VA and DOD Health Care: VA Has Policies and Outreach Efforts to  
Smooth Transition from DOD Health Care, but Sharing of Health	 
Information Remains Limited (28-SEP-05, GAO-05-1052T).		 
                                                                 
Operation Iraqi Freedom (OIF) and Operation Enduring Freedom	 
(OEF) servicemembers and those who are discharged from military  
service may receive health care from the Department of Veterans  
Affairs (VA). Since the onset of OIF and OEF, the Department of  
Defense (DOD) has reported that more than 15,000 servicemembers  
have been wounded in combat. Those who are seriously injured	 
require comprehensive health care services and may be treated at 
either DOD or VA medical facilities. Because VA is expected to	 
provide health care to many of the injured OIF and OEF		 
servicemembers, concerns have been raised about the ease with	 
which these individuals and their health care information	 
transition from DOD's to VA's health care system. This statement 
is based on GAO's preliminary work on "seamless transition" and  
focuses on (1) the policies and outreach efforts that VA has	 
instituted to provide timely access to health care to OIF and OEF
servicemembers and (2) the extent to which individually 	 
identifiable health information is shared systematically between 
DOD and VA. Since GAO's work is still in the early stages of	 
review, the statement is limited to information gathered to date.
-------------------------Indexing Terms------------------------- 
REPORTNUM:   GAO-05-1052T					        
    ACCNO:   A38560						        
  TITLE:     VA and DOD Health Care: VA Has Policies and Outreach     
Efforts to Smooth Transition from DOD Health Care, but Sharing of
Health Information Remains Limited				 
     DATE:   09/28/2005 
  SUBJECT:   Health care facilities				 
	     Health care programs				 
	     Health care services				 
	     Interagency relations				 
	     Military personnel 				 
	     Military policies					 
	     Policy evaluation					 
	     Information sharing				 
	     Policies and procedures				 
	     DOD Operation Iraqi Freedom			 
	     Operation Enduring Freedom 			 

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GAO-05-1052T

     

     * Background
     * VA Has Established Policies and Outreach Efforts Intended to
          * Recent VA Policies Designed to Facilitate Transition to VA H
          * VA Outreach Efforts to OIF and OEF Servicemembers
     * Sharing of Health Information between DOD and VA Is Limited
          * Contacts and Acknowledgments
     * Related GAO Products
     * Order by Mail or Phone

Testimony

Before the Committee on Veterans' Affairs, House of Representatives

United States Government Accountability Office

GAO

For Release on Delivery Expected at 10:30 a.m. EDT

Wednesday, September 28, 2005

VA AND DOD HEALTH CARE

VA Has Policies and Outreach Efforts to Smooth Transition from DOD Health
Care, but Sharing of Health Information Remains Limited

Statement of Cynthia A. Bascetta

Director, Health Care

GAO-05-1052T

Mr. Chairman and Members of the Committee:

Thank you for inviting me to share our work to date on the Department of
Veterans Affairs' (VA) collaboration with the Department of Defense (DOD)
to ensure that servicemembers are able to make a "seamless transition"
from DOD health care to VA health care services. Servicemembers, under
certain conditions, 1 and those who are discharged from service may
receive health care from VA. On September 20, 2005, DOD reported that more
than 15,000 servicemembers had been wounded during Operation Iraqi Freedom
(OIF) and Operation Enduring Freedom (OEF).2 Many return to active duty
after they are treated, but those who are seriously injured require
comprehensive health care services and may undergo a medical evaluation to
determine their ability to stay in the military. Because VA is expected to
provide health care for injured OIF and OEF servicemembers, including
those who have been discharged, concerns have been raised about the ease
with which these individuals transition from DOD's to VA's health care
system.

My remarks today are based on preliminary work done on this issue and
focus on (1) the policies and outreach efforts that VA has instituted to
provide timely access to care to OIF and OEF servicemembers and (2) the
extent to which individually identifiable health information is shared
systematically between DOD and VA.

In conducting our review, we interviewed DOD, National Guard, Reserve, and
VA officials and obtained documents on relevant policies, procedures, and
VA outreach materials. Among these documents, we reviewed the June 29,
2005, memorandum of understanding (MOU) for the sharing of data between
DOD and VA and the applicable law and regulations that govern the sharing
of individually identifiable health information. In addition, we examined
issues related to eligibility and medical staff roles and
responsibilities. We also visited the two DOD medical facilities that
receive and treat most of the seriously injured OIF and OEF servicemembers
and two VA medical centers that also treat them.3 We did our work from May
2005 through September 2005 in accordance with generally accepted
government auditing standards.

