VA and DOD Health Care
VA Has Policies and Outreach Efforts to Smooth Transition from DOD Health Care, but Sharing of Health Information Remains Limited Gao ID: GAO-05-1052T September 28, 2005Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF) servicemembers and those who are discharged from military service may receive health care from the Department of Veterans Affairs (VA). Since the onset of OIF and OEF, the Department of Defense (DOD) has reported that more than 15,000 servicemembers have been wounded in combat. Those who are seriously injured require comprehensive health care services and may be treated at either DOD or VA medical facilities. Because VA is expected to provide health care to many of the injured OIF and OEF servicemembers, concerns have been raised about the ease with which these individuals and their health care information transition from DOD's to VA's health care system. This statement is based on GAO's preliminary work on "seamless transition" and focuses on (1) the policies and outreach efforts that VA has instituted to provide timely access to health care to OIF and OEF servicemembers and (2) the extent to which individually identifiable health information is shared systematically between DOD and VA. Since GAO's work is still in the early stages of review, the statement is limited to information gathered to date.
Since 2002, VA has developed policies and procedures that direct its medical facilities to provide OIF and OEF servicemembers timely access to care. Most notably, VA assigned VA social workers to selected military treatment facilities in August 2003, directed VA facilities to designate combat case managers in October 2003, and directed the establishment of four VA polytrauma centers for OIF and OEF servicemembers in June 2005. In January 2005, VA established the Seamless Transition Office to further improve coordination within the Veterans Benefits Administration and the Veterans Health Administration as well as between DOD and VA. In addition, VA has increased outreach efforts by providing OIF and OEF servicemembers who have been discharged with personal letters and newsletters, a Web site for health information tailored to OIF and OEF servicemembers, counseling services, and briefings on available VA health care services. GAO is in the beginning stages of reviewing VA's efforts to provide a smooth transition from DOD health care and has not yet evaluated the effectiveness of VA's related policies, procedures, and outreach initiatives. An important issue associated with transitioning servicemembers to VA health care is the sharing of health care information between DOD and VA. The two departments have signed a memorandum of understanding for sharing individually identifiable health information, but the memorandum does not specify the particular types of individually identifiable health information that will be exchanged and when the information will be shared. The absence of specific procedures continues to hinder VA's efforts to obtain needed health information from DOD. Recently, DOD has begun to share certain health assessment information with VA on individuals who have been discharged from the military, and the transmitting of this information to VA on a routine basis is expected to occur in October 2005. However, according to VA officials, DOD is not providing health assessment information to VA for Reserve and National Guard members, who comprise 35 percent of the OIF and OEF forces.
GAO-05-1052T, VA and DOD Health Care: VA Has Policies and Outreach Efforts to Smooth Transition from DOD Health Care, but Sharing of Health Information Remains Limited
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Testimony:
Before the Committee on Veterans' Affairs, House of Representatives:
United States Government Accountability Office:
GAO:
For Release on Delivery Expected at 10:30 a.m. EDT:
Wednesday, September 28, 2005:
VA and DOD Health Care:
VA Has Policies and Outreach Efforts to Smooth Transition from DOD
Health Care, but Sharing of Health Information Remains Limited:
Statement of Cynthia A. Bascetta:
Director, Health Care:
GAO-05-1052T:
GAO Highlights:
Highlights of GAO-05-1052T, a testimony before the Committee on
Veterans‘ Affairs, House of Representatives:
Why GAO Did This Study:
Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF)
servicemembers and those who are discharged from military service may
receive health care from the Department of Veterans Affairs (VA). Since
the onset of OIF and OEF, the Department of Defense (DOD) has reported
that more than 15,000 servicemembers have been wounded in combat. Those
who are seriously injured require comprehensive health care services
and may be treated at either DOD or VA medical facilities. Because VA
is expected to provide health care to many of the injured OIF and OEF
servicemembers, concerns have been raised about the ease with which
these individuals and their health care information transition from
DOD‘s to VA‘s health care system.
This statement is based on GAO‘s preliminary work on ’seamless
transition“ and focuses on (1) the policies and outreach efforts that
VA has instituted to provide timely access to health care to OIF and
OEF servicemembers and (2) the extent to which individually
identifiable health information is shared systematically between DOD
and VA. Since GAO‘s work is still in the early stages of review, the
statement is limited to information gathered to date.
