VA and DOD Health Care:
Administration of DOD's Post-Deployment Health Reassessment to National Guard and Reserve Servicemembers and VA's Interaction with DOD
GAO-08-181R: Published: Jan 25, 2008. Publicly Released: Jan 25, 2008.
Congress's long-standing interest in health care services for servicemembers returning from deployment has grown regarding National Guard and Reserve servicemembers because they are being activated in numbers not seen since World War II. For servicemembers who have been deployed overseas--whether National Guard, Reserve, or active duty--the Department of Defense (DOD) has developed a continuum of programs to assess servicemembers' health needs by obtaining information on their health concerns. One health assessment is administered before deployment, another about the time servicemembers return from deployment, and a third 90 to 180 days after deployment, which is called the post-deployment health reassessment (PDHRA). DOD directed the PDHRA to be implemented in June 2005 in response to studies that showed that health concerns were emerging several months after servicemembers' return from deployment. One intent of the PDHRA is to identify servicemembers' health concerns with a specific emphasis on screening for mental health and to assess whether servicemembers need referrals for further evaluation. PDHRAs can result in referrals being made to military treatment facilities, TRICARE providers, chaplains, Military OneSource, or Department of Veterans Affairs (VA) facilities, such as VA medical centers, VA community clinics, and Vet Centers. Congressional interest in health care services for National Guard and Reserve servicemembers returning from deployment has increased because of their large numbers and because they have reported post-deployment mental health concerns at a higher rate than their active duty counterparts, though this varies by military service. Related to this interest, Congress asked us to describe the administration of the PDHRA to National Guard and Reserve servicemembers. This report describes: (1) how DOD administers the PDHRA to National Guard and Reserve servicemembers and what information it obtains and (2) how VA interacts with DOD in the PDHRA process for these servicemembers and the information VA obtains.
DOD uses a health care contractor in all but a small number of cases to administer the PDHRA to National Guard and Reserve servicemembers either in person or by telephone through a call center. Specifically, DOD contracts with a company that provides administrative staff and health care providers--physicians, physician's assistants, and nurse practitioners--to administer the assessments. The PDHRA form asks for demographic information--such as the servicemember's date of birth, gender, and marital status--and health information that can lead to referrals for additional evaluation. For example, the PDHRA asks servicemembers questions about the occurrence of nightmares, conflicts with family and friends, and increased alcohol use. Servicemembers who answer affirmatively to these questions may receive a referral for further evaluation for mental health conditions, such as post-traumatic stress disorder or alcohol abuse. These referrals result from in-person or telephone discussions that take place between the servicemember and the health care provider during the PDHRA administration. Of the about 156,000 PDHRAs completed by National Guard and Reserve servicemembers from June 2005 through January 1, 2008, nearly 46 percent resulted in referrals for further evaluation for physical or mental health concerns. According to our discussions with VA and DOD officials, VA officials interact with DOD officials in the PDHRA process in several ways and receive information about servicemembers from DOD. Through coordination with DOD, VA officials are generally present when PDHRAs are administered to National Guard and Reserve servicemembers during drill weekends, whether the PDHRAs are administered in person or by telephone through a call center. VA interaction with DOD also occurs when servicemembers are referred to a VA facility. VA staff provide servicemembers with information about VA benefits and help them make appointments at VA facilities. Information VA receives from DOD includes the location of PDHRA administrations, numbers of servicemembers referred to VA facilities, and the PDHRAs of individual servicemembers who access VA health care. Of the National Guard and Reserve servicemembers referred through the PDHRA process for either physical or mental health concerns from June 2005 through January 1, 2008, 47 percent (almost 34,000) were referred to VA facilities.