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Many servicemembers supporting Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) have engaged in intense and prolonged combat, which research has shown to be strongly associated with the risk of developing post-traumatic stress disorder (PTSD). GAO, in response to the Ronald W. Reagan National Defense Authorization Act for Fiscal Year 2005, (1) describes DOD's extended health care benefit and VA's health care services for OEF/OIF veterans; (2) analyzes DOD data to determine the number of OEF/OIF servicemembers who may be at risk for PTSD and the number referred for further mental health evaluations; and (3) examines whether DOD can provide reasonable assurance that OEF/OIF servicemembers who need further mental health evaluations receive referrals.

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Recommendations for Executive Action

Agency Affected Recommendation Status
Department of Defense The Secretary of Defense should direct the Assistant Secretary of Defense for Health Affairs to identify the factors that DOD health care providers use in issuing referrals for further mental health or combat/operational stress reaction evaluations to explain provider variation in issuing referrals.
Closed - Not Implemented
In the January 2008 "Report to Congress on the Effectiveness of Self-Report Questionnaires Included in Deployment Health,? DOD wrote that it had created an additional form (DD Form 2900) on which providers could record whether they assessed a reported concern to be minor, major, or of no concern. DOD wrote that this form is intended to provide additional data points about the interaction and clinical decision making process that takes place during the PDHRA. DOD has also noted that it collects information on the percentage of service members receiving referrals due to mental health concerns identified through the PDHRA as part of the Force Health Protection Quality Assurance Program. However, these steps do not directly address the recommendation we made to study the factors providers use in making referrals to track or explain provider variation in issuing referrals. DOD has not identified any further actions related to this recommendation.

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