition Units

WTUs are an asset of the local military treatment facility and, by 

extension, under the command and control of the senior mission 

Commander on the relevant installation. The Army’s Warrior Transition 

Command is charged with providing policy and oversight of the WTU 

program. The Warrior Transition Command is a subcommand of the Army 

Medical Command, and reports to the Army Surgeon General. Starting 

June 2016, the Warrior Transition Command will be reorganized as a 

directorate within the Army Medical Command. The Army Surgeon 

General, as Commanding General of the Army Medical Command, is 

ultimately responsible for oversight of the Warrior Transition Command 

and the WTU program.

Given the changes that are occurring in the Army’s WTU program, the 

House Report3 accompanying a bill for the National Defense 

Authorization Act for Fiscal Year 2016 included a provision for us to 

review various aspects of the program. We examined the extent to which 

the Army has (1) assessed the effectiveness of the Triad of Care staffing 

model for managing WTU soldiers’ care; (2) established processes to 

oversee its WTU personnel selection, assess the training of these 

personnel, and adjust staff levels; (3) assessed adherence to WTU 

admittance criteria and the impact of any changes to these criteria for the 

active-duty and reserve components; and (4) instituted methods to 

address WTU soldiers’ complaints.

To address the objectives, we reviewed policies governing the WTU 

program, obtained and analyzed program documents and data, and 

interviewed officials from the Warrior Transition Command, the Office of 

the Army Surgeon General, and other Army offices with responsibilities 

for medical and personnel management. We conducted site visits to five 

WTUs.4 We selected these sites based on their mix of active-duty and 

reserve components, data on soldier’s complaints, and geographic 

dispersion. While the results from these visits are not generalizable, they 

provide useful information on WTU operations and relevant issues.

 3 H. R. Rep. No. 114-102, at 157-158 (May 5, 2015). 

4 We visited WTUs at Walter Reed National Military Medical Center in Bethesda, MD; 

Joint Base San Antonio in San Antonio, TX; Fort Hood in Killeen, TX; Fort Carson in 

Colorado Springs, CO; and Fort Eustis in Newport News, VA. 
Page 3 GAO-16-583 Warrior Transition Units

For our first objective, we compared policy and other documents 

concerning the use of the Triad of Care model with federal internal control 

standards for risk assessment, which emphasize the need for 

management to identify, analyze, and respond to any significant changes 

that could affect its ability to achieve defined objectives.5 To identify 

changes in the WTU population over time, we analyzed data from the 

Warrior Transition Command on WTU soldiers’ medical diagnoses. We 

found these data to be sufficiently reliable for our use based on interviews 

with Warrior Transition Command officials about how the data were 

captured, stored, and checked for accuracy. We spoke with Warrior 

Transition Command officials about the Triad of Care model, changes 

with the WTU soldier population, and their WTU inspections. We also 

interviewed officials at each of the five WTUs we visited about the Triad of 

Care model and the management of their soldiers’ care.

For our second objective, we compared current Army policies with 

previous Army policies regarding selecting and training WTU staff. We 

reviewed federal internal control standards,6 which state that 

management should demonstrate a commitment to recruit, develop, and 

retain competent individuals, and we reviewed our work7 identifying the 

attributes of effective training. We obtained information on current 

practices for selecting and training WTU staff and obtained the 

perspectives of Army and WTU officials to provide context and clarity. We 

focused on the selection and training of squad leaders and platoon 

sergeants based on these discussions. We also reviewed policies 

concerning the Army’s ability to adjust staff levels and federal internal 

 5 GAO, Standards for Internal Control in the Federal Government, GAO/AIMD-00-21.3.1

(Washington, DC: Nov. 1, 1999). These standards were in effect prior to fiscal year 2016 

and cover most of the time period since the inception of the WTUs. The standards were 

subsequently updated and state that effective information and communication are vital to 

achieving objectives and that management needs access to relevant and reliable 

communication about internal events. The updated standards went into effect on October 

1, 2015. See GAO, Standards for Internal Control in the Federal Government, 

GAO-14-704G (Washington, D.C.: Sept. 2014)

6 GAO/AIMD-00-21.3.1. 

7

GAO, Human Capital: A Guide for Assessing Strategic Training and Development Efforts 

in the Federal Government, GAO-04-546G (Washington, D.C.: Mar. 2004). We developed 

this framework to serve as a guide in assessing how agencies plan, design, implement, 

and evaluate effective training and development programs that contribute to improved 

organization performance and enhanced employee skills and competencies.
Page 4 GAO-16-583 Warrior Transition Units

control standards,8 which emphasize the need to demonstrate a 

commitment to competence through succession and contingency 

planning, and the need for control activities such as the management of 

human capital to maintain a continuity of needed skills and abilities. We 

also interviewed Warrior Transition Command and WTU officials to 

provide context and clarity.

For our third objective, we examined the Army’s policies and process for 

admitting soldiers into the WTUs, including any proposed changes to 

admittance criteria. We compared the Army’s application of these policies 

with federal internal control standards9 which require that management 

design control activities, such as establishment and review of 

performance measures and indicators, to achieve objectives and respond 

to risks. In addition, we compared plans for the introduction of a WTUalternative program for the Army Reserve with our prior work,10 which 

calls for a performance-based analysis of benefits and costs for each 

alternative when considering program changes.

For our fourth objective, we obtained and analyzed information on the 

Army’s approach for handling complaints11 by WTU soldiers. We 

compared the Army’s approach for handling complaints with federal 

internal control standards, which state that information should be 

communicated to management and others who need it in such a way that 

they can carry out their responsibilities.12 A more detailed discussion of 

our scope and methodology is provided in appendix I.

We conducted this performance audit from August 2015 to July 2016 in 

accordance with generally accepted government auditing standards. 

Those standards require that we plan and perform the audit to obtain 

sufficient, appropriate evidence to provide a reasonable basis for

 8 GAO/AIMD-00-21.3.1. 

9 GAO/AIMD-00-21.3.1.

10 GAO, Business Process Reengineering Assessment Guide, GAO/AIMD-10.1.15 

(Washington, D.C.: May 1997).

11 For the purposes of this report, we use the term “complaints” to refer to complaints, 

concerns, or issues raised by WTU soldiers. 

12 GAO/AIMD-00-21.3.1. 
Page 5 GAO-16-583 Warrior Transition Units

our findings and conclusions based on our audit objectives. We believe 

that the evidence obtained provides a reasonable basis for our findings 

and conclusions based on our audit objectives.

Due to improved battlefield medicine, soldiers who might have died in 

past conflicts are now surviving, many with multiple serious injuries that 

require extensive outpatient rehabilitation, such as amputations, burns, 

and traumatic brain injuries. Prior to the establishment of WTUs, the Army 

provided care for soldiers recovering from serious medical conditions 

through Medical Hold and Holdover Units.13 According to Army 

documents, the previous system did not have a uniform structure and

exhibited varying levels of resources. For example, some units fell under 

the command of the local military treatment facility, while others fell under 

the command of the local installation. In addition, the Army did not have a 

uniform system of staffing, as the relevant command had to resource the 

units by reassigning personnel from other missions and functions. 

Further, the increased workload associated with care for these soldiers at 

the local military treatment facility was not reflected in increased staffing 

levels or resources.

In response to congressional interest and media coverage regarding 

inadequate and substandard care for Army soldiers recovering from 

serious medical conditions at the former Walter Reed Army Medical 

Center, the Army in 2007 developed its Army Medical Action Plan. This 

plan laid out a series of steps to address the problems highlighted at 

Walter Reed and other facilities, including the establishment of the WTU 

program. According to Army documents, the primary differences between 

the previous system of Medical Hold and Holdover Units and the WTU 

program was the establishment of (1) a uniform structure and ratios of 

staff to WTU soldiers by specialty and (2) a program (the Comprehensive 

Transition Plan) to facilitate the soldiers’ transition to either a return to the 

force or separation from the Army.

 13 Active duty soldiers were organized into Medical Hold Units, and reserve component 

soldiers were organized into Medical Holdover units.

Background

Evolution of the Army’s 

Approach for Caring for 

Wounded Soldiers
Page 6 GAO-16-583 Warrior Transition Units

The central structure of the WTU program is the Triad of Care model, 

which includes a primary care manager, a nurse case manager, and a 

squad leader or platoon sergeant, who direct and supervise the WTU 

soldiers’ healing process. Along with these Triad of Care key staff, there 

are other medical and nonmedical providers—such as social workers and 

occupational therapists—who work together to develop a plan of care 

specific to each soldier. The plan of care is intended to address the 

soldiers’ medical needs and support their transition either back to duty or 

to separation from the Army. This staffing model formalized the 

relationship between some of the same positions that had existed in the 

prior Medical Hold and Holdover Units’ and established ratios for the 

number of WTU soldiers that were to be under the care of each of the 

Triad of Care’s key staff. Figure 1 provides position descriptions and 

staffing ratios for the Triad of Care model.

Figure 1: Position Descriptions and Staffing Ratios for the Triad of Care Model

Note: Although the primary care manager, nurse case manager, and squad leader are the key staff of 

the Triad of Care model, the platoon sergeant (who supervises squad leaders) may also act in the 

same capacity as the squad leader. That said, the squad leader is the first line supervisor for the 

WTU soldier.
Page 7 GAO-16-583 Warrior Transition Units

In 2007, the Army began establishing individual WTUs at geographically 

dispersed locations to serve active-duty, Army Reserve, and Army 

National Guard soldiers needing this type of assistance. Figure 2 shows 

trends in the WTU soldier population over time. In line with this reduction 

in population, the Army reduced the number of WTUs from a high of 45 in 

2008 to 25 in 2014, with plans to inactivate another 11 by August 2016. At 

that point, the Army will have 14 WTUs remaining.

Figure 2: Trends in the Population of Army Warrior Transition Unit Soldiers by Component (June 2007 to February 19, 2016)

Note: The Army began establishing WTUs in 2007, and 2008 was the first full year of operation for 

the WTU program. The figure shows monthly population data available from the program’s initiation 

until February 2016, the most recent available at the time of our request.

