Providing More Timely and Accessible Care for Returning Servicemembers
Video Message: Randall B. Williamson
Daniel Bertoni
Director, Education, Workforce, and Income Security
bertonid@gao.gov
(202) 512-5988
As of October 2008, over 33,000 servicemembers have been wounded in action, resulting in serious injuries such as amputations, traumatic brain injury (TBI), and post-traumatic stress disorder (PTSD). We have identified a number of weaknesses with the health care returning servicemembers are receiving as well as the complex and cumbersome disability systems they must navigate. While improvement efforts have started, identifying and treating servicemembers for specific combat-related health conditions, providing timely and accessible disability services, and addressing continuity of care issues are critical challenges facing our nation and will require sustained attention, systematic oversight by the Departments of Defense (DOD) and Veterans Affairs (VA), and sufficient resources. We have identified and reported on the following key challenges:
While returning servicemembers and veterans may have a range of health care needs, many servicemembers have been exposed to combat conditions that increase their risk of experiencing a TBI or developing PTSD. Identification and treatment of TBI and PTSD is critical; however DOD and VA face challenges screening, diagnosing, and treating TBI and PTSD.
DOD and VA operate separate disability evaluation processes for wounded servicemembers and veterans, respectively, that together may take months or years to complete. Since November 2007, the agencies have been piloting a joint process for determining disability benefits, but whether their efforts have been successful has not been determined. In the discussion on Improving and Modernizing Federal Disability Programs in GAO’s 2009 update to the High Risk Series, GAO highlighted the importance of soundly evaluating the pilot and carefully managing potential large-scale implementation.
Over 850,000 servicemembers have left active duty and are eligible for health care and potentially other benefits from VA. In recent years, problems have been identified with DOD and VA efforts to coordinate care and services for this population, including managing their transition from DOD to VA’s health care system, and expediting their access to VA disability benefits.
DOD and VA also are in the process of setting up a new interagency program office that will play a crucial role in accelerating their efforts to achieve electronic health records and capabilities that allow for full interoperability between the two departments’ systems. However, the departments’ plan for achieving interoperability by September 2009, as required in law, is incomplete because many milestones have yet to be determined.
The Army should explore options for improving its disability evaluation process and its servicemember satisfaction survey.
Highlights of GAO-08-1137 (PDF)
DOD and VA should establish criteria for determining whether their pilot of a joint process for determining disability benefits should be widely implemented, and take steps to sustain management attention on pilot evaluation and implementation.
Highlights of GAO-08-1137 (PDF)
VA needs to better manage the Benefits Delivery at Discharge program, which expedites VA disability benefits for servicemembers leaving the military, and DOD needs to coordinate with VA to improve servicemembers’ access to this beneficial program.
Highlights of GAO-08-901 (PDF)
VA needs to expeditiously evaluate the clinical validity and reliability of its TBI screening tool.
Highlights of GAO-08-276 (PDF)
DOD needs to require a review of medical records as part of its pre-deployment health assessment.
Highlights of GAO-08-615 (PDF)
DOD and VA should give priority to fully establishing the Joint Interagency Program Office and finalizing the implementation plan for achieving fully interoperable electronic health record systems.
Highlights of GAO-08-954 (PDF)
High-Risk Series: An UpdateGAO-09-271 , January 22, 2009Summary (HTML) Highlights Page (PDF) Full Report (PDF, 99 pages) Accessible Text
Information Technology: DOD and VA Have Increased Their Sharing of Health Information, but Further Actions Are NeededGAO-08-1158T , September 24, 2008Summary (HTML) Highlights Page (PDF) Full Report (PDF, 29 pages) Accessible Text
Military Disability System: Increased Supports for Servicemembers and Better Pilot Planning Could Improve the Disability Evaluation ProcessGAO-08-1137 , September 24, 2008Summary (HTML) Highlights Page (PDF) Full Report (PDF, 54 pages) Accessible Text Recommendations (HTML)