1Generally, VA supplements care that is not available from DOD or when the
demand for such care cannot be met by DOD.

2OIF, which began in March 2003, supports combat operations in Iraq and
other locations. OEF, which began in October 2001, supports combat
operations in Afghanistan and other locations.

In summary, VA has developed policies and procedures that direct its
medical facilities to provide OIF and OEF servicemembers timely access to
care. VA has also increased outreach efforts by providing OIF and OEF
servicemembers who have been discharged with personal letters and
newsletters, a Web site for health information tailored to OIF and OEF
servicemembers, counseling services, and briefings on available VA health
care services. We are in the beginning stages of our review of VA's
efforts to provide a smooth transition from DOD health care and have not
yet evaluated the effectiveness of VA's related policies, procedures, and
outreach initiatives. We are reviewing the implementation of these efforts
in our ongoing work for this committee.

An important issue associated with transitioning servicemembers to VA
health care is the sharing of health care information between DOD and VA.
Currently, DOD does not have specific procedures for routinely
transmitting to VA health information on servicemembers who are likely to
be discharged from the military due to their medical condition. Recently,
DOD has begun to share certain health assessment information with VA on
individuals who have separated from the military, and the transmitting of
this information to VA on a routine basis is expected to occur in October
2005. However, according to VA officials, DOD is not providing health
assessment information to VA for Reserve and National Guard members, who
comprise 35 percent of the OIF and OEF forces.

                                   Background

Since the onset of OIF and OEF, over 1 million servicemembers have been
deployed. As of the end of June 2005, more than 393,000 active duty,
Reserve, and National Guard servicemembers from OIF and OEF have separated
from active duty. Of these, over 100,000 have sought health care services
from VA, including over 2,400 who received inpatient care at VA medical
centers. The Reserves and National Guard account for about 54,000 of those
servicemembers who sought health care services from VA. The three most
common health problems have been musculoskeletal ailments (primarily joint
and back disorders), dental problems, and mental health disorders.

3The DOD facilities were Walter Reed Army Medical Center and the National
Naval Medical Center; the VA facilities were the Augusta VA Medical Center
and the Richmond VA Medical Center.

Servicemembers injured during OIF and OEF are surviving injuries that
would have been fatal in past conflicts. In World War II, 30 percent of
Americans injured in combat died; this proportion dropped to 24 percent
for those injured in the Vietnam War and further dropped to about 10
percent for those injured in OIF and OEF. Many of the injured OIF and OEF
servicemembers are returning with severe disabilities, including traumatic
brain injuries and missing limbs.

About 65 percent of OIF and OEF combat injuries are from improvised
explosive devices, blasts, landmines, and fragments. Of those injured
personnel, about 60 percent have some degree of traumatic brain injury and
may require comprehensive inpatient rehabilitation services to address
complex cognitive, physical, and mental health issues resulting from
trauma. Traumatic brain injuries may cause problems with cognition
(concentration, memory, judgment, and mood), movement (strength,
coordination, and balance), sensation (tactile sensation and vision), and
emotion (instability and impulsivity). The Department of Health and Human
Services' Centers for Disease Control and Prevention reports that an
estimated 15 percent of persons who sustain a mild brain injury continue
to experience symptoms 1 year after injury.

Initially, most severely injured servicemembers, including Reserve and
National Guard members, are brought to Landstuhl Regional Medical Center
in Germany for treatment. From there, they are transported to appropriate
U.S. military medical facilities, with most of the seriously injured
admitted to Walter Reed Army Medical Center or the National Naval Medical
Center, both located in the Washington, D.C., area. Once these
servicemembers are medically stabilized, many are relocated closer to
their homes or military commands and continue recovering either on an
inpatient or outpatient basis at a VA medical facility, a DOD military
treatment facility (MTF), or DOD civilian provider.4

Those who have served, or are now serving, in OIF and OEF may receive care
from VA for conditions that are or may be related to their combat services
for a 2-year period following the date of their separation from active
duty without copayment requirements. Following this 2-year period, they
may continue to receive VA care but may be subject to a copayment for
their health care.

