oversight

Operation Provide Comfort: Review of U.S. Air Force Investigation of Black Hawk Fratricide Incident

Published by the Government Accountability Office on 1997-11-05.

Below is a raw (and likely hideous) rendition of the original report. (PDF)

                United States General Accounting Office

GAO             Report to Congressional Requesters




November 1997
                OPERATION PROVIDE
                COMFORT
                Review of U.S. Air
                Force Investigation of
                Black Hawk Fratricide
                Incident




GAO/OSI-98-4
      United States
GAO   General Accounting Office
      Washington, D.C. 20548

      Office of Special Investigations

      B-266152.2

      November 5, 1997

      The Honorable Steve Buyer
      Chairman
      The Honorable Gene Taylor
      Ranking Minority Member
      Subcommittee on Military Personnel
      Committee on National Security
      House of Representatives

      The Honorable Mac Collins
      House of Representatives

      In response to written requests from the Subcommittee and subsequent discussions with your
      offices, this report presents the results of our review of military investigations made subsequent
      to the April 14, 1994, shootdown by U.S. Air Force F-15 fighters of two U.S. Army Black Hawk
      helicopters over Iraq in which 26 individuals died. We were asked to determine if the Air Force’s
      subsequent Aircraft Accident Investigation Board investigation of the fratricide had met its
      objectives, if the resulting Uniform Code of Military Justice investigations had followed
      established guidelines, and if military officials had improperly or unlawfully influenced these
      investigations. We were also asked to, during our investigation, consider concerns voiced by
      victims’ family members and others.

      We are sending copies of this report to the Secretary of Defense, the Secretaries of the Air
      Force and the Army, and interested congressional committees. Copies will also be made
      available to other interested parties upon request.

      If you have questions about this report, please call me or Deputy Director for Investigations,
      Donald G. Fulwider, at (202) 512-7455. Major contributors to this report are listed in appendix
      III.




      Eljay B. Bowron
      Assistant Comptroller General
        for Special Investigations
Executive Summary


             On April 14, 1994, two U.S. Army Black Hawk helicopters and their crews
Purpose      assigned to Operation Provide Comfort were transporting U.S., United
             Kingdom, French, and Turkish military officers; Kurdish representatives;
             and a U.S. political advisor in northern Iraq. Concurrently, a U.S. Air Force
             Airborne Warning and Control Systems (AWACS) aircraft was flying over
             Turkey to provide airborne threat warning and control for Operation
             Provide Comfort aircraft, including the Black Hawk helicopters. The pilots
             of two U.S. F-15 fighters patrolling the area misidentified the Black Hawks
             as Iraqi Hind helicopters and shot them down, killing all 26 individuals
             aboard.

             As a result of questions raised by concerned individuals, including family
             members of those killed in the fratricide, the House Committee on
             National Security held a hearing in August 1995 to examine the causes of
             the incident, the resulting investigation by an Air Force Aircraft Accident
             Investigation Board, and the judicial actions under the Uniform Code of
             Military Justice (UCMJ) that followed. After the hearing, the Committee
             asked GAO to determine if (1) the Board investigation of the shootdown
             had met its objectives, (2) the subsequent UCMJ investigations had followed
             established guidelines, and (3) Department of Defense and/or Air Force
             officials had improperly or unlawfully influenced these investigations. The
             Committee also requested that, during its investigation, GAO consider
             concerns of victims’ family members and others, including corrective
             actions taken to help prevent another accident.

             To do so, GAO interviewed over 160 individuals throughout the United
             States, Europe, and the Middle East. They included family members;
             involved aircrews; Army and Air Force personnel who had served in
             Operation Provide Comfort; Board members, legal staff, and technical
             staff; and command personnel responsible for staff assigned to Operation
             Provide Comfort. GAO reviewed its previous work concerning Operation
             Provide Comfort and analyzed Board and UCMJ documentation, including
             25 volumes and about 700 pieces of supporting evidence from the Board,
             thousands of classified documents, hearing and court-martial transcripts,
             and reports of corrective actions taken. However, the Department of
             Defense prevented GAO from interviewing key officials in the process,
             including the Convening Officials and the Inquiry and Investigating
             Officers. The Department of Defense voiced the belief that “any
             Congressional intrusion” into the UCMJ deliberative process would
             compromise the independence of the military justice system. GAO did not
             evaluate the appropriateness of the disciplinary or corrective actions
             taken.



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             Executive Summary




             In April 1991, the United Nations Security Council passed Resolution 688
Background   that demanded that Iraq stop repressing the Kurds in northern Iraq and
             called on member nations to help meet the humanitarian needs of the
             region. An emergency relief effort was initiated, named Operation Provide
             Comfort. Military units from the United States and 12 other countries soon
             joined the effort as a coalition. The air forces of four coalition members,
             including the United States, began securing the area of northern Iraq
             above the 36th parallel, prohibiting Iraqi aircraft from flying north of that
             parallel—the “no-fly zone.” The coalition also established a security zone
             for the Kurds, inside the no-fly zone, into which no Iraqi military could
             enter.

             The U.S. Commander in Chief, Europe, directed the creation of a
             Combined Task Force with all coalition members. By September 1991, the
             Combined Task Force organization, headed by U.S. and Turkish
             co-commanders, included a Combined Task Force staff; a Combined
             Forces Air Component (CFAC); and a Military Coordination Center. The
             CFAC Commander exercised daily control of the Operation Provide
             Comfort flight mission through his Director of Operations (CFAC/DO), as
             well as a ground-based Mission Director at the Combined Task Force
             headquarters and an Airborne Command Element aboard the AWACS. The
             CFAC/DO was responsible for publishing guidance, including the Airspace
             Control Order, for conduct of Operation Provide Comfort missions. (The
             Airspace Control Order was a directive to all Operation Provide Comfort
             aircrews that provided rules and procedures governing Operation Provide
             Comfort flight operations.) The Military Coordination Center monitored
             conditions in the security zone and was supported by a U.S. Army
             helicopter detachment.

             Planes and personnel assigned to Operation Provide Comfort on a
             temporary duty basis conducted air operations. U.S. air assets included,
             among others, AWACS aircraft, F-15 fighters, and Black Hawk helicopters.
             Daily flight operations were referred to as “mission packages.” AWACS
             aircraft were to (1) control aircraft enroute to and from the tactical area of
             responsibility (TAOR), or no-fly zone; (2) coordinate air refueling;
             (3) provide airborne threat warning and control in the TAOR; and
             (4) provide surveillance, detection, and identification of all unknown
             aircraft. F-15 fighters, as the first aircraft in the TAOR, were to
             search—“sanitize”—the area with radar and electronic measures to ensure
             that it was clear of hostile aircraft and then fly orbit to provide air cover
             for the rest of the package. The Army’s Black Hawk helicopters flew
             supply and transport missions for the Military Coordination Center. They



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Executive Summary




also provided transport into the TAOR to visit Kurdish villages and maintain
a visual presence.

On the day of the incident, two Black Hawks and their crews were
transporting officials inside the TAOR. Although the AWACS crew flying
support for the day’s mission package were aware that the Black Hawks
were in the area, the two F-15 pilots sanitizing the area were not aware of
their presence. The F-15 pilots received two radar contacts (helicopters)
and stated that they attempted unsuccessfully to identify them by
electronic means. They twice reported their unsuccessful attempts to the
AWACS but were not informed of the presence of the Black Hawks in the
contact area. As required, the F-15 pilots attempted a visual identification
of the helicopters. However, their attempt, involving a single pass each,
was at speeds, altitudes, and distances at which it was unlikely that they
would have detected the helicopters’ markings. This resulted in the lead
pilot’s misidentification of the helicopters as Iraqi Hinds and the
subsequent shootdown of the Black Hawks.

Later that day, the U.S. Secretary of Defense ordered an investigation that
resulted in the convening of an Aircraft Accident Investigation Board,
which made information more readily available to the public than would a
Safety Board Investigation. The Board report and the required Board
President’s opinion (see app. I)—issued May 27, 1994—identified “a chain
of events” as the incident’s cause: beginning with the Combined Task
Force’s failure to provide clear guidance to its component organizations,
the components’ misunderstanding of their responsibilities, Operation
Provide Comfort’s failure to integrate Army helicopter and Air Force
operations, AWACS crew mistakes, and ending with the F-15 lead pilot’s
misidentification of the helicopters and the wingman’s failure to notify the
lead pilot of his inability to positively identify the helicopters.

On the basis of the report, the Secretary of Defense directed applicable
military commands to determine if UCMJ violations had occurred.
Subsequently, the commands appointed Inquiry Officers and Investigating
Officers to investigate 14 officers. The UCMJ process resulted in the
following: one officer was tried by court-martial, resulting in an acquittal;
one officer received nonjudicial punishment under Article 15, consisting of
a letter of reprimand; and nine others received administrative letters of
either reprimand, admonition, or counseling. No adverse action was taken
against the remaining three officers.




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                   Executive Summary




                   The primary purpose of an Aircraft Accident Investigation Board, in
Results in Brief   accordance with Air Force Regulation 110-14 (since replaced by Air Force
                   Instruction 51-503), is to gather and preserve evidence for claims,
                   litigation, and disciplinary and administrative needs. Within a limited time
                   frame of 42 days, the Board conducted an extensive investigation that
                   complied with the regulation’s evidentiary requirements and guidelines in
                   collecting and preserving evidence. It also produced a “Summary of
                   Facts,” or report, that with a few exceptions provided an overview of the
                   factual circumstances relating to the accident.

                   The Aircraft Accident Investigation Board report focused on, among other
                   matters, command and control problems, including individuals’ lack of
                   knowledge of specific procedures. The report, however, (1) did not
                   discuss the F-15 pilots’ responsibility, under the Airspace Control Order, to
                   report to the Airborne Command Element when encountering an unknown
                   aircraft in the TAOR and (2) cited a CFAC Commander statement that
                   inaccurately portrayed the Airborne Command Element as not having
                   authority to stop the incident, even though evidence that the Airborne
                   Command Element had the authority was available to the Board. Further,
                   the Board President erroneously concluded that the Black Hawks’ use of
                   an incorrect electronic identification code in the TAOR resulted in the F-15
                   pilots not receiving an electronic response.

                   Additionally, at the August 1995 hearing, family members and others raised
                   concerns about a perceived general lack of discipline in the F-15 pilot
                   community in Operation Provide Comfort and a perceived urgency by the
                   F-15 pilots to engage during the shootdown. The Board’s report and
                   opinion did not discuss these issues. While an examination of these issues
                   was not required under Air Force Regulation 110-14, the regulation did not
                   preclude it; and GAO found the issues relevant to its inquiry.

                   In response to GAO inquiries, Operation Provide Comfort officials stated
                   that the pilots’ failure on April 14, 1994, to contact the Airborne Command
                   Element was the result of a lack of F-15 mission discipline in Operation
                   Provide Comfort at the time of the incident. In addition, Operation Provide
                   Comfort officials stated that, in their view, there was no reason for the
                   F-15 pilots’ urgency to engage. These issues are not inconsistent with the
                   Board President’s conclusion regarding the chain of events that led to the
                   misidentification and shootdown of the Black Hawks. Including them in
                   the Board’s report, however, may have raised additional questions about
                   the actions of the F-15 pilots and the Airborne Command Element that




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                              Executive Summary




                              could have been useful in subsequent administrative and disciplinary
                              actions.

                              During its review of the Aircraft Accident Investigation Board process, GAO
                              found no evidence of improper or unlawful command influence. That
                              review included access to, among others, Board members, technical
                              advisers, and investigative staff as well as investigative documents.

                              Regarding the questions concerning the subsequent UCMJ process and
                              improper or unlawful command influence during that process, GAO
                              determined the following. UCMJ investigations complied with provisions of
                              the UCMJ and the Manual for Courts-Martial. Based on a review of the
                              summary reports of investigation, a statement by the AWACS Investigating
                              Officer, and stipulations by several of the officials involved in UCMJ
                              investigations, GAO found no evidence of improper or unlawful command
                              influence. However, GAO was unable to confirm whether the consideration
                              and disposition of suspected offenses under the UCMJ were the result of
                              improper or unlawful command influence because the Department of
                              Defense, concerned about any congressional intrusion into the
                              deliberative process, denied GAO’s request to interview the applicable UCMJ
                              Convening Authorities, Inquiry Officers, and Investigating Officers.

                              Finally, immediately following the accident and as the result of additional
                              reviews and analyses, the Department of Defense and the Air Force took
                              hundreds of corrective actions, including insertion of Black Hawk flight
                              times on the daily Air Tasking Order, to help prevent a similar shootdown.
                              The Chief of Staff, Air Force, also took additional personnel actions,
                              including issuing letters of evaluation, after finding that a number of
                              individuals’ performance evaluations had not reflected previous
                              administrative actions taken as a result of the individuals’ failure to meet
                              Air Force standards.



Principal Findings

Aircraft Accident             The Aircraft Accident Investigation Board was properly convened and met
Investigation Met Objective   the objective as set forth in Air Force Regulation 110-14 of conducting an
but Report Was Not            extensive investigation that preserved evidence of the facts surrounding
                              the incident. The required report, which included the Board President’s
Complete                      opinion, focused on Combined Task Force command and control




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                              Executive Summary




                              problems, among other matters, citing lack of knowledge of command and
                              control guidance as one reason for the deficiencies of the AWACS crew and
                              activity by the incident Black Hawk pilots. However, the Board report did
                              not discuss or did not properly assess relevant information available to it
                              regarding three aspects involving the F-15 pilots and the Airborne
                              Command Element. Further, concerning F-15 pilot discipline, Operation
                              Provide Comfort officials told GAO that mission discipline problems with
                              F-15 pilots did exist at the time of the incident and they saw no reason for
                              the incident F-15 pilots’ urgency to shoot.

