With Congressional pressure and media scrutiny intensifying, the defense secretary came out with a bold plan to fix the Pentagon’s struggling mission to recover remains of missing service members: reorganize the effort into a new agency.

“This new organization provides an efficient management structure for pursuing our goal of obtaining the fullest possible accounting for all missing Americans. Resolving POW/MIA issues is of the highest national priority and we will continue to work vigorously toward this end.”

Those remarks easily could have come from Secretary of Defense Chuck Hagel in March when he announced just such a change. But they were actually made two decades ago, by then-Secretary of Defense Les Aspin when the Pentagon first tried restructuring the bureaucracy as a way to solve troubling issues with the effort. Another consolidation, accompanied by similar rhetoric, happened in 2003.

The Pentagon spends about $100 million annually to recover and identify missing service members from the Vietnam War, Korean War and World War II, but identified just 60 last year – far short of the 200 per year mandated by Congress starting next year. A ProPublica and NPR investigation found that the mission was hampered by outdated science, overlapping bureaucracy and poor leadership.

On March 31, Hagel said that the two major agencies in charge 2014 the Joint Prisoners of War/Missing in Action Accounting Command, or J-PAC, and the Defense Prisoners of War and Missing Personnel Office, or DPMO 2013 would be consolidated into one to streamline the inefficient, duplicative process.

This latest restructuring is the broadest one yet, taking on the science used to make identifications and creating public-private partnerships, but it’s unclear whether it will be a reorganization just on paper like it was in the past. Indeed, the two long-troubled, soon-to-be combined agencies, J-PAC and DPMO, are themselves the product of the earlier consolidations.

Critics on Capitol Hill, in family advocacy groups and among former employees of the agencies all said that in order to have meaningful, lasting impact the changes must go beyond bureaucratic reshuffling to instead include new leadership.

“Any time you have a change that is truly philosophical it’s very difficult to accomplish that if the people being tasked with it still believe in the old ways of doing things,” Cmdr. Renee Richardson, a former DPMO staffer, said.

Given the “stories we’re being told, there definitely should be some people who are fired,” Sen. Claire McCaskill, who was one of the vocal critics on the Hill, said in an interview earlier this year.

Acting Under Secretary of Defense for Policy Michael Lumpkin, who is spearheading the changes, said at the time of the announcement that the new agency will be fundamentally new and different, ridding the effort of “outdated, institutionalized thinking.”

But asked if anyone was being held accountable for the problems that led to the need for changes, Lumpkin referred to a “structurally flawed” system rather than leadership.

The agencies’ current leaders might stay a part of the new as-yet-unnamed agency. Although the positions of DPMO director and J-PAC commander will disappear along with the organizations when the new agency is formed in the next 18 months, Lumpkin said, the people who held those positions “may be reclaimed” in the new organization.

The only personnel changes that have been announced are a director for the new agency who will report to the under secretary of defense for policy and an Armed Forces Medical Examiner who will be in charge of making identifications and overseeing the scientific operations of the lab. The latter strips Tom Holland, J-PAC’s longtime scientific director, of his primary authority, but Lumpkin wouldn’t comment on whether Holland would be a part of the new agency.

ProPublica and NPR reported that under Holland’s leadership, the laboratory has not used DNA as the first step in identifying remains, even though DNA has been the centerpiece of similar efforts worldwide for more than a decade.

Lumpkin did say that Hagel was putting the director of the new agency under the Office of the Secretary of Defense because he wanted someone he could hold accountable for the mission’s responsibilities – what Lumpkin called “a single belly button.”

The civilian leadership of DPMO and J-PAC has been entrenched for decades. Holland has been there since 1992. Johnie Webb, the deputy commander for external relations, has been with J-PAC since 1983. The current director of DPMO, retired Brig. Gen. W. Montague “Que” Winfield, was the first commander of J-PAC.

Complicating matters, for years J-PAC and DPMO have battled each other for territory, authority and responsibility.

