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Vocational Rehabilitation: More VA and DOD Collaboration Needed to Expedite Services for Seriously Injured Servicemembers

GAO-05-167 Published: Jan 14, 2005. Publicly Released: Jan 26, 2005.
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More than 10,000 U.S. military servicemembers, including National Guard and Reserve members, have been injured in the conflicts in Afghanistan and Iraq. Those with serious injuries are likely to be discharged from the military and return to civilian life with disabilities. The Department of Veterans Affairs (VA) offers vocational rehabilitation and employment (VR&E) services to help these injured servicemembers in their transition to civilian employment. GAO has noted that early intervention--the provision of rehabilitation services as soon as possible after the onset of a disability--is a practice that significantly facilitates the return to work. GAO examined how VA expedites VR&E services to seriously injured servicemembers and the challenges VA faces in its efforts to do so.

VA has taken steps to expedite vocational rehabilitation and employment services for servicemembers returning from Afghanistan and Iraq with serious injuries. The agency has instructed its regional offices to make seriously injured servicemembers a high priority for all VA assistance, including VR&E services, and has asked DOD to provide data that would help VA identify and monitor this population. It has also deployed additional staff to five major Army military treatment facilities where the majority of the seriously injured are treated. Pending an agreement with DOD for sharing data, VA has relied on its regional offices to learn who the seriously injured are and where they are located. We found that the regional offices we reviewed had developed information that varied in completeness and reliability. We also found that VA does not have a policy for maintaining contact with those with serious injuries who may later be ready for VR&E services but did not initially apply for VR&E. Nevertheless, some regional offices did attempt to maintain contact while other regional offices did not. VA faces significant challenges in expediting VR&E services to seriously injured servicemembers. These include: the inherent challenge that individual differences and uncertainties in the recovery process make it difficult to determine when a servicemember will be ready to consider VR&E services; DOD's concerns that VA's outreach, including early intervention with VR&E, could work at cross purposes to military retention goals for servicemembers whose discharge from military service is not yet certain; and the lack of access to data from DOD that would allow VA to readily know which servicemembers are seriously injured and where they are located. VA and DOD generally concurred with our findings and recommendations.

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Recommendations for Executive Action

Agency Affected Recommendation Status
Department of Defense To improve VA's efforts to expedite VR&E services to seriously injured servicemembers, VA and DOD should collaborate to reach an agreement for VA to have access to information that both agencies agree is needed to promote servicemembers' recovery and return to work.
Closed – Implemented
In response to a GAO recommendation, the Department of Defense (DOD) and Department of Veterans Affairs (VA) in June 2005 entered into a Memorandum of Understanding (MOU) that sought to ensure timely delivery of health care benefits and the processing of VA disability compensation claims and other applications. The MOU laid the groundwork to provide for the rapid transfer of information, including protected health information, on all service members who transition from DOD to VA during the life cycle of their service to their country or who are eligible for benefits administered by VA during their military service.
Department of Veterans Affairs To improve VA's efforts to expedite VR&E services to seriously injured servicemembers, VA and DOD should collaborate to reach an agreement for VA to have access to information that both agencies agree is needed to promote servicemembers' recovery and return to work.
Closed – Implemented
In its FY 2007 Performance and Accountability Report, the Department of Veterans Affairs (VA) reported it had implemented a Veterans Tracking Application (VTA). VTA, a modification of the Department of Defense's Joint Patient Tracking Application, provides the VA with the ability to track severely injured servicemembers from Landstuhl, Germany to a military treatment facility, and onto a VA medical facility or regional office. Using VTA, a Vocational Rehabilitation and Employment (VR&E) officer said VR&E coordinators for Operations Enduring and Iraqi Freedom can identify servicemembers who have newly arrived to either military treatment facilities or VA medical facilities in their regional offices' jurisdiction. They can then conduct outreach to make the servicemember aware of the return to work benefits offered under the VR&E program.
Department of Veterans Affairs The Secretary of Veterans Affairs should direct the Under Secretary for Benefits to develop a policy and procedures for regional offices to maintain contact with seriously injured servicemembers who do not initially apply for VR&E services, in order to ensure that they have the opportunity to participate in the program when they are ready.
Closed – Implemented
In March 2005, VA's Undersecretary for Benefits informed all VA regional offices (VARO) about procedures it established for initial outreach to injured service members returning from Iraq and Afghanistan; for maintaining contact as service members are discharged from a DOD medical facility; and as VA processes requests for benefits and services. Noting that early intervention is particularly important with severely disabled service members who may need vocational rehabilitation and/or independent living services, VA instructed each VARO to provide outreach to all seriously disabled service members arriving in its jurisdiction. Each VARO is also required to establish coordinator(s) who first visit seriously injured service members at the DOD medical facility when medically feasible; help them complete benefit forms; provide them with a business card to use whenever they need to make contact; obtain discharge information from the medical facility and; when these service members are discharged, provide them with information on the coordinator working at the appropriate VA regional office. In addition, if a seriously injured service member indicates that he/she is not interested in or ready for vocational rehabilitation, VA's vocational rehabilitation staff at the VAROs will arrange to contact him/her within one year of the initial contact to determine whether the service members expresses greater interest.

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