4DOD provides health care to beneficiaries through its TRICARE program.
TRICARE beneficiaries can obtain health care through DOD's direct care
system of military hospitals and clinics, commonly referred to as MTFs,
and through DOD's purchased care system of civilian providers.

To ensure that servicemembers engaged in conflicts receive the health care
services they need, Congress passed legislation in May 1982 that
authorized VA to provide medical services to members of the armed forces
during and immediately following wartime or national emergencies involving
the armed forces in armed conflict.5 The law authorized the Secretary of
VA to give servicemembers responding to or involved in a war or national
emergency a higher priority for medical services than all veterans, except
those with a service-connected disability.6 VA has established an
enrollment system to manage veterans' access to care. This system includes
eight priority categories for enrollment, with higher priority given to
veterans with service-connected disabilities, lower incomes, or other
recognized statuses such as former prisoners of war.

Separation from the military and return to civilian life may entail the
exchange of individually identifiable health information between DOD and
VA. The exchange of this information must comply with the Health Insurance
Portability and Accountability Act of 1996 (HIPAA)7 and the HIPAA Privacy
Rule, which became effective April 14, 2001.8 The HIPAA Privacy Rule
permits DOD and VA to share servicemembers' health information under
certain circumstances, such as for continuity of health care treatment or
if the individual signs a proper authorization.

5The Veterans' Administration and Department of Defense Health Resources
Sharing and Emergency Operations Act, Pub. L. No. 97-174, S:4(a), 96 Stat.
70, 74-75.

6A service-connected disability is an injury or disease that was incurred
or aggravated while on active military duty.

7Pub. L. No. 104-191, 110 Stat. 1936 (1996).

8The HIPAA Privacy Rule applies to covered entities and specifies how
individually identifiable health data may be used and disclosed by covered
entities. See 45 C.F.R. S: 164.500(a), 164.502 (2004). Covered entities
are defined in the HIPAA Privacy Rule as health plans, clearinghouses, and
certain health care providers. Both DOD's health care system and VA's
health care system are covered entities. See 45 C.F.R. S: 160.103 (2004).
All covered entities had to comply with the HIPAA Privacy Rule by April
14, 2003, with the exception of small health plans.

VA Has Established Policies and Outreach Efforts Intended to Smooth the
Transition from DOD Health Care

VA has taken several steps to provide OIF and OEF servicemembers with
timely access to health care and information on health care services.
These steps include setting policies and developing outreach efforts
targeting OIF and OEF servicemembers.

  Recent VA Policies Designed to Facilitate Transition to VA Health Care

Since 2002, VA has issued a memorandum and four directives addressing
eligibility criteria and the health care needs of recently discharged
servicemembers.9

           o  A September 2002 directive established policies and procedures
           for offering hospital care, medical services, and nursing home
           care to recently discharged servicemembers for a 2-year period,
           beginning on their discharge date, for any illness, without
           requiring proof of its link to military service.10 Under this
           directive, these veterans are enrolled in the lowest priority
           category for service-connected veterans.
           o  In April 2003, when the President declared a national emergency
           with respect to the conflict in Iraq, the Secretary of VA issued a
           memorandum authorizing VA to give priority health care to
           servicemembers who sustained an injury, over veterans and others
           eligible for VA care, except those with service-connected
           disabilities.
           o  An October 2003 directive (1) provided instructions to VA
           employees for determining the eligibility of recent combat
           veterans to be enrolled for VA health care; (2) required each VA
           medical facility to designate a clinically trained combat case
           manager, usually a social worker or nurse, to coordinate all of
           the medical care and services provided to recent combat veterans
           by VA and non-VA agencies until the veterans no longer need care;
           and (3) required VA medical facilities to designate a point of
           contact-administrative staff, social worker, or nurse-to receive
           and expedite transfers of servicemembers from MTFs to VA medical
           facilities and coordinate with VA's combat case managers.11 
           o  A June 2005 directive specified the dates of service and combat
           locations to determine whether recent combat veterans are eligible
           for health care services.12 
           o  Another June 2005 directive expanded the scope of care at VA's
           four regional traumatic brain injury rehabilitation centers and
           redefined these facilities as polytrauma rehabilitation centers.13
           These centers' inclusion of psychological treatment for family
           members and rehabilitation services using high-technology
           prosthetics reflect VA's intention to provide more coordinated
           care for patients, including the growing number of OIF and OEF
           servicemembers with severe and disabling trauma.14 The directive
           states that coordination of care, including intensive clinical and
           social work case management services,15 is essential in these
           severe trauma cases, as patients transition from acute
           hospitalization through acute rehabilitation and ultimately to
           their home communities.

