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
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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
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