What GAO Found:
Since 2002, VA has developed policies and procedures that direct its
medical facilities to provide OIF and OEF servicemembers timely access
to care. Most notably, VA
* assigned VA social workers to selected military treatment facilities
in August 2003,
* directed VA facilities to designate combat case managers in October
2003, and
* directed the establishment of four VA polytrauma centers for OIF and
OEF servicemembers in June 2005.
In January 2005, VA established the Seamless Transition Office to
further improve coordination within the Veterans Benefits
Administration and the Veterans Health Administration as well as
between DOD and VA. In addition, VA has increased outreach efforts by
providing OIF and OEF servicemembers who have been discharged with
personal letters and newsletters, a Web site for health information
tailored to OIF and OEF servicemembers, counseling services, and
briefings on available VA health care services. GAO is in the beginning
stages of reviewing VA‘s efforts to provide a smooth transition from
DOD health care and has not yet evaluated the effectiveness of VA‘s
related policies, procedures, and outreach initiatives.
An important issue associated with transitioning servicemembers to VA
health care is the sharing of health care information between DOD and
VA. The two departments have signed a memorandum of understanding for
sharing individually identifiable health information, but the
memorandum does not specify the particular types of individually
identifiable health information that will be exchanged and when the
information will be shared. The absence of specific procedures
continues to hinder VA‘s efforts to obtain needed health information
from DOD. Recently, DOD has begun to share certain health assessment
information with VA on individuals who have been discharged from the
military, and the transmitting of this information to VA on a routine
basis is expected to occur in October 2005. However, according to VA
officials, DOD is not providing health assessment information to VA for
Reserve and National Guard members, who comprise 35 percent of the OIF
and OEF forces.
www.gao.gov/cgi-bin/getrpt?GAO-05-1052T.
To view the full product, including the scope and methodology, click on
the link above. For more information, contact Cynthia A. Bascetta at
(202) 512-7101 or bascettac@gao.gov.
[End of section]
Mr. Chairman and Members of the Committee:
Thank you for inviting me to share our work to date on the Department
of Veterans Affairs' (VA) collaboration with the Department of Defense
(DOD) to ensure that servicemembers are able to make a "seamless
transition" from DOD health care to VA health care services.
Servicemembers, under certain conditions,[Footnote 1] and those who are
discharged from service may receive health care from VA. On September
20, 2005, DOD reported that more than 15,000 servicemembers had been
wounded during Operation Iraqi Freedom (OIF) and Operation Enduring
Freedom (OEF).[Footnote 2] Many return to active duty after they are
treated, but those who are seriously injured require comprehensive
health care services and may undergo a medical evaluation to determine
their ability to stay in the military. Because VA is expected to
provide health care for injured OIF and OEF servicemembers, including
those who have been discharged, concerns have been raised about the
ease with which these individuals transition from DOD's to VA's health
care system.
My remarks today are based on preliminary work done on this issue and
focus on (1) the policies and outreach efforts that VA has instituted
to provide timely access to care to OIF and OEF servicemembers and (2)
the extent to which individually identifiable health information is
shared systematically between DOD and VA.
In conducting our review, we interviewed DOD, National Guard, Reserve,
and VA officials and obtained documents on relevant policies,
procedures, and VA outreach materials. Among these documents, we
reviewed the June 29, 2005, memorandum of understanding (MOU) for the
sharing of data between DOD and VA and the applicable law and
regulations that govern the sharing of individually identifiable health
information. In addition, we examined issues related to eligibility and
medical staff roles and responsibilities. We also visited the two DOD
medical facilities that receive and treat most of the seriously injured
OIF and OEF servicemembers and two VA medical centers that also treat
them.[Footnote 3] We did our work from May 2005 through September 2005
in accordance with generally accepted government auditing standards.
In summary, VA has developed policies and procedures that direct its
medical facilities to provide OIF and OEF servicemembers timely access
to care. VA has also increased outreach efforts by providing OIF and
OEF servicemembers who have been discharged with personal letters and
newsletters, a Web site for health information tailored to OIF and OEF
servicemembers, counseling services, and briefings on available VA
health care services. We are in the beginning stages of our review of
VA's efforts to provide a smooth transition from DOD health care and
have not yet evaluated the effectiveness of VA's related policies,
procedures, and outreach initiatives. We are reviewing the
implementation of these efforts in our ongoing work for this committee.
