VA and DOD Health Care:

Efforts to Provide Seamless Transition of Care for OEF and OIF Servicemembers and Veterans

GAO-06-794R: Published: Jun 30, 2006. Publicly Released: Jul 31, 2006.

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As of the end of March 2006, over 1.3 million U.S. military servicemembers had served or were serving in Operation Enduring Freedom (OEF) or Operation Iraqi Freedom (OIF). These servicemembers, including members of the reserves and National Guard, may be eligible to receive health care from the Department of Veterans Affairs (VA) while serving on active duty or upon separating from active duty. Although the Department of Defense (DOD) provides health care services to servicemembers under TRICARE, legislation passed by the Congress in May 1982 authorized VA to provide health care services to servicemembers in time of war or national emergency, when DOD may have insufficient resources to care for casualties. Through December 16, 2005, DOD had arranged for 193 active duty servicemembers with serious injuries--traumatic brain injuries and other complex trauma, such as missing limbs--to receive medical and rehabilitative care at VA polytrauma rehabilitation centers (PRC). In addition, about 30 percent (over 144,000) of the servicemembers who had separated from active duty following service in OEF or OIF have sought VA health care, including over 4,000 who received inpatient care at VA medical facilities. In September 2005, we testified on VA's collaboration with DOD to provide seamless transition of care for servicemembers between DOD and VA health care systems--that is, no interruption of care as the person moves from being a DOD patient to being a VA patient. We reported that VA has developed policies and procedures that direct its medical facilities to provide OEF and OIF servicemembers with timely access to care but that the sharing of health information between DOD and VA was limited. Congress asked us to update the information we provided in our testimony by reviewing the efforts VA is making to inform servicemembers and veterans about VA health care services and to help ensure that there is a seamless transition of care for servicemembers from DOD's to VA's health care system. We addressed the following questions: (1) What outreach efforts has VA made to inform OEF and OIF servicemembers and veterans about the VA health care services that may be available to them? (2) What actions has VA taken to facilitate the seamless transition of medical and rehabilitation care for seriously injured OEF and OIF servicemembers who are transferred between DOD medical treatment facilities (MTF) and PRCs? (3) What special educational activities or clinical tools is VA using to help ensure its medical providers are aware of and recognize the needs of eligible OEF and OIF servicemembers and veterans?

VA has made a variety of outreach efforts to provide OEF and OIF servicemembers and veterans and their families with information on VA health care services. VA reported that from October 1, 2000, through May 31, 2006, it provided about 36,000 briefings to almost 1.4 million active duty, reserve, and National Guard servicemembers about VA health care services that may be available to them. In some cases, family members also attended these briefings, which were provided at over 200 sites, including 70 sites outside the United States. VA also maintains a Web site containing health information focused on OEF and OIF servicemembers and veterans, distributes brochures and pamphlets to provide information about topics of interest to OEF and OIF servicemembers and veterans and their families, and sends letters and newsletters to veterans about VA health care services and health issues specific to veterans. VA has taken several actions to facilitate the transition of medical and rehabilitative care for seriously injured servicemembers who are being transferred from MTFs to PRCs. In April 2003, the Secretary of VA authorized VA medical facilities to give priority to OEF and OIF servicemembers over veterans, except those with service-connected disabilities. In April 2004, VA signed a memorandum of agreement (MOA) with DOD that established the referral procedures for transferring injured servicemembers from DOD to VA medical facilities. VA and DOD also established joint programs to ease the transfer of injured servicemembers to VA medical facilities, including a program that assigned VA social workers to selected MTFs to coordinate patient transfers to VA medical facilities. Nevertheless, problems remain in the process for electronically sharing the medical records VA needs to determine whether servicemembers are medically stable enough to participate in vigorous rehabilitation activities. VA has developed a number of educational activities and online clinical tools to help ensure that VA medical providers and other staff are aware of and recognize the health care needs of OEF and OIF servicemembers and veterans. Examples of VA's educational efforts include developing online courses on infectious diseases of Southwest Asia; holding conferences on brain injuries; conducting conference calls, each of which provided more than 100 VA staff with information on transferring servicemembers from DOD to VA health care services; and developing publications on the long-term effects of using an antimalarial drug. VA has also provided educational activities at two East Coast centers targeting medical professionals (such as physicians, nurses, and social workers), including conferences on topics such as physical and mental health issues, infectious disease issues, and health care services provided by VA. Furthermore, VA has developed clinical tools to help its staff be aware of and responsive to the needs of OEF and OIF servicemembers and veterans. VA and DOD have also developed guidelines to assist clinicians in providing medical care to OEF and OIF veterans.

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