Veterans Affairs: Post-hearing Questions Regarding the		 
Departments of Defense and Veterans Affairs Providing Seamless	 
Health Care Coverage to Transitioning Veterans (25-NOV-03,	 
GAO-04-294R).							 
                                                                 
The Ranking Minority Member of the House Committee on Veterans	 
Affairs requested that GAO respond to follow-up questions on its 
testimony on its report "Hand-off or Fumble: Are DOD and VA	 
Providing Seamless Health Care Coverage to Transitioning	 
Veterans?"							 
-------------------------Indexing Terms------------------------- 
REPORTNUM:   GAO-04-294R					        
    ACCNO:   A08947						        
  TITLE:     Veterans Affairs: Post-hearing Questions Regarding the   
Departments of Defense and Veterans Affairs Providing Seamless	 
Health Care Coverage to Transitioning Veterans			 
     DATE:   11/25/2003 
  SUBJECT:   Health care services				 
	     Health hazards					 
	     Health resources utilization			 
	     Medical records					 
	     Military operations				 
	     Military personnel 				 
	     Military personnel records 			 
	     Military policies					 
	     Medical information systems			 
	     Quality assurance					 
	     DOD Operation Iraqi Freedom			 
	     Operation Enduring Freedom 			 
	     Operation Joint Guardian				 

******************************************************************
** This file contains an ASCII representation of the text of a  **
** GAO Product.                                                 **
**                                                              **
** No attempt has been made to display graphic images, although **
** figure captions are reproduced.  Tables are included, but    **
** may not resemble those in the printed version.               **
**                                                              **
** Please see the PDF (Portable Document Format) file, when     **
** available, for a complete electronic file of the printed     **
** document's contents.                                         **
**                                                              **
******************************************************************
GAO-04-294R

United States General Accounting Office Washington, DC 20548

November 25, 2003

The Honorable Lane Evans Ranking Democratic Member Committee on Veterans
Affairs House of Representatives

Subject: Veterans Affairs: Post-hearing Questions Regarding the
Departments of Defense and Veterans Affairs Providing Seamless Health Care
Coverage to Transitioning Veterans

Dear Mr. Evans:

On October 16, 2003, I testified before your Subcommittee's hearing on
Hand-off or Fumble: Are DOD and VA Providing Seamless Health Care Coverage
to Transitioning Veterans?1 This letter responds to your request that we
provide answers to follow-up questions from the hearing. Your questions,
along with my responses, follow.

1. "Is there any reason for us to be optimistic that DOD [Department of
Defense] is in better compliance with force protections and surveillance
policies for Operation Iraqi Freedom than it was for Operation Enduring
Freedom and Operation Joint Guardianship? Why or why not?"

Answer: We believe that strong leadership and appropriate follow-through
are key to improving compliance. We are encouraged that the compliance
problems we found for Operation Enduring Freedom and Operation Joint
Guardian prompted the Assistant Secretary of Defense for Health Affairs
and the military services' Surgeons General to promptly take a number of
actions to help ensure compliance with DOD's force health protection and
surveillance policies. As you know, we recommended that DOD establish an
effective quality assurance program that will ensure compliance with these
policies for all servicemembers.2 In commenting on our report, the
Assistant Secretary of Defense stated that his office had already
established a quality assurance program for pre-deployment and
post-deployment health assessments and that the services have implemented
their quality assurance programs. As you know, Operation Iraqi Freedom is
an ongoing operation with deployments of servicemembers who presumably are
covered by the new quality assurance programs. On the basis these actions,
we are optimistic that progress is

1 See U.S. General Accounting Office: Defense Health Care: DOD Needs to
Improve Force Health
Protection and Surveillance Processes, GAO-04-158T (Washington, D.C.: Oct.
16, 2003).
2 See U.S. General Accounting Office: Defense Health Care: Quality
Assurance Process Needed to
Improve Force Health Protection and Surveillance, GAO-03-1041 (Washington,
D.C.: Sept. 19, 2003).

                        GAO-04-294R Defense Health Care

occurring. However, the extent of compliance can be determined only from
an examination of servicemembers' medical records.

2. "You still believe DOD lacks data on troop locations that obviously
calls into question its ability to provide effective surveillance. It
won't have a system in place until 2007 at the earliest. How could that
impair VA's [Department of Veterans Affairs] ability to determine
presumption of service-connection and effective treatments for exposures?"

