In the spring and summer of 2014, Army Staff Sgt. Lauren Montoya didn’t like what she was hearing from her doctors. “They were telling me I probably wasn’t going to walk again,” she said, “and that I should stop thinking about staying in the military.”

On March 22 of that year, Montoya, a member of an all-female Cultural Support Team (CST), manning a .50-caliber machine gun on an RG-33 mine-resistant ambush protected vehicle, was returning to base after a day of reconnaissance in and around Kandahar, Afghanistan. The vehicle struck a buried improvised explosive device (IED) that caused an avalanche of heavy equipment to land on her left leg, crushing her heel bone, rupturing her Achilles tendon, and damaging muscles and nerves throughout her lower leg and foot. She was evacuated, evaluated, and treated at hospitals in Kandahar, Bagram, Landstuhl, and finally San Antonio, where doctors were determined to salvage her leg if possible.

Over the next year, Montoya endured limb salvage treatments that included nine surgeries, and she wasn’t any closer to walking. She was in pain, tired of getting around with the use of either a wheelchair or crutches. She decided it was time to argue forcefully for the life she wanted, rather than the one doctors projected for her: She wanted to lose the leg and keep her job. As a member of special operations forces (SOF), Montoya knew she would have potent allies: the U.S. Special Operations Command’s (SOCOM) Warrior Care Program (Care Coalition), formed in 2005 to advocate for and support SOF who return home wounded, ill, or injured. Almost immediately after her injury, an advocate from the Care Coalition was ready for Montoya, and somebody from the program reached out to her every step of the way, from Kandahar to San Antonio.

Once Montoya had made the final decision about her leg, she said, she turned to the Care Coalition. “They don’t really take no for an answer,” she said. “My advocate listened to me and … essentially said, ‘Okay, that’s what you want to do, so now we’re going to go and we’re going to fight.’” The advocate, Montoya said, “found doctors who were going to listen to what I was saying about how miserable I was, in trying to save a leg that didn’t even work and was never going to work again. They found opportunities outside of normal military medicine.”

Her left leg was amputated below the knee in April 2015 and soon a military medical evaluation board, after hearing a case presented with help from Care Coalition advocates, declared Montoya fit for active-duty military service.

Today, Montoya is married, with a daughter, and stationed at SOCOM headquarters at MacDill Air Force Base in Tampa, a member of the Care Coalition staff helping plan the 2019 Warrior Games. She knows the games well, as an athlete who trained, competed, and won medals in multiple events in the 2016 Invictus Games and 2018 Warrior Games.

She’ll also be competing in the 2019 games, which she’s decided will be her last, for two reasons: She wants to step aside and let other wounded warriors have the same opportunities she’s had. And she wants to be ready if the military needs her to serve in any other capacity. “I’m in the Army,” Montoya said. “And we are still at war. I came into the service wanting to do my job, and now I have the opportunity to do that, because I’ve fought to come back and be deployable and go back to work.”

The Care Coalition

The program that helped Montoya to become what she wanted to be was launched under the tenure of Gen. Bryan Douglas “Doug” Brown, the commander who transformed SOCOM to meet the demands of the war on terrorism. During Brown’s tenure, he convinced the Department of Defense (DOD) and Congress to increase SOCOM’s size by 40 percent and its budget by $20 million, training and equipping more special operators and giving them the skills and materiel they needed to fight.

Brown took command of SOCOM wanting to transform not only the way special operators fought, but also the way they experienced their return from service, especially if they were wounded, ill, or injured. “I grew up in special ops,” he said, “and the motto we always heard was: ‘Once you’re in SOF, you’re in SOF for life.’” During one of his periodic visits to the Walter Reed National Military Center, Brown met a wounded special operator who made him think about the real meaning of the “SOF for Life” motto. The operator was a young man, wounded badly enough that he would be unable to live independently.

