VA Health Care:

Persian Gulf Dependents' Medical Exam Program Ineffectively Carried Out

HEHS-98-108: Published: Mar 31, 1998. Publicly Released: Apr 30, 1998.

Additional Materials:

Contact:

Stephen P. Backhus
(202) 512-7111
contact@gao.gov

 

Office of Public Affairs
(202) 512-4800
youngc1@gao.gov

Pursuant to a congressional request, GAO reviewed the Department of Veterans Affairs' (VA) implementation of the Persian Gulf Spouse and Children Examination Program, focusing on: (1) outreach efforts; (2) obstacles to family members' participation; and (3) contracting issues.

GAO noted that: (1) the Persian Gulf Spouse and Children Examination Program has faced numerous implementation problems that have limited its effectiveness in providing medical examinations; (2) to inform Persian Gulf veterans and their family members about the program, VA approached outreach in two ways--with a national campaign supplemented by local efforts at coordinating VA medical centers; (3) GAO found that some medical centers made efforts to contact Persian Gulf veterans and their families, while others relied on headquarters' outreach efforts; (4) however, GAO could not assess the effectiveness of these efforts because of a lack of information on the potential number of Persian Gulf family members who believe their illnesses are related to a family member's service in the Gulf War; (5) although as of January 1998 coordinating medical centers had received 2,802 requests for examinations, VA has completed only 872; (6) forty-one percent of applicants either failed to report for appointments, refused examinations, or had not yet answered requests to schedule examinations; (7) program participants face a lengthy and cumbersome scheduling process carried out through VA offices other than the local VA medical centers; (8) GAO's analysis showed that it takes an average of over 15 weeks for a participant to get an examination; (9) in addition, because VA chose to administer the program through only 36 of its 172 medical centers, examination sites are not always easily accessible to participants; (10) three of the 16 coordinating medical centers GAO contacted have not conducted any examinations because they have not contracted with their affiliated medical schools or other providers; (11) VA headquarters officials were unaware that examinations had not been conducted in two of the centers because of turnover in key center positions, and because VA did not start requiring monthly activity reports, which give the cumulative status of examination requests, from coordinating medical centers until October 1997; (12) GAO found that payment delays are caused in part by contractors incorrectly completing required paperwork, which staff from VA medical centers and affiliated medical schools told GAO is time consuming to complete and lacks clear instructions; and (13) although VA reserved $200,000 of authorized funds to cover the costs of tests, medical center officials told GAO they would have requested more referrals but believed resources were limited and the approval process would require additional time and travel for participants.

Recommendations for Executive Action

  1. Status: Closed - Implemented

    Comments: P.L. 105-368 granted VA authority to use its fee-basis contract authority to provide examinations to dependents of Persian Gulf veterans. Examinations were previously provided under VA's contractual arrangements with affiliated medical schools, which were not always conveniently located or interested in participating in the program. Local physicians can now complete examinations when the veteran's family cannot travel to affiliated medical centers.

    Recommendation: In an effort to improve participation rates in the Persian Gulf Spouse and Children Examination Program, the Secretary-designate of Veterans Affairs should direct the Under Secretary for Health to simplify the process for requesting and scheduling examinations.

    Agency Affected: Department of Veterans Affairs

  2. Status: Closed - Implemented

    Comments: In lieu of reimbursement for travel expenses, VA uses its fee-basis authority to contract with local physicians to provide required examinations. This process eliminates the former hardships of long and potentially expensive trips for some families not located near participating affiliated medical centers.

    Recommendation: In an effort to improve participation rates in the Persian Gulf Spouse and Children Examination Program, the Secretary-designate of Veterans Affairs should direct the Under Secretary for Health to offer examinations in more locations and seek approval to reimburse participants who are required to travel long distances to receive examinations.

    Agency Affected: Department of Veterans Affairs

  3. Status: Closed - Implemented

    Comments: VA coordinating facilities are required to submit monthly reports showing the status of all requests for examinations. For those examinations requested prior to initiation of fee-basis arrangements with local physicians, coordinating facilities are encouraged to contact veterans' families when possible to determine whether they are still interested in participating in the program.

    Recommendation: In an effort to improve participation rates in the Persian Gulf Spouse and Children Examination Program, the Secretary-designate of Veterans Affairs should direct the Under Secretary for Health to enhance the capacity of the Office of Public Health and Environmental Hazards to monitor program implementation by field personnel.

    Agency Affected: Department of Veterans Affairs

 

Explore the full database of GAO's Open Recommendations »

Sep 29, 2016

Sep 28, 2016

Sep 15, 2016

Sep 14, 2016

Sep 12, 2016

Sep 9, 2016

Sep 6, 2016

Looking for more? Browse all our products here