LOA 5—Facilities: Responsible for addressing issues relating to  military and VA medical facilities. Additional Efforts by DOD and VA to Address Problems Facing Recovering Servicemembers and Veterans

In addition to the Senior Oversight Committee’s efforts, DOD, its military  services, and VA developed or modified a number of programs and  initiatives to assist recovering servicemembers and veterans in navigating  the recovery care continuum. DOD and VA Have Not Fully Resolved Persistent Problems with Case Management and Care Coordination, Disability Evaluation Systems, and Electronic Sharing of Health Records

		Recovering Servicemembers and Veterans Do Not Always Have Access to the Case Management and Care Coordination Programs Designed to Assist Them

Recovering servicemembers’ access to case management and care  coordination programs has been impeded by two main factors—(1) the  limited ability to identify and refer those servicemembers who could  benefit from enrollment in the programs along with officials’ reluctance to  refer them, and (2) variations in eligibility criteria among the military  services’ wounded warrior programs, resulting in access disparities for  similarly situated recovering servicemembers. Delays in DOD’s and VA’s Integrated Disability Evaluation System Persist, Limiting Recovering Servicemembers’ Ability to Plan for Their Future

Although IDES provides improved timeliness over the separate DOD and  VA disability evaluation systems, processing times have continued to  increase since its implementation in November 2007, resulting in  frustration and uncertainty for servicemembers going through the  process. DOD and VA Have Not Fully Resolved Long-standing Problems Due to Deficiencies in Leadership and Oversight, Resources, and Collaboration

		Lack of Leadership and Oversight Has Limited DOD’s and VA’s Ability to Effectively Manage Programs for Recovering Servicemembers and Veterans

The lack of leadership and program oversight has limited DOD’s and VA’s  ability to effectively manage programs created to serve recovering  servicemembers and veterans. Whether the Joint Executive Council can effectively address the issues  once managed by the Senior Oversight Committee has yet to be seen. This lack of central oversight over the wounded  warrior programs has been one of the main reasons for the large  discrepancies between these programs. Despite Repeated Attempts, DOD and VA Have Failed to Effectively Collaborate to Align Their Care Coordination Programs; New Efforts Are Under Way

According to DOD and VA officials, the departments have identified 54 joint capabilities  that will be implemented by the end of fiscal year 2017. will depend upon achieving cooperation between the departments—which  has been elusive for many years—as well as with the military services. Conclusions

The deficiencies exposed at Walter Reed in 2007 served as a catalyst  compelling DOD and VA to address a host of problems that complicate  the course of a wounded, ill, and injured servicemember’s recovery,  rehabilitation, and return to active duty or civilian life. Initially, departmental leadership exhibited focus and commitment— through the Senior Oversight Committee—to addressing problems related  to case management and care coordination, disability evaluation systems,  and data sharing between DOD and VA. However, to date, these  efforts have not fully resolved key issues, and our nation’s recovering  servicemembers and veterans continue to face obstacles and challenges,  especially as they transition from DOD’s to VA’s health care system. Recommendations for Executive Action

To ensure that servicemembers have equitable access to the military  services’ wounded warrior programs, including the RCP, and to establish  central accountability for these programs, we recommend that the  Secretary of Defense establish or designate an office to centrally oversee  and monitor the activities of the military services’ wounded warrior  programs to include the following:
Develop consistent eligibility criteria to ensure that similarly situated  recovering servicemembers from different military services have  uniform access to these programs. DOD concurred with specific components of our first recommendation  regarding the establishment of central accountability for the military  services’ wounded warrior programs. However, DOD only partially concurred with other components of our first  recommendation—that DOD develop consistent eligibility criteria for  enrollment in wounded warrior programs and that DOD establish a  common mechanism to systematically monitor the performance of these  programs. The Joint Executive Council’s strategic planning and annual  reports focus on joint efforts between the departments and do not report  on the performance of the military services’ wounded warrior programs. DOD and VA both concurred with our second recommendation that the  departments ensure that care coordination, disability evaluation, and  electronic health record sharing receive sustained leadership attention  and collaboration at the highest levels, with a singular focus on what is  best for the individual servicemember or veteran to ensure continuity of  care and a seamless transition from DOD to VA. Key contributors to this report are listed in  appendix V.