The Army uses an annual process known as a Strategic Posture Review 

to determine the required capability and capacity for each WTU location 

and for WTUs across the Army enterprise, such as determinations for the 

number of WTUs. This process includes estimating the future population 

of WTU soldiers using a model validated by the Army14 and then applying 

 14This model is validated by the U.S. Army Manpower Analysis Agency. 

Trends in the Population of 

Soldiers in the WTU 

Program
Page 8 GAO-16-583 Warrior Transition Units

the estimated population to the current capacity of WTUs based on 

established ratios of the numbers of WTU soldiers to the numbers of 

primary care managers, nurse case managers, and squad leaders. If 

excess capacity is identified, the Warrior Transition Command reviews a 

series of criteria to determine which WTUs should remain open. For 

example, as part of the most recent review that recommended the 

inactivation of 11 sites, Army officials stated that they had selected sites 

to remain open that were co-located with force projection platforms and 

the best Army medical facilities. These recommendations are ultimately 

approved by senior Army officials.

The ability to reverse these inactivations if demand for WTUs were to rise 

in the future was a key planning consideration in the decision to inactivate 

11 WTUs by August 2016. As a result, the Army has issued policy to 

maintain control and oversight of former WTU facilities at inactivating 

locations. For example, the policy requires that the Installation 

Management Command conduct annual inspections of inactivated WTU 

facilities to ensure that compliance with Army standards for WTU 

facilities. The same policy calls for the Army’s Installation Management 

Command to be prepared to return deactivated facilities to WTU program 

use within 180 days of notification of the unit’s reactivation.

While assigned to the WTU program, soldiers are to work toward meeting 

the goals identified in their individualized Comprehensive Transition 

Plan.15 This standardized framework has six main phases: (1) inprocessing, (2) goal setting, (3) transition review, (4) rehabilitation, (5) 

reintegration, and (6) post-transition. As part of the Comprehensive 

Transition Plan and in addition to attending medical appointments, 

soldiers might, depending on their needs, undergo physical rehabilitation, 

meet with behavioral health therapists, participate in adaptive sports and 

reconditioning programs, participate in internships and training, and 

prepare to transition out of the WTU program. The last phase, posttransition, occurs after a soldier has left the WTU program.

 15 Army Regulation 40-58, Medical Services: Warrior Care and Transition Program (March 

23, 2015). 

Transition Process
Page 9 GAO-16-583 Warrior Transition Units

The point in the WTU soldiers’ rehabilitation process when it can be 

determined whether or not further medical care will cause a soldier to be 

found fit for duty is called the medical retention determination point.16

During their stay, WTU soldiers take part in activities to help them 

transition either back to the Army or to separate from the Army. For WTU 

soldiers who are returning to the Army, these activities could include 

taking Army career-related education or training, including college 

courses and other soldier development classes. For WTU soldiers who 

are transitioning out of the Army, these activities could include going 

through the disability evaluation systems, as well as participating in 

education and readiness opportunities that fit with the soldiers’ career 

goals. See appendix II for additional information concerning trends in 

WTU soldiers’ separation from the Army and in WTU soldiers’ lengths of 

stay in the WTU program.

The Army has not assessed the effectiveness of the Triad of Care model, 

the core structure of the WTU program and consisting of a team of three 

key staff that provide medical case management. The Army designed the 

Triad of Care model at a time when WTU soldiers’ diagnoses were 

primarily for physical conditions. However, since then, the composition of 

diagnoses has changed significantly. Despite this change, the Army has 

not assessed its approach for managing soldiers’ medical care. The five 

WTUs we visited reported having taken ad-hoc measures to help meet 

the increase in behavioral health needs in the absence of such an 

assessment. For example, medical officials at each of the five WTUs that 

we visited told us that they include social workers as a fourth member of 

the Triad of Care staff.

The Army established the Triad of Care model at a time when WTU 

soldiers’ diagnoses were primarily for physical conditions.17 Since then, 

the composition of diagnoses has changed significantly. Specifically, in 

 16 Army Regulation 40-58.

17This staffing model formalized the relationship between some of the same positions that 

had existed in the prior Medical Hold and Holdover Units’ and established ratios for the 

number of WTU soldiers that were to be under the care of each of the key staff in the 

Triad of Care.

The Army Has Not 

Assessed the 

Effectiveness of the 

Triad of Care Model 

despite the Change in 

the Composition of 

Diagnoses among 

WTU Soldiers

Composition of Diagnoses 

among WTU Soldiers Has 

Changed Significantly
Page 10 GAO-16-583 Warrior Transition Units

2008, the first full year of the WTU program, about 36 percent of the 

12,228 WTU soldiers had a behavioral health diagnosis, while in 2015, 

over half of the 2,628 soldiers, about 52 percent, had such a diagnosis. 

According to Warrior Transition Command officials, these diagnoses 

include post-traumatic stress disorder diagnoses and all behavioral health 

or psychiatric diagnoses that are not categorized as post-traumatic stress 

disorder, such as major depression, anxiety disorder, panic disorder, and 

schizophrenia.

Our analysis of these data showed that in 2008, 2,553 of 12,228 WTU 

soldiers (about 21 percent) entered the WTU program with a behavioral 

health issue as their primary diagnosis, compared with 830 of the 2,628 

WTU soldiers in 2015 (about 32 percent). Moreover, over that same time 

frame, 4,424 of 12,228 WTU soldiers (about 36 percent) entered the WTU 

program with a behavioral health issue as their primary, secondary, or 

tertiary diagnosis, compared with 1,355 of 2,628 WTU soldiers in 2015 

(about 52 percent). Warrior Transition Command officials stated that the 

greater prevalence of behavioral health issues is likely related to the 

Army’s efforts to de-stigmatize behavioral health issues.18 They told us 

that, as a result, it has now become acceptable for soldiers to notify 

medical personnel when these issues arise, impacting the number of 

soldiers being recognized and coming forward for assistance with 

behavioral health diagnoses.

 18 GAO recently issued a report assessing efforts to reduce mental health care stigma 

within the Department of Defense. See GAO, Human Capital: Additional Actions Needed 

to Enhance DOD’s Efforts to Address Mental Health Care Stigma, GAO-16-404 

(Washington, D.C.: Apr. 18, 2016).
Page 11 GAO-16-583 Warrior Transition Units

While the Army conducts reviews and inspections of the WTU program 

and WTUs, it has not assessed the effectiveness of the Triad of Care 

model, in light of the change in the composition of diagnoses. Warrior 

Transition Command senior officials told us that validation reviews of the 

population and staffing models have been conducted on an approximately 

3-year basis and that periodic unit inspections have also been conducted.

• Validation reviews. The U.S. Army Manpower Analysis Agency 

conducts validation reviews of the Warrior Transition Command’s 

population and staffing models within the WTUs.19 These reviews 

examine, among other things, the staffing ratios for different types of 

personnel (including for members of the Triad of Care).

• Unit inspections. The Warrior Transition Command conducts 

inspections of each WTU under the Organizational Inspection 

Program, inspections that are to assess numerous aspects of each 

WTU’s operations and provide an avenue for other concerns to be 

raised.20 These inspections generally include a pre-questionnaire to 

WTU soldiers, their family members, and staff; a process evaluation to 

determine a WTU’s adherence to policies and procedures; and an 

after-action review with a WTU’s leadership and staff to rate the 

inspection process.

According to Warrior Transition Command officials, these reviews and 

inspections should indicate whether changes are needed to the Triad of 

Care model. However, we found that while both validation reviews and 

unit inspections assess important aspects of the Army’s approach to care, 

neither has specifically assessed whether changes are needed to the 

Triad of Care model to address, for example, the greater prevalence of 

WTU soldiers’ behavioral health needs. The Army designed the Triad of 

Care model at a time when the preponderance of injuries among WTU 

soldiers were physical. Since that time, the Army has not assessed 

whether these significant changes to the WTU soldier population’s 

diagnoses have impacted its approach for managing soldiers’ medical 

care. Federal standards for internal control state that management should 

 19 The U.S. Army Manpower Analysis Agency is responsible for reviewing and validating 

manpower requirements models.

20 Army Regulation 40-58. Beginning in fiscal year 2016, Operations Order (OPORD) 15-

17, FY16 Warrior Transition Unit Organizational Inspection Program, requires the 

inspections to take place annually at each WTU.

The Warrior Transition 

Command Has Not 

Assessed Whether Armywide Changes to the Triad 

of Care Model Are Needed 

to Respond to the Change 

in the Composition of 

Diagnoses
Page 12 GAO-16-583 Warrior Transition Units

analyze relevant risks associated with achieving a program’s objectives.21

The increasing prevalence of behavioral health diagnoses in WTU 

soldiers and the resulting increase in soldiers’ need for behavioral health 

services needs is one such relevant risk.

In the absence of an assessment by the Warrior Transition Command, 

officials from each of the five WTUs we visited told us that they have 

taken various ad-hoc steps to meet the challenges posed by the 

increasing prevalence of behavioral health diagnoses. For example, 

medical officials at each of the WTUs we visited told us that they include 

social workers as an additional member of the Triad of Care model in 

response to the need for specialized medical case management. While 

social workers have always played a role in the WTUs’ interdisciplinary 

team, officials at these WTUs told us that the greater prevalence of 

behavioral health diagnoses among soldiers warranted a greater role for 

social workers, who serve as the WTUs’ behavioral health experts. 

Further, senior officials at several of these WTUs told us that they now 

refer to their model as the “Quad of Care” or “Square of Care” in response 

to the social workers’ inclusion. In addition, at four of the five WTUs, 

social workers told us that they have been directly providing certain types 

of behavioral health care to soldiers, such as therapy sessions, in part 

because obtaining behavioral health appointments at the local military 

treatment facility can be difficult.22 Medical officials from one of these four 

WTUs also told us that, in addition to providing the social workers’

therapy sessions, the unit borrows a psychiatrist from the local military 

treatment facility 2 days each week to provide behavioral health care. At 

the remaining WTU, the local military treatment facility contracted for a 

full-time psychiatrist in order to meet soldiers’ need for behavioral health 

services.

