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.
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.
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.
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.
DOD Health Care: Mental Health and Traumatic Brain Injury Screening Efforts Implemented, but Consistent Pre-Deployment Medical Record Review Policies Needed
VA and DOD Health Care: Administration of DOD's Post-Deployment Health Reassessment to National Guard and Reserve Servicemembers and VA's Interaction with DOD
DOD Health Care: Mental Health and Traumatic Brain Injury Screening Efforts Implemented, but Consistent Pre-Deployment Medical Record Review Policies Needed
VA and DOD Health Care: Progress Made on Implementation of 2003 President's Task Force Recommendations on Collaboration and Coordination, but More Remains to Be Done
VA and DOD Health Care: Administration of DOD's Post-Deployment Health Reassessment to National Guard and Reserve Servicemembers and VA's Interaction with DOD