F-15 Pilots’ Requirement to   The Board’s report did not discuss the F-15 pilots’ responsibility, under the
Contact Airborne Command      Airspace Control Order, to report any unusual circumstance or
Element                       occurrence, such as an unidentified aircraft in the TAOR, to the Airborne
                              Command Element aboard the AWACS. The Board had reviewed this
                              provision of the order and evidence that the pilots knew of the provision.
                              The Board report did not discuss the F-15 pilots’ failure to report to the
                              Airborne Command Element because the Board concluded that the
                              Airborne Command Element had been aware of the F-15s’ intercept of the
                              helicopters. Therefore, the Board did not consider the pilots’
                              nonadherence to be a significant cause of the accident. According to a
                              Board representative, the nonadherence was an example of a general
                              breakdown in command and control, and it “may not have been common
                              practice” for pilots to make this contact. While the Board conducted an
                              extensive investigation, it did not know of a CFAC/DO oral directive given
                              about a week before the shootdown, reemphasizing the requirement for
                              fighter pilots to report to the Airborne Command Element. That directive
                              was the result of an incident in which F-15 pilots had initially ignored
                              directions from an Airborne Command Element, concerned about a
                              possible trap, to “knock off,” or stop, an intercept with an Iraqi aircraft.

Airborne Command Element      Also, the Board cited a CFAC Commander’s inaccurate testimony that the
Had Authority to Stop         Airborne Command Element had no decision-making authority with
Encounter                     regard to aircraft encounters in the TAOR. Other testimony—gathered
                              during the Board’s investigation—from more knowledgeable individuals,
                              including the CFAC/DO who used the Airborne Command Element as “his
                              eyes and ears” in the TAOR, contradicted that statement. Under the
                              Airspace Control Order, the Airborne Command Element had the authority
                              to stop fighters from engaging hostile or unknown aircraft in the TAOR.

Black Hawks’ Use of Wrong     The Board President erroneously concluded that the Black Hawks’ use of
Electronic Code Should Not    an incorrect electronic code resulted in the F-15 pilots not receiving a
Have Prevented F-15 Pilots    response when using their electronic Air-to-Air Interrogation/Identification
From Receiving Response


                              Page 7               GAO/OSI-98-4 Review of USAF Investigation of Fratricide Incident
                               Executive Summary




                               Friend or Foe (AAI/IFF) systems. A subsequent Air Force analysis was
                               inconclusive as to why the F-15 pilots did not receive a response.
                               However, that analysis—based on the pilots’ testimony regarding their
                               system interrogation settings—indicated that during certain interrogation
                               sequences, the F-15 pilots should have received a response regardless of
                               the Black Hawks’ code. Although the Board reviewed the pilots’ testimony,
                               as well as other information about the IFF system settings and operation,
                               the Board President drew an erroneous conclusion from the information.

Operation Provide              Family members and others raised concerns about perceived Operation
Comfort—Perceived Discipline   Provide Comfort discipline issues not described in the report or the
Problem and Urgency to Fire    opinion: lack of mission discipline by F-15 pilots in general and the
                               incident pilots’ urgency to fire. Although these issues were not required to
                               be in the Board’s report or opinion, the Board was not precluded from
                               probing them; and GAO found the issues relevant to its review.

                               In response to GAO’s questions, Operation Provide Comfort officials stated
                               that they had experienced a number of mission discipline problems with
                               F-15 pilots. These included the knock-off incident a week before the
                               shootdown. Operation Provide Comfort officials also noted that the rivalry
                               between F-15 and F-16 pilots, normally perceived as leading to a positive
                               professional competition, had become more pronounced and intense at
                               the time of the shootdown. Further, one command official stated that this
                               rivalry may have led to the incident F-15 pilots’ perceived rush to shoot.
                               According to Operation Provide Comfort officials, the Airspace Control
                               Order was specifically designed to slow a situation, allowing CFAC time to
                               check it out. These officials said the F-15 pilots had no need for haste, as
                               the sighted helicopters had posed no threat to the F-15s or the mission
                               package.


Question of Command            Based on GAO’s review of extensive information made available to it and
Influence During the           interviews of Board members and technical and legal advisors, GAO found
Aircraft Accident              no evidence of improper or unlawful command influence exerted during
                               the Aircraft Accident Investigation Board process.
Investigation Board
Process
Military Justice Process       The Air Force UCMJ investigations that followed the Aircraft Accident
and Administrative Actions     Investigation complied with provisions in the UCMJ and the Manual for
                               Courts-Martial. In accordance with Department of Defense guidelines,
                               charges are ordinarily forwarded to the accuseds’ immediate commander




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                            Executive Summary




                            for initial consideration as to disposition. Thus, individuals were
                            considered under UCMJ by two separate commands.

                            A command under the U.S. Air Combat Command investigated seven
                            officers; one—the AWACS Senior Director—was court-martialed. He was
                            found not guilty. Another—the Commander, 963d Air Control
                            Squadron—retired. Four others received letters of reprimand: one letter
                            was the result of nonjudicial punishment; the others were administrative
                            actions. No action was taken against the CFAC Mission Director because he
                            was judged blameless in the incident.

                            A command under the U.S. Air Forces in Europe investigated the other
                            seven officers—five Operation Provide Comfort officials and the two F-15
                            pilots. The pilots received letters of reprimand; two other officers received
                            less severe letters of admonition, with one—the Commander, Operation
                            Provide Comfort Combined Task Force—also being reassigned to a
                            noncommand position; the Director of Operations for Plans and Policy
                            received a letter of counseling and revocation of a medal for meritorious
                            service. No action was taken against the two remaining officers.


Question of Command         GAO  found no evidence of command influence, based on a review of
Influence During the UCMJ   information made available to it—including (1) summary reports of
Process                     investigation during the UCMJ process that included the suspected
                            violations, facts considered, and analysis involved in the decisions
                            reached; (2) a statement by the Investigating Officer in the AWACS
                            investigation denying outside influence; and (3) statements by six
                            cognizant officials denying any improper influence. In GAO’s attempt to
                            confirm whether the consideration and disposition of suspected offenses
                            under the UCMJ process were the result of improper or unlawful command
                            influence, GAO requested access to the Convening Authorities, Inquiry
                            Officers, and Investigating Officers. However, the Department of
                            Defense—saying “any Congressional intrusion into the deliberative
                            process . . . endangers the actual and perceived independence of the
                            military justice system”—refused to allow GAO to interview these military
                            officers, thus limiting GAO’s investigation in this area.


Air Force Corrective        Within 24 hours of the shootdown, European Command and Combined
Actions and Task Force      Task Force Commanders instituted corrective actions, including
Findings                    modifications of the Rules of Engagement, addition of helicopter flight




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                            Executive Summary




                            times on the daily Air Tasking Order, and further definition of AWACS
                            responsibilities.

                            When the Chairman, Joint Chiefs of Staff, submitted the Board report to
                            the Secretary of Defense, he noted that the tragic deaths of 26 men and
                            women on the Black Hawk helicopters were attributable to a series of
                            avoidable errors and the failure of safeguards in place at the time of the
                            shootdown. In July 1994, he ordered a review of Joint Task Force
                            operations with the objectives of strengthening operational oversight,
                            implementing change, and reviewing AWACS training and certification
                            procedures.

                            An Air Combat Command “Tiger Team” studied AWACS/Airborne command
                            and control, visual identification, and ground command and control and
                            made about 140 recommendations in its September 14, 1994, report.
                            Concurrently, a special Air Force task force composed of more than 120
                            people in 6 commands concluded that 2 breakdowns in individual
                            performance contributed to the shootdown: (1) The AWACS mission crew
                            did not provide the F-15 pilots an accurate picture of the situation and
                            (2) the F-15 pilots misidentified the target.


Actions by the Flying       Flying Evaluation Boards were convened by the Air Force as a result of
Evaluation Boards and the   the shootdown. Upon review of the Boards’ findings and
Air Force Chief of Staff    recommendations, the Commander, 17th Air Force concluded that the lead
                            F-15 pilot and the F-15 wingman should remain qualified for noncombat
                            aviation service. In a subsequent review, the Commander, U.S. Air Forces
                            in Europe (1) concurred with the decisions relating to the lead pilot and
                            (2) determined that the wingman remain qualified for aviation service but
                            directed that he be reassigned to a staff position not involved in flying
                            duties.

                            At the request of the Secretary of the Air Force, the Air Force Chief of
                            Staff reviewed the administrative actions taken in regard to the Air Force
                            personnel involved in the shootdown. While the Chief of Staff determined
                            that a proper balance had been maintained between command
                            involvement and individual rights, he noted that a number of performance
                            evaluations were inadequate, as they were inconsistent with
                            administrative actions taken by higher level commanders. Accordingly, he
                            prepared letters of evaluation for seven Air Force personnel, noting their
                            failure to meet certain Air Force standards, and took additional action
                            against five of the personnel. The two F-15 pilots were disqualified from



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                  Executive Summary




                  aviation service for 3 years and three members of the AWACS crew were
                  disqualified from assignment to duties involving control of aircraft in air
                  operations for at least 3 years.


                  GAO   is making no recommendations.
Recommendations
                  In written comments on a draft of this report, the Department of Defense
Agency Comments   concurred in GAO’s conclusions that (1) the Board was properly convened,
                  complied with the law, and met its objectives; (2) the military justice
                  investigations that followed the accident investigation also complied with
                  applicable law; and (3) no evidence of unlawful or improper command
                  influence existed with respect to the accident investigation or military
                  justice processes. Defense agreed that the few differences between GAO’s
                  report and the accident investigation report would not have affected the
                  Board President’s conclusions. These comments are reprinted in appendix
                  II.




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Contents



Executive Summary                                                                                         2


Chapter 1                                                                                                14
                       Background                                                                        14
Introduction           Objectives, Scope, and Methodology                                                18

Chapter 2                                                                                                22
                       Investigation Met Objective but the Report Contained Three                        23
Aircraft Accident        Deficiencies
Investigation          No Improper/Unlawful Command Influence Found                                      25
                       No Discussion of F-15 Pilots’ Requirement to Report to Airborne                   25
                         Command Element Who Had Authority to Stop Encounter
                       Board President’s Erroneous Conclusion That Black Hawks’ Use                      29
                         of Wrong Code Prevented F-15 Pilots From Receiving Response
                       A Perceived Discipline Problem and a Perceived Rush to Engage                     32
                       Conclusions                                                                       35

Chapter 3                                                                                                36
                       UCMJ Process                                                                      37
The Military Justice   Air Combat Command’s UCMJ Actions Against AWACS and                               39
Process and              Related Officers
                       U.S. Air Forces in Europe’s UCMJ Actions Against Operation                        40
Administrative           Provide Comfort Officials and F-15 Pilots
Actions                UCMJ Activities Concerning Combined Task Force Chief of Staff                     42
                       Actions by Flying Evaluation Boards and Air Force Chief of Staff                  42
                       The Question of Command Influence                                                 45

Chapter 4                                                                                                47
                       Immediate Corrective Actions                                                      47
Corrective and Other   European Command’s Operations Assessments and Corrective                          48
Actions by the           Actions
                       Joint Chiefs of Staff’s Corrective Actions                                        48
Department of          Air Combat Command’s—Tiger Team’s—Corrective Actions                              49
Defense and the Air    Air Force Special Task Force                                                      49
Force After the
Shootdown
Appendixes             Appendix I: Aircraft Accident Investigation Board President’s                     52
                         Opinion




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         Contents




         Appendix II: Comments From the Department of Defense                             55
         Appendix III: Major Contributors to This Report                                  56

Figure   Figure 1.1: Operation Provide Comfort Operations Area                            15




         Abbreviations

         AAI/IFF    Air-to-Air Interrogation/Identification Friend or Foe system
         AWACS      Airborne Warning and Control Systems aircraft
         CFAC       Combined Forces Air Component
         CFAC/DO    Combined Forces Air Component Director of Operations
         GAO        U.S. General Accounting Office
         OSI        Office of Special Investigations
         RCM        Rules for Court-Martial
         TAOR       tactical area of responsibility
         UCMJ       Uniform Code of Military Justice
         USAF       U.S. Air Force


         Page 13             GAO/OSI-98-4 Review of USAF Investigation of Fratricide Incident
Chapter 1

Introduction



Background

Operation Provide Comfort   In April 1991, and in concert with United Nations Security Council
Mission                     Resolution 688, military units from a coalition of the United States and 12
                            other countries began providing direct emergency care and assistance to
                            Kurds and other ethnic groups in northern Iraq following a revolt against
                            the Iraqi government.1 This emergency relief effort was named Operation
                            Provide Comfort.

                            Coalition forces secured an area of northern Iraq that excluded Iraqi
                            aircraft above the 36th parallel—the tactical area of responsibility (TAOR),2
                            or no-fly zone—and prepared transit camps within Iraq for the return of
                            the people who had fled from the advancing Iraqi army. To provide a
                            secure environment for the returnees, the coalition established a security
                            zone within the TAOR into which Iraqi forces could not enter. Coalition air
                            forces from France, Turkey, the United Kingdom, and the United States
                            were assembled to conduct frequent air operations in the TAOR. A Military
                            Coordination Center was established in Zakhu, Iraq, located inside the
                            security zone, to provide a direct communications link with the Iraqi
                            military, humanitarian relief agencies, and Kurdish leaders. Figure 1.1
                            illustrates the location of pertinent points in and around the TAOR.




                            1
                             The U.S. Commander in Chief, Europe, directed the creation of a Combined Task Force with all
                            coalition members. Members at that time were the United States, Australia, Belgium, Italy, Canada,
                            Turkey, the United Kingdom, France, Germany, Spain, the Netherlands, Portugal, and Luxembourg.
                            2
                             The TAOR was the airspace north of 36 degrees north latitude in Iraq from which Iraqi aircraft were
                            prohibited.