Appendix I: Enrollment and Populations for Select Department of Defense and Department of Veterans Affairs Programs

Both the Department of Defense (DOD) and the Department of Veterans  Affairs (VA) operate care coordination and case management programs  designed to assist servicemembers and veterans as they navigate the  recovery care continuum, from acute medical treatment and stabilization,  through rehabilitation, to reintegration—either back to active duty or to the  civilian community as a veteran. The FRCP was established in January 2008.
Why GAO Did This Study

The National Defense Authorization Act for Fiscal Year 2008 required DOD and VA to jointly develop and implement policy on the care, management, and transition of recovering servicemembers. It also required GAO to report on DOD's and VA's progress in addressing these requirements. This report specifically examines (1) the extent to which DOD and VA have resolved persistent problems facing recovering servicemembers and veterans as they navigate the recovery care continuum, and (2) the reasons DOD and VA leadership have not been able to fully resolve any remaining problems. To address these objectives, GAO visited 11 DOD and VA medical facilities selected for population size and range of available resources and met with servicemembers and veterans to identify problems they continue to face. GAO also reviewed documents related to specific DOD and VA programs that assist recovering servicemembers and veterans and interviewed the leadership and staff of these programs to determine why problems have not been fully resolved.

What GAO Found

Deficiencies exposed at Walter Reed Army Medical Center in 2007 served as a catalyst compelling the Departments of Defense (DOD) and Veterans Affairs (VA) to address a host of problems for wounded, ill, and injured servicemembers and veterans as they navigate through the recovery care continuum. This continuum extends from acute medical treatment and stabilization, through rehabilitation to reintegration, either back to active duty or to the civilian community as a veteran. In spite of 5 years of departmental efforts, recovering servicemembers and veterans are still facing problems with this process and may not be getting the services they need. Key departmental efforts included the creation or modification of various care coordination and case management programs, including the military services' wounded warrior programs. However, these programs are not always accessible to those who need them due to the inconsistent methods, such as referrals, used to identify potentially eligible servicemembers, as well as inconsistent eligibility criteria across the military services' wounded warrior programs. The departments also jointly established an integrated disability evaluation system to expedite the delivery of benefits to servicemembers. However, processing times for disability determinations under the new system have increased since 2007, resulting in lengthy wait times that limit servicemembers' ability to plan for their future. Finally, despite years of incremental efforts, DOD and VA have yet to develop sufficient capabilities for electronically sharing complete health records, which potentially delays servicemembers' receipt of coordinated care and benefits as they transition from DOD's to VA's health care system.
Collectively, a lack of leadership, oversight, resources, and collaboration has contributed to the departments' inability to fully resolve problems facing recovering servicemembers and veterans. Initially, departmental leadership exhibited focus and commitment--through the Senior Oversight Committee--to addressing problems related to case management and care coordination, disability evaluation systems, and data sharing between DOD and VA. However, the committee's oversight waned over time, and in January 2012, it was merged with the VA/DOD Joint Executive Council. Whether this council--which has primarily focused on long-term strategic planning--can effectively address the shorter-term policy focused issues once managed by the Senior Oversight Committee remains to be seen. Furthermore, DOD does not provide central oversight of the military services' wounded warrior programs, preventing it from determining how well these programs are working across the department. However, despite these shortcomings, the departments continue to take steps to resolve identified problems, such as increasing the number of staff involved with the electronic sharing of health records and the integrated disability evaluation process. Additionally, while the departments' previous attempts to collaborate on how to resolve case management and care coordination problems have largely been unsuccessful, a joint task force established in May 2012 is focused on resolving long-standing areas of disagreement between VA, DOD, and the military services. However, without more robust oversight and military service compliance, consistent implementation of policies that result in more effective case management and care coordination programs may be unattainable. GAO recommends that DOD provide central oversight of the military services' wounded warrior programs and that DOD and VA sustain high-level leadership attention and collaboration to fully resolve identified problems. DOD partially concurred with the recommendation for central oversight of the wounded warrior programs, citing issues with common eligibility criteria and systematic monitoring. DOD and VA both concurred with the recommendation for sustained leadership attention.

What GAO Recommends

GAO recommends that DOD provide central oversight of the military services wounded warrior programs and that DOD and VA sustain high-level leadership attention and collaboration to fully resolve identified problems. DOD partially concurred with the recommendation for central oversight of the wounded warrior programs, citing issues with common eligibility criteria and systematic monitoring. DOD and VA both concurred with the recommendation for sustained leadership attention.