 21 GAO/AIMD-00-21.3.1. 

22 We recently reported on behavioral health wait times and found that recent data 

showed that the Army was generally meeting three of its four appointment wait-time 

access standards in its direct-care system. However, recent Department of Defense 

surveys also showed that about a third of servicemembers reported that they had 

experienced problems accessing mental health care—indicating that servicemember 

perceptions of access and the department’s data on access to care may not be aligned. 

See GAO, Defense Health Care: DOD Is Meeting Most Mental Health Care Access 

Standards, but It Needs a Standard for Follow-up Appointments, GAO-16-416 

(Washington, D.C.: Apr. 28, 2016). 
Page 13 GAO-16-583 Warrior Transition Units

While these local adaptations represent efforts to meet an immediate 

need, they are not supported by analysis of whether the Triad of Care 

model must change to meet the increasing behavioral health needs of the 

WTU soldier population. For example, the differing approaches of various 

WTUs, with some making greater use of social workers and others 

turning to psychiatrists, merits review and assessment by the Army to 

determine which approach best benefits WTU soldiers. Assessing the 

Triad of Care model in light of changes in, for example, the prevalence of 

behavioral health conditions would position the Army to better determine 

how to meet WTU soldiers’ medical needs.

The Army has established selection processes and updated its selection 

criteria to require additional information about potential squad leaders and 

platoon sergeants for its WTUs, but the Army is not monitoring full 

adherence to policy, specifically the requirement to interview candidates 

for these positions. Further, while the Army had made improvements to its 

training program, the program does not incorporate a post-training 

assessment on the application of training to the work environment. In 

addition, the Army has not developed a plan that explains how to meet 

any potential increases in demand for staff, if needed, at the WTUs. 

The Army has established processes to select WTU squad leaders and 

platoon sergeants, and has updated its selection criteria to require greater 

experience and additional screening. WTU squad leaders and platoon 

sergeants are selected by various methods based on whether they are 

active duty or members of the reserve components, and the senior 

Commander at the installation is the final approval authority for all 

assignments. WTU positions are designed to be representative of the 

entire Army, with a mix of military occupational specialties and all three 

active and reserve components. Prior to selection, squad leaders and 

The Army Faces 

Challenges in 

Overseeing the 

Selection of Certain 

WTU Staff, in 

Evaluating Their 

Training, and in 

Adjusting Staff Levels 

if Needed

The Army Has Established 

Selection Processes and 

Updated Its Selection 

Criteria
Page 14 GAO-16-583 Warrior Transition Units

platoon sergeants must meet minimum grade, experience, and training 

qualifications.23

Squad leader and platoon sergeant positions can be filled by personnel 

sourced through one of the following: from the installation where the WTU 

is located; the Human Resources Command; and, for reserve component 

soldiers, the Tour of Duty system.24 Senior Commanders can identify 

personnel from the installation where the WTU is located to interview for 

squad leader and platoon sergeant positions. If senior Commanders are 

unable to identify staff at the installation, a request is sent to the Human 

Resources Command to identify personnel to be screened and sent to the 

WTU program. Using the Tour of Duty system, reserve component 

personnel can apply for open squad leader and platoon sergeant 

positions, and local Commanders and their selection panels interview and 

select the best-qualified candidates. Figure 3 shows the three sources 

and the processes for filling the squad leader and platoon sergeant 

positions.

 23Army Regulation 40–58.

24 Tour of Duty is an Internet-based system where reserve component soldiers can 

identify and apply for active-duty tours.
Page 15 GAO-16-583 Warrior Transition Units

Figure 3: Sources and Processes for Filling Squad Leader and Platoon Sergeant 

Positions

a

Tour of Duty is an Internet-based system where reserve component soldiers can identify and apply 

for active-duty tours.

In November 2015, the Army updated its selection policy for WTU squad 

leaders and platoon sergeants. The November 2015 policy increases the 

minimum grade and experience requirements and identifies minimum 

training requirements.25 According to WTC officials, the updated 

requirements give WTU squad leaders and platoon sergeants more 

experience to draw from when working with WTU soldiers. In addition, the 

policy identifies squad leaders and platoon sergeants as positions of 

significant trust and authority.26 Through this designation, the Army 

requires more screening, including through the use of records concerning 

 25 Headquarters, Department of the Army (HQDA), EXORD 040-16, ISO MEDCOM 

Warrior Care and Transition Program Force Structure Implementation-Cadre Selection 

Criteria Annex A, (November 2015).

26 HQDA, EXORD 040-16, ISO MEDCOM Warrior Care and Transition Program Force 

Structure Implementation, (November 2015).
Page 16 GAO-16-583 Warrior Transition Units

police encounters, substance abuse, sex offender status, and behavioral 

health and records held by Army personnel offices.27

The updated policy also requires WTU squad leaders and platoon 

sergeants to have previously served successfully in a grade-equivalent 

leadership position and to meet minimum grade and training 

requirements. For example, potential squad leaders are required to hold 

the minimum grade of E-6 and to have completed the Advanced Leader 

Course, and potential platoon sergeants are required to hold the minimum 

grade of E-7 and have completed the Senior Leader Course. Table 1 lists 

the WTU program selection criteria for squad leaders and platoon 

sergeants before and after November 2015.

Table 1: Warrior Transition Unit (WTU) Program Selection Criteria for Squad Leader and Platoon Sergeant Positions before 

and after November 2015 

WTU

position

Criteria before

November 2015

Criteria after

November 2015a

Squad leaders • Minimum E-5

• Warrior Leader Course required; 

Advanced Leader Course preferred.

• At least 1 year successful leadership as 

a squad leader preferred.

• Minimum E-6

• Advanced Leader Course required.

• Previous successful performance in grade-equivalent 

leadership position.

Platoon sergeants • Minimum E-6

• Advanced Leader Course required, 

Senior Leader Course preferred

• At least one successful leadership 

experience as a squad leader or platoon 

sergeant required.

• Minimum E-7

• Senior Leader Course required.

• Previous successful performance in grade-equivalent 

leadership position.

Source: GAO analysis of Army Information. | GAO-16-583

a

Effective June 1, 2016, WTU program squad leaders and platoon sergeants must meet minimum 

screening requirements for positions of significant trust and authority including screening of the 

following records: police, Army substance abuse program, family housing, family advocacy, Army 

central registry, medical related to behavioral health, Army Human Resources records; check of U.S. 

 27Effective June 1, 2016, WTU staff including squad leaders and platoon sergeants must 

meet minimum screening requirements for positions of significant trust and authority 

including screening of the following records: police, Army substance abuse program, 

family housing, family advocacy, Army central registry, medical related to behavioral 

health, Army Human Resources records; check of U.S. Department of Justice National 

Sex Offender Registry, Department of the Army Inspector General files, U.S. Army 

Criminal Investigation Command/Crime Records Center databases, any other records that 

may be relevant to qualification and suitability for a position of trust and authority.
Page 17 GAO-16-583 Warrior Transition Units

Department of Justice National Sex Offender Registry, Department of the Army Inspector General 

files, U.S. Army Criminal Investigation Command/Crime Records Center databases, any other 

records that may be relevant to qualification and suitability for a position of trust and authority.

Although the Army has updated its policy for selecting squad leaders and 

platoon sergeants, the Warrior Transition Command is not monitoring full 

adherence to this policy, specifically the requirement to interview 

candidates for these positions. According to the policy effective before 

November 2015, Commanders or their staff selection panels are required 

to review the records of candidates and interview them to validate 

whether a candidate possesses the required skills and attributes to work 

as WTU staff.28 This provision did not change with the new regulation 

effective November 2015.29 However, the Army does not have a 

mechanism in place to monitor whether the interviews are conducted.

According to Warrior Transition Command guidance,30 the WTU selection 

process for squad leaders and platoon sergeants is important to ensure 

the selection of individuals who are best suited for the position. Warrior 

Transition Command officials stated that squad leader and platoon 

sergeant positions within the WTU are categorized as “broadening 

positions” because they reflect responsibilities and duties outside of their 

Army military occupational specialty. Candidates for these positions are 

drawn from a mix of Army occupations, such as infantry or transportation 

corps, and the selection process, including interviews, is intended to 

ensure the suitability of the staff selected for the position. Warrior 

Transition Command guidance recommends using the structured 

interview process when evaluating candidates to significantly improve the 

likelihood of selecting good candidates. A structured interviewed process 

involves the WTU Commander or a staff selection board asking the same 

questions of each candidate and scoring the answers using a predeveloped rating scale. The guidance explains that interviewing provides 

Commanders and their selection panels the ability to learn more about 

the candidate and gives candidates the opportunity to demonstrate their 

 28Army Regulation 40-58.

29HQDA EXORD 040-16, Annex A.

30 Department of the Army, Warrior Transition Command, Warrior Care and Transition 

Program Soldier and Leader Guide Version 1, (July 23, 2014).

The Army Is Not 

Monitoring Full Adherence 

to Selection Policy 

Requirement
Page 18 GAO-16-583 Warrior Transition Units

responses to situational job scenarios such as supervising WTU soldiers 

with behavioral health issues.

The Warrior Transition Command, which is responsible for oversight of 

the WTU program and operations, has not monitored whether units 

adhere to the requirement to interview squad leaders and platoon 

sergeants for WTU positions. The Warrior Transition Command directs 

the Army Human Resource Action Branch to conduct a quarterly analysis 

of a random sample of squad leader and platoon sergeants’ records to 

validate that candidates meet, for example, minimum grade and 

experience requirements. However, this quarterly analysis does not 

include validation of whether the selection process was followed as 

required, including whether the candidate was interviewed. At four of the 

five WTUs we visited, squad leaders and platoon sergeants told us that 

they were not interviewed prior to assuming their positions. In contrast, 

senior officials at three of the five WTUs we visited stated that they 

believed that interviews for squad leaders and platoon sergeants are 

conducted. However, in the absence of a mechanism to monitor this, the 

Army does not have assurance that the interviews are being conducted. 