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                                                 Chapter 1
                                                 Introduction




Figure 1.1: Operation Provide Comfort Operations Area

        N

   W        E

        S                                                                                                 TURKEY
                                                                        Diyarbakir                                                         IRAN

         Incirlik                                                                                          Zakhu

                                                                                                             Security
                                                                                                              Zone
                                                                                                                                Crash
                                                                                                                                Sites
                                                                                                         TAOR           Irbil
                                                                                           IRAQ
                                         SYRIA
                                                                                           IRAQ            36 TH PARALLEL




TAOR = tactical area of responsibility



Command Structure                                The U.S. Commander in Chief, Europe, delegated operational control of
                                                 assigned U.S. Army and Air Force units to the Combined Task Force
                                                 Commander located at Incirlik Air Base, Turkey. The Combined Task
                                                 Force Commander also had tactical control of participating Turkish,
                                                 French, and British forces; but operational control of those forces was
                                                 retained by their parent commands.3

                                                 On July 20, 1991, the Combined Task Force Commander issued an
                                                 operations plan governing the conduct of the Operation Provide Comfort.
                                                 The plan delineated the command relationships and organizational
                                                 responsibilities within Combined Task Force Operation Provide Comfort.
                                                 The Combined Task Force was headed by U.S. and Turkish
                                                 co-commanders and included a Combined Task Force staff; a Combined
                                                 Forces Air Component (CFAC); and the Army component, including the
                                                 Military Coordination Center.



                                                 3
                                                  Tactical control is the detailed, and usually local, direction and control of movements and maneuvers
                                                 necessary to accomplish the assigned mission. Operational control is the authority to command
                                                 subordinate forces, assign tasks, designate objectives, and give authoritative direction necessary to
                                                 accomplish the mission.



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                            Chapter 1
                            Introduction




Operation Provide Comfort   CFAC coordinated air operations for Operation Provide Comfort. It had
Air Operations              operational control of air assets—such as Airborne Warning and Control
                            System aircraft (AWACS) and F-15 and F-16 fighters—and tactical control of
                            Army helicopters. The Military Coordination Center at Zakhu was
                            supported by a Black Hawk helicopter detachment at Diyarbakir, Turkey.
                            (See fig. 1.1.) Air operations were conducted by planes and personnel
                            assigned to Operation Provide Comfort on a temporary duty basis.

Fighter Aircraft            Fighter aircraft performed the bulk of the Operation Provide Comfort
                            flying mission. A typical “mission package” contained as many as 30 to 40
                            fighter aircraft and a variety of aircraft with specific mission capabilities.
                            The fighters flew two- and four-ship formations and provided the following
                            capabilities: visual and sensor reconnaissance of military targets,
                            defensive counter air operations, suppression of enemy air defenses, and
                            on-call precision-guided munitions delivery. At the beginning of each
                            mission, no other aircraft was supposed to enter the TAOR until fighters
                            with airborne intercept radars had searched, or “sanitized,” the area.

AWACS                       During the daily operations, the AWACS was responsible for (1) controlling
                            aircraft enroute to and from the TAOR; (2) coordinating air refueling;
                            (3) providing airborne threat warning and control for Operation Provide
                            Comfort aircraft operating in the TAOR; and (4) providing surveillance,
                            detection, and identification of all unknown aircraft. The AWACS took off
                            about 2 hours before the rest of the fixed-wing package and eventually
                            entered an orbit in Turkish air space slightly north of the TAOR. (See fig.
                            1.1.)

                            The AWACS mission crew was headed by a Mission Crew Commander who
                            had overall responsibility for the AWACS mission. The Mission Crew
                            Commander directly supervised an Air Surveillance Officer; Senior
                            Director; and various communications, radar, and data processing
                            technicians. The Air Surveillance Officer supervised air surveillance
                            technicians who were responsible for identifying and monitoring
                            non-Operation Provide Comfort aircraft. The Senior Director supervised
                            and directed the activity of the controllers. The Enroute Controller was
                            responsible for Operation Provide Comfort aircraft going to and from the
                            TAOR. The Tanker Controller was responsible for coordinating the refueling
                            of Operation Provide Comfort aircraft. The TAOR Controller was
                            responsible for Operation Provide Comfort aircraft in the TAOR. In
                            addition, a Turkish controller was present on each AWACS mission flight.




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                               Chapter 1
                               Introduction




Military Coordination Center   Military Coordination Center Black Hawk helicopters stationed at
Helicopters                    Diyarbakir provided air transportation for the Military Coordination
                               Center liaison team and conducted resupply missions at Zakhu, as
                               required. The Black Hawks also used Zakhu as a stage for flying missions
                               further in the TAOR to visit Kurdish villages, monitored conditions in the
                               security zone, and conducted search and rescue missions.


The Shootdown                  On April 14, 1994, two U.S. Army Black Hawk helicopters and their crew
                               assigned to the Military Coordination Center were transporting U.S.,
                               United Kingdom, French, and Turkish military officers; Kurdish
                               representatives; and a U.S. political advisor in the TAOR. The Black Hawks
                               had departed Zakhu enroute to Irbil, Iraq. (See fig. 1.1.) At the same time,
                               two F-15s were sanitizing the area that the Black Hawks were in; and the
                               AWACS was over Turkey providing airborne threat warning and control. The
                               AWACS was aware that the Army Black Hawk helicopters had departed
                               Zakhu and were proceeding east into the TAOR. However, the F-15 pilots
                               were unaware that Black Hawk helicopters were already in the area and
                               were not advised of the presence of friendly aircraft. The fighters twice
                               informed the AWACS that they had unknown radar contacts in the TAOR, and
                               the AWACS had access to electronic information regarding the presence of
                               friendly aircraft in the vicinity of the F-15s’ reported radar contacts.
                               Throughout the incident, the helicopters were unable to hear the radio
                               transmissions between the F-15 pilots and the AWACS because they were on
                               a different radio frequency.

                               According to the Aircraft Accident Investigation Board President’s
                               opinion, when the F-15 pilots were unable to get positive/consistent
                               electronic responses, they performed a visual intercept with each making
                               a single identification pass over the Black Hawks to identify the
                               “unknown” aircraft. However, the Board President concluded that the
                               identification passes were carried out at speeds, altitudes, and distances at
                               which it was unlikely that the pilots would have been able to detect the
                               Black Hawks’ markings. The pilots said that they did not recognize the
                               differences between the U.S. Black Hawk helicopters with wing-mounted
                               fuel tanks and Hind helicopters with wing-mounted weapons. The Board
                               President determined that the pilot in the lead F-15 aircraft had
                               misidentified the U.S. Black Hawks as Iraqi Hind helicopters and the
                               wingman did not confirm, when asked by the lead pilot, that he had been
                               unable to make a positive identification. The flight lead fired a single
                               missile and shot down the trailing Black Hawk helicopter. At the lead
                               pilot’s direction, the F-15 wingman fired a single missile and shot down the



                               Page 17              GAO/OSI-98-4 Review of USAF Investigation of Fratricide Incident
                     Chapter 1
                     Introduction




                     lead helicopter. All 26 individuals aboard the two helicopters were killed
                     in the fratricide.


Aircraft Accident    When the Combined Task Force Commander learned that the Black
Investigation        Hawks had been shot down on April 14, 1994, he appointed the former
                     CFAC Commander to conduct a Safety Board Investigation.4 The appointee
                     assembled a staff and began to collect relevant information. Later on
                     April 14, the Secretary of Defense ordered an Aircraft Accident
                     Investigation, which provides more disclosure to the public than does a
                     safety investigation. As a result, the safety investigation was discontinued;
                     and an Aircraft Accident Investigation Board was convened under Air
                     Force Regulation 110-14, since replaced by Air Force Instruction 51-503.
                     The investigation’s main objectives were (1) to gather and preserve
                     evidence for further investigations and inquiries by conducting a thorough
                     investigation and preparing an accident report and (2) to determine if
                     possible, through the Board President’s opinion, the accident’s main
                     causes.


                     The House Committee on National Security held a hearing in August 1995
Objectives, Scope,   related to the April 14, 1994, incident. Subsequently, the Chairman and
and Methodology      Ranking Minority Member of the Committee’s Subcommittee on Military
                     Personnel and Representative Mac Collins asked us, not to reinvestigate
                     the shootdown but, to determine whether (1) the Board investigation of
                     the Black Hawk shootdown had met its objectives and goals,
                     (2) subsequent Uniform Code of Military Justice (UCMJ) investigations had
                     followed established guidelines, and (3) any Department of Defense and/or
                     Air Force officials had improperly or unlawfully influenced these
                     investigations. The Subcommittee also requested that we consider
                     concerns raised by victims’ families and others. We did not evaluate the
                     appropriateness of resultant disciplinary or corrective actions.

                     We interviewed family members of the U.S. victims and others with
                     concerns about how the military had handled the incident. In general, they
                     had questions about the process and results of the Aircraft Accident
                     Investigation Board and the UCMJ investigations. We examined thousands


                     4
                      Air Force Regulation 127-4 (Safety), since replaced by Air Force Instruction 91-204, establishes the
                     general program for investigating and reporting all U.S. Air Force mishaps. Safety investigations are
                     conducted to find the cause(s) and take preventive actions. Since much of that information is available
                     only from the person(s) directly involved, a promise of confidentiality is given to all witnesses; and
                     privileged information is protected from disclosure outside the Air Force safety community. Therefore,
                     restrictions are placed on the dissemination of the information obtained and the resulting report.



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Chapter 1
Introduction




of documents, including over 2,000 classified documents; interviewed over
160 individuals; and visited localities in the United States, Europe, and the
Middle East.

To assess compliance with regulations, we reviewed the Aircraft Accident
Investigation Board’s report, its exhibits, and applicable regulations. We
interviewed Board members, both legal and technical advisors to the
Board, accident recovery team members, and many of those interviewed
by the Board concerning their role in the incident. In particular, we
examined how the Board investigated the incident, conducted its analyses,
and produced its report and the Board President’s opinion. We also
reviewed information developed by the Inquiry and Investigating Officers
under UCMJ and the court-martial trial transcripts and exhibits.

To address questions raised by victims’ family members and others
regarding the actions of the two F-15 pilots, the AWACS crew, and command
officials, we reviewed the then existing rules of engagement, operations
plan, pertinent orders (Airspace Control Order, Air Tasking Order, and
Aircrew Read Files), and guidance. We interviewed F-15 pilots and Air
Force officials to determine their understanding of the existing orders and
guidance for fighters in Operation Provide Comfort. We questioned these
individuals regarding the two F-15 pilots’ actions during, and statements
concerning, the April 14, 1994, incident. We also interviewed the F-15
pilots involved in the shootdown. Further, we interviewed senior board
members of the Flying Evaluation Boards that were convened. We
reviewed the two F-15 pilots’ flight and military records and interviewed
former instructors and fellow pilots to gain additional insight into their
qualifications and abilities.

Regarding the Identification Friend or Foe (IFF) system and its operation
on April 14, 1994, we reviewed the (1) Airspace Control Order and the Air
Tasking Order authority by which the IFF system was to be employed;
(2) statements of the two F-15 pilots regarding their operation and
responses received from the systems on April 14, 1994; and (3) subsequent
Air Force task force studies. We also interviewed other pilots, IFF
technicians, and other technical experts to better understand the
limitations and performance of the incident F-15 IFF systems.

With regard to AWACS operations, we reviewed the applicable procedures
for AWACS operations on the date of the incident. We interviewed crew
members aboard the AWACS during the shootdown to determine their
knowledge of the events and their understanding of the roles and



Page 19              GAO/OSI-98-4 Review of USAF Investigation of Fratricide Incident
Chapter 1
Introduction




responsibilities of the crew members. We also interviewed other AWACS
crew members who had served in Operation Provide Comfort to
determine the general understanding among AWACS crew members of their
roles and responsibilities; the commanders and other command personnel
of the 552d Air Control Wing, which operated the AWACS in Operation
Provide Comfort; and Air Combat Command personnel responsible for
identifying and instituting changes in AWACS operations following the
investigations. To gain an understanding of command and control issues at
the Combined Task Force, we interviewed personnel who were stationed
at Operation Provide Comfort both before and after the incident.

With respect to Black Hawk operations, we examined the procedures used
by Military Coordination Center personnel in scheduling helicopter
activities and the Center’s integration with the other Operation Provide
Comfort mission components. In addition, we interviewed individuals
responsible for developing the procedures for Black Hawk flights; those
who prepared the helicopters for their mission on April 14, 1994; and
responsible Combined Task Force officials. We also reviewed documents
concerning the Combined Task Force and the Black Hawk helicopters at
the Center for Army Lessons Learned at Fort Leavenworth, Kansas.
Further, we interviewed Combined Task Force and European Command
officials and reviewed directives and files at Incirlik, Turkey, and Stuttgart,
Germany.

Regarding improper or unlawful command influence during the Board’s
investigation process, we interviewed the Board President and Deputy,
members, and advisors. We also contacted the Commander, U.S. Air
Forces in Europe, who had convened the Aircraft Accident Board
Investigation. In addition, we reviewed records that cautioned against
unlawful influence.

Regarding improper or unlawful command influence during the UCMJ
investigations process, we reviewed the record of decisions made by the
Inquiry Officers and Investigating Officers in the UCMJ investigations to
determine whether they were in compliance with provisions in the UCMJ
and the Manual for Courts-Martial. These records of decisions included the
suspected violations, the facts considered, and the analyses used to arrive
at the conclusions and recommendations reached. The Department of
Defense would not allow us to interview the Convening Authorities or the
Inquiry and Investigating Officers.




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Chapter 1
Introduction




The Department of Defense provided written comments on a draft of this
report. Those comments concur with our primary conclusions and agreed
that the few differences between our report and the Board report would
not have affected the Board President’s conclusions.