“I was talking to his mother,” Brown recalled, “and she said, ‘I want to give him some privacy in his own life, but he can’t live without me.’” The mother wanted to expand the family garage into an apartment for the young man, but didn’t have the money to pay for the remodel. As generous as the DOD and VA assistance programs were, it wasn’t possible to use taxpayer money for the remodel – but Brown knew a number of new charities had been founded since the beginning of the war, chartered expressly to help returning service members. Probably, Brown thought, he could turn to them for help.

He wasn’t yet sure where to start, however, and he faced a bigger problem: SOCOM didn’t have a mechanism for keeping track of wounded, ill, or injured special operators. According to Jim Lorraine, who at the time was an Air Force officer and flight nurse in the SOCOM Command Surgeon’s Office, the command had trouble matching the pace of 21st century communications technology: “Our SOF were getting wounded and then evacuated out so quickly,” he said, “that when they would show up at Landstuhl, someone would hand them a cell phone and they would call their family and say: ‘I just got wounded. Don’t worry about it.’ And … the commands had no idea that they’d even gotten wounded, because the reporting wasn’t keeping up with the speed of the evacuation.” For SOF, the problem was compounded by the fact that people were processed into the military medical system and the career transition programs of the individual service branches. “And then before you knew it,” said Lorraine, “a high-functioning Green Beret was out of the military.”

Brown decided SOCOM needed its own organization to track special operators, evaluate their needs, and link them to organizations – military, VA, or nongovernmental – that could meet these needs for the rest of their lives. “I wanted these people to feel like they had a personal connection, a face from SOCOM and a voice at the end of the phone they always recognized,” Brown said. With the help of Dr. George Gamble, who remains deputy director of requirements for SOCOM, Brown designed a program and hired Lorraine to be its first director.

The program launched with Lorraine and five employees. His first meeting with Brown, Lorraine said, was memorable: “[Gen. Brown] said: ‘I want you to No.1, find all of our wounded or injured since 9/11, because they’ve volunteered so many times that we owe it to them to help them and to connect them to services. And after you’ve found them all, I want you to advocate for them for life.’ And I said, ‘Anything else?’ And he said, ‘No, that’s about it.’”

Lorraine and his staff, using a spreadsheet, tracked down 681 special operators who’d been wounded or injured by 2005 – and all but two of them were interested in working with the program, now known as the Care Coalition. While the staff worked on advocating for these warriors, the coalition sent its first two liaisons to Walter Reed, to connect with those returning home. Another was soon dispatched to Landstuhl Regional Medical Center in Germany. To establish the collaboration necessary to advocate for clients over their lifetimes, the coalition invited representatives from every service branch, the military health system, and the VA to planning sessions. “We had all the experts in one room,” said Lorraine.

Brown remembers the early days of the program, when two NCOs on the Care Coalition staff would drive to Fort Bragg to take care of family pets and allow service members’ spouses to visit Walter Reed. “That wasn’t their job,” he said. “They were just so dedicated that on the weekends, they would do those kinds of things. Whatever it took to allow the family to be with the wounded is what they would do.” Soon Care Coalition partners had funded a small block of simple apartments where visiting family members could stay, and a couple of vans that could shuttle them on day trips to Walter Reed.

The Care Coalition evolved rapidly, as did the roles and interplay between care coordinators – staff members focused solely on the needs of service members and their families – and liaisons, who had in-depth knowledge of the people and services at the facilities where clients were being cared for. Lorraine’s emphasis on medical and administrative advocacy was supplemented by his successor, Kevin McDonnell, who, after becoming director in 2011, added jobs and economic empowerment programs to the coalition’s efforts.

The successes of the Care Coalition led to its recognition in 2013 by the Pentagon, and then by Congress, as the fifth DOD warrior care program, along with those belonging to each of the service branches. Still known informally within SOCOM by its original name, the Care Coalition, it’s now usually denoted to recognize both its new official status and its heritage: the U.S. Special Operations Command Warrior Care Program (Care Coalition).

