Agent Orange:

VA Needs To Further Improve Its Examination and Registry Program

HRD-86-7: Published: Jan 14, 1986. Publicly Released: Feb 14, 1986.

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In response to a congressional request, GAO reviewed the Veterans Administration's (VA) Agent Orange examination program to determine: (1) how promptly VA examined veterans; (2) whether VA was formally notifying veterans of examination results; and (3) how reliable and complete the Agent Orange registry was.

GAO found that: (1) veterans scheduled for appointments in the summer of 1984 had to wait an average of no more than 30 days at five of the eight medical centers visited; (2) at two of the centers, which did not give examinations within 30 days, delays resulted from the demand created by publicity after the settlement of an Agent Orange lawsuit; (3) at the third center, delays resulted from publicity and a heavy work load; (4) some veterans who had serious health problems were not formally notified of their problems, as required; (5) six of the eight centers visited were sending letters to veterans after their examinations most of the time; (6) one center sent letters only to veterans who did not return to discuss their laboratory test results with the physician; (7) only two centers that sent letters explained both examination and laboratory test results; (8) the computerized registry that records veterans' symptoms is not reliable because only a restricted number of codes can be used to identify complaints; and (9) as of June 1985, about 47,600 of the over 199,400 examinations medical facilities reported had not been entered in the registry, limiting its usefulness.

Recommendations for Executive Action

  1. Status: Closed - Implemented

    Comments: The applicable circular was revised.

    Recommendation: The Administrator of Veterans Affairs, through the Chief Medical Director, should clarify whether a veteran must claim exposure to Agent Orange to be eligible for priority care under P.L. 97-72, and the relationship between the law and the Agent Orange examination program.

    Agency Affected: Veterans Administration

  2. Status: Closed - Implemented

    Comments: VA stated that it will continue its policy of qualifying data when used in speeches and presentations, but qualification is not necessary when data is used in-house.

    Recommendation: The Administrator of Veterans Affairs, through the Chief Medical Director, should qualify all analyses of registry data by stating that the records of many veterans who received Agent Orange examinations are not included.

    Agency Affected: Veterans Administration

  3. Status: Closed - Implemented

    Comments: The circular supplement will direct that controls be established.

    Recommendation: The Administrator of Veterans Affairs, through the Chief Medical Director, should direct medical facilities to establish controls to ensure that all codesheets are submitted to the Agent Orange registry.

    Agency Affected: Veterans Administration

  4. Status: Closed - Implemented

    Comments: The circular supplement will require the appropriate review and completion of codesheets, but VA does not intend to use the entire ICD-9-CM system to code complaints. While GAO believes that the use of the entire system would be more appropriate, it does not intend to pursue this further.

    Recommendation: The Administrator of Veterans Affairs, through the Chief Medical Director, should revise instructions to medical centers regarding the collection of registry data. The instructions should allow coders to use the entire ICD-9-CM classification system to code veterans' complaints and require appropriate medical center officials to complete or review page one of the codesheet in the veteran's presence.

    Agency Affected: Veterans Administration

  5. Status: Closed - Implemented

    Comments: Two medical centers in each region will sample letters on a quarterly basis.

    Recommendation: The Administrator of Veterans Affairs, through the Chief Medical Director, should increase the monitoring of medical center compliance with the requirement to send complete and timely letters to veterans informing them of the results of their Agent Orange examinations, including laboratory tests, by such means as increasing the number of field visits made by central office staff.

    Agency Affected: Veterans Administration

  6. Status: Closed - Not Implemented

    Comments: VA stated that: (1) there is no feasible way to calculate the number of days examinations are pending without noting the request date; and (2) the current system identifies most delinquent facilities.

    Recommendation: The Administrator of Veterans Affairs, through the Chief Medical Director, should require facilities to report the number of examinations pending for more than 30 days at the end of each month.

    Agency Affected: Veterans Administration

  7. Status: Closed - Implemented

    Comments: VA circular, dated February 17, 1987, instructed facilities to make every effort to give veterans Agency Orange examinations within 30 days of the request date.

    Recommendation: The Administrator of Veterans Affairs, through the Chief Medical Director, should specify in VA program guidance that, to the extent practical, facilities should give veterans Agent Orange examinations within 30 days of the request date.

    Agency Affected: Veterans Administration

  8. Status: Closed - Implemented

    Comments: New instructions include a code for unsure exposure but do not describe how the staff should determine if care was for a condition related to exposure. Because of scientific uncertainty over this cause-and-effect relationship, GAO believes that VA has done as much as it can.

    Recommendation: The Administrator of Veterans Affairs, through the Chief Medical Director, should revise the instructions for reporting episodes of care provided under P.L. 97-72 to include a code for veterans unsure of their exposure and a description of how staff should determine whether an episode of care was for a condition possibly related to exposure.

    Agency Affected: Veterans Administration

 

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