VA Health Care:
Progress and Challenges in Conducting the National Vietnam Veterans Longitudinal Study
GAO-10-658T, May 5, 2010
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This testimony discusses the National Vietnam Veterans Longitudinal Study (NVVLS). According to the Department of Veterans Affairs (VA), experts estimate that up to 30 percent of Vietnam veterans have experienced post-traumatic stress disorder (PTSD), an anxiety disorder that can occur after a person is exposed to a life-threatening event. 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). According to VA, the NVVRS was a landmark study and is the only nationally representative study of PTSD in Vietnam veterans. 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. The law specifies certain requirements that the follow-up study must meet, including that the study must use the database and sample of the NVVRS and be designed to yield information on the long-term effects of PTSD and whether particular subgroups were at greater risk of chronic or more severe problems with PTSD. In 2001, VA awarded another contract to the Research Triangle Institute to plan and conduct a follow-up study, the NVVLS. However, in 2003, before data collection for the study began, VA terminated the contract and the study was not completed. In September 2009, the Secretary of Veterans Affairs announced that the agency planned to award a new contract to an external entity to conduct the NVVLS.
We found that since September 2009, VA has taken a number of steps toward conducting the 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 conducting 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. The challenges reported by VA included the following: (1) Locating and gaining consent from NVVLS participants, (2) Mitigating possible bias in a follow-up study, and (3) Assessing PTSD in the NVVLS. Overall, VA officials do not know whether, given the challenges they face, the NVVLS can be completed. VA's NVVLS draft 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. In responding to a draft of the report from which this testimony is based, VA explained its position on the ownership of the NVVRS and NVVLS study data. VA stated that the NVVRS contract provided that the study data was the property of the agency and did not provide that the identifying information be kept from VA. The agency also stated that the NVVRS consent documents did not restrict VA from possessing the identifying information of participants. VA confirmed that the agency intends to receive all the NVVLS study data, including participants' identifying information, upon completion of the study, and stated that the NVVLS consent form will explain to participants that VA does not intend to use the data to determine eligibility for VA benefits.