           In addition to VA's directives, a joint DOD and VA program was
           established in August 2003 to assign VA social workers to selected
           MTFs to coordinate patient transfers between MTFs and VA medical
           facilities.16 The social workers make appointments for care,
           ensure continuity of therapy and medications, and followup with
           patients to verify success of the discharge. By mid-July 2005, the
           social workers had received 3,907 requests for transfer of
           care-almost two-thirds of them had been transferred to VA
           facilities; the rest were pending. Further, VA benefits counselors
           work with the social workers to inform servicemembers about VA
           benefits and to initiate paperwork for disability compensation
           claims, vocational rehabilitation and employment assistance, and
           other VA benefits.

           Also in August 2003, VA created the Taskforce for the Seamless
           Transition of Returning Service Members. The taskforce, composed
           of senior VA leadership, focused on developing and implementing VA
           policies to improve the transition of injured servicemembers to
           civilian life. In January 2005, VA established the Seamless
           Transition Office to further improve coordination within the
           Veterans Benefits Administration and the Veterans Health
           Administration as well as between DOD and VA.17 The goals of the
           Seamless Transition Office include improving communication,
           coordination, and collaboration within VA and with DOD with
           respect to health care; educating VA staff about veteran's health
           care and other needs; and ensuring that policies and procedures
           are in place to enhance the transition from servicemember to
           veteran. The Seamless Transition Office uses the taskforce in an
           advisory capacity.

           To help ensure that VA staff assisting OIF and OEF servicemembers
           can be responsive to their health care needs, the agency created
           an internal Web site to provide a single source of access to VA
           policies, procedures, and directives for wounded, ill, and
           seriously injured servicemembers and veterans. According to VA,
           the internal Web site also includes a list of the points of
           contact at medical facilities and articles about
           transition-related activities.

           VA has instituted several outreach strategies to provide
           information about the health care services available to OIF and
           OEF servicemembers who have been discharged. These include the use
           of newsletters, personal letters, an external Web site, counseling
           services, and briefings on VA benefits and services.

           Using DOD rosters of OIF and OEF servicemembers who have separated
           from active duty, VA sends newsletters and personal letters with
           pertinent information to these new veterans. VA has sent three
           newsletters since December 2003, with information on benefits and
           health issues specific to OIF and OEF veterans. In addition, the
           Secretary of VA sends these new veterans a letter thanking them
           for their service to the country and informing them about VA
           health care services and assistance to aid in their transition to
           civilian life. The letter includes a toll-free number for
           obtaining information on VA health care and two brochures on VA
           health care as well as benefit information, including disability
           compensation, education and training, vocational rehabilitation
           and employment, home loans, and life insurance. In addition, the
           Secretary of VA has sent letters to all the Adjutants General and
           Chiefs of the Reserves to inform them of VA services and
           benefits.18

           VA has also sought to improve access to health care information.
           It created a Web site that provides information specific to those
           who served in OIF and OEF, such as information on VA health and
           medical services; dependents' benefits and services; transition
           assistance; and benefits for active duty military, Reserve, and
           National Guard personnel.19 In addition, VA developed a
           wallet-sized card with relevant toll-free telephone numbers and
           Web site addresses. VA officials reported that the agency has
           distributed 1 million copies of this wallet card.

           VA has enhanced outreach to those who served in OIF and OEF and
           their families through its Vet Center Readjustment Counseling
           Service, consisting of 207 centers. Vet Centers function as
           community points of access by providing information and referrals
           to VA medical facilities. Additionally, they offer counseling,
           employment services, and a range of social services to assist
           individuals in readjusting from wartime military service to
           civilian life. VA reported that during 2004, it hired 50 peer
           counselors and placed them at Vet Centers where significant
           numbers of servicemembers were returning from OIF and OEF.
           According to a VA official, VA is in the process of hiring an
           additional 50 peer counselors.

