VA and DOD Health Care:

Efforts to Coordinate a Single Physical Exam Process for Servicemembers Leaving the Military

GAO-05-64: Published: Nov 12, 2004. Publicly Released: Nov 12, 2004.

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Servicemembers who leave the military and file disability claims with the Department of Veterans Affairs (VA) may be subject to potentially duplicative physical exams in order to meet requirements of both the Department of Defense's (DOD) military services and VA. To streamline the process for these servicemembers, the military services and VA have attempted to coordinate their physical exam requirements by developing a single separation exam program. In 1998, VA and DOD signed a memorandum of understanding (MOU) instructing local units to establish single separation exam programs. This report examines (1) VA's and the military services' efforts to establish single separation exam programs, and (2) the challenges to establishing single separation exam programs. To obtain this information, GAO interviewed VA and military service officials about establishing the program; evaluated existing programs at selected military installations; and visited selected installations that did not have programs.

Since 1998, VA and the military services have collaborated to establish single separation exam programs. However, while we were able to verify that the program was being delivered at some military installations, DOD, its military services, and VA either could not provide information on program locations or provided us with inaccurate information. As of May 2004, VA reported that 28 military installations had single separation exam programs that used one of five basic approaches to deliver an exam that met both VA's and the military services' requirements. However, when we evaluated 8 of the 28 installations, we found that 4 of the installations did not actually have programs in place. Nonetheless, VA and DOD leadership continue to encourage the establishment of single separation exam programs and have recently drafted a new memorandum of agreement (MOA) that is intended to replace the 1998 MOU. Like the original MOU, the draft MOA delegates responsibility for establishing single separation exam programs to local VA and military installations, depending on available resources. However, the draft MOA also contains a specific implementation goal that selected military installations should have single separation exam programs in place by December 31, 2004. This would require implementation at 139 installations--an ambitious plan given the seemingly low rate of program implementation since 1998 and the lack of accurate information on existing programs. Several challenges impede the establishment of single separation exam programs. The predominant challenge is that the military services may not benefit from a program designed to eliminate the need for two separate physical exams because they usually do not require that servicemembers receive a separation exam. As of August 2004, only the Army had a general separation exam requirement for retiring servicemembers. The other military services primarily require separation exams when the servicemember's last physical exam or medical assessment received during active duty is no longer considered current. In fiscal year 2003, only an estimated 13 percent of servicemembers who left the military received a separation exam. Consequently, the military services may not realize resource savings by eliminating or sharing responsibility for this exam. According to some military officials, another challenge to establishing single separation exam programs is that resources, such as facility space and medical personnel, are needed for other priorities, such as ensuring that active duty servicemembers are healthy enough to perform their duties. Additionally, because single separation exam programs require coordination between personnel from both VA and the military services, military staff changes, including those due to routine rotations, can make it difficult to maintain existing programs.

Status Legend:

More Info
  • Review Pending-GAO has not yet assessed implementation status.
  • Open-Actions to satisfy the intent of the recommendation have not been taken or are being planned, or actions that partially satisfy the intent of the recommendation have been taken.
  • Closed-implemented-Actions that satisfy the intent of the recommendation have been taken.
  • Closed-not implemented-While the intent of the recommendation has not been satisfied, time or circumstances have rendered the recommendation invalid.
    • Review Pending
    • Open
    • Closed - implemented
    • Closed - not implemented

    Recommendations for Executive Action

    Recommendation: To determine where single separation exam programs are established and operating, the Secretary of VA and the Secretary of Defense should develop systems to monitor and track the progress of VA regional offices and military installations in implementing these programs at BDD sites.

    Agency Affected: Department of Defense

    Status: Closed - Implemented

    Comments: GAO recommended that VA and DOD develop systems to monitor and track the progress of implementing single separation exam programs. VBA's Chief of Procedures Staff hired an official in November 2004 to monitor single separation exam programs at BDD sites with MOUs in place. He monitors and tracks the progress of the single separation exam programs in several ways. First, each VA Regional Office must provide a monthly report on BDD sites' activities. Included in these reports is information on the number of single separation exams that have been conducted. In addition, this official has conducted on-site evaluations at 5 locations and is planning to make 7 additional site visits in the near future. He will use information obtained in these site visits to develop best practices for other single separation exam programs. He plans to continue to conduct site visits in the future. DOD uses VA's tools and its database to monitor the progress of single separation examination sites. Each month, DOD reviews VA's database to determine where these programs are in place.

    Recommendation: To determine where single separation exam programs are established and operating, the Secretary of VA and the Secretary of Defense should develop systems to monitor and track the progress of VA regional offices and military installations in implementing these programs at BDD sites.

    Agency Affected: Department of Defense

    Status: Closed - Implemented

    Comments: GAO recommended that VA and DOD develop systems to monitor and track the progress of implementing single separation exam programs. VBA's Chief of Procedures Staff hired an official in November 2004 to monitor single separation exam programs at BDD sites with MOUs in place. He monitors and tracks the progress of the single separation exam programs in several ways. First, each VA Regional Office must provide a monthly report on BDD sites' activities. Included in these reports is information on the number of single separation exams that have been conducted. In addition, this official has conducted on-site evaluations at 5 locations and is planning to make 7 additional site visits in the near future. He will use information obtained in these site visits to develop best practices for other single separation exam programs. He plans to continue to conduct site visits in the future. DOD uses VA's tools and its database to monitor the progress of single separation examination sites. Each month, DOD reviews VA's database to determine where these programs are in place.

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