	Background

DOD and VA offer health care benefits to active duty servicemembers and  veterans, among others. As part of the Army’s Medical Action Plan, the Army has developed a new  organizational structure—Warrior Transition Units—for providing an  integrated continuum of care for servicemembers who generally require at  least 6 months of treatment, among other factors. The military  also provides legal counsel to servicemembers in the disability evaluation  process. Based on the results of this exercise,  DOD and VA implemented the selected pilot design using live cases at  three Washington, D.C.-area military treatment facilities including Walter  Reed Army Medical Center in November 2007. The Army Continues to Increase Support to Servicemembers Undergoing Medical Treatment and Disability Evaluation, but Faces Challenges Reaching Stated Goals

The Army has made strides increasing key staff positions in support of  servicemembers undergoing medical treatment as well as disability  evaluation, but faces a number of challenges to achieving or maintaining  stated goals. Although the Army has made significant progress in staffing  its Warrior Transition Units, several challenges remain, including hiring  medical staff in a competitive market, replacing temporarily borrowed  personnel with permanent staff, and getting eligible servicemembers into  the units. Despite Hiring Efforts, Army Faces Challenges Providing Sufficient Staff to Help Servicemembers Navigate the Disability Evaluation Process

Injured and ill servicemembers who must undergo a fitness for duty  assessment and disability evaluation rely on the expertise and support of  several key staff—board liaisons, legal personnel, and board physicians— to help them navigate the process. With respect to board liaisons, the Army has expanded hiring efforts and  met its goals for reducing caseloads at most treatment facilities, but not at  some of the facilities with the most servicemembers in the process. In  August 2007, the Army established an average caseload target of 30  servicemembers per board liaison. As of February 2008, the Army had  expanded the number of board liaisons by about 22 percent. 2.) DOD-VA Joint Disability Evaluation Process Pilot Geared Toward Quick Implementation, but Pilot Evaluation Plans Lack Key Elements

DOD and VA have joined together to quickly pilot a streamlined disability  evaluation process, but evaluation plans currently lack key elements. In  August 2007, DOD and VA conducted an intensive 5-day “table top”  exercise to evaluate the relative merits of four potential pilot alternatives. Though the exercise yielded data quickly, there were trade-offs in the  nature and extent of data that could be obtained in that time frame. In  November 2007, DOD and VA jointly initiated a 1-year pilot in the  Washington, D.C. area using live cases, although DOD and VA officials told  us they may consider expanding the pilot to other locations beyond the  current sites around July 2008. However, pilot results may be limited at  that and other critical junctures, and pilot evaluation plans currently lack  key elements, such as criteria for expanding the pilot. Further, pilot planners have not laid  out an approach for measuring the pilot’s performance on key metrics— including timeliness and accuracy of decisions—against the current  process. Selection of the comparison group cases is a significant decision,  because it will help DOD and VA determine the pilot’s impact, compared  with the current process, and help planners identify needed corrections  and manage for success. Concluding Observations

Over the past year, the Army has made substantial progress toward  improving care for its servicemembers.
Why GAO Did This Study

In February 2007, a series of Washington Post articles about conditions at Walter Reed Army Medical Center highlighted problems in the Army's case management of injured servicemembers and in the military's disability evaluation system. These deficiencies included a confusing disability evaluation process and servicemembers in outpatient status for months and sometimes years without a clear understanding about their plan of care. These reported problems prompted various reviews and commissions to examine the care and services to servicemembers. In response to problems at Walter Reed and subsequent recommendations, the Army took a number of actions and DOD formed a joint DOD-VA Senior Oversight Committee. This statement updates GAO's September 2007 testimony and is based on ongoing work to (1) assess actions taken by the Army to help ill and injured soldiers obtain health care and navigate its disability evaluation process; and to (2) describe the status, plans, and challenges of DOD and VA efforts to implement a joint disability evaluation system. GAO's observations are based largely on documents obtained from and interviews with Army, DOD, and VA officials. The facts contained in this statement were discussed with representatives from the Army, DOD, and VA.

What GAO Found

Over the past year, the Army significantly increased support for servicemembers undergoing medical treatment and disability evaluations, but challenges remain. To provide a more integrated continuum of care for servicemembers, the Army created a new organizational structure--the Warrior Transition Unit--in which servicemembers are assigned key staff to help manage their recovery. Although the Army has made significant progress in staffing these units, several challenges remain, including hiring medical staff in a competitive market, replacing temporarily borrowed personnel with permanent staff, and getting eligible servicemembers into the units. To help servicemembers navigate the disability evaluation process, the Army is increasing staff in several areas, but gaps and challenges remain. For example, the Army expanded hiring of board liaisons to meet its goal of 30 servicemembers per liaison, but as of February 2008, the Army did not meet this goal at 11 locations that support about half of servicemembers in the process. The Army faces challenges hiring enough liaisons to meet its goals and enough legal personnel to help servicemembers earlier in the process. To address more systemic issues, DOD and VA promptly designed and are now piloting a streamlined disability evaluation process. In August 2007, DOD and VA conducted an intensive 5-day exercise that simulated alternative pilot approaches using previously-decided cases. This exercise yielded data quickly, but there were trade-offs in the nature and extent of data that could be obtained in that time frame. The pilot began with "live" cases at three treatment facilities in the Washington, D.C. area in November 2007, and DOD and VA may consider expanding the pilot to additional sites around July 2008. However, DOD and VA have not finalized their criteria for expanding the pilot beyond the original sites and may have limited pilot results at that time. Significantly, current evaluation plans lack key elements, such as an approach for measuring the performance of the pilot--in terms of timeliness and accuracy of decisions--against the current process, which would help planners manage for success of further expansion.