The WCP(CC) Today

Now recognized as a warrior care program on par with those of the Army, Air Force, Navy, and Marines, the program became more formalized as a part of DOD’s organizational structure. It was a necessary step, given the growth in the number of people it served, and it has involved certain trade-offs: The Care Coalition’s current director, Army Col. Cary Harbaugh, hired in 2014, found himself having to adapt to these. Where his predecessors had many constraints in its early years, Harbaugh now enjoys working with an apparatus and authority they didn’t have.

Compared to the first years of the program, when Lorraine struggled to find those first 681 special operators to offer assistance, “We now service over 15,000 people,” Harbaugh said. “The sheer numbers have to change the way you do things. When Gen. Brown stood this thing up, he did it with about six people, and now I’m nearing roughly 150.” In the five years since Harbaugh first took over the program, the number of warriors supported by the Care Coalition has doubled.

Today’s Care Coalition often begins its support of a wounded, ill, or injured warrior as a medical advocate. Before he was director of the program, Harbaugh was a client; an Army intelligence officer who served as director of intelligence at USSOCOM Europe from 2001 to 2004, Harbaugh was working in Africa when he contracted a blood infection that caused a series of health problems: strokes, blood clots in his brain and lungs, and a debilitating autoimmune response. It was a strange, poorly understood affliction, and the Care Coalition advocate worked to connect Harbaugh with the best available care.

“Our job is to plead the case of the wounded warrior,” Harbaugh said. When appropriate or necessary, Care Coalition advocates often work to move clients out of the military health care system into facilities covered under the military’s TRICARE health insurance network – those with melanoma, for instance, may access the expertise of the Moffitt Cancer Center in Tampa, while those with liver cancer may consult with experts at MD Anderson Cancer Center in Houston. Lorraine recalled the story of Romy Camargo, a Special Forces soldier who was paralyzed from the shoulders down in September 2008 when a sniper’s bullet pierced his neck. After more than a year of intensive and often excruciating physical therapy, Camargo wanted to see if an experimental stem cell transplant might help rejuvenate the nerves in his spinal cord.

“The U.S. wasn’t doing stem cell treatments at the time,” Lorraine said. “We coordinated for him to go to Portugal for the stem cell treatments, and had DOD pay for it.” Today, Camargo runs his own nonprofit organization for helping people recover from spinal cord injury, Stay in Step, in Tampa. It sometimes happens, Harbaugh said, that a client may need access to a promising medical innovation that’s beyond the cutting edge of DOD and VA medicine, and for whatever reason isn’t covered under TRICARE. In these situations, when physicians believe such care might be beneficial to the SOF client, the Care Coalition can often turn to a willing charitable organization to help offset costs.

In addition to helping clients access care that might otherwise be unavailable to them, the coalition, through its Benevolent Support section, assists service members, veterans, and their families by securing grants and other gifts and services that may close gaps in what DOD and VA can provide. For Montoya, whose family was from Austin, Texas, this meant the coalition connected them with organizations that donated gasoline gift cards to help finance their drives to and from San Antonio. The Fisher House Foundation provided housing for her visiting family members. “Initially,” Montoya said, “I was in the hospital for so long that my mom had to take time off of work. So they made sure she was able to get paid as my nonmedical attendant.”

At the time, Montoya said, she and her family weren’t fully aware of how these expenses, big and small, could accumulate over time to comprise a considerable burden. The coalition’s Benevolent Support activities are designed to ease that burden. “The DOD and VA can only cover so much,” said Harbaugh. “They’ve got restrictions. Our benevolent organizations are there to assist families through these crisis periods.”

Another focus of the coalition’s work is in helping wounded, ill, or injured special operators either continue their military careers, or transition into another career – or retirement, as a veteran receiving benefits and services. Faced with life-changing and potentially debilitating diagnoses, both Harbaugh and Montoya confronted fateful examinations by a medical evaluation board (MEB), which could have medically retired them both. They each faced the board with the Care Coalition’s expert advocates on their side. “The Care Coalition,” said Harbaugh, “really not only helped save my life, but they helped my family through a crisis period and saved my career, too.”