Answer: Knowing which servicemembers were at certain locations at specific
times in the theater of operations is important for determining their
possible exposures to chemical, biological, or environmental health
hazards that DOD may know about currently or later discover. Without this
exposure information, it would likely be more problematic for VA to
determine a presumption of service-connection and to ascertain whether
treatments are appropriate.

3. "Has anything improved since your last report on compliance with
policies on force protection and surveillance?"

Answer: When we issued our May 1997 report,3 DOD had not finalized its
draft joint medical surveillance policy. DOD subsequently finalized its
joint medical surveillance policy in August 1997. Although there are some
methodological differences between our May 1997 and September 2003
reports, it is clear that force health protection and surveillance
compliance problems continue in several areas. However, there appears to
be some improvement in DOD's collection of predeployment blood serum
samples from deploying servicemembers. Specifically, we reported, in our
May 1997 report, that 9.3 percent of the 26,000 servicemembers who had
deployed to Bosnia did not have a blood serum sample on file. In contrast,
nearly 100 percent of our samples for deployments examined in our
September 2003 report had blood serum samples on file.

                                   _ _ _ _ _

We are sending copies of this report to the Secretary of Veterans Affairs,
the Office of the Secretary of Defense, and other interested parties. We
will also make copies available to others upon request. In addition, this
report will be available at no charge on the GAO Web site at
http://www.gao.gov.

3 See U.S. General Accounting Office: Defense Health Care: Medical
Surveillance Improved Since Gulf War, but Mixed Results in Bosnia,
GAO/NSIAD-97-136 (Washington, D.C.: May 13, 1997).

                     Page 2 GAO-04-294R Defense Health Care

If you have any questions about this report or need additional
information, please call me at (757) 552-8100.

Sincerely yours,

Neal P. Curtin
Director, Operations and Readiness Issues

(350473)

                     Page 3 GAO-04-294R Defense Health Care

This is a work of the U.S. government and is not subject to copyright
protection in the United States. It may be reproduced and distributed in
its entirety without further permission from GAO. However, because this
work may contain copyrighted images or other material, permission from the
copyright holder may be necessary if you wish to reproduce this material
separately.

The General Accounting Office, the audit, evaluation and investigative arm
of

GAO's Mission 	Congress, exists to support Congress in meeting its
constitutional responsibilities and to help improve the performance and
accountability of the federal government for the American people. GAO
examines the use of public funds; evaluates federal programs and policies;
and provides analyses, recommendations, and other assistance to help
Congress make informed oversight, policy, and funding decisions. GAO's
commitment to good government is reflected in its core values of
accountability, integrity, and reliability.

The fastest and easiest way to obtain copies of GAO documents at no cost
is through the Internet. GAO's Web site (www.gao.gov) contains abstracts
and full-

Obtaining Copies of GAO Reports and Testimony

text files of current reports and testimony and an expanding archive of
older products. The Web site features a search engine to help you locate
documents using key words and phrases. You can print these documents in
their entirety, including charts and other graphics.

Each day, GAO issues a list of newly released reports, testimony, and
correspondence. GAO posts this list, known as "Today's Reports," on its
Web site daily. The list contains links to the full-text document files.
To have GAO email this list to you every afternoon, go to www.gao.gov and
select "Subscribe to e-mail alerts" under the "Order GAO Products"
heading.

Order by Mail or Phone 	The first copy of each printed report is free.
Additional copies are $2 each. A check or money order should be made out
to the Superintendent of Documents. GAO also accepts VISA and Mastercard.
Orders for 100 or more copies mailed to a single address are discounted 25
percent. Orders should be sent to:

U.S. General Accounting Office 441 G Street NW, Room LM Washington, D.C.
20548

To order by Phone: 	Voice: (202) 512-6000 TDD: (202) 512-2537 Fax: (202)
512-6061

To Report Fraud,	Contact: Web site: www.gao.gov/fraudnet/fraudnet.htm

                  Waste, and Abuse in E-mail: [email protected]

Federal Programs Automated answering system: (800) 424-5454 or (202)
512-7470

Public Affairs 	Jeff Nelligan, Managing Director, [email protected] (202)
512-4800 U.S. General Accounting Office, 441 G Street NW, Room 7149
Washington, D.C. 20548
*** End of document. ***