           Briefings are another form of outreach used by VA to inform OIF
           and OEF servicemembers about health care services.

           o  From fiscal year 2001 through the third quarter of fiscal year
           2005, VA held more than 30,800 briefings on VA benefits for more
           than 1.1 million servicemembers.20 These briefings include about
           3,700 predeployment and postdeployment briefings for about 230,000
           activated Reserve and National Guard servicemembers.20 VA held
           some of these briefings aboard the USS Constellation, the USS
           Enterprise, and the USS George Washington during the return of
           these vessels from the Persian Gulf to the United States.
           o  VA's staff from the Seamless Transition Office have given
           educational briefings on VA services and benefits to senior
           leadership in the National Guard and the Army Reserve. Under a May
           2005 memorandum of agreement between VA and the National Guard, VA
           is in the process of making staff available to provide briefings
           to Guard units in each state.

           An important issue in providing a smooth transition from DOD's to
           VA's heath care system is the sharing of individually identifiable
           health information. In its May 2003 report, the President's Task
           Force to Improve Health Care Delivery for Our Nation's Veterans
           stated that "a seamless transition from military service to
           veteran status is especially critical in the context of health
           care, where readily available, accurate, and current medical
           information must be accessible to health care providers." The task
           force further stated that increased collaboration is needed
           between the departments for the transfer of personnel and health
           information. DOD and VA officials have told us that health
           information is being shared when injured servicemembers are
           transferred from DOD to VA medical facilities.21 For OIF and OEF
           servicemembers who may potentially use VA services, DOD and VA
           share some types of administrative data, such as individuals'
           names and addresses; however, the sharing of health information
           between the two departments remains limited.

           As we reported at a hearing in May 2005, DOD and VA did not have
           an agreement-after 2 years of discussion-that specifies what types
           of individually identifiable health information can be exchanged
           and when they may be shared.22 Shortly after the hearing, DOD and
           VA signed an MOU for the sharing of individually identifiable
           health information.23 The MOU constitutes an agreement on the
           circumstances under which DOD and VA will exchange individually
           identifiable health information and includes references to
           provisions of the HIPAA Privacy Rule and applicable laws that
           permit sharing. The MOU does not specify particular types of
           individually identifiable heath information that will be exchanged
           and when the information will be shared. The absence of specific
           data sharing procedures continues to hinder VA's efforts to obtain
           needed health information from DOD.

           For example, DOD does not have specific procedures to routinely
           provide VA with health information on servicemembers who have
           injuries or illnesses that preclude them from continuing on active
           duty and, as a result, are being evaluated by a DOD physical
           evaluation board (PEB) for separation from the military.24
           According to VA officials, if a list of these individuals were
           transmitted routinely to VA, it would enable VA to contact the
           individuals to make the appropriate transfer of health care to a
           VA medical facility before the individuals are discharged from the
           military. Such information could reduce the potential for
           interruption to these individuals' health care treatment plans.
           DOD officials told us that they are in the process of developing a
           policy directive that would establish procedures for sharing
           information with VA on servicemembers who are entering the PEB
           process, but they could not determine when this policy directive
           would become effective.

           Recent progress in VA and DOD data sharing involves a health
           assessment questionnaire that DOD requires servicemembers to
           complete following deployment.25 This document contains, among
           other things, self-reported information about a servicemember's
           potential exposure to toxic substances and includes four questions
           that can be used to identify individuals at risk of developing
           post-traumatic stress disorder. In July 2005, DOD transmitted to
           VA postdeployment health assessment data for those individuals who
           have been discharged from the military. According to VA officials,
           DOD is expected to transmit these data monthly beginning in
           October 2005. For these individuals, VA clinicians will be able to
           access the data through VA's computerized medical record system
           when the individuals seek VA health care services. However,
           according to VA officials, DOD is not providing health assessment
           information to VA for Reserve and National Guard members, who
           comprise 35 percent of the OIF and OEF forces.

           In addition to individual health information from the
           postdeployment questionnaire, VA officials state that the agency
           could use aggregate data from the questionnaire to plan for the
           needs of current servicemembers who may one day be eligible for
           health care and benefits from VA. This is consistent with an
           observation made by the President's task force that comprehensive
           servicemember health data are essential for forecasting and
           preparing for changes in the demand for health care services.
           Currently, the data from the individual postdeployment assessments
           are not accessible in a format that can be aggregated and
           manipulated to provide the desired trend information.