Ann Mills-Griffith, founder of the lobbying group National League of POW/MIA Families, described the infighting as “destructive bickering.”

“It’s such a noble mission…every person wants the same thing,” said current J-PAC commander Gen. Kelly McKeague. “Where it breaks down – and this is where I shake my head – is the ‘how.'”

There was also feuding within J-PAC. There have been dozens of complaints about management and a hostile work environment – and employees who left with cash settlements.

With the struggle to make more identifications, Mark Leney, a former J-PAC anthropologist, said it’s hard to discern what “are technical difficulties of a unique mission to execute and what are ordinary issues of poor management.”

The Pentagon’s inspector general is investigating problems with the MIA effort, an inquiry that, according to several people who have been interviewed for it, is expected to address management and leadership issues.

The new agency will also face questions about mission priorities.

The Pentagon has long focused its recovery efforts on troops missing from the Vietnam War, a decision that experts say might not be the best use of its resources now. In fiscal year 2013, for example, J-PAC spent 65 percent of its field mission budget in Southeast Asia, but identified just nine Vietnam veterans.

In part, this is because the soil in Southeast Asia is so acidic it eats away at bones, essentially dissolving them. Several current and former J-PAC scientists have said that time might have run out there – there just may not be bones left to find.

Still, it remains politically delicate to cross advocates for Vietnam vets, some of whom have accused the government of covering up the existence of live POWs.

Mills-Griffiths, the most prominent and well-connected advocate for those missing from Vietnam, has long pushed to keep Vietnam at the forefront of MIA recovery efforts. Hagel personally thanked her at his press conference announcing the reorganization, and many of its features were recommended by her.

In a memo to Hagel, Mills-Griffiths blamed J-PAC’s decision to not increase field operations in Vietnam in part on a “misplaced focus by some on remains recoveries related to WWII as a means of increasing the number of IDs.”

Lisa Phillips, founder of WWII Families for the Return of the Missing, said, “We want exactly as Congress mandated. The fullest possible accounting of all POW MIA services members, regardless of the circumstances of the loss.”

Mills-Griffiths, whose brother is among the missing from Vietnam, has said the MIA effort was started for Vietnam vets, so families from other wars need “to stand in line“2013 raising the ire of advocates for World War II and Korean War veterans. But she has also said it isn’t a competition. Efforts on behalf of one war’s veterans shouldn’t be at the expense of others, she said.

Some families of troops missing in Southeast Asia have fought the disinterment of almost 10,000 troops buried as unknown casualties of the Korean War and World War II. That discord led to a 2009 DPMO memo saying that exhuming the graves of unknowns and using DNA to try to identify them should take a back seat to finding remains of service members still lost on the battlefield.

Lumpkin said the new agency would pursue more disinterments, but didn’t provide any details. J-PAC currently only exhumes remains in about 4 percent of the cases in which such a step is recommended. The average disinterment costs about $1,000 – significantly less than field operations.

Some families of missing troops from World War II and their advocates are hoping they will benefit from the move to embrace public-private partnerships, which could free their loved ones’ cases from the government’s grasp and allow them to move forward faster.

Updated May 15, 2014 3:38 p.m.: The article was updated to clarify that CDC estimates for nonfatal, violent gun injuries “include only injuries caused by violent assault, not accidents, self-inflicted injuries, or shootings by police.”

How many Americans have been shot over the past 10 years? No one really knows. We don’t even know if the number of people shot annually has gone up or down over that time.

The government’s own numbers seem to conflict. One source of data on shooting victims suggests that gun-related violence has been declining for years, while another government estimate actually shows an increase in the number of people who have been shot. Each estimate is based on limited, incomplete data. Not even the FBI tracks the total number of nonfatal gunshot wounds.

“We know how many people die, but not how many are injured and survive,” said Dr. Demetrios Demetriades, a Los Angeles trauma surgeon who has been studying nationwide gunshot injury trends.