An important issue associated with transitioning servicemembers to VA
health care is the sharing of health care information between DOD and
VA. Currently, DOD does not have specific procedures for routinely
transmitting to VA health information on servicemembers who are likely
to be discharged from the military due to their medical condition.
Recently, DOD has begun to share certain health assessment information
with VA on individuals who have separated from the military, and the
transmitting of this information to VA on a routine basis is expected
to occur in October 2005. However, according to VA officials, DOD is
not providing health assessment information to VA for Reserve and
National Guard members, who comprise 35 percent of the OIF and OEF
forces.
Background:
Since the onset of OIF and OEF, over 1 million servicemembers have been
deployed. As of the end of June 2005, more than 393,000 active duty,
Reserve, and National Guard servicemembers from OIF and OEF have
separated from active duty. Of these, over 100,000 have sought health
care services from VA, including over 2,400 who received inpatient care
at VA medical centers. The Reserves and National Guard account for
about 54,000 of those servicemembers who sought health care services
from VA. The three most common health problems have been
musculoskeletal ailments (primarily joint and back disorders), dental
problems, and mental health disorders.
Servicemembers injured during OIF and OEF are surviving injuries that
would have been fatal in past conflicts. In World War II, 30 percent of
Americans injured in combat died; this proportion dropped to 24 percent
for those injured in the Vietnam War and further dropped to about 10
percent for those injured in OIF and OEF. Many of the injured OIF and
OEF servicemembers are returning with severe disabilities, including
traumatic brain injuries and missing limbs.
About 65 percent of OIF and OEF combat injuries are from improvised
explosive devices, blasts, landmines, and fragments. Of those injured
personnel, about 60 percent have some degree of traumatic brain injury
and may require comprehensive inpatient rehabilitation services to
address complex cognitive, physical, and mental health issues resulting
from trauma. Traumatic brain injuries may cause problems with cognition
(concentration, memory, judgment, and mood), movement (strength,
coordination, and balance), sensation (tactile sensation and vision),
and emotion (instability and impulsivity). The Department of Health and
Human Services' Centers for Disease Control and Prevention reports that
an estimated 15 percent of persons who sustain a mild brain injury
continue to experience symptoms 1 year after injury.
Initially, most severely injured servicemembers, including Reserve and
National Guard members, are brought to Landstuhl Regional Medical
Center in Germany for treatment. From there, they are transported to
appropriate U.S. military medical facilities, with most of the
seriously injured admitted to Walter Reed Army Medical Center or the
National Naval Medical Center, both located in the Washington, D.C.,
area. Once these servicemembers are medically stabilized, many are
relocated closer to their homes or military commands and continue
recovering either on an inpatient or outpatient basis at a VA medical
facility, a DOD military treatment facility (MTF), or DOD civilian
provider.[Footnote 4]
Those who have served, or are now serving, in OIF and OEF may receive
care from VA for conditions that are or may be related to their combat
services for a 2-year period following the date of their separation
from active duty without copayment requirements. Following this 2-year
period, they may continue to receive VA care but may be subject to a
copayment for their health care.
To ensure that servicemembers engaged in conflicts receive the health
care services they need, Congress passed legislation in May 1982 that
authorized VA to provide medical services to members of the armed
forces during and immediately following wartime or national emergencies
involving the armed forces in armed conflict.[Footnote 5] The law
authorized the Secretary of VA to give servicemembers responding to or
involved in a war or national emergency a higher priority for medical
services than all veterans, except those with a service-connected
disability.[Footnote 6] VA has established an enrollment system to
manage veterans' access to care. This system includes eight priority
categories for enrollment, with higher priority given to veterans with
service-connected disabilities, lower incomes, or other recognized
statuses such as former prisoners of war.
Separation from the military and return to civilian life may entail the
exchange of individually identifiable health information between DOD
and VA. The exchange of this information must comply with the Health
Insurance Portability and Accountability Act of 1996 (HIPAA)[Footnote
7] and the HIPAA Privacy Rule, which became effective April 14,
2001.[Footnote 8] The HIPAA Privacy Rule permits DOD and VA to share
servicemembers' health information under certain circumstances, such as
for continuity of health care treatment or if the individual signs a
proper authorization.
VA Has Established Policies and Outreach Efforts Intended to Smooth the
Transition from DOD Health Care:
VA has taken several steps to provide OIF and OEF servicemembers with
timely access to health care and information on health care services.
