DOD and VA Health Care: Challenges Encountered by Injured	 
Servicemembers during Their Recovery Process (08-MAR-07,	 
GAO-07-606T).							 
                                                                 
As of March 1, 2007, over 24,000 servicemembers have been wounded
in action since the onset of Operation Enduring Freedom (OEF) and
Operation Iraqi Freedom (OIF), according to the Department of	 
Defense (DOD). GAO work has shown that servicemembers injured in 
combat face an array of significant medical and financial	 
challenges as they begin their recovery process in the health	 
care systems of DOD and the Department of Veterans Affairs (VA). 
GAO was asked to discuss concerns regarding DOD and VA efforts to
provide medical care and rehabilitative services for		 
servicemembers who have been injured during OEF and OIF. This	 
testimony addresses (1) the transition of care for seriously	 
injured servicemembers who are transferred between DOD and VA	 
medical facilities, (2) DOD's and VA's efforts to provide early  
intervention for rehabilitation for seriously injured		 
servicemembers, (3) DOD's efforts to screen servicemembers at	 
risk for post-traumatic stress disorder (PTSD) and whether VA can
meet the demand for PTSD services, and (4) the impact of problems
related to military pay on injured servicemembers and their	 
families. This testimony is based on GAO work issued from 2004	 
through 2006 on the conditions facing OEF/OIF servicemembers at  
the time the audit work was completed.				 
-------------------------Indexing Terms------------------------- 
REPORTNUM:   GAO-07-606T					        
    ACCNO:   A66624						        
  TITLE:     DOD and VA Health Care: Challenges Encountered by Injured
Servicemembers during Their Recovery Process			 
     DATE:   03/08/2007 
  SUBJECT:   Health care facilities				 
	     Health care services				 
	     Interagency relations				 
	     Medical care evaluation				 
	     Mental health					 
	     Mental health care services			 
	     Military pay					 
	     Military personnel 				 
	     Post-traumatic stress disorders			 
	     Veterans						 
	     Veterans benefits					 
	     Veterans' medical care				 
	     DOD Operation Iraqi Freedom			 
	     Operation Enduring Freedom 			 

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GAO-07-606T

   

     * [1]DOD and VA Have Taken Actions to Facilitate the Transfer of
     * [2]DOD and VA Collaboration Is Important for Early Intervention
     * [3]DOD Screens Servicemembers for PTSD after Deployment, but DO
     * [4]Problems Related to Military Pay Have Resulted in Debt and O
     * [5]Contacts and Acknowledgments
     * [6]Related GAO Products

          * [7]Order by Mail or Phone

Testimony

Before the Subcommittee on Oversight and Investigations, Committee on
Veterans' Affairs, House of Representatives

United States Government Accountability Office

GAO

For Release on Delivery Expected at 3:30 p.m. EST
Thursday, March 8, 2007

DOD AND VA HEALTH CARE

Challenges Encountered by Injured Servicemembers during Their Recovery
Process

Statement of Cynthia A. Bascetta
Director, Health Care

GAO-07-606T

Mr. Chairman and Members of the Subcommittee:

I am pleased to be here today to discuss health care and other services
for U.S. military servicemembers wounded during Operation Enduring Freedom
(OEF) or Operation Iraqi Freedom (OIF).1 On March 1, 2007, the Department
of Defense (DOD) reported that over 24,000 servicemembers have been
wounded in action since the onset of the two conflicts. In 2005, DOD
reported that about 65 percent of the OEF and OIF servicemembers wounded
in action were injured by blasts and fragments from improvised explosive
devices, land mines, and other explosive devices. More recently, DOD
estimated in 2006 that as many as 28 percent of those injured by blasts
and fragments have some degree of trauma to the brain. These injuries
often require comprehensive inpatient rehabilitation services to address
complex cognitive and physical impairments. In addition to their physical
injuries, OEF/OIF servicemembers who have been injured in combat may also
be at risk for developing mental health impairments, such as
post-traumatic stress disorder (PTSD), which research has shown to be
strongly associated with experiencing intense and prolonged combat.2

