For Veterans, DOD Offers a Benefit for a Specific Period of Time and VA Offers Various Health Care Services

DOD offers an extended health care benefit to some OEF/OIF veterans for  a specific period of time, and VA offers health care services that include  specialized PTSD services. VA also offers health care services to  OEF/OIF veterans following their discharge or release from active duty. DOD Offers Mental Health Benefits to OEF/OIF Veterans for 180 Days or More

Through TAMP, DOD provides health care benefits that allow some  OEF/OIF veterans to obtain health care services, which include mental  health services, for 180 days following discharge or release from active  duty. In addition, OEF/OIF veterans may purchase DOD health care benefits  through CHCBP for 18 months. Based on DOD Data, About 5 Percent of OEF/OIF Servicemembers May Have Been at Risk for Developing PTSD and Over 20 Percent Received Referrals

Using data provided by DOD from the DD 2796s, we found that about   5 percent of the OEF/OIF servicemembers in our review may have been at  risk for developing PTSD, and over 20 percent received referrals for  further mental health or combat/operational stress reaction evaluations. According to the clinical practice guideline jointly  developed by VA and DOD, individuals who respond positively to three or  four of the four PTSD screening questions may be at risk for developing  PTSD. According to  DOD officials, not all of the servicemembers with three or four positive  responses to the PTSD screening questions need referrals for further  evaluations. Conclusions

Many OEF/OIF servicemembers have engaged in the type of intense and  prolonged combat that research has shown to be highly correlated with  the risk for developing PTSD. Knowing the factors upon which DOD health care  providers based their clinical judgments in issuing referrals could help  explain variation in the referral rates and allow DOD to provide reasonable  assurance that such judgments are being exercised appropriately. However, DOD has not identified the factors its health care providers used  in determining why some servicemembers received referrals while other  servicemembers with the same number of positive responses to the four  PTSD screening questions did not. DOD’s plans to develop this information should lead to reasonable  assurance that servicemembers who need referrals receive them. Rather, in this report we identify the health care services  available to OEF/OIF servicemembers who have been discharged or  released from active duty and focus on how decisions are made by DOD  providers regarding referrals for servicemembers who may be at risk for  PTSD. Further, we  reviewed a retrospective study that found that those individuals who  provided three or four positive responses to the four PTSD screening  questions were highly likely to have been previously given a diagnosis of  PTSD prior to the screening. To determine the number of OEF/OIF  servicemembers who may be at risk for developing PTSD and were  referred for further mental health evaluations, we asked AMSA to identify  OEF/OIF servicemembers whose DD 2796 forms indicated that they were  referred for further mental health or combat/operational stress reaction  evaluations by a DOD health care provider. To examine whether DOD has reasonable assurance that OEF/OIF  veterans who needed further mental health evaluations received referrals,  we reviewed DOD’s policies and guidance, as well as policies and  guidance for each of the military service branches (Army, Navy, Air Force,  and Marines).
Why GAO Did This Study

Many servicemembers supporting Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) have engaged in intense and prolonged combat, which research has shown to be strongly associated with the risk of developing post-traumatic stress disorder (PTSD). GAO, in response to the Ronald W. Reagan National Defense Authorization Act for Fiscal Year 2005, (1) describes DOD's extended health care benefit and VA's health care services for OEF/OIF veterans; (2) analyzes DOD data to determine the number of OEF/OIF servicemembers who may be at risk for PTSD and the number referred for further mental health evaluations; and (3) examines whether DOD can provide reasonable assurance that OEF/OIF servicemembers who need further mental health evaluations receive referrals.

What GAO Found

DOD offers an extended health care benefit to some OEF/OIF veterans for a specified time period, and VA offers health care services that include specialized PTSD services. DOD's benefit provides health care services, including mental health services, to some OEF/OIF veterans for 180 days following discharge or release from active duty. Additionally, some veterans may purchase extended benefits for up to 18 months. VA also offers health care services to OEF/OIF veterans following their discharge or release from active duty. VA offers health benefits for OEF/OIF veterans at no cost for 2 years following discharge or release from active duty. After their 2-year benefit expires, some OEF/OIF veterans may continue to receive care under VA's eligibility rules. Using data provided by DOD, GAO found that 9,145 or 5 percent of the 178,664 OEF/OIF servicemembers in its review may have been at risk for developing PTSD. DOD uses a questionnaire to identify those who may be at risk for developing PTSD after deployment. DOD providers interview servicemembers after they complete the questionnaire. A joint VA/DOD guideline states that servicemembers who respond positively to three or four of the questions may be at risk for PTSD. Further, we reviewed a retrospective study that found that those individuals who provided three or four positive responses to the four PTSD screening questions were highly likely to have been previously given a diagnosis of PTSD prior to the screening. Of the 5 percent who may have been at risk, GAO found that DOD providers referred 22 percent or 2,029 for further mental health evaluations. DOD cannot provide reasonable assurance that OEF/OIF servicemembers who need referrals receive them. According to DOD officials, not all of the servicemembers with three or four positive responses to the PTSD screening questions will need referrals for further mental health evaluations. DOD relies on providers' clinical judgment to decide who needs a referral. GAO found that DOD health care providers varied in the frequency with which they issued referrals to OEF/OIF servicemembers with three or more positive responses; the Army referred 23 percent, the Marines about 15 percent, the Navy 18 percent, and the Air Force about 23 percent. However, DOD did not identify the factors its providers used in determining which OEF/OIF servicemembers needed referrals. Knowing the factors upon which DOD health care providers based their clinical judgments in issuing referrals could help explain variation in the referral rates and allow DOD to provide reasonable assurance that such judgments are being exercised appropriately.