These steps include setting policies and developing outreach efforts
targeting OIF and OEF servicemembers.
Recent VA Policies Designed to Facilitate Transition to VA Health Care:
Since 2002, VA has issued a memorandum and four directives addressing
eligibility criteria and the health care needs of recently discharged
servicemembers.[Footnote 9]
* A September 2002 directive established policies and procedures for
offering hospital care, medical services, and nursing home care to
recently discharged servicemembers for a 2-year period, beginning on
their discharge date, for any illness, without requiring proof of its
link to military service.[Footnote 10] Under this directive, these
veterans are enrolled in the lowest priority category for service-
connected veterans.
* In April 2003, when the President declared a national emergency with
respect to the conflict in Iraq, the Secretary of VA issued a
memorandum authorizing VA to give priority health care to
servicemembers who sustained an injury, over veterans and others
eligible for VA care, except those with service-connected disabilities.
* An October 2003 directive (1) provided instructions to VA employees
for determining the eligibility of recent combat veterans to be
enrolled for VA health care; (2) required each VA medical facility to
designate a clinically trained combat case manager, usually a social
worker or nurse, to coordinate all of the medical care and services
provided to recent combat veterans by VA and non-VA agencies until the
veterans no longer need care; and (3) required VA medical facilities to
designate a point of contact--administrative staff, social worker, or
nurse--to receive and expedite transfers of servicemembers from MTFs to
VA medical facilities and coordinate with VA's combat case
managers.[Footnote 11]
* A June 2005 directive specified the dates of service and combat
locations to determine whether recent combat veterans are eligible for
health care services.[Footnote 12]
* Another June 2005 directive expanded the scope of care at VA's four
regional traumatic brain injury rehabilitation centers and redefined
these facilities as polytrauma rehabilitation centers.[Footnote 13]
These centers' inclusion of psychological treatment for family members
and rehabilitation services using high-technology prosthetics reflect
VA's intention to provide more coordinated care for patients, including
the growing number of OIF and OEF servicemembers with severe and
disabling trauma.[Footnote 14] The directive states that coordination
of care, including intensive clinical and social work case management
services,[Footnote 15] is essential in these severe trauma cases, as
patients transition from acute hospitalization through acute
rehabilitation and ultimately to their home communities.
In addition to VA's directives, a joint DOD and VA program was
established in August 2003 to assign VA social workers to selected MTFs
to coordinate patient transfers between MTFs and VA medical
facilities.[Footnote 16] The social workers make appointments for care,
ensure continuity of therapy and medications, and followup with
patients to verify success of the discharge. By mid-July 2005, the
social workers had received 3,907 requests for transfer of care--almost
two-thirds of them had been transferred to VA facilities; the rest were
pending. Further, VA benefits counselors work with the social workers
to inform servicemembers about VA benefits and to initiate paperwork
for disability compensation claims, vocational rehabilitation and
employment assistance, and other VA benefits.
Also in August 2003, VA created the Taskforce for the Seamless
Transition of Returning Service Members. The taskforce, composed of
senior VA leadership, focused on developing and implementing VA
policies to improve the transition of injured servicemembers to
civilian life. In January 2005, VA established the Seamless Transition
Office to further improve coordination within the Veterans Benefits
Administration and the Veterans Health Administration as well as
between DOD and VA.[Footnote 17] The goals of the Seamless Transition
Office include improving communication, coordination, and collaboration
within VA and with DOD with respect to health care; educating VA staff
about veteran's health care and other needs; and ensuring that policies
and procedures are in place to enhance the transition from
servicemember to veteran. The Seamless Transition Office uses the
taskforce in an advisory capacity.
To help ensure that VA staff assisting OIF and OEF servicemembers can
be responsive to their health care needs, the agency created an
internal Web site to provide a single source of access to VA policies,
procedures, and directives for wounded, ill, and seriously injured
servicemembers and veterans. According to VA, the internal Web site
also includes a list of the points of contact at medical facilities and
articles about transition-related activities.
VA Outreach Efforts to OIF and OEF Servicemembers:
VA has instituted several outreach strategies to provide information
about the health care services available to OIF and OEF servicemembers
who have been discharged. These include the use of newsletters,
personal letters, an external Web site, counseling services, and
briefings on VA benefits and services.