While servicemembers are on active duty, DOD decides where they receive
their care--at a military treatment facility (MTF), from a TRICARE
civilian provider,3 or at a Department of Veterans Affairs (VA) medical
facility. From the OEF and OIF conflict areas, seriously injured
servicemembers are usually brought to Landstuhl Regional Medical Center in
Germany for treatment. From there, they are usually transported to MTFs
located in the United States, with most of the seriously injured admitted
to Walter Reed Army Medical Center or the National Naval Medical Center,
both of which are in the Washington, D.C., area.4 Once the servicemembers
are medically stabilized, DOD can elect to send those with traumatic brain
injuries and other complex trauma, such as missing limbs, to one of the
four polytrauma rehabilitation centers (PRC)5 operated by VA for medical
and rehabilitative care. The PRCs are located at VA medical centers in
Palo Alto, California; Tampa, Florida; Minneapolis, Minnesota; and
Richmond, Virginia. While many servicemembers who receive such
rehabilitative services return to active duty after they are treated,
others who are more seriously injured are likely to be discharged from
their military obligations and return to civilian life with disabilities.

1OEF, which began in October 2001, supports combat operations in
Afghanistan and other locations, and OIF, which began in March 2003,
supports combat operations in Iraq and other locations.

2Charles W. Hoge et al., "Combat Duty in Iraq and Afghanistan, Mental
Health Problems, and Barriers to Care," The New England Journal of
Medicine, 351 (2004): 13-22.

3DOD provides health care through TRICARE--a regionally structured program
that uses civilian contractors to maintain provider networks to complement
health care services provided at MTFs.

Our work has shown that servicemembers injured in combat face an array of
significant medical and financial challenges as they begin their recovery
process in the DOD and VA health care systems. In light of these
challenges and recent media reports that have highlighted unsanitary and
decrepit living conditions at the Walter Reed Army Medical Center,6 you
asked us to discuss concerns we have identified regarding DOD and VA
efforts to provide medical care and rehabilitative services for
servicemembers who have been injured during OEF and OIF. Specifically, my
remarks today will focus on (1) the transition of care for seriously
injured OEF/OIF servicemembers--those with traumatic brain injuries or
other complex trauma, such as missing limbs--who are transferred between
DOD and VA medical facilities; (2) DOD's and VA's efforts to provide early
intervention for rehabilitation services as soon as possible after the
onset of a disability for seriously injured servicemembers; (3) DOD's
efforts to screen OEF/OIF servicemembers at risk for PTSD and whether VA
can meet the demand for PTSD services; and (4) the impact of problems
related to military pay on injured servicemembers and their families.

4Other MTFs that received OEF/OIF servicemembers include Brooke Army
Medical Center (San Antonio, Texas), Dwight David Eisenhower Army Medical
Center (Augusta, Georgia), Madigan Army Medical Center (Tacoma,
Washington), Darnall Army Community Hospital (Fort Hood, Texas), Evans
Army Community Hospital (Fort Carson, Colorado), and the Naval Hospital
Camp Pendleton (Camp Pendleton, California).

5The Veterans Health Programs Improvement Act of 2004, Pub. L. No.
108-422, S 302, 118 Stat. 2379, 2383-86, mandated that VA establish
centers for research, education, and clinical activities related to
complex multiple trauma associated with combat injuries. In response to
that mandate, VA established PRCs at four VA medical facilities with
expertise in traumatic amputation, spinal cord injury, traumatic brain
injury, and blind rehabilitation. A PRC addresses the rehabilitation needs
of the combat injured in one setting and in a coordinated manner.

6See, for instance, Dana Priest and Anne Hull, "Soldiers Face Neglect,
Frustration at Army's Top Medical Facility," The Washington Post (Feb. 18,
2007).

My testimony is based on issued GAO work.7 The information I am reporting
today reflects the conditions facing OEF/OIF servicemembers at the time
the audit work was completed and illustrates the types of problems injured
servicemembers encountered during their healing and rehabilitation
process. To complete the work for these products, we visited DOD and VA
facilities, reviewed relevant documents, analyzed DOD data, and
interviewed DOD and VA officials. Our work was performed in accordance
with generally accepted government auditing standards.