When questioned why some interviews may not be conducted, Warrior 

Transition Command officials stated that the interviews were encouraged, 

which stands in contrast to the stated policy.

Federal internal control standards state that management should design 

control activities to achieve objectives and respond to risks.31 Although 

both the regulations effective as of November 201532 and before 

November 201533 state that Commanders or their staff selection panels 

will interview and review the records of candidates to validate whether a 

candidate possesses the required skills and attributes to work as WTU 

squad leaders and platoon sergeants, there is no internal control 

procedure to monitor full adherence to this requirement. By not monitoring 

full adherence to this requirement, the Army does not have assurance 

that squad leaders and platoon sergeants being selected are well suited 

to carry out the sensitive mission of the WTUs.

 31GAO/AIMD-00-21.3.1.

32HQDA EXORD 040-16, Annex A.

33Army Regulation 40–58. 
Page 19 GAO-16-583 Warrior Transition Units

The Army Medical Department Center and School has made efforts to 

make improve WTU training for squad leaders and platoon sergeants, but 

the program does not incorporate a post-training assessment of the 

application of training to the work environment. At three of the five sites 

we visited, WTU squad leaders and platoon sergeants, along with other 

WTU staff, expressed concerns regarding squad leader and platoon 

sergeants’ training. While the Army has implemented several practices to 

incorporate feedback from participants and other WTU professionals into 

its training program for squad leaders and platoon sergeants, these 

efforts may not fully address the concerns.

Currently, according to school officials, the Army Medical Department 

Center and School offers a 3-week residential training course that squad 

leaders and platoons sergeants must take within 90 days of assuming 

their duties. Prior to attending the residence course, staff must complete a 

staff orientation distance learning course. In the first week of residence 

training, squad leaders and platoon sergeants are required to take the 

Cadre Resilience Course, designed to assist those caring for wounded, ill, 

and injured soldiers and their families. According to Army Medical 

Department Center and School officials, the second and third weeks of 

training are designed specifically for the WTU and include information 

related to, for example, communication skills, behavioral health issues, 

the Comprehensive Transition Program, the case management system, 

and role-playing activities. Army Medical Department Center and School 

officials stated that the vast majority of squad leaders and platoon 

sergeants come to the course with little to no knowledge of the WTU 

concept. Army Medical Department Center and School officials also 

stated that the training is designed to provide a foundation for squad 

leaders and platoon sergeants to be able to perform their duties, and is 

not intended to provide them with expert-level proficiency.

While the WTU training program is extensive, WTU squad leaders and 

platoon sergeants at three of the five sites we visited stated that they 

were not sufficiently prepared for their positions after taking the required 

training. Specifically, squad leaders and platoon sergeants stated that 

their training did not address the actual requirements of their positions, 

such as the use of data systems and other day-to-day responsibilities. 

Squad leaders and platoon sergeants expressed frustration with their 

training, noting that there is no military occupational specialty similar to 

their positions, and that their roles and responsibilities were unfamiliar 

and dissimilar to anything in their prior Army experience. Candidates for 

these positions are drawn from a mix of Army occupations, such as 

infantry or transportation corps, and new squad leaders and platoon 

The Army Has Made 

Efforts to Improve 

Training, but Does Not 

Incorporate a Key PostTraining Assessment
Page 20 GAO-16-583 Warrior Transition Units

sergeants may have no background working with soldiers with issues 

typical of the WTU population, such as behavioral health issues. Other 

WTU staff at these sites, such as nurse case managers, social workers, 

and a WTU Commander stated that they also believe that current training 

does not sufficiently prepare squad leaders and platoon sergeants for 

their duties. For example, they noted that in some instances squad 

leaders and platoon sergeants did not have a sufficient understanding of 

behavioral health issues to be charged with responsibility for individuals 

having these issues.

Our prior work on assessing strategic training efforts summarizes 

attributes of effective training and development programs, including those 

related to the evaluation of agency training and development efforts.34

Such attributes include how the agency incorporates evaluation feedback 

into the planning, design, and implementation of its training and 

development efforts. According to school officials, the Army Medical 

Department Center and School currently uses end-of-course surveys and 

feedback from focus groups, WTU leadership, and staff to collect 

information on the effectiveness of the courses offered and make 

changes to course curricula. In addition, Army Medical Department 

Center and Schools officials stated that the Warrior Transition Command 

provides feedback from its Organizational Inspection Program regarding 

training. Warrior Transition Command officials stated that they send 

questionnaires prior to their Organizational Inspection Program and ask 

questions during informal feedback sessions regarding the effectiveness 

of squad leader and platoon sergeant training. These officials stated that 

they believe their current approach provides sufficient feedback to 

improve the training program.

While these efforts represent attempts to improve training through 

feedback, they do not assess the application of training to the work 

environment. Our prior work emphasizes that agencies should use 

analytical approaches appropriate for assessing training and development 

programs, such as assessing the application of training to the work 

environment.35 Application of training to the work environment assesses 

expected changes in behavior that trainees should exhibit on the job 

 34 GAO-04-546G. 

35 GAO-04-546G.
Page 21 GAO-16-583 Warrior Transition Units

because of the training. Army Medical Department Center and School 

officials stated that the WTUs do not evaluate training of squad leaders 

and platoon sergeant through assessments of how well they are able to 

apply their training to the work environment. These officials noted that 

they have previously proposed such an assessment to the Warrior 

Transition Command as the Warrior Transition Command is responsible 

for post-training assessments of staff. Army Medical Department Center 

and School officials noted that 90 days post-training would be an 

opportune time to collect information on the application of squad leaders 

and platoon sergeants’ training to the work environment. However, no 

action has been taken to date.

Without information that could be obtained from conducting post-training 

assessments, the Army Medical Department Center and School may miss 

a valuable opportunity to improve its programs by incorporating useful 

information concerning the practical application of training. Similarly, the 

Warrior Transition Command and WTUs may miss a valuable opportunity 

to further assess the performance of the squad leaders and platoon 

sergeants for the benefit of WTU soldiers.

The Army has not developed plans for increasing its WTU staff levels in 

the event of increased demand for WTUs. A key planning consideration in 

the decision to inactivate 11 WTUs by August 2016 was the Army’s ability 

to reverse these changes in the event that the demand for the Army’s 

WTU program was to increase. The Army’s guidance highlights the 

importance of reversibility, and establishes a number of relevant policies, 

for example, to maintain control of inactive WTU facilities. According to 

the Warrior Transition Command, the enduring 14 WTUs, if staffed by a 

full complement of 1,475 staff, could manage up to 4,400 WTU soldiers. 

With additional staff, the facilities at the enduring WTUs could support up 

to 8,100 WTU soldiers. In line with this projection, the Army has outlined 

plans for “expansion companies” at its enduring locations, with the 

exception of Walter Reed National Military Medical Center and Brooke 

Army Medical Center, that could operate on a temporary basis for a 

period of 2 years, with an assessment after the first 9 months to 

determine whether the company should be added to the unit’s permanent 

staffing document. Each expansion company would require 55 WTU 

personnel and could manage the care of up to 200 WTU soldiers.

While these plans represent positive steps toward planning for a potential 

increase in WTU numbers, the Army has not addressed how it would staff 

the expansion companies at these enduring WTUs, or at any of the 11 

The Army Has Not 

Developed Plans for 

Adjusting Staff Levels to 

Meet Any Potential 

Increases in Demand for 

WTUs
Page 22 GAO-16-583 Warrior Transition Units

inactivating WTUs, if the need arises. Warrior Transition Command 

officials stated that any change in the need for staff would be gradual. In 

addition, the Warrior Transition Command’s population projection model 

takes account of deployment cycles and could possibly anticipate a spike 

in WTU admissions due to an increased operational tempo. However, 

upswings in deployments and operational tempo could create spikes in 

WTU soldier admissions, possibly resulting in the need to expand WTU 

staff at a pace that is greater than the Army’s current expectations.

Regardless of the pace of any increase, the Army could face challenges 

in its efforts to staff these units with appropriately selected and screened 

personnel in a timely manner. As previously noted, the Warrior Transition 

Command recently updated its selection requirements for squad leaders 

and platoon sergeants. As the Warrior Transition Command implements 

requirements for squad leaders and platoon sergeants to undergo 

background checks and behavioral health records checks, effects from 

these changes could result in an increase in the time required to select 

WTU staff. The Warrior Transition Command has emphasized the 

importance of the screening and selection process, noting that it is central 

to the integrity of the WTU program and the duty to care for WTU 

soldiers. In addition, WTUs are staffed by a number of other 

professionals, including primary care managers, nurse case managers, 

social workers, and transition coordination specialists, and hiring wellqualified candidates for these positions will also take time. For example, 

after WTU nurse case managers attend a 3-week training course, they 

must then complete a 4-week preceptorship36 at their assigned WTU 

before they can manage a normal caseload of 20 WTU soldiers. Army 

guidance notes the possibility of hiring term or temporary employees to 

address any gaps. However, such an approach could negatively impact 

the continuity of care, a central principle of the Army’s approach to WTU 

care, because of turnover in key WTU staff.

To handle any sudden increase in demand, WTUs also could potentially 

increase their ratios of squad leaders, nurse case managers, or primary 

care managers to WTU soldiers to accommodate the additional demand, 

but this too could have negative effects due to the heavier case 

 36 A “preceptorship” is a period during which a nurse provides care while being supervised 

and mentored by a more senior nurse.
Page 23 GAO-16-583 Warrior Transition Units

workloads that would result for these individuals. Warrior Transition 

Command officials stated that they regularly monitor the ratios of these 

team members to WTU soldiers, and the regulation underscores the 

relationship between adhering to these ratios and the quality of care 

provided. Further, officials such as squad leaders, platoon sergeants, 

social workers, and nurse case managers at the five WTUs we visited 

stated that the current ratios may be too high. At one site we visited, 

officials have changed local policy to lower the ratio of squad leaders to 

WTU soldiers.