           Mr. Chairman, this concludes my prepared remarks. I will be
           pleased to answer any questions you or other members of the
           committee may have.

           For further information regarding this testimony, please contact
           Cynthia A. Bascetta at (202) 512-7101 or [email protected].
           Michael T. Blair, Jr., Assistant Director; Mary Ann Curran; Hannah
           Fein; Cynthia Forbes; Marcia Mann; Kevin Milne; and Cherie Starck
           also contributed to this statement.

           Military and Veterans' Benefits: Improvements Needed in Transition
           Assistance Services for Reserves and National Guard. GAO-05-844T .
           Washington, D.C.: June 29, 2005.

           Military and Veterans' Benefits: Enhanced Services Could Improve
           Transition Assistance for Reserves and National Guard. GAO-05-544
           . Washington, D.C.: May 20, 2005.

           DOD and VA: Systematic Data Sharing Would Help Expedite
           Servicemembers' Transition to VA Services. GAO-05-722T .
           Washington, D.C.: May 19, 2005.

           Vocational Rehabilitation: VA Has Opportunities to Improve
           Services, but Faces Significant Challenges. GAO-05-572T .
           Washington, D.C.: April 20, 2005.

           VA Disability Benefits and Health Care: Providing Certain Services
           to the Seriously Injured Poses Challenges. GAO-05-444T .
           Washington, D.C.: March 17, 2005.

           Vocational Rehabilitation: More VA and DOD Collaboration Needed to
           Expedite Services for Severely Injured Servicemembers. GAO-05-167
           . Washington, D.C.: January 14, 2005.

           VA and Defense Health Care: More Information Needed to Determine
           if VA Can Meet an Increase in Demand for Post-Traumatic Stress
           Disorder Services. GAO-04-1069 . Washington, D.C.: September 20,
           2004.

           Major Management Challenges and Program Risks: Department of
           Veterans Affairs. GAO-03-110 . Washington, D.C.: January 2003.

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9VA sometimes refers to individuals who served in combat after the Gulf
War or during a period of hostilities after November 11, 1998, as "recent
combat veterans". Our reference to discharged servicemembers includes
deactivated Reserve and National Guard members.

10VHA Directive 2002-049, Combat Veterans are Eligible for Medical
Services for 2-Years After Separation from Military Service
Notwithstanding Lack of Evidence for Service Connection, September 11,
2002.

11VHA Directive 2003-061, Combat Veteran Intake Processing and Software
Implementation, October 23, 2003.

12VHA Directive 2005-020, Determining Combat Veteran Eligibility, June 2,
2005. Both this and the October 2003 directive allow VA to provide health
care services to a veteran without proof of combat service. If VA later
determines that the veteran is not a recent combat veteran, VA will
reevaluate the veteran's eligibility.

13VHA Directive 2005-024, Polytrauma Rehabilitation Centers, June 8, 2005.
The four centers are located in Minneapolis, Minnesota; Palo Alto,
California; Richmond, Virginia; and Tampa, Florida.

14Because of the high percentage of veterans from OIF and OEF who are
surviving multiple massive injuries, Congress mandated that VA establish
polytrauma rehabilitation centers for research, education, and clinical
activities for servicemembers with complex combat injuries. See the
Veterans Health Programs Improvement Act of 2004, Pub. L. No. 108-422, S:
302, 118 Stat. 2379, 2383-86.

15Case management includes assessment of the individual's health care
needs, care planning and implementation, referral coordination,
monitoring, and periodic reassessment of the individual's care needs.

16Five MTFs were originally selected because they received most of the OIF
and OEF casualties. The MTFs were Walter Reed Army Medical Center
(Washington, D.C.), Brooke Army Medical Center (San Antonio, Texas),
Dwight David Eisenhower Army Medical Center (Augusta, Georgia), Madigan
Army Medical Center (Tacoma, Washington), and the National Naval Medical
Center (Bethesda, Maryland). In 2004 and 2005, three additional
MTFs-Darnall Army Community Hospital (Fort Hood, Texas), Evans Army
Community Hospital (Fort Carson, Colorado), and the Naval Hospital Camp
Pendleton (Camp Pendleton, California)-were added to care for returning
OIF and OEF servicemembers.

