Veterans Affairs
Post-hearing Questions Regarding the Departments of Defense and Veterans Affairs Providing Seamless Health Care Coverage to Transitioning Veterans
Gao ID: GAO-04-294R November 25, 2003
The Ranking Minority Member of the House Committee on Veterans Affairs requested that GAO respond to follow-up questions on its testimony on its report "Hand-off or Fumble: Are DOD and VA Providing Seamless Health Care Coverage to Transitioning Veterans?"
GAO believes that strong leadership and appropriate follow-through are key to improving compliance with force protections and surveillance policies for Operation Iraqi Freedom. It is encouraged that the compliance problems it found for Operation Enduring Freedom and Operation Joint Guardian prompted the Assistant Secretary of Defense for Health Affairs and the military services' Surgeons General to promptly take a number of actions to help ensure compliance with the Department of Defense's (DOD) force health protection and surveillance policies. Operation Iraqi Freedom is an ongoing operation with deployments of servicemembers who presumably are covered by the new quality assurance programs. On the basis these actions, GAO is optimistic that progress is occurring. However, the extent of compliance can be determined only from an examination of servicemembers' medical records. Knowing which servicemembers were at certain locations at specific times in the theater of operations is important for determining their possible exposures to chemical, biological, or environmental health hazards that DOD may know about currently or later discover. Without this exposure information, it would likely be more problematic for the Department of Veterans Affairs to determine a presumption of service-connection and to ascertain whether treatments are appropriate. When GAO issued its May 1997 report, DOD had not finalized its draft joint medical surveillance policy. DOD subsequently finalized its joint medical surveillance policy in August 1997. Although there are some methodological differences between the May 1997 and September 2003 reports, it is clear that force health protection and surveillance compliance problems continue in several areas. However, there appears to be some improvement in DOD's collection of predeployment blood serum samples from deploying servicemembers.
GAO-04-294R, Veterans Affairs: Post-hearing Questions Regarding the Departments of Defense and Veterans Affairs Providing Seamless Health Care Coverage to Transitioning Veterans
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Departments of Defense and Veterans Affairs Providing Seamless Health
Care Coverage to Transitioning Veterans' which was released on November
25, 2003.
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November 25, 2003:
The Honorable Lane Evans:
Ranking Democratic Member:
Committee on Veterans Affairs:
House of Representatives:
Subject: Veterans Affairs: Post-hearing Questions Regarding the
Departments of Defense and Veterans Affairs Providing Seamless Health
Care Coverage to Transitioning Veterans:
Dear Mr. Evans:
On October 16, 2003, I testified before your Subcommittee's hearing on
Hand-off or Fumble: Are DOD and VA Providing Seamless Health Care
Coverage to Transitioning Veterans?[Footnote 1] This letter responds to
your request that we provide answers to follow-up questions from the
hearing. Your questions, along with my responses, follow.
1. "Is there any reason for us to be optimistic that DOD [Department of
Defense] is in better compliance with force protections and
surveillance policies for Operation Iraqi Freedom than it was for
Operation Enduring Freedom and Operation Joint Guardianship? Why or why
not?":
Answer: We believe that strong leadership and appropriate follow-
through are key to improving compliance. We are encouraged that the
compliance problems we found for Operation Enduring Freedom and
Operation Joint Guardian prompted the Assistant Secretary of Defense
for Health Affairs and the military services' Surgeons General to
promptly take a number of actions to help ensure compliance with DOD's
force health protection and surveillance policies. As you know, we
recommended that DOD establish an effective quality assurance program
that will ensure compliance with these policies for all
servicemembers.[Footnote 2] In commenting on our report, the Assistant
Secretary of Defense stated that his office had already established a
quality assurance program for pre-deployment and post-deployment health
assessments and that the services have implemented their quality
assurance programs. As you know, Operation Iraqi Freedom is an ongoing
operation with deployments of servicemembers who presumably are covered
by the new quality assurance programs. On the basis these actions, we
are optimistic that progress is occurring. However, the extent of
compliance can be determined only from an examination of
servicemembers' medical records.
2. "You still believe DOD lacks data on troop locations that obviously
calls into question its ability to provide effective surveillance. It
won't have a system in place until 2007 at the earliest. How could that
impair VA's [Department of Veterans Affairs] ability to determine
presumption of service-connection and effective treatments for
exposures?":
Answer: Knowing which servicemembers were at certain locations at
specific times in the theater of operations is important for
determining their possible exposures to chemical, biological, or
environmental health hazards that DOD may know about currently or later
discover. Without this exposure information, it would likely be more
problematic for VA to determine a presumption of service-connection and
to ascertain whether treatments are appropriate.
3. "Has anything improved since your last report on compliance with
policies on force protection and surveillance?":
Answer: When we issued our May 1997 report,[Footnote 3] DOD had not
finalized its draft joint medical surveillance policy. DOD subsequently
finalized its joint medical surveillance policy in August 1997.
Although there are some methodological differences between our May 1997
and September 2003 reports, it is clear that force health protection
and surveillance compliance problems continue in several areas.
However, there appears to be some improvement in DOD's collection of
pre-deployment blood serum samples from deploying servicemembers.
Specifically, we reported, in our May 1997 report, that 9.3 percent of
the 26,000 servicemembers who had deployed to Bosnia did not have a
blood serum sample on file. In contrast, nearly 100 percent of our
samples for deployments examined in our September 2003 report had blood
serum samples on file.
We are sending copies of this report to the Secretary of Veterans
Affairs, the Office of the Secretary of Defense, and other interested
parties. We will also make copies available to others upon request. In
addition, this report will be available at no charge on the GAO Web
site at http://www.gao.gov.
If you have any questions about this report or need additional
information, please call me at (757) 552-8100.
Sincerely yours,
Neal P. Curtin:
Director, Operations and Readiness Issues:
Signed by Neal P. Curtin:
(350473):
FOOTNOTES
[1] See U.S. General Accounting Office: Defense Health Care: DOD Needs
to Improve Force Health Protection and Surveillance Processes, GAO-04-
158T (Washington, D.C.: Oct. 16, 2003).
[2] See U.S. General Accounting Office: Defense Health Care: Quality
Assurance Process Needed to Improve Force Health Protection and
Surveillance, GAO-03-1041 (Washington, D.C.: Sept. 19, 2003).
[3] See U.S. General Accounting Office: Defense Health Care: Medical
Surveillance Improved Since Gulf War, but Mixed Results in Bosnia, GAO/
NSIAD-97-136 (Washington, D.C.: May 13, 1997).
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