The following chapters discuss the Aircraft Accident Investigation Board
report and subsequent findings, subsequent investigations under the UCMJ,
the results of Flying Evaluation Boards, and corrective actions taken.




Page 21              GAO/OSI-98-4 Review of USAF Investigation of Fratricide Incident
Chapter 2

Aircraft Accident Investigation


               The congressional requesters asked us, among other points, to
               (1) determine if the Aircraft Accident Investigation Board’s investigation
               had met its objectives, (2) determine whether improper or unlawful
               command influence had occurred during the investigation, and
               (3) consider concerns raised by victims’ family members and others.

               We found that the Board, in a limited time frame, conducted an extensive
               investigation that fulfilled the requirements of Air Force Regulation 110-14
               to obtain and preserve evidence and, with a few exceptions, to report the
               factual circumstances relating to the accident. Also consistent with the
               regulation, the Board President stated his opinion of the accident’s causes.
               In addition, our interviews of the Board President and other Board
               members, as well as technical and legal advisors, disclosed no evidence of
               improper or unlawful command influence during the Board process.

               During our review of the Board’s investigation/report and subsequent
               Department of Defense reviews, plus our interviews of Operation Provide
               Comfort officials and participants, we noted that the Board report and/or
               opinion (1) did not discuss the incident F-15 pilots’ responsibility, under
               the Airspace Control Order, to report to the Airborne Command Element
               aboard the AWACS about the unidentified helicopters; (2) cited a CFAC
               Commander statement that inaccurately portrayed the Airborne Command
               Element as not having authority to stop the incident; and (3) erroneously
               concluded that the Black Hawks’ use of an incorrect electronic code
               prevented the F-15 pilots from receiving electronic responses from the
               helicopters.

               Last, victims’ family members and others at the August 1995 congressional
               hearing raised concerns that included possible discipline problems in the
               F-15 community in Operation Provide Comfort at the time of the
               shootdown and the incident F-15 pilots’ perceived urgency to engage
               during the shootdown. While Air Force Regulation 110-14 did not require
               the Board to examine these issues, it did not preclude the examination;
               and we determined that the issues were pertinent to our review. Indeed,
               discipline problems did exist in the F-15 community in Operation Provide
               Comfort, and some Operation Provide Comfort officials questioned the
               incident F-15 pilots’ haste to engage the unknown helicopters.




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                             Aircraft Accident Investigation




Investigation Met
Objective but the
Report Contained
Three Deficiencies

Board Investigation/Report   At the direction of the Secretary of Defense on the day of the shootdown,
and President’s Opinion      the U.S. Commander in Chief, Europe, ordered the Commander, U.S. Air
                             Forces in Europe, to conduct an Aircraft Accident Investigation. The
                             Aircraft Accident Investigation Board was properly convened under Air
                             Force Regulation 110-14. The Board’s investigation met its goal to obtain
                             and preserve documentary, testimonial, and physical evidence for possible
                             claims, litigation, and disciplinary and administrative needs.

                             On May 27, 1994, also in accordance with Air Force Regulation 110-14, the
                             Aircraft Accident Investigation Board issued a 60-page summary report
                             including the Board President’s opinion that, with three exceptions,
                             provided a summary of the most important facts and circumstances of the
                             incident. Those deficiencies—involving the incident F-15 pilots, the
                             incident Airborne Command Element, and the Black Hawks’ use of an
                             incorrect electronic identification code—are discussed later in this
                             chapter.

                             The Board President’s opinion, which was also required by the regulation
                             and was included in the summary, identified the accident’s causes as a
                             chain of events that began with the lack of a clear understanding among
                             the Operation Provide Comfort organizations about their respective
                             responsibilities and culminated with the F-15 lead pilot’s misidentification
                             of the Black Hawks as Iraqi Hinds and the F-15 wingman’s failure to notify
                             the lead pilot that he had not positively identified the helicopters. (The
                             Board President’s opinion appears as app. I.1) The Board report was
                             transmitted through the Chairman of the Joint Chiefs of Staff to the
                             Secretary of Defense.


Composition of the Board     On April 15, 1994, the Commander, U.S. Air Forces in Europe, appointed
                             the Commander, 3d Air Force (a major general), as President of the

                             1
                              A supplement to the Board’s report was prepared at the request of the U.S. Commander in Chief,
                             Europe. It was a synopsis of interviews of individuals who had been AWACS mission crew members in
                             Operation Provide Comfort before the incident. The Board President reviewed the interviews and
                             related documents but did not change his opinion.



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                   Aircraft Accident Investigation




                   Aircraft Accident Investigation Board. The other Board members included
                   a Deputy Board President (an Army colonel), a Chief Investigator who was
                   an F-15 pilot, an AWACS expert, a Black Hawk pilot, a Black Hawk
                   maintenance officer, a flight surgeon, a Board recorder, and a public
                   affairs officer.2 The Board also included 13 technical advisors and 4 legal
                   advisors (3 Air Force and 1 Army).


Scope of Board’s   The Board conducted its investigation from April 15 to May 27, 1994,3
Investigation      when it issued its report, including 25 volumes of evidence containing
                   testimony from 137 witnesses.4 The Board reviewed directives on
                   command and control; rules of engagement, pertinent orders (Airspace
                   Control Order, Air Tasking Order, and Aircrew Read Files5), aircrew
                   preparation, and scheduling; aircraft maintenance documentation on the
                   involved aircraft; aircrew qualification and training records and materials;
                   physical and medical examinations; data on the sequence of events for
                   each of the aircraft, such as flight plans, communications tapes, and
                   briefing and preflight preparations; search and rescue activities; and
                   integration of Army and Air Force operations. The Board also reviewed
                   classified documents, video tapes, and magnetic tapes relating to the
                   accident. To assess the possible malfunction of the Air-to-Air Interrogation
                   (AAI) and Identification Friend or Foe (IFF) system components,6 the
                   Board commissioned testing of the incident fighters’ AAI systems and the
                   helicopters’ transponders. It also commissioned a filmed re-creation of the
                   incident with an F-15 fighter approaching a Black Hawk helicopter at
                   various elevations, distances, and approaches.

                   2
                    The Board President and the Chief Investigator had previous accident investigation experience.
                   3
                    Accident investigations are normally completed within 30 days unless, as in this case, the appointing
                   authority grants an extension.
                   4
                    The Deputy Board President (Army), a former Black Hawk commander, was present at the interviews
                   of the two F-15 pilots. Although a second Army Board member and the Army legal advisor were not
                   invited to be present during these interviews, they were advised that, if they had questions, they would
                   be asked. The Black Hawk Board member recalled reviewing the transcript of the interviews and
                   stated that all the questions that he would have asked had been addressed.
                   5
                    (1) The Airspace Control Order provided rules and procedures for aircrews. (2) Combined Task Force
                   flying operations for all aircraft were scheduled in a daily Air Tasking Order, which listed information
                   pertinent to each day’s flight operations, or “mission package,” such as flying times and IFF codes. In
                   the case of the Black Hawk helicopters, the notation “as required” was included rather than specific
                   flying times due to the uncertainty of their schedules. (3) Aircrew Read Files, prepared by the CFAC/DO,
                   contained Operation Provide Comfort policy and guidance information.
                   6
                    In the AAI/IFF system, the AAI component interrogates an airborne aircraft to determine its identity;
                   and the IFF component answers. A challenging aircraft transmits an interrogation signal via the AAI
                   component to a target aircraft. The target aircraft’s transponder system, part of the IFF component,
                   sends back a coded signal. The challenging aircraft receives the return signal and processes it
                   internally. If the return signal is valid, it appears on the challenging aircraft’s visual display.



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                         Aircraft Accident Investigation




                         Section 104 (a)(2) of the Rules for Court-Martial (RCM), Manual for
No                       Courts-Martial, defines unlawful command influence as an attempt to
Improper/Unlawful        coerce or, by any unauthorized means, influence the action of a
Command Influence        court-martial or any other military tribunal or any member thereof, in
                         reaching the findings or sentence in any case or the action of any
Found                    convening, approving, or reviewing authority with respect to such
                         authority’s judicial acts.

                         We found no evidence of improper or unlawful command influence
                         exerted during the Aircraft Accident Investigation Board process. The
                         Board members and technical and legal advisors we interviewed stated
                         that they had had free rein to examine all facets during the investigation.

                         According to the Commander, U.S. Air Forces in Europe, when the U.S.
                         Commander in Chief, Europe, tasked him to convene the Aircraft Accident
                         Investigation Board, he was told to uncover the facts and get all the
                         details. Also according to the Commander, when he assigned the Board
                         President, he told the president to leave no rock unturned and bring up
                         every fact during the investigation. According to the Board President, his
                         directions to the Board members were to let the “chips fall” where they
                         may and to hold back nothing. He stated that there was “absolutely no
                         command influence” and that the Board was extremely careful to avoid
                         even the appearance of any influence.


                         Although the Aircraft Accident Investigation Board reported that incident
No Discussion of F-15    participants, including the Black Hawk pilots, lacked knowledge of
Pilots’ Requirement to   command and control guidance, such as portions of the Airspace Control
Report to Airborne       Order, it did not discuss the F-15 pilots’ responsibility under the Airspace
                         Control Order to report to the Airborne Command Element when
Command Element          encountering an unknown aircraft during Operation Provide Comfort
Who Had Authority to     missions.7 Further, although it had evidence to the contrary, the Board,
                         through its report, cited a CFAC Commander’s inaccurate testimony that the
Stop Encounter           Airborne Command Element had no decision-making authority regarding
                         aircraft encounters in the TAOR.

                         According to the Board’s Senior Legal Advisor, the Board did not report
                         the F-15 pilots’ nonadherence to that aspect of the order because the
                         Airborne Command Element was aware of the intercept; thus the Board
                         did not consider the pilots’ nonadherence to be a significant cause of the

                         7
                         The report did state that the F-15 pilots had adhered to the order’s requirement to contact the
                         Airborne Command Element before entering the TAOR.



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                            shootdown. The Senior Legal Advisor stated that, in the Board’s opinion,
                            Operation Provide Comfort management had allowed operations to
                            degrade to such a point that the Board report, partly for this reason,
                            focused on command and control problems.


Command and Control of      Combined Task Force flying operations were conducted according to an
Airspace Operations in      Airspace Control Order published by the CFAC Director of Operations
Operation Provide Comfort   (CFAC/DO).8 The two-volume Airspace Control Order, which provided the
                            rules and procedures governing all Operation Provide Comfort aircrews,
                            was required reading for those aircrews. Volume II augmented volume I by
                            providing detailed and specific guidance and procedures for conducting
                            Operation Provide Comfort air operations.

                            The CFAC/DO directed the Operation Provide Comfort flight operations
                            through a ground-based Mission Director at Incirlik Air Base and an
                            Airborne Command Element9 aboard the AWACS. The Airborne Command
                            Element, according to the Board report, was to act as the “’eyes and ears’
                            of the CFAC/DO” aboard the AWACS. In support of this, as excerpted from the
                            Airspace Control Order, “[the Airborne Command Element] will contact
                            [the Mission Director] who will then pass the information to the CFAC/DO”
                            concerning any unusual circumstances, such as an unidentified aircraft in
                            the TAOR.


Requirement to Report to    The Board report and Board President’s opinion did not address that the
Airborne Command            pilots were required to report to the Airborne Command Element in an
Element                     “unusual circumstance” as specified by the following excerpt from volume
                            II of the Airspace Control Order.10 (For the sake of clarity, we have used
                            titles in place of code names.)



                            8
                              The CFAC/DO was responsible for updating the Airspace Control Order; briefing incoming aircrews on
                            its application; and holding Detachment Commander meetings twice a week to discuss air-operation
                            problems and corrective actions.
                            9
                             In Operation Provide Comfort, the Airborne Command Element was called the “Duke.” During
                            wartime situations, such as Desert Storm, the Airborne Command Element was a colonel or a general
                            and operated as the air battle manager. In Operation Provide Comfort, the Airborne Command
                            Element was a lieutenant colonel or major and operated in a reactive mode.
                            10
                              Volume I of the Airspace Control Order states, “Aircrews experiencing unusual
                            circumstances/occurrences will pass details to [the Airborne Command Element] or AWACS.” Volume
                            II clarifies the statement by (1) directing aircrews to first contact the Airborne Command Element and,
                            if that individual is unavailable, to then contact AWACS and (2) defining “unusual
                            circumstances/occurrences.”



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“Aircrews experiencing any unusual circumstances/occurrences while flying [Operation
Provide Comfort] missions will report the incident [as soon as possible] to [the Airborne
Command Element] or [the AWACS crew] if [the Airborne Command Element] is
unavailable.”


The list of six such unusual circumstances/occurrences contained in the
Airspace Control Order included “[a]ny intercept run on an ’Unidentified
aircraft.’” According to Operation Provide Comfort officials, the Airspace
Control Order was specifically designed to slow down a potential
engagement to allow CFAC time to check things out.

In response to questions we raised, the Board’s Senior Legal Advisor said
that the Board had reviewed that provision and evidence showing that the
F-15 pilots had read both volumes of the Airspace Control Order
containing the requirement to contact the Airborne Command Element for
guidance. He added that the contact-requirement issue was not significant
to the Board because the Airborne Command Element was aware of the
discussion between the F-15 pilots and the TAOR controller about the
intercept. He also said that the Board concluded that the F-15 pilots had
reason to believe that the Airborne Command Element was monitoring the
conversation and that the Airborne Command Element was, in fact, aware
of the intercept and did not intervene.11 Further, the Operation Provide
Comfort management, in the Board’s opinion, had allowed operations to
degrade to such a degree that it “may not have been common practice” at
the time for F-15 pilots to contact the Airborne Command Element. He
said that partly because of this degradation, the Board’s focus turned to
the command and control failures that had created an environment that
allowed the incident to occur.