The most obvious difference between the Care Coalition and other warrior care programs is in the number of wounded, ill, or injured warriors who return to service: SOCOM’s retention rate is 74 percent, compared to an average of around 10 percent for the other programs.

There are several possible reasons for this, said Harbaugh: First, the “special sauce” that makes one a special operator to begin with. “Our guys take 10 to 12 years to build,” he said, “They have to be uniquely tough people with the physical attributes and mental capacity to be able to be a special operator. We have people who have been built up to be resilient – and were resilient to start with, or they never would have made it through the screening to get into SOF in the first place.”

Another key factor in that high retention rate, said Harbaugh, has been the support of the program from its leaders. Every commander who has succeeded Brown – Adm. Eric Olson, Adm. William McRaven, Gen. Joseph Votel, and Gen. Raymond Thomas – has stood behind the program, as well as every command senior enlisted leader. Harbaugh describes the incumbent, Command Sgt. Maj. Patrick McCauley, as “one of those advocates who keeps us thriving by believing in what we do and ensuring we get the resources we need.”

Finally, Harbaugh attributes the coalition’s success to its staff, most of whom come from within SOF themselves. “Most of them were special ops wounded warriors themselves,” he said. “They have a tremendous love for the people they serve. They’re unbelievably dedicated to giving hours that go beyond what normal governmen civilians and contractors work. And it takes that. It takes a passion and a heart for this.”

Future Battles

In the five years since Harbaugh has taken charge of the program, the Care Coalition has changed dramatically in size and structure. Despite SOCOM’s relatively small size – it has about 70,000 personnel enrolled in Care Coalition – it’s the largest warrior care program in the Department of Defense. About 48 percent of the wounded warriors on active duty are enrolled in the SOCOM Care Coalition.

This dramatic difference may be due in part to the fact that special operators remain actively engaged on the diverse and increasingly “multi-domain” battlefields of the Earth. “SOF continues to take hits,” Harbaugh said, “despite a lot of change in the dynamics and, certainly, severe reductions in combat wounds and losses in the conventional forces. The special ops force has not seen that abatement.”

One of the challenges for the Care Coalition’s future will be the continuing need to accommodate growth: It seems unlikely, given existing doctrine and future scenarios that the military’s reliance on special operators will decrease anytime soon. In addition to adding resources and personnel, Harbaugh is in the process of structuring the program so that each component footprint contains a unit of activity built like its counterpart at SOCOM Headquarters. “They’re like a battalion, so to speak,” he said, “and we are the group headquarters. I’ve put out these four operating nodes in order to federate a lot of the activity and not have it all run from the mothership here.”

Another challenge for the future: As the program enters its 15th year of existence, some of its first clients are approaching middle age and acquiring a set of concerns that hadn’t initially occupied the program’s care coordinators. Today’s military, and special operators particularly, have endured 18 years of intense combat. Harbaugh, who is 60 years old, feels this acutely, both as a soldier and the program director. “This is unprecedented in U.S. military history,” he said, “that you have people who have grown up at war … and that population now moves into retirement age more battered than any in history. Yet we’ve got a VA that’s flooded with folks. I have concerns, and we have to be prepared to continue to support the growing need for care.”

Despite these challenges, you won’t find anyone who’s worked for the Care Coalition, past or present, who thinks it won’t handle them. Lorraine, who left the program in 2011, is now president and CEO of America’s Warrior Partnership, a national nonprofit veteran advocacy group. “If it weren’t for Gen. Brown’s commitment and vision, this never would have happened,” he said. “Being a great soldier or sailor or airman or Marine isn’t about your brawn. It’s about your brain. You may hit an obstacle, but you can keep being part of the team. Gen. Brown allowed that to happen.”

Harbaugh believes this just as passionately. “You are SOF for life,” he said. “We’re going to take care of you. And if you want to get back on the line, we’re going to fight to get you back on the line. That’s why we’ve got guys wearing prosthetics who are still out there kicking doors and taking out bad guys – because we’ve got people who still want to do that, and have got the capacity to do it.”