At the height of the wars in Iraq and Afghanistan, then-Army Chief of Staff Gen. George W. Casey, Jr., grew increasingly concerned that something was terribly wrong in how the Army dealt with the families of the fallen.
As a Gold Star son, he had personal experience. His father, Army Maj. Gen. George W. Casey, Sr., was killed in a helicopter crash in July 1970 while commanding the 1st Cavalry Division in Vietnam. He was the highest-ranking officer killed in action in that war.
As chief of staff in 2007, Casey was hearing it from the families. In visits to bases with his wife, Sheila, he said that "every place we went we met with groups of survivors. The feedback we got, and this was six years into the war ... all we're doing is casualty assistance."
Casualty assistance officers would make the knock on the door to inform of the death, funeral arrangements would be made, and phone numbers for assistance would be handed out.
"Women, especially the younger ones, were being thrust into these positions where they had to make all kinds of long-term financial decisions, and there was no support, there was no help," Casey said.
At a Pentagon event, Casey said he heard it in detail from Donna Engeman, whose husband, Army Chief Warrant Officer 4 John W. Engeman, was killed by an improvised explosive device in Baghdad in 2006.
She told him how hard it was to get answers out of the casualty assistance officers, how hard it was to deal with the bureaucracies of the Army and the Department of Veterans Affairs on benefits, Casey said.
"We didn't have a way to get more immediate and direct feedback from our survivors to allow us to shape our policies correctly," he said. He decided to form an advisory board of survivors and enlisted Engeman to be part of it.
The advisory board grew into the current Army Survivor Advisory Working Group, or SAWG, a panel of 12 survivors who meet regularly with the Army chief of staff to provide guidance on survivor assistance.
The work of the group was instrumental in changing Army policy on a range of issues, from extending training for casualty assistance officers from one to three days and granting longer bereavement leaves for soldiers, to giving military families more leeway before having to make a permanent change of station move.
The SAWG was also influential to the 2008 creation of Army Survivor Outreach Services to provide support coordinators and financial counselors on a continuing basis to families, regardless of the circumstances of a soldier's death.
Army Col. Steve Lewis, the current chief of the Army's Family Programs Branch, said the goal was to provide a "continuum of support" for the survivors, beginning with the casualty assistance officers who will then coordinate with an Army civilian or contractor from Survivor Outreach Services.
Under the program, the Survivor Outreach Services civilian will relay case management information to the SAWG to enable the panel "to understand issues and concerns that come forward" to be taken to Army leadership, Lewis said.
But the issues are constantly evolving. A 2016 study by the Center for the Study of Traumatic Stress at the Uniformed Services University of the Health Sciences discussed a new clinical term: persistent complex bereavement disorder, or PCBD.
He'll Be 27 Forever
At the Association of the U.S. Army's convention last month, three women -- Candace Martin, Jane Horton and Col. Rebecca Eggers -- were honored for their work with SAWG.
Martin brought a unique perspective to the task. As a member of the Army reserves and National Guard, she once made the dreaded knock on the door to notify a family of a death. Four months later came the knock on her own door.
She was at Fort Sam Houston in Texas when the call came to help in notifying a family.
"You don't want to do it," she said, but "a lot of our names will end up on a duty roster. I was told to report to the casualty office and I thought 'Why me?'"
"That was the last thing I wanted to do because I just didn't think that I could do it" in the manner that the family deserved, she said.
However, "after I got involved with the family, I was so confident that I was the right person for that job to help this young widow get through making those tough decisions and being the conduit between the military and her and her little boy," Martin said. "It was the most prideful moment I had, and I think I served them well."
At the time, the training for a notification officer was one day. "It's now been expanded to three days. The training's been changed because of the SAWG. That's just one of the avenues where the SAWG did make a difference," she said.
Four months later, in October 2007, Martin herself had to be notified. Her son, Army 1st Lt. Tom Martin, had been killed in action in Iraq.
"He was 27; he'll be 27 forever," she said.
Tom Martin had enlisted out of high school and later was accepted at West Point, graduating in 2005. He deployed to Iraq out of Fort Richardson, Alaska, and was part of the troop surge in 2007, Martin said.
"He believed in what he was doing, and I believed in what he was doing, so that keeps me going to know that he didn't die in vain," she said.
