Disabled Veterans' Care

The Department of Veterans Affairs (VA) concluded in its annual report for fiscal year 1998 that it had maintained its mandated capacity to provide reasonable access to needed specialized care and rehabilitative services to veterans with spinal cord dysfunction, blindness, amputations, or mental illness. However, VA's data are not sufficient to support that conclusion because of extensive data problems, such as the use of unreliable proxy measures to identify veterans with special disabilities. Moreover, VA based its conclusion on national statistics that indicated that more special disability veterans were served with fewer resources expended in 1998 than in 1996. However, there is considerable variability among the Veterans Integrated Service Networks (VISN) and, in fact, some VISNs reported serving fewer veterans. In addition, VA attributed reduced expenditures and the use of fewer resources to efficiency gains, but because it lacks outcome measures, VA cannot tell whether it has maintained, enhanced, or diminished the quality of care. VA faces challenges in maintaining its capacity to serve special disability populations. In particular, the lack of a single VA headquarters unit accountable for ensuring compliance with the capacity legislation may have caused delays in monitoring and investigating locations where capacity appears to have declined and in fully implementing congressionally mandated performance standards for VA employees responsible for allocating and managing special disability program resources. To ensure compliance with the capacity legislation, GAO recommends that VA designate a single office to be accountable for fully implementing the mandate to maintain capacity in special disability programs.

GAO noted that: (1) VA concluded in its annual report for FY 1998 that it had maintained its capacity to treat veterans with special disabilities; (2) however, VA's data are not sufficient to support that conclusion because of extensive data problems, such as the use of unreliable proxy measures to identify veterans with special disabilities; (3) moreover, VA based its conclusion on national statistics that indicated more special disability veterans were served with fewer resources expended in 1998 than in 1996; (4) however, there is considerable variability among the Veterans Integrated Service Networks (VISN), and, in fact, some VISNs reported serving fewer veterans; (5) in addition, VA attributes reduced expenditures and the use of fewer resources to efficiency gains--however, because it lacks outcome measures, VA cannot tell whether it has maintained, enhanced, or diminished quality of care; (6) VA faces challenges in maintaining its capacity to serve special disability populations; and (7) in particular, the lack of a single VA headquarters unit accountable for ensuring compliance with the capacity legislation may have caused delays in: (a) monitoring and investigating locations where capacity appears to have declined; and (b) fully implementing congressionally mandated performance standards for VA employees responsible for allocating and managing special disability program resources.

Recommendations

Our recommendations from this work are listed below with a Contact for more information. Status will change from "In process" to "Open," "Closed - implemented," or "Closed - not implemented" based on our follow up work.

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