Although the task force’s initial priority was to ensure  the continuity of medical care for injured servicemembers as they  transitioned from military to VA health care, it also coordinated efforts to  ensure access to all other VA benefits, including vocational rehabilitation. The Privacy Rule permits VA and  DOD to share servicemembers’ health data under certain circumstances. VA Has Taken Steps to Expedite Vocational Rehabilitation Services, but Lack of Systematic Data from DOD Poses a Challenge

VA has given priority consideration and assistance to seriously injured  servicemembers returning from Afghanistan and Iraq. Despite efforts by VA’s regional offices to identify and obtain medical  information on seriously injured OEF/OIF servicemembers, lack of  systematic data from DOD poses a challenge. Although VA requested in  the spring of 2004 that DOD provide on a systematic basis personal  identifying data, medical data, and DOD’s injury classification for seriously  injured servicemembers, DOD and VA have not developed a data sharing  agreement. As a result, VA cannot provide reasonable  assurance that some seriously injured servicemembers who may benefit  from vocational rehabilitation services have not been overlooked. In our review of 12 VA regional offices, we found that the nature of the  local relationship between VA staff and MTF staff was a key factor in the  completeness and reliability of the information that the MTF provided on  seriously injured servicemembers. Several VA headquarters’ officials and  regional office staff we interviewed said that systematic data from DOD  would provide them with a way to reliably identify and follow up with  seriously injured servicemembers. Additionally, VA officials said these  data would help them plan for projected increases in services for newly  returning OEF/OIF servicemembers. Unresolved Issues Continue to Delay a Data Sharing Agreement

After more than 2 years of discussion, DOD and VA have not developed a  data sharing agreement. Although DOD and VA officials agree that the  HIPAA Privacy Rule permits the exchange of individually identifiable  health data if the individual signs a proper authorization, the departments  have not pursued this as an alternative to a data sharing agreement. However, DOD and VA differ in their  understanding of HIPAA Privacy Rule provisions that govern the sharing  of individually identifiable health data for servicemembers currently  receiving treatment in MTFs without an authorization, and the extent to  which the Privacy Rule would permit that exchange. DOD’s and VA’s  inability to resolve these differences has impeded coming to an agreement  on exchanging servicemembers’ individually identifiable health data. VA officials also said  they believe that DOD and VA provide public benefits. According to DOD officials, it would be premature for VA to begin  working with servicemembers who may eventually return to active duty. Despite being unable to agree on an exchange of individually identifiable  health data, DOD and VA are currently reviewing a draft memorandum of  understanding. However, we found that the draft memorandum of  understanding restates many of the legal authorities contained in the  Privacy Rule for the use and disclosure of individually identifiable health  data. As a  result, even if the memorandum of understanding is finalized, DOD and VA  will still not have a data sharing agreement that specifies what types of  individually identifiable health data can be exchanged and when the data  can be shared. Related GAO Products

Vocational Rehabilitation: VA Has Opportunities to Improve Services,  but Faces Significant Challenges. Vocational Rehabilitation: More VA and DOD Collaboration Needed to  Expedite Services for Seriously Injured Servicemembers.
Why GAO Did This Study

Since the onset of Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF), the Department of Defense (DOD) reported that more than 12,000 servicemembers have been injured in combat. While many return to active duty, others with more serious injuries are likely to be discharged from the military. To ensure the continuity of medical care and access to all other Department of Veterans Affairs' (VA) benefits, such as vocational rehabilitation, VA formed its Seamless Transition Task Force. In January 2005, GAO reported that VA had given high priority to OEF/OIF servicemembers, but faced challenges in identifying, locating, and following up with seriously injured servicemembers. GAO recommended that VA and DOD reach an agreement for VA to obtain systematic data from DOD, and the departments concurred. However, DOD raised privacy concerns. GAO was asked to review VA's efforts to expedite vocational rehabilitation services to seriously injured servicemembers and to determine the status of an agreement between DOD and VA to share health data. GAO relied on its prior work; interviewed VA and DOD officials; and reviewed the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and the HIPAA Privacy Rule, which govern the sharing of individually identifiable health data.

What GAO Found

While VA has taken steps to expedite services to seriously injured servicemembers, VA does not have systematic data from DOD on seriously injured servicemembers who may need VA vocational rehabilitation and other benefits. As a result, VA has had to rely on its regional offices to develop informal data sharing arrangements with local military treatment facility (MTF) staff to identify servicemembers who may need vocational rehabilitation services. However, VA staff have no official data source from DOD from which to confirm the completeness and reliability of the data they obtain. Furthermore, they cannot provide reasonable assurance that some seriously injured servicemembers who may have benefited from vocational rehabilitation services have not been overlooked. Although several VA headquarters officials and regional office staff GAO interviewed said that systematic data from DOD would provide them with a way to reliably identify and follow up with seriously injured servicemembers, DOD and VA have not developed a data sharing agreement. Additionally, VA officials said these data would help VA plan for projected increases in the need for services for newly returning OEF/OIF servicemembers. VA has requested that DOD provide systematic data on seriously injured servicemembers who may need vocational rehabilitation. DOD and VA have been working on a data sharing agreement for over 2 years, but have not reached an agreement. DOD and VA differ in their understanding of HIPAA Privacy Rule provisions that govern the sharing of individually identifiable health data for servicemembers currently receiving treatment at MTFs, and the extent to which the Privacy Rule would permit that exchange. DOD's and VA's inability to resolve these differences has impeded coming to an agreement on exchanging seriously injured servicemembers' individually identifiable health data. Despite being unable to agree on an exchange of individually identifiable health data, DOD and VA are reviewing a draft memorandum of understanding, which the departments believe will move them closer to a data sharing agreement. However, GAO found that the draft memorandum restates many of the legal authorities contained in the Privacy Rule for the use and disclosure of individually identifiable health data. As a result, even if the memorandum of understanding is finalized, DOD and VA will still have to agree on what types of individually identifiable health data can be exchanged and when the data can be shared. DOD and VA generally agreed with GAO's findings.