However, this duty to contact the Airborne Command Element for
directions concerning unusual circumstances had been reemphasized by
an oral directive issued because of an incident about a week before the
shootdown.12 In that incident, F-15 pilots had initially ignored an Airborne
Command Element’s directions to “knock off,” or stop, an engagement
with a hostile fighter aircraft they thought was in the no-fly zone. The
Airborne Command Element overheard the pilots preparing to engage the


11
  The Airborne Command Element testified to the Board that once he heard the visual identification
call, he was trying to put together a plan because he was considering the threat of an Iraqi trap. He
testified that he did not intervene because, in his view, the F-15 pilots were not committed to “anything
[engaging the targets]” at the visual identification point and he had no idea they were going to react so
quickly.
12
 According to Operation Provide Comfort documents and statements from Operation Provide
Comfort officials, it appears that this incident occurred on April 7, 1994.



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                         aircraft and contacted them, telling them to stop the engagement because
                         he had determined that the hostile aircraft was outside the no-fly zone and
                         that he was also leery of a “bait and trap” situation.13 After several
                         unsuccessful attempts to call off the engagement during which the F-15
                         pilots did not respond to him, he ordered the pilots to return either to their
                         assigned patrol point or to base. The F-15s returned to their assigned
                         patrol point.

                         The CFAC/DO issued the resultant oral directive to the F-15 detachment
                         representative at the next Detachment Commander meeting14 following
                         the incident. At the meeting, the CFAC/DO listened to the complaints of the
                         F-15 representative and then told him that the word of the Airborne
                         Command Element was final.15 He also told the F-15 representative that
                         the Airspace Control Order was very clear and must be followed.16 While
                         the Board did an extensive investigation, it was unaware of this oral
                         directive.


Discussion of Airborne   The Aircraft Accident Investigation Board report cited as fact the former
Command Element’s        CFAC Commander’s testimony17 that the Airborne Command Element “had

Authority                no decision-making authority.” The Board justified citing the statement as
                         fact in its report because it was made by the Commander, from whom the
                         Board believed all authority for CFAC operations stemmed. The Board did
                         not include in its report, testimony from the CFAC Commander at the time
                         of the shootdown, the CFAC/DO,18 a Mission Director, and others with more

                         13
                          In such a strategy, a fighter aircraft is lured into an area by one or more enemy targets and then
                         attacked by other fighter aircraft or surface-to-air missiles.
                         14
                           The twice-weekly Detachment Commander meetings were attended by Detachment Commanders
                         (including fighter squadron Commanders) or their representatives to discuss operational issues and
                         problems.
                         15
                          The Dec. 1993 Airspace Control Order, Vol. I, stated “Direction from [Mission Director]/[Airborne
                         Command Element] is final.”
                         16
                           We were unable to substantiate that the F-15 wingman (who was also the Squadron Commander)
                         involved in the shootdown was at the Detachment Commander meeting. At that time, he was the
                         Squadron Commander/Detachment Commander. Operation Provide Comfort officials told us, on the
                         other hand, that the knock-off incident and subsequent guidance by the CFAC/DO were well known
                         throughout the Operation Provide Comfort fighter community.
                         17
                           The testimony cited was that of the CFAC Commander who had been reassigned several days before
                         the shootdown. The testimony of the CFAC Commander at the time of the shootdown was that the
                         CFAC/DO supervised day-to-day Operation Provide Comfort flight operations and monitored these
                         operations through the Mission Director and Airborne Command Element, which he characterized as
                         command and control positions.
                         18
                           Because the CFAC Commander also served as the 39th Wing Commander and the 7440th Composite
                         Wing (Provisional) Commander, the CFAC/DO was, in fact, acting as the CFAC Commander according to
                         the Combined Task Force Commander.



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                        knowledge of actual Operation Provide Comfort air operations that
                        contradicted the former CFAC Commander’s reported testimony concerning
                        Airborne Command Element authority.

                        The CFAC/DO told the Board and us that he had delegated time-sensitive
                        decision-making authority to his Mission Directors and Airborne
                        Command Elements.19 He testified to the Board that he had given the
                        authority to the Airborne Command Element to terminate the mission
                        package “and bring the entire operation back.” He further told us that the
                        week before the shootdown he had supported the Airborne Command
                        Element’s decision to knock off the F-15 pilots’ intercept and had
                        commended the Airborne Command Element on his actions. The
                        Combined Task Force Commander also supported the Airborne Command
                        Element’s decision.


                        The Board President’s opinion erroneously concluded that the Black
Board President’s       Hawks’ use of a wrong code prevented the F-15s from receiving a response
Erroneous Conclusion    in one of the electronic identification modes. We agree with an Air Force
That Black Hawks’       analysis, using information that was also available to the Board, that
                        determined that the F-15 pilots should have received a response despite
Use of Wrong Code       the wrong code. The analysis based its finding on the manner in which the
Prevented F-15 Pilots   pilots testified that they had interrogated the helicopters.
From Receiving
Response
Background              During their sanitization sweep, the F-15 pilots, using radar, located
                        unknown, slow-moving contacts in the TAOR that were subsequently
                        identified as helicopters. In an attempt to identify if the helicopters were
                        friendly, the F-15 pilots interrogated the aircraft with their AAI/IFF systems.
                        An F-15’s AAI/IFF system can interrogate using four identification signals, or
                        modes: I, II, III, and IV.20 In the TAOR, the transponders on Black Hawk
                        helicopters transmit Modes I, II, and IV. However, two Mode I codes were
                        designated for use in Operation Provide Comfort at the time of the
                        incident: one inside, the other outside the TAOR. As stated in the Board

                        19
                         A lieutenant colonel and three majors rotated between the Mission Director and Airborne Command
                        Element positions.
                        20
                          Mode I was the general identification signal that permitted the selection of 32 codes. Mode II was an
                        aircraft-specific identification mode allowing the use of 4,096 possible codes. Mode III provided a
                        nonsecure friendly identification of both military and civilian aircraft and was not used in the TAOR.
                        Mode IV was secure and provided high-confidence identification of friendly targets. A compatible code
                        had to be loaded into the cryptographic system of both the challenging and the responding aircraft to
                        produce a friendly response.



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report, the Black Hawk pilots were using the Mode I code for outside the
TAOR,21 and the F-15 pilots’ systems were set to the Mode I code for inside
the TAOR. The Board report and its President’s opinion noted that the Black
Hawks’ use of the wrong Mode I code had resulted in the F-15 pilots’
failure to receive a Mode I response.

The Aircraft Accident Investigation Board took testimony from the pilots
who had flown the same F-15s on flights immediately before and after the
shootdown, in addition to testimony from the incident lead pilot and
wingman, to determine whether they had experienced any problems with
the IFF systems. All said that they had had no problems and had
successfully interrogated other aircraft using Modes I and IV.22

The Board also had operational tests performed on the F-15s’ AAI/IFF
components a few days after the incident. The tests revealed no problem
that would have prevented the lead aircraft from interrogating and
displaying Modes I, II, and IV. The wingman’s AAI system was found to be
capable of interrogating Modes I, II, and IV and of displaying Mode I and II
signals. However, it could not display Mode IV signals generated by the
test set. After the operational testing, the Board removed the AAI
components from the F-15s and sent them to two Air Force laboratories
for teardown analysis. The laboratory tests were performed without
recalibrating the components, and the reports showed no problems that
would have affected the performance of the equipment.

Because of weapons impact, the resulting crash, and/or the subsequent
fire, the transponder on one helicopter was completely destroyed. The
transponder in the other helicopter was partly destroyed and was sent to a

21
  Other Black Hawk pilots told us, as was also mentioned in the Board report, that they routinely used
the Mode I code for outside the TAOR while operating in the TAOR and no one had advised them that
it was incorrect to do so.
22
  The lead pilot stated on April 14, 1994, that the initial AAI contact on the unknown helicopters in the
TAOR was a negative Mode I and a positive Mode IV. When he testified before the Board, on April 23,
1994, he described the initial positive Mode IV contact as lasting only a second and attributed it to an
AAI system “anomaly.” The Aircraft Accident Investigation Board was unable to determine why the
F-15s reportedly did not receive a Mode IV response from the Black Hawks based on the AAI
interrogation of the helicopters that the F-15 pilots said they made. We were also unable to make this
determination.

The Commander, U.S. Army in Europe, after reviewing the Board report and its president’s opinion,
objected to one sentence in the opinion that attributed the unsuccessful Mode IV interrogation to one
or more things, including “both helicopter IFF transponder codes may have been loaded incorrectly.”
He added that nothing in the Board report supported the possibility that the codes had been loaded
improperly and that it was clear the Army crews were not at fault in this matter. The U.S. Commander
in Chief, Europe, agreed with his view. Although the language in the opinion was not changed, the
Commander, U.S. Army in Europe, said his concerns were addressed because his complaint had been
included as an attachment to the Board report.



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                           Department of Defense laboratory. The report of the teardown analysis of
                           this transponder concluded that it had been on at the time of the incident
                           but that the testing could not determine conclusively whether the system
                           had been fully operational at the time.


F-15 Pilots Should Have    The Board President’s opinion concluded that the Black Hawks had been
Received Mode I Response   using the wrong Mode I code inside the TAOR after they departed Zakhu for
                           Irbil, Iraq, and that the incorrect code was responsible for the F-15 pilots’
                           failure to receive a Mode I response when they interrogated the
                           helicopters. However, the Air Force special task force’s23 subsequent
                           review of the IFF component revealed that, based on the descriptions of
                           the system settings that the pilots testified they had used on several
                           interrogation attempts, the F-15s should have received and displayed any
                           Mode I or II24 response, regardless of code. Thus, the helicopters’ use of
                           the wrong Mode I code should not have prevented the F-15s from
                           receiving a response.

                           In reaching his conclusion, the Board President relied on the evidence
                           collected by the Board, which included the pilots’ testimony as well as
                           other information about the IFF system settings and how the system
                           should perform. In its report, the Board cited three of four interrogation
                           attempts about which the lead pilot had testified on April 23, 1994. One of
                           the three was performed in a way that should have displayed any Mode I
                           or II response,25 as later noted by the Air Force special task force. The task
                           force also found that the additional interrogation attempt described on
                           April 23 was identical to the one that should have displayed any Mode I or
                           II response. The additional interrogation, not reported by the Board, took
                           place during the period in which the AWACS was receiving friendly Mode I
                           and II returns from the helicopters at an increasingly frequent rate26 and

                           23
                            The Air Force Air Combat Command assembled a task force to review, among other issues, visual
                           and electronic identification systems and procedures.
                           24
                             According to the Airspace Control Order, the primary means of identifying friendly aircraft in the
                           TAOR were through Modes II and IV in the IFF interrogation process. According to the Board report,
                           the F-15 lead pilot, in his preflight briefing, specified that the fighter pilots would use Modes I and IV.
                           25
                            The Board report found that the Black Hawks’ transponders were transmitting the correct Mode II
                           codes specified in the day’s Air Tasking Order.
                           26
                             According to the AWACS magnetic tape replay of the shootdown, the AWACS received IFF returns
                           (Modes I and II) from the helicopters at the same time that the F-15s received no response. The Board
                           report stated that beginning approximately 7 minutes before the shootdown, the AWACS was receiving
                           intermittent IFF returns that increased in frequency for the next 3 minutes. The returns then continued
                           uninterrupted for 2 minutes. During the final 2 minutes before the shootdown, according to the Board
                           report, the F-15 and Black Hawk returns appeared too close together on the AWACS consoles for the
                           crew to identify the helicopters.



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                        when the lead pilot was closer to the helicopters than during his initial
                        interrogation attempt at the same settings.

                        The Board President recalled discussions about the F-15 IFF-system
                        settings and said the Board report had included the interrogation attempts
                        about which the Board was certain. He told us that because of the
                        difference between the lead pilot’s incident-day statement and his
                        testimony, it was difficult to determine the number of times that the lead
                        pilot had interrogated the helicopters.


                        Victims’ family members and others raised concerns about the lack of
A Perceived             discussion in the Board report concerning the discipline of F-15 pilots in
Discipline Problem      general in Operation Provide Comfort and the F-15 pilots’ perceived
and a Perceived Rush    urgency to engage during the shootdown. Although Air Force Regulation
                        110-14, under which the Board’s investigation was conducted, did not
to Engage               require the Board to examine such environment issues, neither did the
                        regulation rule out an examination. However, the two issues were relevant
                        to our review.

                        According to Operation Provide Comfort officials, the pilots’ failure on
                        April 14, 1994, to contact the Airborne Command Element was a product
                        of a lack of F-15 mission discipline, as demonstrated by the incident a
                        week before the shootdown when F-15 pilots initially ignored Airborne
                        Command Element instructions to “knock off” an engagement with an
                        Iraqi aircraft. According to the Combined Task Force Commander, the
                        pilots’ failure was also related to a rivalry-induced urgency to engage
                        “hostile” aircraft.


F-15 Pilots’ Previous   The Mission Director during the shootdown and the Airborne Command
Problems With Mission   Element involved in the knock-off incident told us that they had had
Discipline Issues       problems with mission discipline issues involving F-15 pilots assigned to
                        Operation Provide Comfort during the time period leading up to the
                        shootdown. The Airborne Command Element stated that on the evening of
                        the knock-off incident, several F-15 pilots, including the pilots whom he
                        had ordered to cease their proposed engagement, approached him and
                        questioned whether he was a “combat player” and whether Airborne
                        Command Elements were perhaps too conservative.

                        According to CFAC officials, the F-15 pilot community was “very upset”
                        about the intervention of the Airborne Command Element during the



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                            knock-off incident and felt he had interfered with the carrying out of the
                            F-15 pilots’ duties.

