GAO Testimony – DOD and VA
This is a troubling situation. We have our kids off at war and they become severely injured, physically and mentally. Our country has pulled out all stops to provide the best possible care for them and still we have problems. Due to the protective gear and terrific and speedy medical care, thankfully more and more are surviving. This shift in the severity and long term recovery needs requires major adjustments in our programs for treatment and rehabitation, for our benefits and compensation programs. The cause and effect has driven the case loads and delays out of sight at the expense of our wounded heroes.
The good news is that that there is a scramble going on to correct these problems as soon as possible. There are people in high places capable of fixing the problem that have a heart for our heroes and are working very hard to fix the problems. There are people in our VA and in militray trauma centers that are just as frustrated as we are. There is a continuum of care mentality for our soldiers starting at the battlefield and continuing through our VA system. There are programs under development to reduce the time required to make determinations before our heroes get the treatment and benefits they need.
The bad news is there are still more than 150,000 cases more than 6 months old among the pending 600,000 cases in the VBA system, and we have no idea how old these cases really are. The GAO found that new programs designed to correct the problems are not yet fully off the ground and there are severe staffing problems in key places, both on the active duty side and the veteran side of the picture. It appears to me that some of it is due to needing to move physicians from one program to staff another, leaving both under staffed.
What the GAO found
Warrior Transition Unit
Challenges have emerged for staffing the Warrior Transition Unit in which servicemembers are assigned to three key staff – a physician care manager, a nurse care manager, and a squad leader. For example, as of mid-September 2007, over half the U.S. Warrior Transition Units had significant shortfalls in one or more of these critical positions. In addition the number of recovery coordinators and how many servicemembers each would serve have yet to be determined.
This table shows that in actuality we have only 35% perminent staffing for these teams. More than 450 of the existing staff (19%) have been borrowed from elsewhere, likely reducing the staff, already short, in othere facilities. The table below shows where those with less than 50% staffing are located.
PTSD and TBI
Three independent review groups examining the deficiencies found at Walter Reed identified a range of complex problems associated with DOD and VA’s screening, diagnosis, and treatment of TBI (Traumatic Brain Injury) and PTSD, signature injuries of recent conflicts. Both conditions are sometimes referred to as “invisible injuries” because outwardly the individual’s appearance is just as it was before the injury or onset of symptoms. In terms of mild TBI, there may be no observable head injury and symptoms may overlap with those associated with PTSD. With respect to PTSD, there is no objective diagnostic test and its symptoms can sometimes be associated with other psychological conditions (e.g., depression).
This table outlines what is being implimented (or planned) for handling TBI and PTSD better. However, according to Army officials and the Independent Review Group report, obtaining qualified health professionals, such as clinical psychologists, is a challenge, which is due to competition with private sector salaries and difficulty recruiting for certain geographical locations.
In addition, the Dole-Shalala Commission noted that while VA is considered a leader in PTSD research and treatment, knowledge generated through research and clinical experience is not systematically disseminated to all DOD and VA providers of care.
This table shows the efforts being taken to improve the data sharing between organizations.
As GAO and others have previously reported, providing timely and consistent disability decisions is a challenge for both DOD and VA. To address identified concerns, the Army has taken steps to streamline its disability evaluation process and reduce bottlenecks. To address identified concerns, the Army has taken steps to streamline its disability evaluation process and reduce bottlenecks. The Army has also developed and conducted the first certification training for evaluation board liaisons who help servicemembers navigate the system. To address more systemic concerns, the Senior Oversight Committee is planning to pilot a joint disability evaluation system. Pilot options may incorporate variations of three key elements:
(1) a single, comprehensive medical examination;
(2) a single disability rating done by VA; and
(3) a DOD-level evaluation board for adjudicating servicemembers’ fitness for duty.
DOD and VA officials hoped to begin the pilot in August 2007, but postponed implementation in order to further review options and address open questions, including those related to proposed legislation.
Fixing these long-standing and complex problems as expeditiously as possible is critical to ensuring high-quality care for returning servicemembers, and success will ultimately depend on sustained attention, systematic oversight by DOD and VA, and sufficient resources.
You are invited to download and read the entire report here: GAO Report (pdf - 32 pages)