	DOD and VA Have Taken Actions to Facilitate the Transfer of Servicemembers but Experienced Problems in Exchanging Health Care Information

In our June 2006 report, we found that DOD and VA had taken actions to  facilitate the transition of medical and rehabilitative care for seriously  injured servicemembers who were being transferred from MTFs to PRCs. DOD and VA reported that as of  December 2005 two of the four PRCs had real-time access to the electronic  medical records maintained at Walter Reed Army Medical Center and only  one of the two also had access to the records at the National Naval  Medical Center. According to PRC officials, obtaining additional medical  information in this way, rather than electronically, is very time consuming  and often requires multiple phone calls and faxes. DOD was concerned that VA’s efforts may  conflict with the military’s retention goals. While VA tries to prepare servicemembers  for a transition to civilian life, VA’s outreach process may overlap with  DOD’s process for evaluating servicemembers for a possible return to  duty. In our report, we concluded that instead of working at cross purposes to  DOD goals, VA’s early intervention efforts could facilitate servicemembers’  return to the same or a different military occupation, or to a civilian  occupation if the servicemembers were not able to remain in the military. In this regard, the prospect for early intervention with vocational  rehabilitation presents both a challenge and an opportunity for DOD and  VA to collaborate to provide better outcomes for seriously injured  servicemembers. DOD Screens Servicemembers for PTSD after Deployment, but DOD and VA Face Challenges Ensuring Further PTSD Services

In our May 2006 report, we described DOD’s efforts to identify and  facilitate care for OEF/OIF servicemembers who may be at risk for PTSD. DOD health  care providers review completed questionnaires, conduct face-to-face  interviews with servicemembers, and use their clinical judgment in  determining which servicemembers need referrals for further mental  health evaluations. Using data provided by DOD, we found  that 22 percent, or 2,029, of the 9,145 OEF/OIF servicemembers in our  review who may have been at risk for developing PTSD were referred by  DOD health care providers for further mental health evaluations. According to DOD officials,  not all of the OEF/OIF servicemembers with three or four positive  responses on the screening questionnaire need referrals. However, at the time of our review  DOD had not identified the factors its health care providers used to  determine which OEF/OIF servicemembers needed referrals. Although OEF/OIF servicemembers may obtain mental health evaluations  or treatment for PTSD through VA when they transition to veteran status,  VA may face a challenge in meeting the demand for PTSD services. As a result, VA medical facility officials  estimated that follow-up appointments for veterans receiving care for  PTSD could be delayed. VA officials estimated the delays to be up to   90 days. Problems Related to Military Pay Have Resulted in Debt and Other Hardships for Hundreds of Sick and Injured Servicemembers

As discussed in our April 2006 testimony, problems related to military pay  have resulted in overpayments and debt for hundreds of sick and injured  servicemembers. We found that hundreds of  battle-injured servicemembers were pursued for repayment of military  debts through no fault of their own, including at least 74 servicemembers  whose debts had been reported to credit bureaus and private collections  agencies. In our 2005 testimony about Army National Guard and Reserve  servicemembers, we found that poorly defined requirements and  processes for extending injured and ill reserve component  servicemembers on active duty have caused servicemembers to be  inappropriately dropped from active duty. For some, this has led to  significant gaps in pay and health insurance, which has created financial  hardships for these servicemembers and their families. VA and DOD Health Care: Efforts to Provide Seamless Transition of  Care for OEF and OIF Servicemembers and Veterans. VA and Defense Health Care: More Information Needed to Determine If  VA Can Meet an Increase in Demand for Post-Traumatic Stress Disorder  Services.
Why GAO Did This Study

As of March 1, 2007, over 24,000 servicemembers have been wounded in action since the onset of Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF), according to the Department of Defense (DOD). GAO work has shown that servicemembers injured in combat face an array of significant medical and financial challenges as they begin their recovery process in the health care systems of DOD and the Department of Veterans Affairs (VA). GAO was asked to discuss concerns regarding DOD and VA efforts to provide medical care and rehabilitative services for servicemembers who have been injured during OEF and OIF. This testimony addresses (1) the transition of care for seriously injured servicemembers who are transferred between DOD and VA medical facilities, (2) DOD's and VA's efforts to provide early intervention for rehabilitation for seriously injured servicemembers, (3) DOD's efforts to screen servicemembers at risk for post-traumatic stress disorder (PTSD) and whether VA can meet the demand for PTSD services, and (4) the impact of problems related to military pay on injured servicemembers and their families. This testimony is based on GAO work issued from 2004 through 2006 on the conditions facing OEF/OIF servicemembers at the time the audit work was completed.

What GAO Found

Despite coordinated efforts, DOD and VA have had problems sharing medical records for servicemembers transferred from DOD to VA medical facilities. GAO reported in 2006 that two VA facilities lacked real-time access to electronic medical records at DOD facilities. To obtain additional medical information, facilities exchanged information by means of a time-consuming process resulting in multiple faxes and phone calls. In 2005, GAO reported that VA and DOD collaboration is important for providing early intervention for rehabilitation. VA has taken steps to initiate early intervention efforts, which could facilitate servicemembers' return to duty or to a civilian occupation if the servicemembers were unable to remain in the military. However, according to DOD, VA's outreach process may overlap with DOD's process for evaluating servicemembers for a possible return to duty. DOD was also concerned that VA's efforts may conflict with the military's retention goals. In this regard, DOD and VA face both a challenge and an opportunity to collaborate to provide better outcomes for seriously injured servicemembers. DOD screens servicemembers for PTSD but, as GAO reported in 2006, it cannot ensure that further mental health evaluations occur. DOD health care providers review questionnaires, interview servicemembers, and use clinical judgment in determining the need for further mental health evaluations. However, GAO found that 22 percent of the OEF/OIF servicemembers in GAO's review who may have been at risk for developing PTSD were referred by DOD health care providers for further evaluations. According to DOD officials, not all of the servicemembers at risk will need referrals. However, at the time of GAO's review DOD had not identified the factors its health care providers used to determine which OEF/OIF servicemembers needed referrals. Although OEF/OIF servicemembers may obtain mental health evaluations or treatment for PTSD through VA, VA may face a challenge in meeting the demand for PTSD services. VA officials estimated that follow-up appointments for veterans receiving care for PTSD may be delayed up to 90 days. GAO's 2006 testimony pointed out problems related to military pay have resulted in debt and other hardships for hundreds of sick and injured servicemembers. Some servicemembers were pursued for repayment of military debts through no fault of their own. As a result, servicemembers have been reported to credit bureaus and private collections agencies, been prevented from getting loans, gone months without paychecks, and sent into financial crisis. In a 2005 testimony GAO reported that poorly defined requirements and processes for extending the active duty of injured and ill reserve component servicemembers have caused them to be inappropriately dropped from active duty, leading to significant gaps in pay and health insurance for some servicemembers and their families.