                            The Airborne Command Element from the knock-off incident also told us
                            that so many flight discipline incidents had occurred that CFAC held a
                            group safety meeting in late February or early March 1994 to discuss the
                            need for more discipline. The flight discipline issues included midair close
                            calls, unsafe incidents when refueling, and unsafe takeoffs. The Combined
                            Task Force Commander said that he had recognized a potential
                            supervisory problem with the F-15 Detachment because no F-15 pilots
                            were on the Combined Task Force staff.27 He had made several
                            unsuccessful requests to the Commander, 17th Air Force, to have an
                            experienced F-15 pilot—on flying status—assigned to the Combined Task
                            Force staff. According to the Combined Task Force Commander, the 17th
                            Air Force Commander told him that the available number of F-15 slots was
                            limited and one could not be spared for Operation Provide Comfort. We
                            noted, however, that as part of the corrective actions taken following the
                            shootdown, an F-15 pilot was assigned to the Combined Task Force staff.

                            Further, the shootdown occurred, according to the CFAC/DO’s statement to
                            us, because of a lack of training and aircrew discipline in following
                            established guidelines on the part of the two F-15 pilots involved in the
                            incident. He stated, “[t]he pilots made a terrible mistake” and with greater
                            discipline—coupled with the multiple safeguards designed to prevent such
                            an incident—this fratricide may have been avoided.


Pilots’ Perceived Urgency   The Combined Task Force Commander and other Operation Provide
to Engage                   Comfort officials acknowledged that a rivalry existed between the F-15
                            and F-16 communities, including those in Operation Provide Comfort
                            detachments. Operation Provide Comfort officials told us that while such
                            rivalry was normally perceived as healthy and leading to positive
                            professional competition, at the time of the shootdown the rivalry had
                            become more pronounced and intense. The Combined Task Force
                            Commander attributed this atmosphere to the F-16 community’s having
                            executed the only fighter shootdown in Operation Provide Comfort and all
                            shootdowns in Bosnia.

                            27
                              The CFAC Assistant Director of Operations told us there was very little F-15 oversight in Operation
                            Provide Comfort at the time of the shootdown. He explained that an F-15 pilot was needed on the
                            Combined Task Force staff to help communicate with the F-15 group because contentious issues
                            involving F-15 actions had become common topics of discussion at Detachment Commander meetings.
                            He said that CFAC tried to have a certified F-15 pilot assigned to the Combined Task Force staff, but
                            U.S. Air Forces in Europe did not support such an assignment. He also said that an F-15 pilot was
                            assigned to the staff after the shootdown, which “paid big dividends.”



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In the opinion of the Combined Task Force Commander, the shootdown
pilots’ haste was due in part to the planned entry of two F-16s into the
TAOR 10 to 15 minutes after the F-15s. He said that if the F-15 pilots had
involved the chain of command, the pace would have slowed down,
ruining the pilots’ chances for a shootdown.

Further, CFAC officials stated that the Airspace Control Order was
specifically designed to slow down a potential engagement to allow CFAC
time to check things out.28 They said that the presence of the helicopters,
which were flying southeast away from the security zone, posed no threat
to the mission and there was no need for haste. For example, the Mission
Director stated that, given the speed of the helicopters, the fighters had
time to return to Turkish airspace, refuel, and still return and engage the
helicopters before they could have crossed south of the 36th parallel.
According to the F-15 Squadron Operations Officer at the time of the
shootdown and the Board’s Senior Legal Advisor, the tactical environment
did not warrant a rush to judgment. The Operations Officer added that the
F-15 pilots had acted too hastily and should have asked more questions.
The Senior Legal Advisor said that, in his opinion, the pilots had an
unnecessarily aggressive attitude toward the intercept and shootdown.

The lead incident pilot told us that he was concerned about going low to
check out the unknown aircraft. His primary concerns at the time were
(1) being fired on from the ground, (2) flying into the ground, and (3) a
possible air threat. Because of these concerns, he remained high for as
long as possible and dropped down briefly for a visual identification that
lasted, according to the lead pilot, “between 3 and 4 seconds.” He told us
that he saw no Iraqi flag on the helicopters and that the helicopters were
not acting in a hostile manner. He assumed they were Iraqi Hinds because
they were in the middle of Iraq, although he acknowledged that they could
have been Syrian or Iranian Hinds.

The incident wingman told us that his visual identification was not as
close to the helicopters as was the lead pilot’s.29 His visual identification


28
  The Airborne Command Element at the time of the shootdown testified to the Board that he was
surprised at the speed of the engagement, noting that he thought the F-15 pilots would have at least
told the AWACS of their intentions or asked for guidance. This testimony was not included in the
Board report. Also, not included in the Board report was testimony from the former CFAC Commander
that decisions concerning “out of the ordinary” occurrences while on missions were to be pushed up
the chain of command, to the CFAC/DO level or higher.
29
  The Board report found that the F-15s’ identification passes had been accomplished at speeds,
altitudes, and distances where it was unlikely that the pilots would have been able to detect the Black
Hawks’ markings.



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              lasted “between 2 and 3 seconds.” He said, in hindsight, “We should have
              taken another pass; but at the time, I was comfortable with the decision.”


              The Board report and Board President’s opinion would have presented a
Conclusions   more complete record of the incident’s events had they discussed the
              incident F-15 pilots’ requirement to report to the Airborne Command
              Element, accurately assessed the Airborne Command Element’s authority,
              not concluded that the Black Hawks’ use of an incorrect code had
              prevented Mode I electronic responses from the helicopters, and
              addressed F-15 pilot discipline issues. This more complete information, in
              turn, may have raised additional questions about the actions and inaction
              of the F-15 pilots and the Airborne Command Element and, therefore,
              could have influenced subsequent disciplinary or corrective actions.
              However, if the information had been included, it would not have affected
              the Board President’s conclusion: that a chain of events, whose final
              actions were the lead pilot’s incorrect identification and the wingman’s
              failure to clarify his lack of identification, caused the fratricide. Further, it
              is difficult to predict if the incident’s outcome would have differed had the
              F-15 pilots contacted the Airborne Command Element directly.




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Chapter 3

The Military Justice Process and
Administrative Actions

               The congressional requesters also asked us to (1) determine whether
               military justice investigations, conducted after the Aircraft Accident
               Investigation Board completed its work, had complied with provisions in
               the Uniform Code of Military Justice (UCMJ);1 (2) determine if improper or
               unlawful command influence had been exerted during the UCMJ process;
               and (3) answer general questions raised by family members and others
               regarding actions taken following the investigations.

               First, we found that the subsequent UCMJ investigations complied with
               provisions in the UCMJ and the Manual for Courts-Martial. Preliminary
               inquiries, under the Rules for Court-Martial (RCM), were conducted into the
               actions of 14 officers. The Air Force used two separate investigative paths,
               one for seven AWACS-related officers and the other for the two F-15 pilots
               and five Operation Provide Comfort officials. The former were
               investigated by a command separate from the one to which they were
               assigned. This command developed evidence beyond the material
               contained in the Board’s report. As a result of the preliminary inquiry,
               charges were preferred against four AWACS crew members and the
               Airborne Command Element. An Investigating Officer investigated these
               charges under Article 32, UCMJ; one officer was determined to be
               blameless; and the Commander, 963d Air Control Squadron retired as a
               Lieutenant Colonel although he had been selected for promotion. After the
               Article 32 investigation, one officer—the Senior Director of the AWACS
               crew—was tried by general court-martial and acquitted, and one officer
               received nonjudicial punishment in the form of a letter of reprimand. The
               remaining three officers received administrative letters of reprimand.

               On a separate path, the actions of the two F-15 pilots and five Operation
               Provide Comfort officials were reviewed under RCM in a preliminary
               inquiry conducted by the pilots’ Wing Commander. The Wing Commander
               relied on the Board report and filed dereliction-of-duty and negligent
               homicide charges against the F-15 wingman that were the focus of an
               Article 32 investigative hearing.2 Subsequently, charges against this pilot
               were dropped; however, he later received a letter of reprimand.
               Administrative action was taken against four other officers: the lead pilot
               received a letter of reprimand, two other officers received letters of

               1
                 UCMJ, 10 USC § 801 et seq., governs the conduct of military personnel. It contains both substantive
               and procedural law applicable to the military justice process and administration. It also describes the
               system of military courts, defines offenses, authorizes punishment, and provides statutory due-process
               safeguards.
               2
                The Wing Commander also preferred charges against two of the five Operation Provide Comfort
               officials. Following further analysis, these charges were not investigated at an Article 32 investigative
               hearing.



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               admonition, and one received a letter of counseling. No action was taken
               against the remaining two officers.

               The Air Force also convened Flying Evaluation Boards for the two F-15
               pilots involved in the shootdown. In addition, 16 months after the incident
               and 6 days after the House Committee on National Security hearing, the
               Chief of Staff of the Air Force found that a number of performance
               evaluations of personnel involved in the incident (1) were inconsistent
               with administrative actions taken by higher-level commanders and
               (2) failed to reflect that some officers had not met Air Force standards.
               Accordingly, the Chief of Staff prepared negative letters of evaluation
               regarding seven officers involved in the shootdown and implemented
               additional actions against five of them.

               Second, based on our review of the summary reports of investigation and
               statements made by cognizant officials, we found no evidence of improper
               or unlawful command influence in the investigative or judicial process.
               However, we were unable to complete our investigation and determine
               whether the consideration and disposition of suspected offenses under the
               UCMJ were the result of improper or unlawful command influence.
               Department of Defense officials would not allow us to interview the key
               officials—Convening Authorities, Inquiry Officers, and Investigating
               Officers—involved in the UCMJ investigations.


               On July 12, 1994, the Secretary of Defense approved the Aircraft Accident
UCMJ Process   Investigation Board report. The Secretary of the Air Force thereafter
               forwarded the report to the Commander, Air Combat Command, and the
               Commander, U.S. Air Forces in Europe, as well as to the Commander, U.S.
               Army in Europe, for appropriate action under the UCMJ and any
               administrative actions. Thus, the Air Force UCMJ investigations followed
               two separate paths—through Air Combat Command (AWACS-related
               personnel) and U.S. Air Forces in Europe (Combined Task Force
               Operation Provide Comfort personnel and F-15 pilots).

               The AWACS mission crew and 963d Squadron Commander involved in the
               shootdown were assigned to the 552d Air Control Wing, which was under
               the jurisdiction of the 12th Air Force. However, the Staff Judge Advocate
               to the 12th Air Force had served as Legal Advisor to the Aircraft Accident
               Investigation Board. As a result, the Air Force considered him disqualified
               from conducting an RCM investigation or serving as staff judge advocate to
               the Convening Authority during the disciplinary review.



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Therefore, the Commander, Air Combat Command, designated the
Commander of the 8th Air Force as the court-martial Convening Authority.3
The Commander, 8th Air Force, appointed an Inquiry Officer to conduct an
RCM 3034 inquiry regarding the actions of seven officers under Air Combat
Command’s command. The seven officers were the CFAC Mission Director,
Airborne Command Element, 963d Squadron Commander, AWACS Mission
Crew Commander, AWACS Senior Director, AWACS Enroute Controller, and
AWACS TAOR Controller. On July 18, 1994, the Convening Authority
appointed an Inquiry Officer to conduct the RCM 303 investigation.

The Commander, U.S. Air Forces in Europe, designated the Commander of
the 17th Air Force as the court-martial Convening Authority. On July 22,
1994, the Convening Authority appointed an Inquiry Officer to conduct a
preliminary inquiry under RCM 303 into the roles of the following seven
officers in the shootdown: Combined Task Force Commander, CFAC
Commander, CFAC/DO, Combined Task Force Director of Plans and Policy,
Combined Task Force Intelligence Officer, and the two F-15 pilots. The
F-15 pilots were assigned to the 53d Fighter Squadron at Spangdahlem Air
Base, Germany. The Inquiry Officer was the Commander of the 52d Fighter
Wing at Spangdahlem Air Base to whom the F-15 pilots’ squadron
reported.

The Commander, U.S. Army in Europe, directed the Judge Advocate, U.S.
Army in Europe, to determine whether administrative or disciplinary
action was warranted against any Army personnel for their role in the
incident. The actions of one person—the Combined Task Force Chief of
Staff (an Army colonel)—were considered as possible for review.




3
 The Convening Authority is a commissioned officer in command who is authorized to convene
courts-martial. A commander may administer nonjudicial punishment upon military personnel of that
command under Article 15, UCMJ. (Nonjudicial punishment under Article 15 is generally appropriate
when administrative corrective measures are inadequate and a trial by court-martial is not necessary.)
Charges are ordinarily forwarded to the accuseds’ immediate commander for initial consideration as to
disposition. However, a superior commander may withhold a subordinate commander’s disposition
authority. Unless the authority is withheld by a superior commander, each commander has
independent discretion to determine disposition under RCM 306.
4
 An RCM 303 is a preliminary inquiry into suspected offenses to gather all reasonably available
evidence that bears on guilt or innocence and that relates to mitigating, extenuating, or aggravating
circumstances. The appropriate commander determines what, if any, adverse administrative or judicial
actions should be taken against personnel accused or suspected of committing offenses, triable by
court-martial, that are referred for consideration under RCM 306.