Veterans' Disability Benefits: Better Accountability and Access Would Improve the Benefits Delivery at Discharge ProgramGAO-08-901 , September 9, 2008Summary (HTML) Highlights Page (PDF) Full Report (PDF, 54 pages) Accessible Text Recommendations (HTML)
Defense Health Care: Oversight of Military Services' Post-Deployment Health Reassessment Completion Rates Is LimitedGAO-08-1025R , September 4, 2008Summary (HTML) Full Report (PDF, 20 pages) Accessible Text
Electronic Health Records: DOD and VA Have Increased Their Sharing of Health Information, but More Work RemainsGAO-08-954 , July 28, 2008Summary (HTML) Highlights Page (PDF) Full Report (PDF, 48 pages) Accessible Text Recommendations (HTML)
DOD Health Care: Mental Health and Traumatic Brain Injury Screening Efforts Implemented, but Consistent Pre-Deployment Medical Record Review Policies NeededGAO-08-615 , May 30, 2008Summary (HTML) Highlights Page (PDF) Full Report (PDF, 48 pages) Accessible Text Recommendations (HTML)
DOD and VA: Preliminary Observations on Efforts to Improve Care Management and Disability Evaluations for ServicemembersGAO-08-514T , February 27, 2008Summary (HTML) Highlights Page (PDF) Full Report (PDF, 29 pages) Accessible Text
VA Health Care: Mild Traumatic Brain Injury Screening and Evaluation Implemented for OEF/OIF Veterans, but Challenges RemainGAO-08-276 , February 8, 2008Summary (HTML) Highlights Page (PDF) Full Report (PDF, 55 pages) Accessible Text Recommendations (HTML)
VA and DOD Health Care: Administration of DOD's Post-Deployment Health Reassessment to National Guard and Reserve Servicemembers and VA's Interaction with DODGAO-08-181R , January 25, 2008Summary (HTML) Full Report (PDF, 18 pages) Accessible Text
DOD and VA: Preliminary Observations on Efforts to Improve Health Care and Disability Evaluations for Returning ServicemembersGAO-07-1256T , September 26, 2007Summary (HTML) Highlights Page (PDF) Full Report (PDF, 32 pages) Accessible Text
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Military Disability System: Increased Supports for Servicemembers and Better Pilot Planning Could Improve the Disability Evaluation ProcessGAO-08-1137 , September 24, 2008Summary (HTML) Highlights Page (PDF) Full Report (PDF, 54 pages) Accessible Text Recommendations (HTML)
Information Technology: DOD and VA Have Increased Their Sharing of Health Information, but Further Actions Are NeededGAO-08-1158T , September 24, 2008Summary (HTML) Highlights Page (PDF) Full Report (PDF, 29 pages) Accessible Text
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Veterans' Disability Benefits: Better Accountability and Access Would Improve the Benefits Delivery at Discharge ProgramGAO-08-901 , September 9, 2008Summary (HTML) Highlights Page (PDF) Full Report (PDF, 54 pages) Accessible Text Recommendations (HTML)
Defense Health Care: Oversight of Military Services' Post-Deployment Health Reassessment Completion Rates Is LimitedGAO-08-1025R , September 4, 2008Summary (HTML) Full Report (PDF, 20 pages) Accessible Text
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Government Performance: Lessons Learned for the Next Administration on Using Performance Information to Improve ResultsGAO-08-1026T , July 24, 2008Summary (HTML) Highlights Page (PDF) Full Report (PDF, 32 pages) Accessible Text
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Immigration Benefits: Improvements Needed to Address Backlogs and Ensure Quality of AdjudicationsGAO-06-20 , November 21, 2005Summary (HTML) Highlights Page (PDF) Full Report (PDF, 80 pages) Full Report (HTML) Accessible Text Recommendations (HTML)
VA Benefits: Other Programs May Provide Lessons for Improving Individual Unemployability AssessmentsGAO-06-207T , October 27, 2005Summary (HTML) Highlights Page (PDF) Full Report (PDF, 22 pages) Accessible Text
VA Disability Benefits: Routine Monitoring of Disability Decisions Could Improve ConsistencyGAO-06-120T , October 20, 2005Summary (HTML) Highlights Page (PDF) Full Report (PDF, 13 pages) Accessible Text
Department of Homeland Security: Strategic Management of Training Important for Successful TransformationGAO-05-888 , September 23, 2005Summary (HTML) Highlights Page (PDF) Full Report (PDF, 51 pages) Accessible Text Recommendations (HTML)
Homeland Security: Managing First Responder Grants to Enhance Emergency Preparedness in the National Capital RegionGAO-05-889T , July 14, 2005Summary (HTML) Highlights Page (PDF) Full Report (PDF, 15 pages) Accessible Text
Homeland Security: DHS' Efforts to Enhance First Responders' All-Hazards Capabilities Continue to EvolveGAO-05-652 , July 11, 2005Summary (HTML) Highlights Page (PDF) Full Report (PDF, 69 pages) Accessible Text
