Recommendations for Executive Action

1. 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

2. 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

3. 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

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: 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

6. 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

7. 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

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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