Federal internal control standards emphasize the need for control 

activities, such as the management of human capital, to maintain a 

continuity of needed skills and abilities.37 While the Army’s recently issued 

policy38 does not require the Warrior Transition Command to develop a 

plan for increasing its staff levels in response to future demand, the policy 

states that the Warrior Transition Command should “be prepared to 

reactivate previously inactivated WTUs.” Senior Warrior Transition 

Command officials told us that this is an implied requirement for a plan 

related to staffing. However, they stated that they have not yet taken 

steps to address this issue. Absent such a plan, the Army does not have 

assurance that it can, with limited notice, expand its staffing to effectively 

carry out the WTU mission.

 37 GAO/AIMD-00-21.3.1.

38 HQDA EXORD 040-16.
Page 24 GAO-16-583 Warrior Transition Units

The Army has implemented a structured process for reviewing the 

eligibility of soldiers to be admitted to WTUs, but it does not track 

instances in which Commanders have made exceptions to these criteria 

for active-duty soldiers. In addition, Warrior Transition Command and 

Army Reserve officials stated that they came to an agreement that 

admittance criteria for members of the reserve component will not change 

until a WTU-alternative program is expanded to the Army Reserve. 

However, the Army has not yet examined the costs and benefits of 

expanding this alternative program relative to the current system.

According to Warrior Transition Command officials, the Army does not 

track instances in which individual WTUs have made exceptions to the 

Army’s WTU admittance criteria for active-duty soldiers. While the Army 

has established a structured process for reviewing the eligibility of 

soldiers to enter WTUs, Warrior Transition Command officials stated that 

the senior mission Commander at the relevant installation can choose to 

admit soldiers to WTUs outside of this process by approving an exception 

to the eligibility criteria.

Army regulations state that for admittance into the WTU program, activeduty component soldiers must either (1) need care requiring 6 months or 

more of treatment or (2) have a significant behavioral health issue that 

presents a danger to themselves or others.39 The Army’s structured 

process for reviewing the eligibility of soldiers to enter WTUs comprises 

the requirement that the WTU Commander, local hospital Commander, 

and senior mission Commander compare potential WTU soldiers’ medical 

case history with the WTU admittance criteria and decide whether 

soldiers are eligible. Warrior Transition Command officials stated that 

 39 Army Regulation 40–58.

The Army Does Not 

Track Instances in 

Which Commanders 

Have Made 

Exceptions to WTU 

Admittance Criteria 

and Has Not 

Analyzed Proposed 

Changes to Criteria 

for the Reserve 

Component

The Army Does Not Track 

Instances in Which 

Commanders Have Made 

Exceptions to WTU 

Admittance Criteria for the 

Active-Duty Component
Page 25 GAO-16-583 Warrior Transition Units

senior mission Commanders are able to approve exceptions to the criteria 

under a variety of circumstances, such as the need for soldiers stationed 

overseas to process disability status through DOD’s Integrated Disability 

Evaluation System.

Officials at the Warrior Transition Command could not provide data of 

how often exceptions to WTU admittance criteria were approved. Officials 

noted that admitting soldiers who do not meet admittance criteria can be 

appropriate in some situations. For example, the Department of Defense 

and the Veterans Affairs system for assessing individuals’ medical fitness 

for service and level of service-related disability, known as the Integrated 

Disability Evaluation System, is available only to soldiers in the 

continental United States, and soldiers stationed overseas can be 

transferred to a military treatment facility in the continental United States 

with an associated WTU to complete this process. WTU soldiers who will 

not be returning to duty normally go through this process while in the 

WTU.

Officials at our site visits expressed concern related to instances in which 

soldiers were far into the Integrated Disability Evaluation System process, 

near to the point of separation from the Army, and were assigned to a 

WTU to stay for fewer than 6 months, sometimes for fewer than 30 days. 

By virtue of the fact that a soldier is in the late stages of the Integrated 

Disability Evaluation System process, the soldier is unlikely to be in the 

Army for the standard admittance criteria period of 6 months or more of 

care. At three of the five sites we visited, a variety of WTU officials, such 

as nurse case managers, squad leaders, and social workers, among 

others, expressed concern about this issue. Officials at these locations 

noted that this was not the best use of WTU resources, and that such 

soldiers did not have the necessary time to benefit from the medical and 

career opportunities that the WTU program provides.

According to Warrior Transition Command officials, they do not track 

instances in which individual WTUs make exceptions to the Army’s 

admittance criteria because application of the eligibility criteria is the 

responsibility of the senior mission Commander on the relevant 

installation. Standards for Internal Control in the Federal Government 

state that management should design control activities to achieve 
Page 26 GAO-16-583 Warrior Transition Units

objectives.40 These control activities might include performing top-level 

reviews, for example, to ensure that performance is consistent with the 

WTU program’s goals. However, by not tracking this information, the 

Army does not know how frequently such exceptions are made and 

cannot ensure the best use of resources.

The Army is planning to expand an alternative WTU program to the Army 

Reserve, but it has not yet examined the costs and benefits of this 

expansion. Specifically, the Army has not yet estimated the costs and 

benefits of expanding the Reserve Component Managed Care program, 

which currently treats only National Guard soldiers with low-acuity, lowrisk, non-complex medical needs. In addition, the Army has not compared 

the cost of expanding this program with maintaining the status quo for 

soldiers with similar low-acuity, low-risk, non-complex medical needs. 

Army Reserve officials have confirmed their intention to participate in the 

program, but have not yet established a timeline for its introduction.

Currently, active-duty soldiers must need care lasting 6 months or longer 

to be admitted to a WTU.41 In contrast, reserve component soldiers must 

need care lasting 30 days or longer. If reserve component soldiers meet 

this threshold, they can be considered for admittance to a WTU 

Community Care Unit if their medical needs are low-acuity, low-risk, and 

non-complex. Warrior Transition Command and Army Reserve officials 

stated that expansion of the Reserve Component Managed Care program 

to the Army Reserve would be necessary if the Warrior Transition 

Command were to change current WTU admittance policy, specifically by 

applying the more stringent criteria for active-duty soldiers to members of 

the reserve components. However, during the course of our review, 

Warrior Transition Command officials stated that they came to an 

agreement with the Army Reserve that admittance criteria will not change 

until the Reserve Component Managed Care program is expanded to the 

Army Reserve.

 40 GAO/AIMD-00-21.3.1.

41 Active-duty soldiers can also be admitted to a WTU if they have a behavioral health 

condition that presents a substantial danger to themselves or others.

The Army Has Not Yet 

Examined the Costs and 

Benefits of Expanding a

WTU-Alternative Program 

for Army Reserve Soldiers
Page 27 GAO-16-583 Warrior Transition Units

A senior Army Reserve official stated that the lower threshold for 

members of the reserve components stems from requirements under 

law42 and DOD instructions43 for such soldiers to remain in active federal 

service for the purposes of disability evaluation or medical treatment. 

Senior officials at the Warrior Transition Command noted that active-duty 

soldiers needing fewer than 6 months of care can, instead of being 

assigned to a WTU, remain with their line unit and receive medical care in 

that setting. Meanwhile, reserve component soldiers must demobilize as 

their active-duty orders end and, while they can receive DOD-funded 

medical care for a period of time, cannot continue to receive their activeduty pay and other benefits. The 30-day treatment threshold therefore 

allows those soldiers to enter the WTU, whereas active-duty soldiers with 

similar short-term care needs can remain with their unit. Table 2 

summarizes the admittance criteria for the WTU program and for the 

WTU-alternative program.

Table 2: Admittance Criteria for the Warrior Transition Unit (WTU) Program and for the WTU-Alternative Program

WTU Program:

Active component and Active Guard Reserve soldiers must meet one of the following:

• Soldier has received or is anticipated to receive a medical profile of more than 6 months duration, with duty limitations that 

preclude the soldier from training or contributing to unit mission accomplishment, and the complexity of the soldier’s condition 

requires clinical case management.

• Soldier’s psychological condition is evaluated by a qualified medical or behavioral health provider as posing a substantial danger 

to self or others if the soldier remains in the unit.

Reserve component soldiers must meet all of the following:

• Soldier’s condition requires definitive care (specific treatment or a sequence of treatments lasting 30 days or more, as determined 

and appropriately documented by a military medical authority).

• Soldier’s medical condition was incurred or aggravated in the line of duty during an active-duty status (contingency or 

noncontingency) or during inactive-duty status (inactive-duty training, funeral honors duty, etc.), and the soldier may qualify for 

evaluation, treatment, and/or disability evaluation processing while in an active-duty status.

Warrior Transition Community Care Units, part of the WTU program:

Reserve component soldiers previously admitted to a WTU must meet all of the following: a

• Soldier must not be considered high risk or have a behavioral health condition that renders him or her administratively unfit or 

non-retainable. b

 42 10 USC § 12301.

43 Department of Defense Instruction 1332.18, Disability Evaluation System (DES), 

(August 5, 2014). Department of Defense Instruction 1241.01, Reserve Component (RC) 

Line of Duty Determination for Medical and Dental Treatments and Incapacitation Pay 

Entitlements, (April 19, 2016).
Page 28 GAO-16-583 Warrior Transition Units

Reserve Component Managed Care Program, the WTU-alternative program:

National Guard soldiers must meet all of the following:

• Soldier’s medical condition is low risk, low acuity, and requires medical care for 179 days or fewer.

• Soldier’s medical condition was incurred in the line of duty while mobilized in support of a contingency operation or while 

participating in training. 

