Summary

After being in operation for more than 1-1/2 years, the Department of Veterans Affairs' (VA) program to provide medical examinations to spouses and children of Persian Gulf veterans has yet to be fully implemented. To inform Persian Gulf veterans and their families about the program, VA launched a national campaign that was supplemented by local efforts at coordinating VA medical centers. GAO could not assess the effectiveness of these efforts because of a lack of information on the potential number of Persian Gulf family members who believe that their illnesses are linked to a family member's service in the Gulf War. Only 872 of the 2,802 requested examinations had been completed as of January 1998. Forty-one percent of applicants either failed to report for appointments, refused examinations, or had not yet answered requests to schedule examinations. Several factors contributed to the low completion rate. Participants face a lengthy and cumbersome scheduling process, and examination sites are not always easily accessible. Moreover, VA is not authorized to reimburse participants for travel, lodging, or lost wages. Although the clinical examinations may not resolve whether illnesses among Persian Gulf family members are related to the illnesses of veterans, the clinical examination approach provides these family members with an opportunity to visit with a physician and to receive a free medical examination. Standardized examinations also give VA a health surveillance tool for cataloging prominent symptoms among Persian Gulf family members.

GAO noted that: (1) the Persian Gulf Spouse and Children Examination Program has faced numerous implementation problems that have limited its effectiveness in providing medical examinations; (2) to inform Persian Gulf veterans and their family members about the program, VA approached outreach in two ways--with a national campaign supplemented by local efforts at coordinating VA medical centers; (3) GAO found that some medical centers made efforts to contact Persian Gulf veterans and their families, while others relied on headquarters' outreach efforts; (4) however, GAO could not assess the effectiveness of these efforts because of a lack of information on the potential number of Persian Gulf family members who believe their illnesses are related to a family member's service in the Gulf War; (5) although as of January 1998 coordinating medical centers had received 2,802 requests for examinations, VA has completed only 872; (6) forty-one percent of applicants either failed to report for appointments, refused examinations, or had not yet answered requests to schedule examinations; (7) program participants face a lengthy and cumbersome scheduling process carried out through VA offices other than the local VA medical centers; (8) GAO's analysis showed that it takes an average of over 15 weeks for a participant to get an examination; (9) in addition, because VA chose to administer the program through only 36 of its 172 medical centers, examination sites are not always easily accessible to participants; (10) three of the 16 coordinating medical centers GAO contacted have not conducted any examinations because they have not contracted with their affiliated medical schools or other providers; (11) VA headquarters officials were unaware that examinations had not been conducted in two of the centers because of turnover in key center positions, and because VA did not start requiring monthly activity reports, which give the cumulative status of examination requests, from coordinating medical centers until October 1997; (12) GAO found that payment delays are caused in part by contractors incorrectly completing required paperwork, which staff from VA medical centers and affiliated medical schools told GAO is time consuming to complete and lacks clear instructions; and (13) although VA reserved $200,000 of authorized funds to cover the costs of tests, medical center officials told GAO they would have requested more referrals but believed resources were limited and the approval process would require additional time and travel for participants.