"When the time came, when they knocked on our door that Sunday morning, it was just a blur. I remember two officers coming to the door. I don't remember either of their names. I don't even remember what they looked like -- one was a chaplain, one was an officer," she said.
"But it was so surreal that this can't be happening to our family," she said. "This happens to other families, not our family, and I remember thinking that our family would never be the same."
"But I also remember thinking that the Army's going to get this right, because I had been on the delivery end" as a notification officer herself, Martin said. "I knew what care and compassion was behind those knocks at the door."
Jane Horton said she was with a friend at home baking cakes in a jar to be sent to her husband, Army Spc. Christopher Horton, 26, of Collinsville, Oklahoma, when the knock on the door came.
"He always wanted to serve," she said. "He was one of those guys that knew that his country needed him, that we were at war. And he didn't want to grow old one day and tell his kids and grandkids that his country was at war and he didn't step up to the plate and serve."
Then-Army Chief of Staff Gen. Ray Odierno came to the funeral, she said. She later wrote to Odierno, and he met with her in Washington on a Saturday.
"I told him of personal things that could have been better" in the way of Army assistance, Horton said. "He asked me to be on [SAWG], so I've been on it seven years now."
Members of SAWG don't provide direct assistance to families, Horton said, but instead "come up with policy changes and find systematic issues and better ways to serve the survivor community."
"I think we all talk to individual survivors," Rebecca Eggers said, "but our work on the SAWG is to change the policies."
"There are spouses with children who have to worry about when a child turns 18 -- what happens to your benefit, what happens to your Social Security? So that's really lately what I've been advocating for -- how do we prepare families for these changes as they come along as their children age," Eggers said.
Her husband, Capt. Daniel Eggers, 28, of Cape Coral, Florida, with the 3rd Special Forces Group (Airborne) out of Fort Bragg, North Carolina, was leading a convoy near Kandahar, Afghanistan, on May 29, 2004. He was killed when his vehicle hit a landmine, according to the Defense Department.
When the knock on the door came, it was answered by her oldest son John, who was five years old at the time, "so it was pretty traumatic for him," Eggers said. "I was actually napping with our youngest son, Billy, who was three, and that's pretty much how my life changed."
In her work with SAWG, Eggers said "most of the things I've championed" have been for the stabilization of members of the military who have had a death in the family.
"We were having soldiers at the time who would be placed on orders to move less than a year out" from the time of death, she said.
When a spouse or a child is killed, "you're not supposed to be making decisions within the first year," she said. "You're asking someone to pick up their life and move -- the Army just needed to do better."
Not Enough Research on Military Deaths
Among the findings in the 2016 National Military Bereavement Study was that not enough was known about the unique aftereffects for survivors who must cope with the death of a family member serving in an all-volunteer force, whatever the circumstances.
Military deaths are different than civilian deaths, and "there is a lack of substantive research on the impact of the death of a family member serving in the U.S. military," according to the study by the Center for the Study of Traumatic Stress at the Uniformed Services University of the Health Sciences.
However, the findings were that "bereavement leads to increased vulnerability to physical illnesses, and psychological conditions," such as depression and anxiety, according to the study team led by Dr. Stephen Cozza, associate director of CSTS.
"Surviving members of military families may offer a unique perspective to understanding grief," the study said.
"From the initial distress of notification to longer-term challenges, family members face difficult emotional and practical issues possibly related to distinctive characteristics of military death," it added.
The study included quotes from anonymous survivors whose reactions ranged from the bitter to the reflective.
"My son took his own life. I'm angry with him. I'm angry with the military. I'm angry at everyone. I no longer fly the American flag. I feel utterly alone," said one.
Another said: "I have come to realize he was doing what he wanted to do at the time of his death. It was the path he chose. Over time his death has taught me to be grateful and more appreciative of my family, friends, and my life."
In an article earlier this year on the website of the Military Health System, Cozza, a psychiatrist and former Army colonel, said that "we should never expect grief to disappear."
"But over time, we do expect grief to find its rightful place in someone's life so that there also can be opportunities for people to live in productive and joyful ways," he said.
"Some people, however, may have ongoing difficulty adapting to grief," Cozza said. "People can continue to be so preoccupied with the death that they're unable to find happiness or engage in the world or in social interactions."
Military deaths are "different," said Bonnie Carroll, founder and head of the Tragedy Assistance Program for Survivors (TAPS), although she questioned whether there was a lack of research on the impact for families.