Source: GAO analysis of DOD information. | GAO-16-583

a

Active duty soldiers may be assigned to a Community Care Unit under exceptional circumstances on 

a case-by-case basis.

b

Soldier must also meet a number of requirements related to the availability of medical care in their 

home area, proximity of their home to the WTU, and other considerations.

Warrior Transition Command and Army Reserve officials told us that were 

the more stringent active-duty criteria to be applied to members of the 

reserve components, those Army Reserve soldiers needing fewer than 6 

months of care would not be eligible for the WTU program, and would not 

be able to receive their active duty pay while receiving short-term medical 

treatment. According to Warrior Transition Command and Army Reserve 

officials, access to active-duty pay is important because these soldiers 

may not be medically able to return to civilian employment while receiving 

medical care. Warrior Transition Command officials acknowledged that 

this would put Army Reserve soldiers at a disadvantage compared with 

active component soldiers. National Guard soldiers, meanwhile, could 

potentially access the Reserve Component Managed Care Program, 

which provides an alternative to WTUs for soldiers needing 179 days or 

fewer of low-acuity, low-risk medical care while on active-duty orders, 

entitling soldiers to active duty pay and benefits. Army Reserve or 

National Guard soldiers with low-acuity, low-risk, non-complex conditions 

can also be assigned to a WTU Community Care Unit, in which soldiers 

are not physically located at a WTU, but receive remote medical case 

management from their assigned WTU and receive medical care in their 

local area, either in a military treatment facility or from a provider in the 

TRICARE network. To be eligible, soldiers must not be in need of 

complex medical case management, and must meet behavioral healthrisk standards. According to Army data, as of February 2016, there were 

155 Army Reserve soldiers in 11 Community Care Units across the 

United States.

Army Reserve officials told us that they are in the early planning stages of 

considering Reserve Component Managed Care expansion, and that no 

cost estimates of such an expansion have yet been developed. As in the 

National Guard, the active duty Army would pay for active duty pay and 

medical care costs for the reservists in this program. However, officials 
Page 29 GAO-16-583 Warrior Transition Units

told us that the Army Reserve would incur costs because of the need to 

tender a contract for nurse case managers for the program. Unlike the 

National Guard, the Army Reserve does not currently have a large 

network of contracted nurse case managers charged with improving 

medical readiness. While the National Guard is able to utilize its existing 

nurse case manager contract to service the program, officials stated that 

the Army Reserve would incur new costs in procuring these services. 

Further, Army officials have not yet articulated why expansion of the 

Reserve Component Managed Care is preferable to any alternatives, 

such as the continued use of WTU Community Care Units, especially in 

light of the alternative program’s increased costs. One official told us that 

this may stem from a desire to limit the time that reserve component 

personnel spend in the WTU program.

Our Business Process Reengineering Assessment Guide states that 

when considering program changes, officials should develop a 

performance-based analysis of the benefits and costs for each 

alternative, followed by a formal business case analysis making the case 

for a change.44 In this case, such an analysis could assess the costs and 

benefits of expanding the Reserve Component Managed Care program to 

the Army Reserve with alternatives, such as the option of continuing the 

current system of Community Care Units. As noted above, the Army 

Reserve is in the early stages of considering Reserve Component 

Managed Care expansion and no cost estimate has yet been conducted. 

Senior officials from Warrior Transition Command and the Army Reserve 

stated that expansion of the Reserve Component Managed Care program 

requires fewer resources than WTUs and soldiers in this program, on 

average, demonstrate shorter lengths of stay than soldiers in WTUs or 

Community Care Units. However, without conducting a cost-benefit 

analysis to analyze such factors, the Army Reserve may continue with 

plans to expand the Reserve Component Managed Care program and 

incur significant costs without clearly articulated benefits.

 44 GAO/AIMD-10.1.15.
Page 30 GAO-16-583 Warrior Transition Units

The Army has several methods that WTU soldiers can use to register a 

complaint or express a concern about the WTU program, medical care, or 

other issues.45 Although Army Medical Command oversees five complaint 

methods available to WTU soldiers, it does not have an approach to 

ensure that the Warrior Transition Command, which is charged with 

oversight of the WTU program, has access to all of this information. 

Standards for Internal Control in the Federal Government state that 

information should be communicated to management and others who 

need it in such a way that they can carry out their responsibilities.46

However, absent information on potential challenges with the WTU 

program, the Warrior Transition Command cannot fully carry out its 

oversight and policy development responsibilities.

The Army has the following methods, among others,47 by which WTU 

soldiers can register a complaint:

• the WTU chain of command;

• WTU town hall meetings, to be held at least quarterly at the 

Commander’s discretion in order for the Commander to address the 

WTU soldiers and listen to their concerns;

• the local Army ombudsman, who is independent from WTU command 

and located at most WTU sites;

• a toll-free hotline, including the Wounded Soldier and Family Hotline 

managed by the Army Medical Command’s Medical Assistance 

Group, which oversees both the hotline and the Ombudsman 

program; and,

• the WTU chaplain, a confidential source within the command.

The Army Medical Command, with direct purview over Warrior Transition 

Command and the WTUs, oversees these five complaint methods. Local 

WTU Commanders, who coordinate with military treatment facility 

 45 For the purposes of this report, we use the term “complaints” to refer to complaints, 

concerns, or issues raised by WTU soldiers.

46 GAO/AIMD-00-21.3.1. 

47 The Army has other methods—such as the Inspector General, the Equal Opportunity 

program, and Members of Congress—for registering a complaint in addition to those listed 

here. We limited our discussion to those within the purview of Army Medical Command.

The Army Cannot 

Ensure Full Oversight 

of Soldiers’

Complaints
Page 31 GAO-16-583 Warrior Transition Units

Commanders, manage their respective town hall meetings, and are part 

of the WTU chain of command. The Army Medical Command’s Medical 

Assistance Group oversees both the hotline and the Ombudsman 

program. The Regional Medical Commands, which report to Army 

Medical Command, provide chaplain support to the WTUs. The chaplain 

corps adheres to standards of privileged and confidential communications 

but, according to chaplains contacted throughout our review, they can 

provide general and trend information to Commanders.

According to the Army’s Warrior Transition Regulation, the Warrior 

Transition Command provides centralized oversight, guidance, and 

advocacy in support of WTU soldiers and their families, including policy 

development and oversight of the WTUs’ daily operations. In addition, the 

regulation states that WTU soldiers and their families are to be assisted 

through effective collaboration efforts, proactive communication, 

responsive policy, and program oversight.48 However, information from 

the three of the five complaint methods—chain of command, town hall 

meetings, and chaplains—that Army Medical Command has purview over 

may not be shared with the Warrior Transition Command, which therefore 

may not be able to sufficiently identify and address systemic issues. 

Warrior Transition Command officials stated that they do not generally 

receive information about complaints from these complaint methods and 

that complaints are mostly handled by the local chain of command, which 

has the responsibility to investigate and resolve these complaints.

WTU staff at four sites we visited said they handle complaints locally as 

much as possible, and infrequently contact senior leadership or the 

Warrior Transition Command with complaints information. In interviews 

with WTU staff at three of the sites we visited, officials stated that town 

halls may provide useful information to local leadership and referrals to 

other methods, but information from them typically is not forwarded to 

senior leadership. If complaints are expressed and resolved locally and 

information about them is not communicated further, senior leaders would 

remain unaware, and, if present at multiple WTUs, their possible systemic 

nature might go unidentified. In addition, at least one local senior official 

at a site we visited expressed a lack of confidence in the town hall 

system, stating that it yielded no useful information. Further, while Army 

 48 Army Regulation 40–58.
Page 32 GAO-16-583 Warrior Transition Units

chaplains are bound by confidentiality rules concerning communication 

between them and any soldier or family member, chaplains can share 

general information with local Commanders and regional medical 

commands, such as data on trends in the types of issues discussed, and 

such information can provide valuable insight into the issues concerning 

WTU soldiers.

The Warrior Transition Command does receive consistent information 

from some complaint methods, specifically from the two managed by the 

Ombudsman program. According to its operating procedures, the 

Ombudsman program provides information on issues reported by soldiers 

to local ombudsmen and the toll-free hotline through weekly reports to the 

Army’s Office of the Surgeon General and the Warrior Transition 

Command, as well as daily reports on WTU-related issues to the Warrior 

Transition Command’s Commander and staff. However, the Ombudsman 

program’s complaints information represents only two complaint methods 

identified by the Warrior Transition Command and does not present 

complete information about possible concerns raised by WTU soldiers. 

For example, ombudsman data would not include complaints from town 

hall meetings or the WTU chain of command unless WTU soldiers had 

repeated their complaints to the local ombudsman or toll-free hotline.

While the Warrior Transition Command receives information from the two 

programs run by the Ombudsman program, it does not consistently 

receive information from the other three methods of expressing 

complaints. Standards for Internal Control in the Federal Government 

state that information should be communicated to management and 

others who need it in such a way that they can carry out their 

responsibilities.49 The Warrior Transition Command, as the entity which 

provides strategic oversight and policy development support for the WTU 

program, provides a focal point for coordination and support for the 

program, and requires relevant information from the complaint methods to 

inform its oversight responsibilities. Quality information and effective 

communication about relevant complaints from all WTUs would enable 

the Warrior Transition Command and the Army to identify and implement 

necessary policy or program changes. However, the Army does not have 

an approach to ensure relevant complaints information from the various 

 49 GAO/AIMD-00-21.3.1. 
Page 33 GAO-16-583 Warrior Transition Units

methods it presents to WTU soldiers is communicated to appropriate 

senior leadership, such as the Warrior Transition Command. In addition, 

the Army has not clarified which complaints information is important for 

WTU program management and oversight. Warrior Transition Command 

officials stated that they engage on a policy level when there is a trend or 

ongoing problem, but did not explain how it would identify such systemic 

issues absent relevant information from available complaint methods. 