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                    On July 18, 1994, the Convening Authority appointed legal, F-15, and AWACS
Air Combat          advisors to assist the Inquiry Officer. The investigation was conducted
Command’s UCMJ      from July 18 to August 18, 1994. The inquiry team obtained testimony from
Actions Against     AWACS personnel, flew in an AWACS, observed simulated Operation Provide
                    Comfort missions, and interviewed senior directors and controllers not on
AWACS and Related   the incident flight.
Officers
                    The Inquiry Officer prepared a 77-page report, largely consisting of an
                    analysis of the charges against the officers, with 2 volumes of supporting
                    material. The report also reflected the Inquiry Officer’s logic for selecting
                    the appropriate articles of the UCMJ that might be applicable to the actions
                    of the AWACS-related personnel, including manslaughter, negligent
                    homicide, and dereliction of duty. The Inquiry Officer said that voluntary
                    or involuntary manslaughter charges would be inappropriate against the
                    AWACS-related officers for their involvement in the shootdown. The Inquiry
                    Officer concluded that negligent homicide charges could be made against
                    some of them for their involvement in this matter; but he recommended
                    against this course of action, because “the occurrence of an independent,
                    unforeseeable, intervening act, namely the incorrect identification of the
                    helicopters by the F-15 pilots . . .” would not support a conviction for
                    negligent homicide.

                    On August 30 and 31, 1994, the Inquiry Officer preferred
                    dereliction-of-duty charges against the following AWACS-related officers:
                    the Airborne Command Element, the Mission Crew Commander, the
                    Senior Director, the Enroute Controller, and the TAOR Controller. No
                    charges were preferred against the 963d Airborne Air Control Squadron
                    Commander or the Mission Director. The Inquiry Officer concluded that
                    no adverse action should be taken against the Mission Director because he
                    had not failed to take any required actions.

                    On September 7, 1994, the Convening Authority appointed an Article 32,
                    UCMJ, Investigating Officer, who was assigned to the U.S. Air Force Trial
                    Judiciary,5 to examine the charges against the five charged officers, in
                    accordance with RCM 405. The Convening Authority directed the
                    Investigating Officer to inquire into the truth of the matters set forth in the
                    charges, secure information to determine what their disposition should be,
                    and issue a report and advisory recommendations. The Investigating
                    Officer held a joint Article 32 investigative hearing involving all five
                    officers from October 11 to October 26, 1994. Forty-eight witnesses

                    5
                     Investigating officers should be an officer in the grade of major, lieutenant commander, or higher, or
                    one with legal training. In this case, a military judge outside the chain of the Convening Authority’s
                    command was appointed.



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                        testified at the hearing; and the government and defense attorneys entered
                        271 exhibits, including 54 classified exhibits, into the hearing record. The
                        Investigating Officer issued his report on November 12, 1994, and
                        recommended that the dereliction-of-duty charge against the Senior
                        Director be referred to a general court-martial. He also recommended that
                        the Enroute Controller receive nonjudicial punishment under Article 15,
                        UCMJ, and that the charges against the remaining three officers be
                        dismissed.


                        In his appointment letter, the Commander, 17th Air Force, directed the
U.S. Air Forces in      RCM 303 Inquiry Officer to (1) determine if any of the seven officers
Europe’s UCMJ           (Combined Task Force Commander and staff and two F-15 pilots) had
Actions Against         committed acts related to the shootdown that amounted to offenses
                        punishable under the UCMJ, (2) recommend disposition of any offense and
Operation Provide       whether administrative actions were warranted, and (3) file charges if
Comfort Officials and   warranted. He also appointed two legal advisors and a technical advisor to
                        assist the Inquiry Officer. The Inquiry Team reviewed the Aircraft Accident
F-15 Pilots             Investigation Board report and supporting documentation. It neither
                        obtained oral testimony nor collected any additional evidence; instead, it
                        relied on witness interviews conducted by the Board.

                        On August 29, 1994, the Inquiry Officer issued a 66-page report on his
                        investigation. The report identified the following as “possible” offenses:
                        dereliction of duty by all seven officers, involuntary manslaughter by the
                        F-15 pilots, and negligent homicide by all the officers except the
                        Intelligence Officer. After concluding that three officers had committed
                        violations under the UCMJ, the Inquiry Officer preferred dereliction-of-duty
                        charges against two Operation Provide Comfort senior officers and
                        dereliction-of-duty and negligent homicide charges against one F-15 pilot,
                        the wingman.

                        On September 8, 1994, the Commander, U.S. Air Forces in Europe,
                        appointed an Article 32 Investigating Officer,6 who was assigned to the
                        U.S. Air Force Trial Judiciary, European Circuit, to investigate the charges
                        against the F-15 wingman.7 In accordance with RCM 405, Manual for
                        Courts-Martial, the Commander directed the Investigating Officer to
                        inquire into the truth of the matters set forth in the charges by the Inquiry

                        6
                         In this case, a military judge outside the chain of the Convening Authority’s command was appointed
                        as Investigating Officer.
                        7
                         The charges against the two senior officers were dismissed; and, thus, Article 32 investigations were
                        not conducted.



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Officer, secure information to determine what disposition should be made
of the charges, and issue a report with advisory recommendations. The
Investigating Officer held an Article 32 hearing on November 7-9, 1994. The
government attorneys called one witness—the F-15 flight leader8—and
entered 18 exhibits into the hearing record. The exhibits included (1) the
transcript of the F-15 wingman’s taped account of the shootdown made in
the cockpit approximately 45 minutes after the shootdown, (2) the
wingman’s testimony before the Aircraft Accident Investigation Board, and
(3) the flight leader’s testimony during the investigation of the aircraft
accident and the AWACS Article 32 hearing. The defense attorneys called no
witnesses and entered 116 exhibits into the hearing record, including a
prepared statement read by the wingman during the hearing and a
detailed, 102-page factual and legal presentation of his theory of the case.

The Investigating Officer issued his report on November 12, 1994, and
recommended dismissal of the charges against the wingman. His analysis
focused on whether the lead pilot had called the AWACS announcing the
engagement before or after the wingman responded to the lead pilot’s
directive to confirm whether the helicopters were Iraqi Hinds. He
concluded that if the call was made before the wingman’s response, the
lead pilot had relieved the wingman of the duty to independently identify
the helicopters. Based on his review of the pilots’ testimony9 and the
wingman’s experience, he concluded that it was more likely that the lead
pilot’s engagement announcement had preceded the wingman’s alleged
“nonresponsive” confirmation.10




8
 Captain Eric A. Wickson, the flight leader, was granted testimonial immunity for the purpose of
testifying at the wingman’s (Lieutenant Colonel Randy W. May) Article 32 investigative hearing.
Captain Wickson could still be charged, based on all evidence obtained from sources other than his
testimony at these proceedings.
9
 The Investigating Officer found that the wingman consistently stated on three occasions (in the
cockpit 45 minutes after the incident, in his Aircraft Accident Investigation Board testimony, and in his
Article 32 hearing) that the lead pilot had overridden the confirmation directive. He also considered
that the lead pilot, during his Article 32 testimony, had begun to discount significantly his need for the
wingman’s confirmation.
10
  The Aircraft Accident Investigation Board and the RCM Inquiry Officer concluded that the wingman’s
“Tally two” response led the lead pilot to believe reasonably that the wingman had independently seen
two Iraqi Hind helicopters. The wingman has stated that the “Tally two” response merely confirmed his
sighting of two helicopters, not identification of the helicopters.



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                         The Military Justice Process and
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                         On September 30, 1994, the Judge Advocate, U.S. Army in Europe, advised
UCMJ Activities          the Commander, U.S. Army in Europe, that consideration was warranted
Concerning Combined      concerning whether the Combined Task Force Chief of Staff was
Task Force Chief of      responsible for the breakdown in staff communication that had been cited
                         in the Board report. After reviewing the relevant Board testimony and
Staff                    other evidence, however, he recommended that no adverse action be
                         taken against the officer because he had (1) focused his attention
                         according to the Combined Task Force Commander’s direction, (2) had
                         neither specific direction nor specific reason to inquire into the
                         transmission of information between his Director of Operations for Plans
                         and Policy and the CFAC, (3) been the most recent arrival and the only
                         senior Army member of a predominately Air Force staff and therefore
                         generally unfamiliar with air operations, and (4) relied on experienced
                         colonels under whom deficiencies had occurred.


                         The Flying Evaluation Boards11convened as a result of the shootdown,
Actions by Flying        made findings concerning the proficiency, professionalism, care, and
Evaluation Boards        judgment of the two pilots, and made recommendations concerning their
and Air Force Chief of   suitability for future aviation responsibilities. Upon review of the Boards’
                         findings and recommendations, the Commander, 17th Air Force
Staff                    determined that both pilots should be reassigned to noncombat aircraft.
                         He further recommended that the F-15 lead pilot, Captain Eric A. Wickson,
                         should be assigned next as an instructor pilot in basic flight training. The
                         Commander, U.S. Air Forces in Europe concurred with this determination
                         and also concluded that the F-15 wingman, Lieutenant Colonel Randy W.
                         May12 should be reassigned to a nonflying aviator staff position.

                         On the basis of his review of administrative actions taken by higher-level
                         authorities regarding Air Force personnel involved in the shootdown, the
                         Air Force Chief of Staff determined that the personnel records of some
                         involved personnel did not reflect their failure to meet Air Force
                         standards. Accordingly, for seven of those involved in the incident, he
                         wrote letters of evaluation that addressed how each of the officers had
                         failed to meet these standards and took additional action against five
                         officers.

                         11
                          If questions arise regarding a pilot’s fitness to continue flying, a commander may convene a Flying
                         Evaluation Board. That board conducts a hearing in which the pilot can present evidence and
                         cross-examine witnesses. After considering evidence concerning the pilot’s professional qualifications
                         and evaluating the pilot’s ability to perform future flying duties, the Flying Evaluation Board issues an
                         advisory recommendation to the convening commander. (Air Force Regulation 60-13)
                         12
                           Lieutenant Colonel May retired as a Major, the last grade at which, as determined by the Secretary of
                         the Air Force, he had performed satisfactorily.



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Flying Evaluation Boards   On January 20 and 25, 1995, the Commander, 17th Air Force, appointed
                           separate Flying Evaluation Boards for Captain Wickson and Lieutenant
                           Colonel May. Each board consisted of a senior board member and two
                           board members, all of whom were pilots; a legal advisor; a recorder; and a
                           reporter. The Commander, 17th Air Force, directed the two senior board
                           members to make special findings on whether the pilots had shown lack of
                           judgment in performing their duties on April 14, 1994, and whether they
                           were unsuited for duty in a combat aircraft role. The Commander, 17th Air
                           Force, also directed the boards to make recommendations on whether the
                           pilots had potential to continue flying.


Evidence                   Captain Wickson’s Flying Evaluation Board was held on February 6, 1995;
                           and Lieutenant Colonel May’s, on February 9-10, 1995. The pilots were the
                           only witnesses in their Flying Evaluation Board hearings. The government
                           and defense attorneys submitted eight volumes of evidence in the Wickson
                           hearing and seven volumes of evidence in the May hearing, including the
                           Aircraft Accident Investigation Board summary of facts and executive
                           summary; the Operation Plan for Operation Provide Comfort; the Aircrew
                           Read File; each pilot’s testimonies before the Aircraft Accident
                           Investigation Board and Article 32 hearings; the transcript of Lieutenant
                           Colonel May’s aircraft videotape of the incident; a Kurdish citizen’s
                           videotape of the incident; and each pilot’s medical and training records,
                           ratings, and awards.

                           On April 5, 1995, the Commander, U.S. Air Forces in Europe, concurred
                           with the boards’ recommendations that Lieutenant Colonel May and
                           Captain Wickson remain qualified for aviation service. He also directed
                           that Lieutenant Colonel May be reassigned to a staff position not involving
                           flying duties and that Captain Wickson be reassigned to flying duties (1) as
                           an instructor in basic flying training or (2) in other noncombat aircraft.


Air Force Chief of Staff   On July 25, 1995, the Secretary of the Air Force requested that the Air
Actions                    Force Chief of Staff review the administrative actions taken in regard to
                           the Air Force personnel involved in the shootdown. On August 9, 1995, the
                           Air Force Chief of Staff advised the Secretary of the Air Force of the
                           actions he had taken.

                           The Chief of Staff said that the military justice process had worked as it
                           was supposed to after the incident and that he was comfortable with the
                           military justice actions taken. He concluded that a proper balance between



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    The Military Justice Process and
    Administrative Actions




    command involvement and individual rights had been maintained
    throughout the military justice process. Further, the administrative actions
    taken by commanders were within an appropriate range of options
    available to them. However, he said that a number of performance
    evaluations of involved personnel were inadequate because they were
    inconsistent with administrative actions taken by higher-level
    commanders and failed to reflect that the ratees had not met Air Force
    standards. Accordingly, pursuant to authority granted him by the Secretary
    of the Air Force, he prepared the following letters of evaluation regarding
    seven of the Air Force personnel involved in the shootdown and
    implemented additional actions against five.

•   Combined Task Force Commander, Brigadier General Jeffrey S.
    Pilkington. A letter of evaluation addressed his failure to meet Air Force
    standards and became a permanent part of his record.
•   CFAC Commander, Brigadier General Curtis H. Emery.13 A letter of
    evaluation was placed in his permanent record to reflect his failure to
    meet Air Force standards.
•   F-15 Wingman, Lieutenant Colonel Randy W. May. A letter of evaluation
    was placed in his officer selection record to reflect his failure to meet Air
    Force standards. He was disqualified from aviation service for 3 years.
•   F-15 Lead Pilot, Captain Eric A. Wickson. A letter of evaluation was placed
    in his officer selection record to reflect his failure to meet Air Force
    standards. He was disqualified from aviation service for 3 years based on
    his demonstrated lack of judgment associated with flight activities.
•   AWACS Senior Director, Captain Jim Wang. A letter of evaluation detailing
    his failures to meet Air Force standards was included in his officer
    selection record and disqualified him from assignment to duties involving
    control of aircraft in air operations for at least 3 years.
•   AWACS Enroute Controller, Captain Joseph M. Halcli.14 A letter of
    evaluation reflecting his failure to meet Air Force standards was placed in
    his officer selection record and disqualified him from assignment to duties
    involving control of aircraft in air operations for at least 3 years.
•   AWACS TAOR Controller, First Lieutenant Ricky L. Wilson.15 A letter of
    evaluation reflecting his failure to meet Air Force standards was placed in
    his officer selection record. It recommended that he not be assigned to
    duties involving control of aircraft in air operations for at least 3 years.