  VA Outreach Efforts to OIF and OEF Servicemembers

17The Veterans Benefits Administration provides benefits and services,
such as disability compensation, to veterans. The Veterans Health
Administration's primary responsibility is the delivery of health care to
veterans.

18Each state has an Adjutant General overseeing all Army and Air Force
National Guard units in the state.

19The Web site can be accessed through VA's home page at www.va.gov .

Sharing of Health Information between DOD and VA Is Limited

20VA could not report how many of these were OIF and OEF servicemembers.

21The HIPAA Privacy Rule permits the sharing of health information for
continuity of health care treatment purposes.

22GAO, DOD and VA: Systematic Data Sharing Would Help Expedite
Servicemembers' Transition to VA Services, GAO-05-722T (Washington, D.C.:
May 19, 2005).

23VA signed the MOU in May 2005 and DOD signed it in June 2005.

24Military PEBs recommend whether servicemembers are physically unfit to
perform their military duties and should be placed on disability
retirement or discharged from military service.

25All servicemembers who are deployed outside of the United States for 30
or more days to locations without treatment facilities must complete a
postdeployment health assessment questionnaire, DD 2796. DOD uses this
questionnaire to determine the presence of any physical ailments or mental
health issues commonly associated with deployments.

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Highlights of GAO-05-1052T , a testimony before the Committee on Veterans'
Affairs, House of Representatives

September 28, 2005

VA AND DOD HEALTH CARE

VA Has Policies and Outreach Efforts to Smooth Transition from DOD Health
Care, but Sharing of Health Information Remains Limited

Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF)
servicemembers and those who are discharged from military service may
receive health care from the Department of Veterans Affairs (VA). Since
the onset of OIF and OEF, the Department of Defense (DOD) has reported
that more than 15,000 servicemembers have been wounded in combat. Those
who are seriously injured require comprehensive health care services and
may be treated at either DOD or VA medical facilities. Because VA is
expected to provide health care to many of the injured OIF and OEF
servicemembers, concerns have been raised about the ease with which these
individuals and their health care information transition from DOD's to
VA's health care system.

This statement is based on GAO's preliminary work on "seamless transition"
and focuses on (1) the policies and outreach efforts that VA has
instituted to provide timely access to health care to OIF and OEF
servicemembers and (2) the extent to which individually identifiable
health information is shared systematically between DOD and VA. Since
GAO's work is still in the early stages of review, the statement is
limited to information gathered to date.

Since 2002, VA has developed policies and procedures that direct its
medical facilities to provide OIF and OEF servicemembers timely access to
care. Most notably, VA

           o  assigned VA social workers to selected military treatment
           facilities in August 2003,
           o  directed VA facilities to designate combat case managers in
           October 2003, and
           o  directed the establishment of four VA polytrauma centers for
           OIF and OEF servicemembers in June 2005.

In January 2005, VA established the Seamless Transition Office to further
improve coordination within the Veterans Benefits Administration and the
Veterans Health Administration as well as between DOD and VA. In addition,
VA has increased outreach efforts by providing OIF and OEF servicemembers
who have been discharged with personal letters and newsletters, a Web site
for health information tailored to OIF and OEF servicemembers, counseling
services, and briefings on available VA health care services. GAO is in
the beginning stages of reviewing VA's efforts to provide a smooth
transition from DOD health care and has not yet evaluated the
effectiveness of VA's related policies, procedures, and outreach
initiatives.

An important issue associated with transitioning servicemembers to VA
health care is the sharing of health care information between DOD and VA.
The two departments have signed a memorandum of understanding for sharing
individually identifiable health information, but the memorandum does not
specify the particular types of individually identifiable health
information that will be exchanged and when the information will be
shared. The absence of specific procedures continues to hinder VA's
efforts to obtain needed health information from DOD. Recently, DOD has
begun to share certain health assessment information with VA on
individuals who have been discharged from the military, and the
transmitting of this information to VA on a routine basis is expected to
occur in October 2005. However, according to VA officials, DOD is not
providing health assessment information to VA for Reserve and National
Guard members, who comprise 35 percent of the OIF and OEF forces.
*** End of document. ***