Given this, the Army cannot ensure that the Warrior Transition Command 

has relevant, reliable, and timely information necessary to achieve its 

objectives for oversight of and policy development for the WTU program 

and may not be able to identify and address potential systemic issues 

concerning the WTUs.

The Army has taken the following steps that signify its commitment to 

strengthening its WTU program and not repeating some of the mistakes 

made which led to the crisis of care at the former Walter Reed Army 

Medical Center: WTUs are staffed with standard ratios of WTU soldiers to 

providers; soldiers’ transition through the WTUs follows a structured 

process; minimum standards for squad leaders and platoon sergeants are 

being strengthened; and WTU soldiers have a range of methods for 

expressing complaints. These changes represent efforts to develop policy 

for the WTU program to help ensure quality of care and soldiers’ trust in 

the program. However, the Army has not assessed how fundamental 

aspects of the WTUs, such as the Triad of Care model, are impacted by 

the changing composition of diagnoses for WTU soldiers, particularly the 

increasing prevalence of behavioral health diagnoses. Additionally, in 

areas ranging from screening requirements for WTU staff, WTU soldiers’

admittance criteria, and the complaints process, the Army has yet to 

implement management controls to ensure that its policies are maintained 

and implemented in practice. As the Warrior Transition Command moves 

toward its transition to becoming a directorate within the Army Medical 

Command, it will be important that its successor organization increase 

oversight of the program to maintain the commitment to high-quality care 

for WTU soldiers.

To increase oversight of the Army’s Warrior Transition Unit program, we 

recommend that the Secretary of the Army direct the Army Surgeon 

General to take the following six actions:

• Assess the Triad of Care model’s effectiveness in light of the changes 

in WTU diagnoses and take the appropriate action.

Conclusions

Recommendations for 

Executive Action
Page 34 GAO-16-583 Warrior Transition Units

• Exercise oversight responsibility to track full adherence to selection 

processes for squad leaders and platoon sergeants, including the 

requirement to conduct interviews for these positions.

• Develop a mechanism to conduct post-training assessments on squad 

leaders and platoon sergeants’ application of training to the work 

environment and incorporate the results into the training program.

• Develop plans to adjust staff levels, if needed, to accommodate a 

potential future surge in demand.

• Establish a process that assigns oversight responsibility for tracking 

instances in which Commanders make exceptions to WTU entrance 

criteria so that the Army Surgeon General is aware of the extent 

Commanders’ decisions are consistent with program goals.

• Develop and implement an approach and associated procedures for 

providing senior leadership, such as the Warrior Transition Command, 

with complaints information concerning the WTU program and WTU 

soldiers.

To help ensure the best use of resources for managing the medical care 

of soldiers recovering from serious medical conditions, we recommend 

that the Secretary of the Army direct the Chief of the Army Reserve, in 

conjunction with the Army Surgeon General, to take the following action:

• Develop an analysis that compares the costs and benefits of 

maintaining the current system of Community Care Units with the 

costs and benefits of expanding the Reserve Component Managed 

Care program.

In written comments on a draft of this report, DOD concurred with our 

seven recommendations to increase oversight of the Army’s Warrior 

Transition Unit program and to help ensure the best use of resources for 

managing the medical care of Army Reserve soldiers recovering from 

serious medical conditions. DOD’s comments are reprinted in appendix 

III.

We are sending copies of this report to the appropriate congressional 

committees, the Secretary of Defense, the Deputy Secretary of Defense, 

the Secretary of the Army, the Army Surgeon General, and the Chief of 

the Army Reserve. In addition, the report is available at no charge on the 

GAO website at http://www.gao.gov.

Agency Comments 
Page 35 GAO-16-583 Warrior Transition Units

If you or your staff have any questions regarding this report, please 

contact me at (202) 512-3604 or farrellb@gao.gov. Contact points for our 

Offices of Congressional Relations and Public Affairs may be found on 

the last page of this report. GAO staff who made key contributions to this 

report are listed in appendix IV.

Brenda S. Farrell

Director

Defense Capabilities and Management
Appendix I: Scope and Methodology

Page 36 GAO-16-583 Warrior Transition Units

To address the objectives for this review, we reviewed policies governing 

the Army’s Warrior Transition Unit (WTU) program, including the Army 

Medical Action Plan;1 analyzed program documents and data; and 

interviewed officials from the Warrior Transition Command, the Office of 

the Army Surgeon General, and other Army offices with responsibilities 

for medical and personnel management. We conducted site visits to 5 of

the WTUs existing during the course of our review, which we selected 

based on the mix of active-duty and reserve components, the number of 

complaints reported to the ombudsman, and geographic dispersion.2 The 

sites we visited were Walter Reed National Military Medical Center in 

Bethesda, MD; Joint Base San Antonio in San Antonio, TX; Fort Hood in 

Killeen, TX; Fort Carson in Colorado Springs, CO; and Fort Eustis in 

Newport News, VA. At each site, we conducted interviews with squad 

leaders, command staff, nurse case managers, social workers, and other 

professionals. The results of these site visits are non-generalizable but 

provide useful information on WTU program operations and relevant 

issues.

To determine the extent to which the Army has assessed the 

effectiveness of the Triad of Care staffing model for managing WTU 

soldiers’ care, we compared policy and other documents concerning the 

use of the Triad of Care model with federal internal control standards, 

which emphasize the need for management to identify and analyze 

relevant risks associated with achieving defined objectives.3 To identify 

changes in the WTU population over time, we analyzed aggregate data 

from the Warrior Transition Command on WTU soldiers’ medical 

diagnoses upon entry into the WTU program from June 1, 2007 through 

 1 Headquarters, Department of the Army, (HQDA) EXORD 118-07: Healing Warriors

(June 2007). This document is commonly referred to as the Army Medical Action Plan.

2

We selected WTUs that had registered both high and low numbers of complaints to the 

ombudsman.

3

See GAO, Standards for Internal Control in the Federal Government, 

GAO/AIMD-00-21.3.1 (Washington, D.C.: November 1999). These standards were in 

effect prior to fiscal year 2016 and cover most of the time period from the inception of the 

WTUs. The standards were subsequently updated and state that management should 

identify, assess, and respond to any significant risks that could affect its ability to 

accomplish the objectives of its program. The updated standards went into effect on 

October 1, 2015. See GAO, Standards for Internal Control in the Federal Government, 

GAO-14-704G (Washington, D.C.: Sept. 2014).

Appendix I: Scope and Methodology
Appendix I: Scope and Methodology

Page 37 GAO-16-583 Warrior Transition Units

December 2015.4 We did not request or have access to any individual 

WTU soldier’s information, including an individual soldier’s medical 

records or diagnoses. We decided not to present data for soldiers who 

entered a WTU in 2007 because it did not represent a full year of the 

program. We found these data to be sufficiently reliable to show the 

prevalence of behavioral health diagnoses at the time of the soldier’s 

entry into the WTU program. We made this determination based on a 

data reliability questionnaire filled out by Army officials, logic tests of the 

data, and our conversations with Warrior Transition Command officials 

about how the data were captured, stored, and checked for accuracy. We 

also reviewed relevant documentation related to the Warrior Transition 

Command’s most recent unit inspections conducted at each of the five 

individual WTUs we visited (one WTU inspected in 2011, one WTU 

inspected in 2014, and the remaining three inspected in 2015), and 

observed one of these inspections in process to determine what types of 

information were analyzed by the Warrior Transition Command. We 

spoke with Warrior Transition Command officials about the Triad of Care 

model, changes in the WTU soldier population, and their WTU 

inspections. We also interviewed officials at each of the five WTUs we 

visited about the Triad of Care model and the management of their 

soldiers’ care.

To determine the extent to which the Army’s has established processes to 

oversee its WTU personnel selection, assess the training of these 

personnel, and adjust staff levels, we interviewed officials from the 

Warrior Transition Command, the Human Resources Command, and 

officials at various levels at each of the sites we visited concerning their 

views of the selection of squad leaders and platoon sergeants. We also 

interviewed officials at the Army Medical Department Center and School 

regarding the WTU training program. We compared current and past 

Army policies regarding the selection and training of squad leaders and 

platoon sergeants and reviewed the content of our discussions with 

squad leaders and platoon sergeants at various sites we visited. We 

reviewed federal internal control standards which state that management 

should demonstrate a commitment to recruit, develop, and retain 

 4

We requested data on those soldiers who had entered a WTU after June 1, 2007, as that 

is the date that the Warrior Transition Command considers to be the start of the program. 
Appendix I: Scope and Methodology

Page 38 GAO-16-583 Warrior Transition Units

competent individuals and our prior work5 which summarizes the 

attributes of effective training, including the need to ensure that training 

goals and strategies are aligned with organizational goals and attributes 

of effective training and development programs. Though WTU policies 

address issues related to staff in various roles, collectively referred to as 

“cadre,” we decided to focus on the selection and training of squad 

leaders and platoon sergeants based on the content of our discussions 

with officials at each of our site visits. We also discussed the Army’s 

ability to adjust WTU staff levels with officials from the Warrior Transition 

Command. We reviewed the Army’s policy in this area and the principle in 

federal internal control standards6 that states that agencies need to 

demonstrate a commitment to competence through succession and 

contingency plans and to establish control activities, such as for the 

management of human capital, to maintain a continuity of needed skills 

and abilities.

To determine the extent to which the Army has assessed adherence to 

WTU program admittance criteria and the impact of any changes to these 

criteria for the active-duty and reserve components, we reviewed policies 

and procedures for admitting soldiers into the WTU program, including 

any proposed changes to the admittance criteria and discussed the 

application of these policies and procedures with officials at each of the 

sites we visited and with officials from the Warrior Transition Command. 

We compared these policies and procedures with federal internal control 

standards7 which require that management design control activities, such 

as establishing and reviewing performance measures and indicators, to 

achieve objectives and respond to risks, and noted any differences. In 

addition, we reviewed documentation concerning the Army’s Reserve 

Component Managed Care program, a WTU-alternative program, and its 

proposed introduction to the Army Reserve, and discussed this 

information, including estimated costs, with officials from the Army 

Reserve and the Warrior Transition Command. We compared plans for 

the introduction of the program to the Army Reserve with the requirement 

 5

GAO, Human Capital: A Guide for Assessing Strategic Training and Development Efforts 

in the Federal Government, GAO-04-546G (Washington, D.C.: Mar. 2004). 