In summary, DOD and VA have made various efforts to provide medical care
and rehabilitative services for OEF/OIF servicemembers. The departments
established joint programs to facilitate the transfer of injured
servicemembers from DOD facilities to VA medical facilities, assess
whether servicemembers will be able to remain in the military, and assign
VA social workers to selected MTFs to coordinate the transfers. DOD has
also established a program to screen servicemembers after their deployment
outside of the United States has ended to assess whether they are at risk
for PTSD. However, we found several problems in the efforts to provide
health care and rehabilitative services for OEF/OIF servicemembers. For
example, DOD and VA had problems sharing medical records and questions
arose about the timing of VA's outreach to servicemembers whose discharge
from military service was not certain. Furthermore, we found that DOD
cannot provide reasonable assurance that OEF/OIF servicemembers who need
referrals for mental health evaluations receive them. Finally, problems
related to military pay have resulted in overpayments and debt for
hundreds of sick and injured servicemembers.

7See Related GAO Products at the end of this statement.

DOD and VA Have Taken Actions to Facilitate the Transfer of Servicemembers but
Experienced Problems in Exchanging Health Care Information

In our June 2006 report, we found that DOD and VA had taken actions to
facilitate the transition of medical and rehabilitative care for seriously
injured servicemembers who were being transferred from MTFs to PRCs.8 For
example, in April 2004, DOD and VA signed a memorandum of agreement that
established referral procedures for transferring injured servicemembers
from DOD to VA medical facilities. DOD and VA also established joint
programs to facilitate the transfer to VA medical facilities, including a
program that assigned VA social workers to selected MTFs to coordinate
transfers.

Despite these coordination efforts, we found that DOD and VA were having
problems sharing the medical records VA needed to determine whether
servicemembers' medical conditions allowed participation in VA's vigorous
rehabilitation activities. DOD and VA reported that as of December 2005
two of the four PRCs had real-time access to the electronic medical
records maintained at Walter Reed Army Medical Center and only one of the
two also had access to the records at the National Naval Medical Center.
In cases where medical records could not be accessed electronically, the
MTF faxed copies of some medical information, such as the patient's
medical history and progress notes, to the PRC. Because this information
did not always provide enough data for the PRC provider to determine if
the servicemember was medically stable enough to be admitted to the PRC,
VA developed a standardized list of the minimum types of health care
information needed about each servicemember transferring to a PRC. Even
with this information, PRC providers frequently needed additional
information and had to ask for it specifically. For example, if the PRC
provider notices that the servicemember is on a particular antibiotic
therapy, the provider may request the results of the most recent blood and
urine cultures to determine if the servicemember is medically stable
enough to participate in strenuous rehabilitation activities. According to
PRC officials, obtaining additional medical information in this way,
rather than electronically, is very time consuming and often requires
multiple phone calls and faxes. VA officials told us that the transfer
could be more efficient if PRC medical personnel had real-time access to
the servicemembers' complete DOD electronic medical records from the
referring MTFs. However, problems existed even for the two PRCs that had
been granted electronic access. During a visit to those PRCs in April
2006, we found that neither facility could access the records at Walter
Reed Army Medical Center because of technical difficulties.

8GAO, VA and DOD Health Care: Efforts to Provide Seamless Transition of
Care for OEF and OIF Servicemembers and Veterans, GAO-06-794R (Washington,
D.C.: June 30, 2006).