While the number of gun murders has decreased in recent years, there’s debate over whether this reflects a drop in the total number of shootings, or an improvement in how many lives emergency room doctors can save.

Doctors and researchers have been advocating for better gun injury data since the late 1980s. But fierce political battles over gun violence research — including pressure from congressional Republicans that put an end to some government-funded studies on firearms — has meant that we still don’t know many basic facts about gun violence in America.

“In the absence of real data, politicians and policymakers do what the hell they want,” Dr. David Livingston, the director of the New Jersey Trauma Center at University Hospital in Newark. said “They do what the hell they want anyway,” he added, “but in the absence of data, they have nobody to call them on it.”

An initial push to create a national database of firearm injuries in the late 1980s and early 1990s was slowed by the political fight over Centers for Disease Control and Prevention funding for gun research, according to a history of the project written by researchers who worked on it. To make the effort more politically viable, as well as more scientifically rigorous, researchers decided to collect data on all violent deaths, not just firearm deaths.

And to cut costs, they decided to focus only on fatal injuries. Even that more limited effort has languished without full congressional funding — the database currently covers fewer than half of all states.

Most discussions of crime trends in America look back 20 years, to 1993, when violent crime of all kinds hit its peak. Compare 1993 to today, and the picture looks bright: The number of murders is down nearly 50 percent, and other kinds of violent crime have dropped even further.

The Department of Justice has estimates of nonfatal shootings that suggest a similar trend: Its National Crime Victimization Survey shows a decline, from an average of about 22,000 nonfatal shootings in 2002, to roughly 12,000 a year from 2007 to 2011, according to a Department of Justice statistician.

But over the same time period, CDC estimates show that the number of Americans coming to hospitals with nonfatal, violent gun injuries has actually gone up: from an estimated 37,321 nonfatal gunshot injuries in 2002 to 55,544 in 2011. (These numbers include only injuries caused by violent assault, not accidents, self-inflicted injuries, or shootings by police.)

The contrast between the two estimates is hard to clear up, since each data source has serious limitations.

Experts say that household data-gathering efforts, like the National Crime Victimization Survey, likely miss the Americans who are most likely to be victims of gun violence.

Shooting victims are “disproportionately young men of color who are living unstable lives and often involved in underground markets or criminal activity, and this is a group that is incredibly difficult to survey,” said Philip Cook, a gun violence expert at Duke University. “A lot of them are in jail at any point in time, or if they’re not in jail, they have no stable address.”

Meanwhile, the CDC numbers are based on a representative sample of 63 hospitals nationwide, and the margin of error for each estimate is very large. The CDC’s best guess for the number of nonfatal intentional shootings in 2012 is somewhere between 27,000 and 91,000.

“Uncertainty in the estimates precludes definitive conclusions,” one group of medical researchers explained in a back-and-forth in a journal on internal medicine last year.

The FBI also gathers data on gun crime from local police departments, but most departments do not track the number of people who are shot and survive. Instead, shootings are counted as part of the broader category of “aggravated assault,” which includes a range of gun-related crimes, from waving a gun at threateningly to actually shooting someone.

There were about 140,000 firearm aggravated assaults nationwide in 2012, according to the FBI’s report. How many of those assaults represent someone actually getting shot? There’s no way to tell.

The lack of a clear number of nonfatal shootings has caused confusion.

A frequently cited 2012 Wall Street Journal article attributed the falling murder rate to advances in trauma care: “In Medical Triumph, Homicides Fall Despite Soaring Gun Violence.” The article based its conclusion — that “America has become no less violent” over the past two decades — on the CDC’s shooting estimates.

The article did not cite the other estimates of gun violence that show shootings trending down, or the level of uncertainty in the CDC’s own data.