Using DOD rosters of OIF and OEF servicemembers who have separated from
active duty, VA sends newsletters and personal letters with pertinent
information to these new veterans. VA has sent three newsletters since
December 2003, with information on benefits and health issues specific
to OIF and OEF veterans. In addition, the Secretary of VA sends these
new veterans a letter thanking them for their service to the country
and informing them about VA health care services and assistance to aid
in their transition to civilian life. The letter includes a toll-free
number for obtaining information on VA health care and two brochures on
VA health care as well as benefit information, including disability
compensation, education and training, vocational rehabilitation and
employment, home loans, and life insurance. In addition, the Secretary
of VA has sent letters to all the Adjutants General and Chiefs of the
Reserves to inform them of VA services and benefits.[Footnote 18]
VA has also sought to improve access to health care information. It
created a Web site that provides information specific to those who
served in OIF and OEF, such as information on VA health and medical
services; dependents' benefits and services; transition assistance; and
benefits for active duty military, Reserve, and National Guard
personnel.[Footnote 19] In addition, VA developed a wallet-sized card
with relevant toll-free telephone numbers and Web site addresses. VA
officials reported that the agency has distributed 1 million copies of
this wallet card.
VA has enhanced outreach to those who served in OIF and OEF and their
families through its Vet Center Readjustment Counseling Service,
consisting of 207 centers. Vet Centers function as community points of
access by providing information and referrals to VA medical facilities.
Additionally, they offer counseling, employment services, and a range
of social services to assist individuals in readjusting from wartime
military service to civilian life. VA reported that during 2004, it
hired 50 peer counselors and placed them at Vet Centers where
significant numbers of servicemembers were returning from OIF and OEF.
According to a VA official, VA is in the process of hiring an
additional 50 peer counselors.
Briefings are another form of outreach used by VA to inform OIF and OEF
servicemembers about health care services.
* From fiscal year 2001 through the third quarter of fiscal year 2005,
VA held more than 30,800 briefings on VA benefits for more than 1.1
million servicemembers.[Footnote 20] These briefings include about
3,700 predeployment and postdeployment briefings for about 230,000
activated Reserve and National Guard servicemembers.20 VA held some of
these briefings aboard the USS Constellation, the USS Enterprise, and
the USS George Washington during the return of these vessels from the
Persian Gulf to the United States.
* VA's staff from the Seamless Transition Office have given educational
briefings on VA services and benefits to senior leadership in the
National Guard and the Army Reserve. Under a May 2005 memorandum of
agreement between VA and the National Guard, VA is in the process of
making staff available to provide briefings to Guard units in each
state.
Sharing of Health Information between DOD and VA Is Limited:
An important issue in providing a smooth transition from DOD's to VA's
heath care system is the sharing of individually identifiable health
information. In its May 2003 report, the President's Task Force to
Improve Health Care Delivery for Our Nation's Veterans stated that "a
seamless transition from military service to veteran status is
especially critical in the context of health care, where readily
available, accurate, and current medical information must be accessible
to health care providers." The task force further stated that increased
collaboration is needed between the departments for the transfer of
personnel and health information. DOD and VA officials have told us
that health information is being shared when injured servicemembers are
transferred from DOD to VA medical facilities.[Footnote 21] For OIF and
OEF servicemembers who may potentially use VA services, DOD and VA
share some types of administrative data, such as individuals' names and
addresses; however, the sharing of health information between the two
departments remains limited.
As we reported at a hearing in May 2005, DOD and VA did not have an
agreement--after 2 years of discussion--that specifies what types of
individually identifiable health information can be exchanged and when
they may be shared.[Footnote 22] Shortly after the hearing, DOD and VA
signed an MOU for the sharing of individually identifiable health
information.[Footnote 23] The MOU constitutes an agreement on the
circumstances under which DOD and VA will exchange individually
identifiable health information and includes references to provisions
of the HIPAA Privacy Rule and applicable laws that permit sharing. The
MOU does not specify particular types of individually identifiable
heath information that will be exchanged and when the information will
be shared. The absence of specific data sharing procedures continues to
hinder VA's efforts to obtain needed health information from DOD.
