DCOE consists of a central office and six directorates. In fiscal year 2008, Congress specifically appropriated  $75 million for PH and TBI activities. While DCOE’s Role in the Budget Formulation Process Is Limited, More Complete Information Would Be Helpful

		DCOE Does Not Make PH and TBI Budget Formulation Decisions, and Its Input to the Process Is Limited

DCOE had a limited role in budget decision making for the fiscal year 2012  POM process. Guidance contained in OMB Circular A-11 specifies  that the basic requirements for a justification include a description of the  means and strategies used to achieve performance goals. The absence of readily available, comprehensive  historical funding and obligations data indicates that TMA and DCOE did  not have benefit of these data to inform budget formulation. Prior to our review, DCOE did not collect information on the sources and  amounts of funds component centers received in addition to allotments  from DCOE, and therefore did not have benefit of these data to help  inform budget decision making. Limited Information Is Available on DCOE’s Mission, Funding, and Activities

DCOE’s mission has not been clearly defined to Congress. For example, in  one hearing of the House Committee on Armed Services, Members  expressed differing visions of DCOE’s mission. In four congressional subcommittee testimonies,  DCOE’s first director and the Assistant Secretary of Defense for Health  Affairs characterized DCOE as DOD’s “open front door for all concerns  related to PH and TBI.” These statements suggest a divergent  understanding of DCOE’s role and bolster the importance of clear  communication on DCOE’s mission, funding, and activities. DCOE is a relatively small entity and it does not typically appear in DOD  DHP budget presentation materials and falls below the most detailed level  that is presented—the Budget Activity Group level. Specifically, the request stated “$0.8B to fund operations of the  Defense Center of Excellence (DCoE) for Psychological Health and  Traumatic Brain Injury, and to ensure that critical wartime medical and  health professionals are available to provide needed mental health  services by improving hiring and retention bonuses and offering targeted  special pay.”
DOD provides supplemental reporting on PH and TBI expenditures  through reports mandated in the National Defense Authorization Act for  Fiscal Year 2008, as well as ad hoc reports at Congress’s request. While  these reports present activities and accomplishments by strategic  initiative, DOD is not required to separately report on DCOE in its annual  reports. Recommendations for Executive Action

To enhance visibility and improve accountability, we recommend that the  Secretary of Defense direct the Director of TMA to work with the Director  of DCOE on the following three actions:  1.  develop and use additional narrative, such as that available in  component center fact sheets, in budget justifications to explain the  means and strategies that support the request. 2.  establish a process to regularly collect and review data on component  centers’ funding and obligations, including funding external to DCOE. 3.  expand its review and analysis process to include component centers. Specifically, DOD concurred with our  recommendation that the Director of TRICARE Management Activity  (TMA) work with the Director of the Defense Centers of Excellence for  Psychological Health and Traumatic Brain Injury (DCOE) to develop and  use additional narrative, such as that available in component centers’ fact  sheets and budget justifications. DOD also concurred with our  recommendation to establish a process to regularly collect and review  data on component centers’ funding and obligations, including funding  external to DCOE. To understand DCOE’s budget formulation process and  the data used to inform budget requests, we reviewed documentation  relevant to its budget formulation process and interviewed knowledgeable  Department of Defense (DOD) officials.
Why GAO Did This Study

The National Defense Authorization Act for Fiscal Year 2008 established the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury (DCOE) in January 2008 to develop excellence in prevention, outreach, and care for service members with psychological health (PH) conditions and traumatic brain injury (TBI). DCOE consists of six directorates and five component centers that carry out a range of PH- and TBI-related functions. GAO was asked to report on (1) DCOE's budget formulation process; and (2) availability of information to Congress on DCOE. GAO reviewed budget guidance, budget requests and performance data. GAO reviewed Department of Defense (DOD) reports submitted to Congress on PH and TBI and interviewed DOD officials.

What GAO Found

DCOE's role in the DOD budget formulation process is limited. For fiscal year 2012, DCOE's role in budget formulation was limited to consolidating component center budget requests and providing budget requests to the TRICARE Management Activity (TMA). Further, the budget requests DCOE provided to TMA did not have complete narrative justifications. Office of Management and Budget Circular A-11 specifies that the basic requirements for a justification include a description of the means and strategies used to achieve performance goals. At the time of GAO's review, prior-year funding and obligations data and funding received by component centers from sources external to DCOE were not readily available. The absence of these data indicates that TMA and DCOE did not have benefit of this data to inform budget formulation decisions. Also, quarterly reviews conducted by DCOE that collect data on performance and resources do not include component centers. Expansion of reviews and greater access to performance information could provide DCOE an opportunity to collect information that links component center performance with resources and better informs budget decision making. DCOE's mission and funding have not been clearly defined to Congress. At a congressional hearing, Members expressed differing visions of DCOE's mission and voiced concern about the amount of time needed to establish DCOE and achieve results. Moreover, in four congressional subcommittee testimonies, DCOE's first director and the Assistant Secretary of Defense for Health Affairs characterized DCOE as DOD's "open front door for all concerns related to PH and TBI." These statements suggest a divergent understanding of DCOE's role and bolster the importance of clear communication on DCOE's mission, funding, and activities. Because DCOE is a relatively small entity primarily funded through the larger Defense Health Program appropriation, it falls below the most detailed level that is presented in congressional budget presentation materials. In addition, at Congress's request DOD provides mandated and ad hoc reports on PH and TBI expenditures. While these reports present information on activities and accomplishments for PH and TBI, DOD does not--and is not required to--report separately on DCOE.

What GAO Recommends

To enhance visibility and improve accountability, GAO recommends that the Secretary of Defense direct the Director of TMA work with the Director of DCOE to develop and use additional narrative in budget justifications, to regularly collect and review data on funding and obligations, and expand its review and analysis process. DOD concurred with GAO's recommendations. GAO understands that the expanded review and analysis process would not include realigned component centers. GAO agrees that ensuring entities external to TMA comply with regular collections of funding and obligations data could be a limitation.