DOD and VA Collaboration Is Important for Early Intervention for Rehabilitation

As discussed in our January 2005 report, the importance of early
intervention for returning individuals with disabilities to the workforce
is well documented in vocational rehabilitation literature.9 In 1996, we
reported that early intervention significantly facilitates the return to
work but that challenges exist in providing services early.10 For example,
determining the best time to approach recently injured servicemembers and
gauge their personal receptivity to considering employment in the civilian
sector is inherently difficult. The nature of the recovery process is
highly individualized and requires professional judgment to determine the
appropriate time to begin vocational rehabilitation. Our 2007 High-Risk
Series: An Update designates federal disability programs as "high risk"
because they lack emphasis on the potential for vocational rehabilitation
to return people to work.11

In our January 2005 report, we found that servicemembers whose
disabilities are definitely or likely to result in military separation may
not be able to benefit from early intervention because DOD and VA could
work at cross purposes. In particular, DOD was concerned about the timing
of VA's outreach to servicemembers whose discharge from military service
is not yet certain. DOD was concerned that VA's efforts may conflict with
the military's retention goals. When servicemembers are treated as
outpatients at a VA or military hospital, DOD generally begins to assess
whether the servicemember will be able to remain in the military. This
process can take months. For its part, VA took steps to make seriously
injured servicemembers a high priority for all VA assistance. Noting the
importance of early intervention, VA instructed its regional offices in
2003 to assign a case manager to each seriously injured servicemember who
applies for disability compensation. VA had detailed staff to MTFs to
provide information on all veterans' benefits, including vocational
rehabilitation, and reminded staff that they can initiate evaluation and
counseling, and, in some cases, authorize training before a servicemember
is discharged. While VA tries to prepare servicemembers for a transition
to civilian life, VA's outreach process may overlap with DOD's process for
evaluating servicemembers for a possible return to duty.

9GAO, Vocational Rehabilitation: More VA and DOD Collaboration Needed to
Expedite Services for Seriously Injured Servicemembers, GAO-05-167
(Washington, D.C.: Jan. 14, 2005).

10We also reported on early intervention in GAO, SSA Disability:
Return-to-Work Strategies from Other Systems May Improve Federal Programs,
GAO/HEHS-96-133 (Washington, D.C.: July 11, 1996).

11GAO, High-Risk Series: An Update, GAO-07-310 (Washington, D.C.: January
2007).

In our report, we concluded that instead of working at cross purposes to
DOD goals, VA's early intervention efforts could facilitate
servicemembers' return to the same or a different military occupation, or
to a civilian occupation if the servicemembers were not able to remain in
the military. In this regard, the prospect for early intervention with
vocational rehabilitation presents both a challenge and an opportunity for
DOD and VA to collaborate to provide better outcomes for seriously injured
servicemembers.

DOD Screens Servicemembers for PTSD after Deployment, but DOD and VA Face
Challenges Ensuring Further PTSD Services

In our May 2006 report, we described DOD's efforts to identify and
facilitate care for OEF/OIF servicemembers who may be at risk for PTSD.12
To identify such servicemembers, DOD uses a questionnaire, the DD 2796, to
screen OEF/OIF servicemembers after their deployment outside of the United
States has ended. The DD 2796 is used to assess servicemembers' physical
and mental health and includes four questions to identify those who may be
at risk for developing PTSD. We reported that according to a clinical
practice guideline jointly developed by DOD and VA, servicemembers who
responded positively to at least three of the four PTSD screening
questions may be at risk for developing PTSD. DOD health care providers
review completed questionnaires, conduct face-to-face interviews with
servicemembers, and use their clinical judgment in determining which
servicemembers need referrals for further mental health evaluations.13,14
OEF/OIF servicemembers can obtain the mental health evaluations, as well
as any necessary treatment for PTSD, while they are servicemembers--that
is, on active duty--or when they transition to veteran status if they are
discharged or released from active duty.

12GAO, Post-Traumatic Stress Disorder: DOD Needs to Identify the Factors
Its Providers Use to Make Mental Health Evaluation Referrals for
Servicemembers, GAO-06-397 (Washington, D.C.: May 11, 2006).

13Health care providers that review the DD 2796 may include physicians,
physician assistants, nurse practitioners, or independent duty medical
technicians--enlisted personnel who receive advanced training to provide
treatment and administer medications.

14DOD's referrals are used to document DOD's assessment that
servicemembers are in need of further mental health evaluations.