Federal Emergency Management Agency: Crisis Counseling Grants Awarded to the State of New York after the September 11 Terrorist AttacksGAO-05-514 , May 31, 2005Summary (HTML) Highlights Page (PDF) Full Report (PDF, 54 pages) Accessible Text Recommendations (HTML)
Veterans' Disability Benefits: Claims Processing Problems Persist and Major Performance Improvements May Be DifficultGAO-05-749T , May 26, 2005Summary (HTML) Highlights Page (PDF) Full Report (PDF, 15 pages) Accessible Text
DOD and VA: Systematic Data Sharing Would Help Expedite Servicemembers' Transition to VA ServicesGAO-05-722T , May 19, 2005Summary (HTML) Highlights Page (PDF) Full Report (PDF, 14 pages) Accessible Text
Department of Homeland Security: Addressing Management Challenges That Face Immigration Enforcement AgenciesGAO-05-664T , May 5, 2005Summary (HTML) Highlights Page (PDF) Full Report (PDF, 20 pages) Accessible Text
VA Disability Benefits: Board of Veterans' Appeals Has Made Improvements in Quality Assurance, but Challenges Remain for VA in Assuring ConsistencyGAO-05-655T , May 5, 2005Summary (HTML) Highlights Page (PDF) Full Report (PDF, 18 pages) Accessible Text
Post-Hearing Questions Related to the Department of Defense's National Security Personnel System GAO-05-641R , April 29, 2005Summary (HTML) Full Report (PDF, 6 pages) Accessible Text
Homeland Security: Overview of Department of Homeland Security Management ChallengesGAO-05-573T , April 20, 2005Summary (HTML) Highlights Page (PDF) Full Report (PDF, 22 pages) Accessible Text
Vocational Rehabilitation: VA Has Opportunities to Improve Services, but Faces Significant ChallengesGAO-05-572T , April 20, 2005Summary (HTML) Highlights Page (PDF) Full Report (PDF, 17 pages) Accessible Text
Results-Oriented Government: Improvements to DHS's Planning Process Would Enhance Usefulness and AccountabilityGAO-05-300 , March 31, 2005Summary (HTML) Highlights Page (PDF) Full Report (PDF, 25 pages) Accessible Text Recommendations (HTML)
VA Disability Benefits and Health Care: Providing Certain Services to the Seriously Injured Poses ChallengesGAO-05-444T , March 17, 2005Summary (HTML) Highlights Page (PDF) Full Report (PDF, 14 pages) Accessible Text
Department of Homeland Security: A Comprehensive and Sustained Approach Needed to Achieve Management IntegrationGAO-05-139 , March 16, 2005Summary (HTML) Highlights Page (PDF) Full Report (PDF, 39 pages) Accessible Text Recommendations (HTML)
Homeland Security: Much Is Being Done to Protect Agriculture from a Terrorist Attack, but Important Challenges RemainGAO-05-214 , March 8, 2005Summary (HTML) Highlights Page (PDF) Full Report (PDF, 101 pages) Accessible Text Recommendations (HTML)
Human Capital: Observations on Final DHS Human Capital RegulationsGAO-05-391T , March 2, 2005Summary (HTML) Highlights Page (PDF) Full Report (PDF, 31 pages) Accessible Text
DOD and VA Health Care: Incentives Program for Sharing Health ResourcesGAO-05-310R , February 28, 2005Summary (HTML) Full Report (PDF, 11 pages) Accessible Text
Military Pay: Gaps in Pay and Benefits Create Financial Hardships for Injured Army National Guard and Reserve SoldiersGAO-05-125 , February 17, 2005Summary (HTML) Highlights Page (PDF) Full Report (PDF, 73 pages) Accessible Text Recommendations (HTML)
Military Pay: Gaps in Pay and Benefits Create Financial Hardships for Injured Army National Guard and Reserve SoldiersGAO-05-322T , February 17, 2005Summary (HTML) Highlights Page (PDF) Full Report (PDF, 24 pages) Accessible Text
VA Health Care: VA Should Expedite the Implementation of Recommendations Needed to Improve Post-Traumatic Stress Disorder ServicesGAO-05-287 , February 14, 2005Summary (HTML) Full Report (PDF, 62 pages) Accessible Text Recommendations (HTML)
Human Capital: Preliminary Observations on Final Department of Homeland Security Human Capital RegulationsGAO-05-320T , February 10, 2005Summary (HTML) Highlights Page (PDF) Full Report (PDF, 31 pages) Accessible Text
Homeland Security: Process for Reporting Lessons Learned from Seaport Exercises Needs Further AttentionGAO-05-170 , January 14, 2005Summary (HTML) Highlights Page (PDF) Full Report (PDF, 35 pages) Accessible Text Recommendations (HTML)
Veterans Benefits: VA Needs Plan for Assessing Consistency of DecisionsGAO-05-99 , November 19, 2004Summary (HTML) Full Report (PDF, 28 pages) Accessible Text Recommendations (HTML)
VA and DOD Health Care: Efforts to Coordinate a Single Physical Exam Process for Servicemembers Leaving the MilitaryGAO-05-64 , November 12, 2004Summary (HTML) Highlights Page (PDF) Full Report (PDF, 43 pages) Accessible Text Recommendations (HTML)
Homeland Security: Management Challenges Remain in Transforming Immigration ProgramsGAO-05-81 , October 14, 2004Summary (HTML) Highlights Page (PDF) Full Report (PDF, 61 pages) Accessible Text Recommendations (HTML)