"A tremendous amount of research" has been done by the American Psychological Association, other organizations and also in doctoral dissertations by members of TAPS, said Carroll, a retired major in the Air Force Reserves.
"As a society, as a culture, we have to recognize that those who stepped forward to serve their country do something absolutely extraordinary on behalf of our entire population, and however they died, whenever they died," their lives should be remembered, Carroll said.
"Death in the military is unlike any other," added Carroll, whose husband, Army Brig. Gen. Tom Carroll, died in a C-12 plane crash in 1992. The goal of TAPS is "to provide service delivery in the area of care-based emotional support and resolution of grief," she said.
TAPS now has more 90,000 surviving military family members and, with 19 more bereaved family members finding the organization each day, Carroll said. Last year, TAPS took in 6,020 new surviving family members.
'Life Moved On for Everybody'
At the core of TAPS work is a nationwide network of peer support counsellors and trainers who work directly with survivors and with each of the service branches.
Many of them come with their own experience of military loss, such as Chantel Dooley, director of impact assessments for TAPS.
She was engaged to "the most gorgeous man in the world" — Capt. Alex Stanton, a special agent with the Air Force Office of Special Investigations at Luke Air Force Base in Arizona. He was killed in a motorcycle accident on Sept. 30, 2016.
After his death, "every single airman in his detachment just made this beautiful little cocoon right around me. They took such good care of me right after the loss but after Alex was laid to rest, it was like life moved on for everybody except me," Dooley said.
On May 27, 2017, Memorial Day, she was at Alex's gravesite at Arlington National Cemetery. It was supposed to have been their wedding day. A counsellor from TAPS found her and made contact.
"It was such a healing experience or me," she said.
August Cabrera, now beginning her own work with TAPS, said her involvement with the organization came about through the persistence of a TAPS counsellor who wouldn't give up on her.
She recalled the denial and anger that consumed her when she learned of the death on Oct. 29, 2011 of her husband, 41-year-old Army Lt. Col. David Cabrera, the first military social worker killed in action.
A suicide bomber in a vehicle packed with explosives had rammed into his NATO armored vehicle in Afghanistan's Kabul province, setting off a blast that killed 17, including four other U.S. service members. Cabrera had been in country less than 30 days.
August Cabrera said she was out back in her Texas home, talking on the phone and raking leaves. She saw the casualty team approaching. She dropped the phone and the rake, and met them in the driveway.
"Ma'am, can we please go inside?" She responded "No, just tell me. Is he hurt or is he dead? Hurt I can fix. I can't fix dead. Just tell me."
They asked her again to go inside. Again, she refused -- just tell me. One of the officers began the set speech. "The Secretary of the Army regrets to inform..." Cabrera said "I interrupted them. Don't you dare tell me what the Secretary of the Army thinks."
"Then I collapsed. So I never got the knock on the door," she said. At first, she was overwhelmed with guilt at the thought that his death may have been her fault. He had told her that he might be calling that night when he could get a high-speed internet connection in Kabul.
She though he may have been rushing back to Kabul to make the connection when the suicide bomber struck. Army officers serving with Cabrera later assured her that the convoy had been heading out of Kabul to a forward operating base.
"He was doing what he loved," Cabrera said of her husband. "He really wanted to go where he needed to be."
At her husband's burial in Arlington National Cemetery, a woman approached after the ceremony, Cabrera said. The woman said she had served in Afghanistan when David Cabrera was there.
The woman told her "I want you to know your husband saved my life. If it wasn't for him, I would have killed myself."
She had been a patient of Cabrera's in Afghanistan.
Cabrera said she held it together for her two boys but at night she would lay on the kitchen floor, sobbing and drinking wine. A peer mentor from TAPS kept trying to call. "She called and called and I blew her off," Cabrera said.
One night -- she estimated that it was two or three in the morning -- she picked up the phone and the peer mentor "loved on me through the phone." She went back to school and earned a masters in fine arts.
"Now I'm a peer mentor for TAPS," Cabrera said.
Cabrera used the word "forever," and so did Bonnie Carroll and Gen. Casey, in describing the commitment that the nation owes to the families of the fallen.
"It is forever," Casey said. "It is forever."
— Richard Sisk can be reached at Richard.Sisk@Military.com.