Despite DOD's efforts to identify OEF/OIF servicemembers who may need
referrals for further mental health evaluations, we reported that DOD
cannot provide reasonable assurance that OEF/OIF servicemembers who need
the referrals receive them. Using data provided by DOD,15 we found that 22
percent, or 2,029, of the 9,145 OEF/OIF servicemembers in our review who
may have been at risk for developing PTSD were referred by DOD health care
providers for further mental health evaluations. Across the military
service branches, DOD health care providers varied in the frequency with
which they issued referrals to OEF/OIF servicemembers with three or more
positive responses to the PTSD screening questions------the Army referred
23 percent, the Air Force about 23 percent, the Navy 18 percent, and the
Marines about 15 percent. According to DOD officials, not all of the
OEF/OIF servicemembers with three or four positive responses on the
screening questionnaire need referrals. As directed by DOD's guidance for
using the DD 2796, DOD health care providers are to rely on their clinical
judgment to decide which of these servicemembers need further mental
health evaluations. However, at the time of our review DOD had not
identified the factors its health care providers used to determine which
OEF/OIF servicemembers needed referrals. Knowing these factors could
explain the variation in referral rates and allow DOD to provide
reasonable assurance that such judgments are being exercised
appropriately.16 We recommended that DOD identify the factors that DOD
health care providers used in issuing referrals for further mental health
evaluations to explain provider variation in issuing referrals. DOD
concurred with the recommendation.

15In our review we analyzed computerized data provided by DOD to identify
178,664 OEF/OIF servicemembers who were deployed in support of OEF/OIF
from October 1, 2001, through September 30, 2004, and who have since been
discharged or released from active duty. These servicemembers had answered
the four PTSD screening questions on the DD 2796 and had a record of their
completed questionnaire available in a DOD computerized database. We found
that DOD data indicated 9,145 of the 178,664 servicemembers in our review
may have been at risk for developing PTSD.

16The John Warner National Defense Authorization Act for Fiscal Year 2007
required DOD to develop guidelines for mental health referrals, as well as
mechanisms to ensure proper training and oversight, by April 2007. Pub. L.
No. 109-364, S 738, 120 Stat. 2083, 2303-4.

Although OEF/OIF servicemembers may obtain mental health evaluations or
treatment for PTSD through VA when they transition to veteran status, VA
may face a challenge in meeting the demand for PTSD services. In September
2004 we reported that VA had intensified its efforts to inform new
veterans from the Iraq and Afghanistan conflicts about the health care
services--including treatment for PTSD--VA offers to eligible veterans.17
We observed that these efforts, along with expanded availability of VA
health care services for Reserve and National Guard members, could result
in an increased percentage of veterans from Iraq and Afghanistan seeking
PTSD services through VA. However, at the time of our review officials at
six of seven VA medical facilities we visited explained that while they
were able to keep up with the current number of veterans seeking PTSD
services, they may not be able to meet an increase in demand for these
services. In addition, some of the officials expressed concern because
facilities had been directed by VA to give veterans from the Iraq and
Afghanistan conflicts priority appointments for health care services,
including PTSD services. As a result, VA medical facility officials
estimated that follow-up appointments for veterans receiving care for PTSD
could be delayed. VA officials estimated the delays to be up to 90 days.

Problems Related to Military Pay Have Resulted in Debt and Other Hardships for
Hundreds of Sick and Injured Servicemembers

As discussed in our April 2006 testimony, problems related to military pay
have resulted in overpayments and debt for hundreds of sick and injured
servicemembers.18 These pay problems resulted in significant frustration
for the servicemembers and their families. We found that hundreds of
battle-injured servicemembers were pursued for repayment of military debts
through no fault of their own, including at least 74 servicemembers whose
debts had been reported to credit bureaus and private collections
agencies. In response to our audit, DOD officials said collection actions
on these servicemembers' debts had been suspended until a determination
could be made as to whether these servicemembers' debts were eligible for
relief.

17GAO, 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.: Sept. 20, 2004).

18GAO, Military Pay: Military Debts Present Significant Hardships to
Hundreds of Sick and Injured GWOT Soldiers, GAO-06-657T (Washington, D.C.:
April 27, 2006).