    13
      At the time of the incident, Brigadier General Emery was a Colonel.
    14
      At the time of the incident, the AWACS Enroute Controller was a First Lieutenant.
    15
      At the time of the incident, the AWACS TAOR Controller was a Second Lieutenant.



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                    Our review of the summary reports of investigation during the UCMJ
The Question of     process and statements by officials knowledgeable of that process
Command Influence   revealed no evidence of command influence. However, we were unable to
                    confirm that the consideration and disposition of suspected offenses
                    under UCMJ had not been subject to unlawful command influence because
                    we were denied our request to interview applicable UCMJ Convening
                    Authorities, Inquiry Officers, and Investigating Officers.

                    The Investigating Officer in the AWACS Article 32 hearing stated that he had
                    not been subject to command influence during the proceedings. The
                    counsel for the Senior Director, Captain Wang, had filed a motion to
                    dismiss the charges against the Senior Director based on an allegation of
                    unlawful command influence by the Secretary of Defense on the Secretary
                    of the Air Force. In response to that motion, six officials provided either a
                    Stipulation of Expected Testimony, a memorandum, or an affidavit stating
                    that they had neither been the subject of improper command influence nor
                    taken action to improperly influence military justice officials. These
                    officials were the Secretary of the Air Force; Air Force Chief of Staff;
                    Commander, Air Combat Command; Deputy Staff Judge Advocate,
                    Headquarters Air Combat Command (Legal Advisor to the RCM 303); the
                    RCM 303 Inquiry Officer; and the General Court-Martial Convening
                    Authority, the Commander, 8th Air Force.16 The convening judge denied
                    the motion, ruling that the defense had failed to meet its burden of
                    establishing at least the appearance of unlawful command influence.
                    Further, to address the question of command influence in the case of the
                    Senior Director, Captain Wang’s military attorney told us that he
                    interviewed the Secretary of the Air Force about whether she or the
                    Secretary of Defense had intervened in the court-martial. The attorney was
                    satisfied that neither of them had exercised command influence during the
                    UCMJ process.


                    However, our request to the Air Force and the Department of Defense to
                    interview military officials involved in the Black Hawk UCMJ proceedings
                    was denied. These officials included the Convening Authorities, RCM 303
                    Inquiry Officers, and Article 32 Investigating Officers for investigations by
                    both the Air Combat Command and the U.S Air Forces in Europe. The
                    Department of Defense voiced the belief that “any Congressional intrusion
                    into the deliberative process . . . endangers the actual and perceived
                    independence of the military justice system.” We assured the Air Force
                    that we would ask those officials only about the presence of unlawful

                    16
                     Similar stipulations were not provided by the three officials involved in the U.S. Air Forces in Europe
                    UCMJ investigations of five Operation Provide Comfort officials and two F-15 pilots.



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command influence and would not intrude into the deliberative processes
they had used in the proceedings, but we were denied access to those
decision-makers who might have knowledge of possible influence.
Consequently, we were unable to confirm whether the consideration and
disposition of suspected offenses under the UCMJ were the result of
improper or unlawful command influence.




Page 46                  GAO/OSI-98-4 Review of USAF Investigation of Fratricide Incident
Chapter 4

Corrective and Other Actions by the
Department of Defense and the Air Force
After the Shootdown
                       In accord with concerns voiced by victims’ family members and others, we
                       also looked at the corrective and other actions taken after the shootdown.
                       Military officials took immediate actions to help ensure that the Black
                       Hawk accident was not repeated. Further, after the issuance of the
                       Aircraft Accident Investigation Board report, the European Command; the
                       Chairman, Joint Chiefs of Staff; the Air Combat Command; and the Air
                       Force instituted a large number of corrective actions. These actions
                       included modification of the Rules of Engagement; inclusion of Black
                       Hawk flight times on the Air Tasking Order; reviews of command structure
                       and operations, plus operating doctrines and procedures; revision of AWACS
                       training programs and certification procedures; and modifications of
                       visual and electronic identification training.

                       In transmitting the Board report to the Secretary of Defense, the Chairman
                       of the Joint Chiefs of Staff made the following observation:

                       “For over 1,000 days, the pilots and crews assigned to Operation Provide
                       Comfort flew mission after mission, totalling over 50,000 hours of flight
                       operations, without a single major accident. Then, in one terrible moment
                       on the 14th of April, a series of avoidable errors led to the tragic deaths of
                       26 men and women of the American Armed Forces, United States Foreign
                       Service, and the Armed Forces of our coalition allies. In place were not
                       just one, but a series of safeguards—some human, some procedural, some
                       technical—that were supposed to ensure an accident of this nature could
                       never happen. Yet, quite clearly, these safeguards failed.”

                       According to an Air Combat Command official who was familiar with the
                       Board’s report and who participated in the Command’s UCMJ
                       investigations, over 130 separate mistakes were involved in the
                       shootdown. A discussion follows of some corrective actions spawned by
                       the shootdown and the Aircraft Accident Investigation report.


                       Beginning April 15, 1994, the European Command and Combined Task
Immediate Corrective   Force Commanders instituted immediate corrective actions designed to
Actions                prevent a recurrence of the shootdown. The actions included, among
                       others, modification of the Rules of Engagement, to restrict procedures for
                       engaging Iraqi helicopters; inclusion of Black Hawk flight times on the Air
                       Tasking Order; requirement for verbal confirmation of a positive IFF Mode
                       IV check on all Operation Provide Comfort aircraft prior to their entry into
                       the TAOR; reorganization of the Combined Task Force to designate one U.S.
                       Air Force Colonel exclusively as the Commander, CFAC; further definition



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                          Chapter 4
                          Corrective and Other Actions by the
                          Department of Defense and the Air Force
                          After the Shootdown




                          of AWACS responsibilities for coordination of air operations; placement of
                          radios on Black Hawk flights to enable communication with fighter
                          aircraft; and painting of white recognition stripes on the Black Hawk rotor
                          blades to enhance their identification from the air.


                          In response to a directive from the Deputy U.S. Commander in Chief,
European Command’s        Europe, an Air Force/Army team assessed Operation Provide Comfort’s
Operations                mission, organization, and operations. The assessment was conducted
Assessments and           from May 31 to June 8, 1994, and placed particular emphasis on the
                          adequacy of European Command guidance and oversight; the Combined
Corrective Actions        Task Force command structure and organization, manning, and support;
                          and operating doctrine and procedures. The assessment team flew
                          missions with F-15, Black Hawk, and AWACS units; interviewed key
                          personnel and random unit personnel; and reviewed organizational plans,
                          procedures, and directives. The team issued a 59-page classified report
                          that contained over 40 recommendations for operations improvements.
                          During October 14-22, 1995, a second team conducted another operational
                          assessment of Operation Provide Comfort and made 166 additional
                          recommendations in a classified report. A number of recommendations
                          made by both teams have been implemented.


                          On July 7, 1994, the Chairman of the Joint Chiefs of Staff, with the
Joint Chiefs of Staff’s   approval of the Secretary of Defense, directed that (1) all Commanders in
Corrective Actions        Chief review their Joint Task Force operations to ensure that they were
                          conducted in accordance with published joint doctrine; (2) the
                          Commanders in Chief establish a program of regular oversight of all their
                          Joint Task Force operations; and (3) his staff review the curricula of all
                          appropriate professional military education institutions to ensure proper
                          emphasis on Joint Task Force organization, procedures, and operations.
                          The Chairman also recommended that the Secretary of Defense direct the
                          Air Force Chief of Staff to review the adequacy of AWACS training programs
                          and certification procedures, develop a retraining program based on the
                          lessons learned from the shootdown, and ensure that all mission aircrews
                          underwent this training. The Chairman further convened a conference of
                          the Joint Chiefs and all Commanders in Chief on September 15, 1994, to
                          discuss actions being taken to prevent a recurrence of the shootdown.

                          On October 6, 1994, the Chairman advised the Secretary of Defense that all
                          Commanders in Chief had completed reviews of their joint operations,
                          aggressively implemented changes where required, and established



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                         Chapter 4
                         Corrective and Other Actions by the
                         Department of Defense and the Air Force
                         After the Shootdown




                         programs to ensure regular oversight of those operations. Further, the
                         Joint Staff found shortcomings in how Joint Task Force operations had
                         been addressed in professional military education systems. According to
                         the Chairman, each of the shortcomings was being addressed and
                         corrections implemented.


                         At the direction of the Secretary of Defense and the Chairman of the Joint
Air Combat               Chiefs of Staff, the Secretary of the Air Force tasked the Air Combat
Command’s—Tiger          Command to investigate the specific operational issues identified in the
Team’s—Corrective        Aircraft Accident Investigation Board report. The Air Combat Command
                         assembled a “Tiger Team” consisting primarily of Air Combat Command
Actions                  headquarters staff augmented with representatives from the 8th Air Force,
                         Air Force Weapons Center, Air National Guard, and the 552d Air Control
                         Wing. The team divided into three groups: AWACS/Airborne command and
                         control, visual and electronic identification, and ground command and
                         control. The three groups used the Aircraft Accident Investigation Board
                         report as a frame of reference and identified 90 issues, which they studied
                         in depth. The Air Combat Command Tiger Team issued its report on
                         September 14, 1994, making about 140 recommendations, most of which
                         had been completed or were underway when the report was issued. The
                         report also proposed six recommendations for consideration by the Air
                         Staff or the Joint Chiefs of Staff.


                         Concurrent with the Air Combat Command tasking, the Secretary of the
Air Force Special Task   Air Force appointed an Air Force special task force to assist all Air Force
Force                    commands in identifying potential problem areas and implementing
                         appropriate corrections. The task force effort, which included the Air
                         Combat Command Tiger Team work, involved over 120 people and over
                         30,000 hours in 6 major Air Force commands and Air Force Headquarters.
                         The task force’s primary emphasis was to determine if the shootdown was
                         an isolated incident or indicative of a bigger problem. It issued its report to
                         the Secretary of Defense on September 30, 1994. The report concluded
                         that the incident was not indicative of a larger Air Force problem and that
                         the following two breakdowns in individual crew performance had
                         contributed to the incident: (1) the AWACS failed to build and provide an
                         accurate air picture and (2) the F-15 pilots misidentified the target.

                         The report also recommended a one-time retraining and recertification
                         program for all AWACS aircrews and a plan to reduce the temporary duty of
                         AWACS crews to 120 days per year. The report concluded that the Air Force




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                        Chapter 4
                        Corrective and Other Actions by the
                        Department of Defense and the Air Force
                        After the Shootdown




                        had corrected, or was in the process of correcting, training programs to
                        address the shortcomings noted.


Air Combat Command      On July 27, 1995, the Commander, Air Combat Command, informed the Air
Updates on Corrective   Force Chief of Staff that the Air Combat Command had completed a
Actions                 majority of the Tiger Team recommendations and that efforts were on
                        target in achieving the desired results. He said that all AWACS crews had
                        been recertified by October 13, 1994, and that the certification process was
                        being applied to all AWACS crews deploying to any location. He further
                        stated that AWACS temporary duty rates had been decreased from 166 to
                        135 days per year from January 1995 to July 1995. He also said that Air
                        Combat Command planned to increase the number of AWACS crews.1

                        However, he noted that the Air Combat Command was continuing to work
                        on the following three areas: computer-based training devices, visual
                        identification, and electronic identification. For example, he stated that
                        the Air Combat Command had updated visual identification training
                        material, provided computer hardware for the Air Force-improved
                        computer-based training developed by an Air Force contractor, and
                        distributed the material to all Air Combat Command fighter units. The
                        Commander, Air Combat Command, noted that the new product was an
                        improvement over previous training materials (35MM slides and video) but
                        that it did not fully meet the Command’s needs. He said that the Air
                        Combat Command, in conjunction with the Air Education and Training
                        Command, was pursuing an enhanced visual training program that would
                        expand capabilities and allow aircrews to view three-dimensional or
                        animated images against a variety of backgrounds from multiple aspects in
                        all configurations and camouflage paint schemes. This new program was
                        distributed to all Air Combat Command units in January 1996.




                        1
                         By August 1996, the number of AWACS crews had been increased to 40 from the 28 available at the
                        time of the shootdown.



                        Page 50                     GAO/OSI-98-4 Review of USAF Investigation of Fratricide Incident
Page 51   GAO/OSI-98-4 Review of USAF Investigation of Fratricide Incident
Appendix I

Aircraft Accident Investigation Board
President’s Opinion




               Page 52   GAO/OSI-98-4 Review of USAF Investigation of Fratricide Incident
Appendix I
Aircraft Accident Investigation Board
President’s Opinion




Page 53                  GAO/OSI-98-4 Review of USAF Investigation of Fratricide Incident
Appendix I
Aircraft Accident Investigation Board
President’s Opinion




Page 54                  GAO/OSI-98-4 Review of USAF Investigation of Fratricide Incident
Appendix II

Comments From the Department of Defense




              Page 55   GAO/OSI-98-4 Review of USAF Investigation of Fratricide Incident
Appendix III

Major Contributors to This Report


               Barbara W. Alsip; Neyla Arnas; Fred Chasnov; Richard E. Chervenak;
               Barbara C. Coles; Donald G. Fulwider; Robert J. Gettings; Joan M.
               Hollenbach; M. Jane Hunt; Woodrow H. Hunt, Jr.; Shelia A. James; Paul E.
               Jordan; James M. Lager; William E. McDaniel, II; Richard C. Newbold; and
               Carin M. Wyche.




(600392)       Page 56             GAO/OSI-98-4 Review of USAF Investigation of Fratricide Incident
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