For example, DOD does not have specific procedures to routinely provide
VA with health information on servicemembers who have injuries or
illnesses that preclude them from continuing on active duty and, as a
result, are being evaluated by a DOD physical evaluation board (PEB)
for separation from the military.[Footnote 24] According to VA
officials, if a list of these individuals were transmitted routinely to
VA, it would enable VA to contact the individuals to make the
appropriate transfer of health care to a VA medical facility before the
individuals are discharged from the military. Such information could
reduce the potential for interruption to these individuals' health care
treatment plans. DOD officials told us that they are in the process of
developing a policy directive that would establish procedures for
sharing information with VA on servicemembers who are entering the PEB
process, but they could not determine when this policy directive would
become effective.
Recent progress in VA and DOD data sharing involves a health assessment
questionnaire that DOD requires servicemembers to complete following
deployment.[Footnote 25] This document contains, among other things,
self-reported information about a servicemember's potential exposure to
toxic substances and includes four questions that can be used to
identify individuals at risk of developing post-traumatic stress
disorder. In July 2005, DOD transmitted to VA postdeployment health
assessment data for those individuals who have been discharged from the
military. According to VA officials, DOD is expected to transmit these
data monthly beginning in October 2005. For these individuals, VA
clinicians will be able to access the data through VA's computerized
medical record system when the individuals seek VA health care
services. However, according to VA officials, DOD is not providing
health assessment information to VA for Reserve and National Guard
members, who comprise 35 percent of the OIF and OEF forces.
In addition to individual health information from the postdeployment
questionnaire, VA officials state that the agency could use aggregate
data from the questionnaire to plan for the needs of current
servicemembers who may one day be eligible for health care and benefits
from VA. This is consistent with an observation made by the President's
task force that comprehensive servicemember health data are essential
for forecasting and preparing for changes in the demand for health care
services. Currently, the data from the individual postdeployment
assessments are not accessible in a format that can be aggregated and
manipulated to provide the desired trend information.
Mr. Chairman, this concludes my prepared remarks. I will be pleased to
answer any questions you or other members of the committee may have.
Contacts and Acknowledgments:
For further information regarding this testimony, please contact
Cynthia A. Bascetta at (202) 512-7101 or bascettac@gao.gov. Michael T.
Blair, Jr., Assistant Director; Mary Ann Curran;
Hannah Fein; Cynthia Forbes; Marcia Mann; Kevin Milne; and Cherie
Starck also contributed to this statement.
[End of section]
Related GAO Products:
Military and Veterans' Benefits: Improvements Needed in Transition
Assistance Services for Reserves and National Guard. GAO-05-844T.
Washington, D.C.: June 29, 2005.
Military and Veterans' Benefits: Enhanced Services Could Improve
Transition Assistance for Reserves and National Guard. GAO-05-544.
Washington, D.C.: May 20, 2005.
DOD and VA: Systematic Data Sharing Would Help Expedite Servicemembers'
Transition to VA Services. GAO-05-722T. Washington, D.C.: May 19, 2005.
Vocational Rehabilitation: VA Has Opportunities to Improve Services,
but Faces Significant Challenges. GAO-05-572T. Washington, D.C.: April
20, 2005.
VA Disability Benefits and Health Care: Providing Certain Services to
the Seriously Injured Poses Challenges. GAO-05-444T. Washington, D.C.:
March 17, 2005.
Vocational Rehabilitation: More VA and DOD Collaboration Needed to
Expedite Services for Severely Injured Servicemembers. GAO-05-167.
Washington, D.C.: January 14, 2005.
VA and Defense Health Care: More Information Needed to Determine if VA
Can Meet an Increase in Demand for Post-Traumatic Stress Disorder
Services. GAO-04-1069. Washington, D.C.: September 20, 2004.
Major Management Challenges and Program Risks: Department of Veterans
Affairs. GAO-03-110. Washington, D.C.: January 2003.
[End of section]
FOOTNOTES
[1] Generally, VA supplements care that is not available from DOD or
when the demand for such care cannot be met by DOD.
[2] OIF, which began in March 2003, supports combat operations in Iraq
and other locations. OEF, which began in October 2001, supports combat
operations in Afghanistan and other locations.
[3] The DOD facilities were Walter Reed Army Medical Center and the
National Naval Medical Center; the VA facilities were the Augusta VA
Medical Center and the Richmond VA Medical Center.
[4] DOD provides health care to beneficiaries through its TRICARE
program. TRICARE beneficiaries can obtain health care through DOD's
direct care system of military hospitals and clinics, commonly referred
to as MTFs, and through DOD's purchased care system of civilian
providers.