Debt collection actions created additional hardships on servicemembers by
preventing them from getting loans to buy houses or automobiles or pay off
other debt, and sending several servicemembers into financial crisis. Some
battle-injured servicemembers forfeited their final separation pay to
cover part of their military debt, and they left the service with no funds
to cover immediate expenses while facing collection actions on their
remaining debt.

We also found that sick and injured servicemembers sometimes went months
without paychecks because debts caused by overpayments of combat pay and
other errors were offset against their military pay.19 Furthermore, the
longer it took DOD to stop the overpayments, the greater the amount of
debt that accumulated for the servicemember and the greater the financial
impact, since more money would eventually be withheld from the
servicemember's pay or sought through debt collection action after the
servicemember had separated from the service.

In our 2005 testimony about Army National Guard and Reserve
servicemembers, we found that poorly defined requirements and processes
for extending injured and ill reserve component servicemembers on active
duty have caused servicemembers to be inappropriately dropped from active
duty.20 For some, this has led to significant gaps in pay and health
insurance, which has created financial hardships for these servicemembers
and their families.

Mr. Chairman, this completes my prepared remarks. I would be happy to
respond to any questions you or other members of the subcommittee may have
at this time.

19We found that after voluntary allotments and other required deductions,
many times there was no net pay due the servicemember.

20GAO, Military Pay: Gaps in Pay and Benefits Create Financial Hardships
for Injured Army National Guard and Reserve Soldiers, GAO-05-322T
(Washington, D.C.: Feb. 17, 2005).

Contacts and Acknowledgments

For further information about this testimony, please contact Cynthia A.
Bascetta at (202) 512-7101 or [email protected]. Contact points for our
Offices of Congressional Relations and Public Affairs may be found on the
last page of this statement. Michael  T. Blair, Jr., Assistant Director;
Cynthia Forbes; Krister Friday; Roseanne Price; Cherie' Starck; and
Timothy Walker made key contributions to this statement.

Related GAO Products

High-Risk Series: An Update. [8]GAO-07-310 . Washington, D.C.: January
2007.

VA and DOD Health Care: Efforts to Provide Seamless Transition of Care for
OEF and OIF Servicemembers and Veterans. [9]GAO-06-794R . Washington,
D.C.: June 30, 2006.

Post-Traumatic Stress Disorder: DOD Needs to Identify the Factors Its
Providers Use to Make Mental Health Evaluation Referrals for
Servicemembers. [10]GAO-06-397 . Washington, D.C.: May 11, 2006.

Military Pay: Military Debts Present Significant Hardships to Hundreds of
Sick and Injured GWOT Soldiers. [11]GAO-06-657T . Washington, D.C.: April
27, 2006.

Military Disability System: Improved Oversight Needed to Ensure Consistent
and Timely Outcomes for Reserve and Active Duty Service Members.
[12]GAO-06-362 . Washington, D.C.: March 31, 2006.

Military Pay: Gaps in Pay and Benefits Create Financial Hardships for
Injured Army National Guard and Reserve Soldiers. [13]GAO-05-322T .
Washington, D.C.: February 17, 2005.

Vocational Rehabilitation: More VA and DOD Collaboration Needed to
Expedite Services for Seriously Injured Servicemembers. [14]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.
[15]GAO-04-1069 . Washington, D.C.: September 20, 2004.

SSA Disability: Return-to-Work Strategies from Other Systems May Improve
Federal Programs. [16]GAO/HEHS-96-133 . Washington, D.C.: July 11, 1996.

(290621)

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Highlights of [24]GAO-07-606T , a testimony before the Subcommittee on
Oversight and Investigations, Committee on Veterans' Affairs, House of
Representatives

March 8, 2007

DOD AND VA HEALTH CARE

Challenges Encountered by Injured Servicemembers during Their Recovery
Process

As of March 1, 2007, over 24,000 servicemembers have been wounded in
action since the onset of Operation Enduring Freedom (OEF) and Operation
Iraqi Freedom (OIF), according to the Department of Defense (DOD). GAO
work has shown that servicemembers injured in combat face an array of
significant medical and financial challenges as they begin their recovery
process in the health care systems of DOD and the Department of Veterans
Affairs (VA).