6 GAO/AIMD-00-21.3.1.

7 GAO/AIMD-00-21.3.1.
Appendix I: Scope and Methodology

Page 39 GAO-16-583 Warrior Transition Units

in our Business Process Reengineering Assessment Guide8 for a 

performance-based analysis of benefits and costs for each alternative 

when considering program changes, and noted any differences.

To determine whether the Army had instituted methods to address the 

complaints of WTU soldiers, we analyzed information on the Army’s 

approach to handling complaints by WTU soldiers. We interviewed 

program staff and officials regarding the Army’s approach and reviewed 

related Army documentation, such as Army policies on its WTU and 

chaplain corps programs. We compared the Army’s approach for handling 

complaints9 with federal internal control standards which state that 

information should be communicated to management and others who 

need it in such a way that they can carry out their responsibilities.10

We analyzed data regarding the number of soldiers in a WTU over time, 

the date when they entered a WTU, and their average length of stay from 

2007 to 2015.11 We found the data on the number of soldiers in a WTU 

over time to be sufficiently reliable to present monthly changes in the 

WTU soldiers’ census. For the data on when a soldier entered a WTU 

and their lengths of stay, we determined that the 2007 and 2008 data 

were unreliable because of missing data. We also chose not to report 

data on when a soldier entered a WTU and their lengths of stay for 2015 

because of the large number of soldiers that were still in the WTU 

program when the data were reported by Warrior Transition Command 

officials.12 Other than these exceptions, we found the data to be 

sufficiently reliable for showing WTU soldiers’ lengths of stay from the 

time of entry in the WTU program to the time of (1) exiting the WTU and 

(2) until they had reached their medical retention decision point. For each 

 8 GAO, Business Process Reengineering Assessment Guide, GAO/AIMD-10.1.15 

(Washington, D.C.: May 1997).

9 For the purposes of this report, we use the term “complaints” to refer to complaints, 

concerns, or issues raised by WTU soldiers. 

10 GAO/AIMD-00-21.3.1. 

11 For the number of soldiers in a WTU over time, we requested data through February 

19, 2016.

12 Of the approximately 2,600 soldiers who entered a WTU in that year, about 61 percent 

(1,600 soldiers) were still in the WTU program when the data were reported by the Warrior 

Transition Command (February 19, 2016).
Appendix I: Scope and Methodology

Page 40 GAO-16-583 Warrior Transition Units

type of data, we made these determinations based on a data reliability 

questionnaire filled out by Army officials, logic tests of the data, and our 

conversations with Warrior Transition Command officials about how the 

data were captured, stored, and checked for accuracy.

We conducted this performance audit from August 2015 to July 2016 in 

accordance with generally accepted government auditing standards. 

Those standards require that we plan and perform the audit to obtain 

sufficient, appropriate evidence to provide a reasonable basis for our 

findings and conclusions based on our audit objectives. We believe that 

the evidence obtained provides a reasonable basis for our findings and 

conclusions based on our audit objectives.
Appendix II: Trends in Warrior Transition Unit 

Soldiers’ Separation from the Army and 

Lengths of Stay in the Warrior Transition Unit 

Program

Page 41 GAO-16-583 Warrior Transition Units

Of the Army soldiers who entered a Warrior Transition Unit (WTU) 

between 2008 and the end of 2015, generally a higher percentage 

separated from the Army than returned to the Army (see fig. 4).

Figure 4: Percentage of Warrior Transition Unit (WTU) Soldiers Who Separated from the Army, by Year of Entry into the WTU 

Program (2008-15)

Note: The records of 2,913 soldiers over the timeframe were excluded because they had dispositions 

other than returned to the Army or separated from the Army—dispositions such as deceased or court 

martialed.

WTU soldiers’ length of stay—from entry in the WTU until separation—

peaked for soldiers who entered in 2009 and has generally decreased 

since then. For example, the average length of stay was 407 days for 

those soldiers who entered a WTU in 2009, and that number decreased 

to 308 for those who entered a WTU in 2014.1 In addition, WTU soldiers 

 1

We chose not to report lengths of stay for soldiers who entered a WTU in 2015 because, 

of the approximately 2,600 soldiers who entered a WTU that year, about 61 percent 

(1,600 soldiers) were still in the WTU program when the data were reported by the Warrior 

Transition Command on February 19, 2016.

Appendix II: Trends in Warrior Transition Unit 

Soldiers’ Separation from the Army and 

Lengths of Stay in the Warrior Transition Unit 

Program
Appendix II: Trends in Warrior Transition Unit 

Soldiers’ Separation from the Army and 

Lengths of Stay in the Warrior Transition Unit 

Program

Page 42 GAO-16-583 Warrior Transition Units

in the active component generally had shorter lengths of stay than those 

in the Army National Guard or Army Reserve (see fig. 5).

Figure 5: Warrior Transition Unit (WTU) Soldiers’ Average Length of Stay in the WTU Program, by Active and Reserve 

Component (2008-14)

Note: Data were reported as of February 19, 2016. For those soldiers who were in the WTU program 

when these data were reported, February 19, 2016, was used as the exit date from the WTU 

program. For all years of entry other than 2014, the number of soldiers still present in the WTU 

program at the time the data were reported was less than 2 percent of the total that had entered that 

year. For approximately 4,000 soldiers who entered in 2014, about 15 percent (nearly 600 soldiers) 

were in the WTU program at the time the data were reported. We chose not to report lengths of stay 

for soldiers who had entered a WTU in 2015 because, of the approximately 2,600 soldiers who 

entered a WTU that year, about 61 percent (1,600 soldiers) were still in the WTU program when the 

data were reported by the Warrior Transition Command.

Similarly, the average length of time between a WTU soldier’s entrance 

into the WTU program and the medical retention determination point has 

significantly decreased. For example, the average length of time to reach 

the medical retention determination point has decreased by about 45 
Appendix II: Trends in Warrior Transition Unit 

Soldiers’ Separation from the Army and 

Lengths of Stay in the Warrior Transition Unit 

Program

Page 43 GAO-16-583 Warrior Transition Units

percent for those soldiers who had entered a WTU in 2009 as compared 

with those who entered a WTU in 2014 (see fig.6).2

Figure 6: Warrior Transition Unit (WTU) Soldiers’ Average Length of Time in the 

WTU Program before Reaching the Medical Retention Determination Point (2009-14)

Note: Data were reported as of February 19, 2016. The records of 1,521 soldiers were excluded 

because they had dispositions other than returned to the Army or separated from the Army, such as 

deceased or court martialed. We did not include data for soldiers who had entered the WTU in 2007 

or 2008 because of the large number of soldiers who did not have medical retention determination 

point dates in those years. We also did not include lengths of stay for those WTU soldiers who had 

entered a WTU in 2015 because, of the approximately 2,600 soldiers who entered a WTU that year, 

about 61 percent (1,600 soldiers) were still in the WTU when the data were reported as of February 

19, 2016.

 2

Data were reported as of February 19, 2016. The records of 1,521 soldiers were 

excluded because they had dispositions other than returned to the Army or separated 

from the Army, such as deceased or court martialed. We did not include data for soldiers 

who had entered the WTU in 2007 or 2008 because of the large number of soldiers who 

did not have medical retention determination point dates in those years. We also did not 

include lengths of stay for those WTU soldiers who had entered a WTU in 2015 because, 

of the approximately 2,600 soldiers who entered a WTU that year, about 61 percent 

(1,600 soldiers) were still in the WTU when the data were reported as of February 19, 

2016.
Appendix III: Comments from the Department 

of Defense

Page 44 GAO-16-583 Warrior Transition Units

Appendix III: Comments from the 

Department of Defense
Appendix III: Comments from the Department 

of Defense

Page 45 GAO-16-583 Warrior Transition Units
Appendix III: Comments from the Department 

of Defense

Page 46 GAO-16-583 Warrior Transition Units
Appendix III: Comments from the Department 

of Defense

Page 47 GAO-16-583 Warrior Transition Units
Appendix IV: GAO Contact and Staff 

Acknowledgments

Page 48 GAO-16-583 Warrior Transition Units

Brenda S. Farrell, (202) 512-3604 or farrellb@gao.gov

In addition to the contact named above, Lori Atkinson, Assistant Director; 

Rebekah Boone; Nicole Collier; Mae Jones; Amie Lesser; Jeffrey 

Mayhew; Michael Silver; Adam Smith; and Sabrina Streagle made key 

contributions to this report.

Appendix IV: GAO Contact and Staff 

Acknowledgments

GAO Contact

Staff 

Acknowledgments
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Page 49 GAO-16-583 Warrior Transition Units

Military and Veteran Support: DOD and VA Programs That Address the 

Effects of Combat and Transition to Civilian Life. GAO-15-24. 

Washington, D.C.: November 7, 2014.

Recovering Servicemembers and Veterans: Sustained Leadership 

Attention and Systematic Oversight Needed to Resolve Persistent 

Problems Affecting Care and Benefits. GAO-13-5. Washington, D.C.: 

November 16, 2012.

Army Health Care: Progress Made in Staffing and Monitoring Units That 

Provide Outpatient Case Management, but Additional Steps Needed. 

GAO-09-357. Washington, D.C.: April 20, 2009.

DOD and VA: Preliminary Observations on Efforts to Improve Care 

Management and Disability Evaluations for Servicemembers. 

GAO-08-514T. Washington, D.C.: February 27, 2008.

DOD and VA: Preliminary Observations on Efforts to Improve Health Care 

and Disability Evaluations for Returning Servicemembers. 

GAO-07-1256T. Washington, D.C.: September 26, 2007.

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