Livingston, the Newark trauma surgeon, said that it’s “very nice” when journalists give trauma surgeons credit for saving more lives. “I think that improvements in trauma care clearly have made a great difference,” he said. “On the other hand, if you don’t know the extent of all of the patients, and all of the data, you can make some erroneous conclusions.”

At University Hospital, which treats the vast majority of shooting victims from Newark and surrounding towns, Livingston and other doctors decided to do their own research.

“It’s easy to count dead people. But counting people who are merely injured? The data was all over the place, and, frankly, terrible,” Livingston said.

In a paper published early this year, they looked back at their own hospital’s records and logged every gunshot wound patient from 2000 to 2011.

What they found was that the number of patients injured by guns had actually held roughly steady over the past decade. But the injuries were getting worse. The percentage of patients who came in with multiple bullet wounds had increased from only 10 percent in 2001 to 23 percent in 2011. The incidence of brain and spinal cord injuries almost doubled.

And though trauma care has advanced over the past decade, the mortality rate for gunshot wound patients in Newark had actually increased, from 9 percent to 14 percent.

With more severe gunshot injuries came increased costs. The researchers estimated the total cost over 10 years for their hospital was at least $115 million — and three quarters of that was unreimbursed, which meant that taxpayers ultimately paid the bills.

In total, the hospital had treated an average of 527 patients with intentional violent gunshot injuries each year: “unrelenting violence,” as the researchers termed it.

Are the trends that the Newark researchers observed an anomaly? Or are gunshot wound injuries across the county becoming more severe, as they have at this one hospital? The Newark researchers looked for national data and could not find it.

After the American Bar Association and medical and public health groups collaborated on an extensive campaign — with the message, “what we don’t know is killing us” — Congress did approve funds to begin building a National Violent Death Reporting System in 2002. The push was inspired by a successful effort to track highway vehicle accidents, which experts say has helped reduce the number of deaths from car crashes.

But until last year, the system had only received enough congressional funding to collect detailed data on deaths in 18 states. Then after the Sandy Hook shootings, Congress approved an additional nearly $8 million for database, though that still isn’t enough to detail violent deaths in all 50 states.

President Obama has asked for enough funding next year — $23.5 million — to allow the CDC to finally begin to collect violent death data nationwide.

As for tracking the number of Americans who are violently injured and survive, CDC spokeswoman Courtney Lenard, said simply, that “is something that may be considered in the future.”

Funding a CDC effort to track nonfatal violence is not the only path to getting a better answer. Livingston and Demetriades, the Los Angeles trauma surgeon, suggested that independent medical associations could also help collect national nonfatal gun injury data, supported by government funding, and perhaps by legislation. In order to get a clear picture of gun violence, injury data from hospitals should be combined with local law enforcement data about crimes, they said.

Another solution might be better FBI data. “In my opinion, the FBI’s UniformCrime Reports system should be changed so that it tracks nonfatal gunshot woundings in criminal assaults,” said Daniel Webster, a gun violence researcher at Johns Hopkins University.

“If the FBI could get local agencies to include nonfatal criminal shootings into its UCR system, you have the capacity to track information that hospitals couldn’t — distinguishing domestic shootings, from gang shootings, from robbery shootings.”

An FBI spokesman said that changes in data collection practices could be made through congressional mandate or through the Criminal Justice Information Services Division Advisory Process, which would require buy-in from an advisory board of local, state and national law enforcement representatives.

In the past, changes to UCR data collection methods have been rare, the spokesman said. But several changes have been made in recent years, including changing the definition of rape, and changing how data about hate crimes is collected.

Cook, the Duke University researcher, said that the first step should be to find out why CDC data shows a different trend than other measures, and clarifying whether the ways hospitals collect data — or changes in the willingness of patients with minor gunshot wounds to come to the hospital for treatment — might explain the disparity.

“We have a variety of other evidence that gun violence is going down,” Cook said. “By Occam’s razor, I’d have to believe that the simplest explanation is that the nonfatal woundings are going down, too.”