GAO was asked to discuss concerns regarding DOD and VA efforts to provide
medical care and rehabilitative services for servicemembers who have been
injured during OEF and OIF. This testimony addresses (1) the transition of
care for seriously injured servicemembers who are transferred between DOD
and VA medical facilities, (2) DOD's and VA's efforts to provide early
intervention for rehabilitation for seriously injured servicemembers, (3)
DOD's efforts to screen servicemembers at risk for post-traumatic stress
disorder (PTSD) and whether VA can meet the demand for PTSD services, and
(4) the impact of problems related to military pay on injured
servicemembers and their families.

This testimony is based on GAO work issued from 2004 through 2006 on the
conditions facing OEF/OIF servicemembers at the time the audit work was
completed.

Despite coordinated efforts, DOD and VA have had problems sharing medical
records for servicemembers transferred from DOD to VA medical facilities.
GAO reported in 2006 that two VA facilities lacked real-time access to
electronic medical records at DOD facilities. To obtain additional medical
information, facilities exchanged information by means of a time-consuming
process resulting in multiple faxes and phone calls.

In 2005, GAO reported that VA and DOD collaboration is important for providing
early intervention for rehabilitation. VA has taken steps to initiate early
intervention efforts, which could facilitate servicemembers' return to duty or
to a civilian occupation if the servicemembers were unable to remain in the
military. However, according to DOD, VA's outreach process may overlap with
DOD's process for evaluating servicemembers for a possible return to duty. DOD
was also concerned that VA's efforts may conflict with the military's retention
goals. In this regard, DOD and VA face both a challenge and an opportunity to
collaborate to provide better outcomes for seriously injured servicemembers.

DOD screens servicemembers for PTSD but, as GAO reported in 2006, it
cannot ensure that further mental health evaluations occur. DOD health
care providers review questionnaires, interview servicemembers, and use
clinical judgment in determining the need for further mental health
evaluations. However, GAO found that 22 percent of the OEF/OIF
servicemembers in GAO's review who may have been at risk for developing
PTSD were referred by DOD health care providers for further evaluations.
According to DOD officials, not all of the servicemembers at risk will
need referrals. However, at the time of GAO's review DOD had not
identified the factors its health care providers used to determine which
OEF/OIF servicemembers needed referrals. Although OEF/OIF servicemembers
may obtain mental health evaluations or treatment for PTSD through VA, VA
may face a challenge in meeting the demand for PTSD services. VA officials
estimated that follow-up appointments for veterans receiving care for PTSD
may be delayed up to 90 days.

GAO's 2006 testimony pointed out problems related to military pay have
resulted in debt and other hardships for hundreds of sick and injured
servicemembers. Some servicemembers were pursued for repayment of military
debts through no fault of their own. As a result, servicemembers have been
reported to credit bureaus and private collections agencies, been
prevented from getting loans, gone months without paychecks, and sent into
financial crisis. In a 2005 testimony GAO reported that poorly defined
requirements and processes for extending the active duty of injured and
ill reserve component servicemembers have caused them to be
inappropriately dropped from active duty, leading to significant gaps in
pay and health insurance for some servicemembers and their families.

References

Visible links

8. http://www.gao.gov/new.items/d07310.pdf
9. http://www.gao.gov/cgi-bin/getrpt?GAO-06-794R
  10. http://www.gao.gov/cgi-bin/getrpt?GAO-06-397
  11. http://www.gao.gov/cgi-bin/getrpt?GAO-06-657T
  12. http://www.gao.gov/cgi-bin/getrpt?GAO-06-362
  13. http://www.gao.gov/cgi-bin/getrpt?GAO-05-322T
  14. http://www.gao.gov/cgi-bin/getrpt?GAO-05-167
  15. http://www.gao.gov/cgi-bin/getrpt?GAO-04-1069
  16. http://www.gao.gov/cgi-bin/getrpt?GAO-96-133
  24. http://www.gao.gov/cgi-bin/getrpt?GAO-07-606T
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