[5] The Veterans' Administration and Department of Defense Health
Resources Sharing and Emergency Operations Act, Pub. L. No. 97-174,
§4(a), 96 Stat. 70, 74-75.
[6] A service-connected disability is an injury or disease that was
incurred or aggravated while on active military duty.
[7] Pub. L. No. 104-191, 110 Stat. 1936 (1996).
[8] The HIPAA Privacy Rule applies to covered entities and specifies
how individually identifiable health data may be used and disclosed by
covered entities. See 45 C.F.R. § 164.500(a), 164.502 (2004). Covered
entities are defined in the HIPAA Privacy Rule as health plans,
clearinghouses, and certain health care providers. Both DOD's health
care system and VA's health care system are covered entities. See 45
C.F.R. § 160.103 (2004). All covered entities had to comply with the
HIPAA Privacy Rule by April 14, 2003, with the exception of small
health plans.
[9] VA sometimes refers to individuals who served in combat after the
Gulf War or during a period of hostilities after November 11, 1998, as
"recent combat veterans". Our reference to discharged servicemembers
includes deactivated Reserve and National Guard members.
[10] VHA Directive 2002-049, Combat Veterans are Eligible for Medical
Services for 2-Years After Separation from Military Service
Notwithstanding Lack of Evidence for Service Connection, September 11,
2002.
[11] VHA Directive 2003-061, Combat Veteran Intake Processing and
Software Implementation, October 23, 2003.
[12] VHA Directive 2005-020, Determining Combat Veteran Eligibility,
June 2, 2005. Both this and the October 2003 directive allow VA to
provide health care services to a veteran without proof of combat
service. If VA later determines that the veteran is not a recent combat
veteran, VA will reevaluate the veteran's eligibility.
[13] VHA Directive 2005-024, Polytrauma Rehabilitation Centers, June 8,
2005. The four centers are located in Minneapolis, Minnesota; Palo
Alto, California; Richmond, Virginia; and Tampa, Florida.
[14] Because of the high percentage of veterans from OIF and OEF who
are surviving multiple massive injuries, Congress mandated that VA
establish polytrauma rehabilitation centers for research, education,
and clinical activities for servicemembers with complex combat
injuries. See the Veterans Health Programs Improvement Act of 2004,
Pub. L. No. 108-422, § 302, 118 Stat. 2379, 2383-86.
[15] Case management includes assessment of the individual's health
care needs, care planning and implementation, referral coordination,
monitoring, and periodic reassessment of the individual's care needs.
[16] Five MTFs were originally selected because they received most of
the OIF and OEF casualties. The MTFs were Walter Reed Army Medical
Center (Washington, D.C.), Brooke Army Medical Center (San Antonio,
Texas), Dwight David Eisenhower Army Medical Center (Augusta, Georgia),
Madigan Army Medical Center (Tacoma, Washington), and the National
Naval Medical Center (Bethesda, Maryland). In 2004 and 2005, three
additional MTFs--Darnall Army Community Hospital (Fort Hood, Texas),
Evans Army Community Hospital (Fort Carson, Colorado), and the Naval
Hospital Camp Pendleton (Camp Pendleton, California)--were added to
care for returning OIF and OEF servicemembers.
[17] The Veterans Benefits Administration provides benefits and
services, such as disability compensation, to veterans. The Veterans
Health Administration's primary responsibility is the delivery of
health care to veterans.
[18] Each state has an Adjutant General overseeing all Army and Air
Force National Guard units in the state.
[19] The Web site can be accessed through VA's home page at www.va.gov.
[20] VA could not report how many of these were OIF and OEF
servicemembers.
[21] The HIPAA Privacy Rule permits the sharing of health information
for continuity of health care treatment purposes.
[22] GAO, DOD and VA: Systematic Data Sharing Would Help Expedite
Servicemembers' Transition to VA Services, GAO-05-722T (Washington,
D.C.: May 19, 2005).
[23] VA signed the MOU in May 2005 and DOD signed it in June 2005.
[24] Military PEBs recommend whether servicemembers are physically
unfit to perform their military duties and should be placed on
disability retirement or discharged from military service.
[25] All servicemembers who are deployed outside of the United States
for 30 or more days to locations without treatment facilities must
complete a postdeployment health assessment questionnaire, DD 2796. DOD
uses this questionnaire to determine the presence of any physical
ailments or mental health issues commonly associated with deployments.
