VA Health Care:
Status of VA's Approach in Conducting the National Vietnam Veterans Longitudinal Study
GAO-10-578R, May 5, 2010
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In addition to providing health care to over 5 million veterans each year, the Veterans Health Administration, part of the Department of Veterans Affairs (VA), funds research on specific health conditions that veterans may experience. One condition that is examined in VA-funded research is post-traumatic stress disorder (PTSD), an anxiety disorder that can occur after a person is exposed to a life-threatening event. According to VA, experts estimate that up to 30 percent of Vietnam veterans and up to 20 percent of Operation Enduring Freedom veterans and Operation Iraqi Freedom veterans have experienced PTSD. Veterans suffering from PTSD may experience problems sleeping, maintaining relationships, and returning to their previous civilian lives. Additionally, studies have shown that many veterans suffering from PTSD are more likely to be diagnosed with cardiovascular disease and other diseases. After the Vietnam War, Congress wanted information about the psychological effects of the war on Vietnam veterans to inform the need for PTSD services at VA. Consequently, in 1983, Congress mandated that VA provide for the conduct of a study on PTSD and related postwar psychological problems among Vietnam veterans. VA contracted with an external entity, the Research Triangle Institute, to conduct the National Vietnam Veterans Readjustment Study (NVVRS). This cross-sectional study determined the incidence and prevalence of PTSD among Vietnam veterans and Vietnam-era veterans. Under contact with VA, Research Triangle Institute researchers designed the study and analyzed the information collected for the study, which was initiated in 1984 and completed in 1988. Participants' identities were not provided to VA because of the Research Triangle Institute's concerns about Vietnam veterans' distrust of government agencies. According to VA, the NVVRS was a landmark study and is the only nationally representative study that focuses on PTSD in Vietnam veterans. The NVVRS data have since been used in other studies of PTSD. PTSD is an ongoing concern for Vietnam veterans, and today, Vietnam-era veterans still constitute the largest group of veterans receiving VA care for PTSD. Congress and others have been concerned about the continued prevalence of PTSD and VA's capacity to meet the needs of Vietnam veterans. In section 212 of the Veterans Benefits and Health Care Improvement Act of 2000, Congress required that VA contract with an appropriate entity to conduct a follow-up study to the NVVRS. In 2001, VA awarded another contract to the Research Triangle Institute to plan and conduct a follow-up study, the National Vietnam Veterans Longitudinal Study (NVVLS).
Since September 2009, VA has taken a number of steps toward conducting NVVLS. VA convened a project team for the NVVLS consisting of VA officials and PTSD experts both within VA and outside of VA. According to VA officials, the NVVLS project team developed a performance work statement, which outlines VA's requirements for the contractor selected to conduct the NVVLS. VA expects to select a contractor for the NVVLS in the summer of 2010 and for the NVVLS to be completed in 2013. VA officials stated that they plan for the NVVLS to meet all of the requirements of the law where scientifically feasible. In addition, VA is continuing its studies of PTSD in male twin Vietnam-era veterans and female Vietnam-era veterans, and VA officials maintain that these studies will also provide useful information in response to the law. VA reported that it faces several challenges in restarting the NVVLS. However, in several instances, the researchers and methodologists we interviewed offered suggestions for how these challenges could be addressed. For example, VA officials stated that they did not know how many of the NVVRS participants would agree to participate in the NVVLS, which could impact the feasibility of the study. All 10 researchers and 3 methodologists stated that it was important for NVVLS participants to receive assurances of confidentiality--that is, assurances regarding use of their identifying information, as was done with the NVVRS participants--to encourage participation. The 3 methodologists we interviewed agreed that providing assurances of confidentiality is particularly important for government-funded studies because many people distrust government agencies. According to VA's draft performance work statement, the agency plans to take possession of all the study data, including participants' identifying information, at the conclusion of the NVVLS. While 9 of the researchers and 1 methodologist commented that this requirement could impact whether veterans would agree to participate in the NVVLS, VA stated that it conducts many internal research studies and has no material issues recruiting study participants due to mistrust of VA. Overall, VA officials do not know whether, given the challenges they face, the NVVLS can be completed. VA's draft NVVLS performance work statement includes an initial phase during which VA expects the contractor to assess the feasibility of the study. All 10 researchers we interviewed said that restarting the study soon is important because as the study participants continue to age, an increasing number will be lost for follow-up because of illness or death. Nine of the researchers told us that they believe it is important for VA to complete the NVVLS because it will potentially provide important, nationally representative information on PTSD and related issues in Vietnam-era veterans.