This is the accessible text file for GAO report number GAO-05-64
entitled 'VA and DOD Health Care: Efforts to Coordinate a Single
Physical Exam Process for Servicemembers Leaving the Military' which
was released on November 12, 2004.
This text file was formatted by the U.S. Government Accountability
Office (GAO) to be accessible to users with visual impairments, as part
of a longer term project to improve GAO products' accessibility. Every
attempt has been made to maintain the structural and data integrity of
the original printed product. Accessibility features, such as text
descriptions of tables, consecutively numbered footnotes placed at the
end of the file, and the text of agency comment letters, are provided
but may not exactly duplicate the presentation or format of the printed
version. The portable document format (PDF) file is an exact electronic
replica of the printed version. We welcome your feedback. Please E-mail
your comments regarding the contents or accessibility features of this
document to [email protected].
This is a work of the U.S. government and is not subject to copyright
protection in the United States. It may be reproduced and distributed
in its entirety without further permission from GAO. Because this work
may contain copyrighted images or other material, permission from the
copyright holder may be necessary if you wish to reproduce this
material separately.
Report to Congressional Requesters:
United States Government Accountability Office:
GAO:
November 2004:
VA and DOD Health Care:
Efforts to Coordinate a Single Physical Exam Process for Servicemembers
Leaving the Military:
GAO-05-64:
GAO Highlights:
Highlights of GAO-05-64, a report to congressional requesters
Why GAO Did This Study:
Servicemembers who leave the military and file disability claims with
the Department of Veterans Affairs (VA) may be subject to potentially
duplicative physical exams in order to meet requirements of both the
Department of Defense’s (DOD) military services and VA. To streamline
the process for these servicemembers, the military services and VA have
attempted to coordinate their physical exam requirements by developing
a single separation exam program. In 1998, VA and DOD signed a
memorandum of understanding (MOU) instructing local units to establish
single separation exam programs. This report examines (1) VA’s and the
military services’ efforts to establish single separation exam
programs, and (2) the challenges to establishing single separation exam
programs. To obtain this information, GAO interviewed VA and military
service officials about establishing the program; evaluated existing
programs at selected military installations; and visited selected
installations that did not have programs.
What GAO Found:
Since 1998, VA and the military services have collaborated to establish
single separation exam programs. However, while we were able to verify
that the program was being delivered at some military installations,
DOD, its military services, and VA either could not provide information
on program locations or provided us with inaccurate information. As of
May 2004, VA reported that 28 military installations had single
separation exam programs that used one of five basic approaches to
deliver an exam that met both VA’s and the military services’
requirements. However, when we evaluated 8 of the 28 installations, we
found that 4 of the installations did not actually have programs in
place. Nonetheless, VA and DOD leadership continue to encourage the
establishment of single separation exam programs and have recently
drafted a new memorandum of agreement (MOA) that is intended to replace
the 1998 MOU. Like the original MOU, the draft MOA delegates
responsibility for establishing single separation exam programs to
local VA and military installations, depending on available resources.
However, the draft MOA also contains a specific implementation goal
that selected military installations should have single separation exam
programs in place by December 31, 2004. This would require
implementation at 139 installations—an ambitious plan given the
seemingly low rate of program implementation since 1998 and the lack of
accurate information on existing programs.
Several challenges impede the establishment of single separation exam
programs. The predominant challenge is that the military services may
not benefit from a program designed to eliminate the need for two
separate physical exams because they usually do not require that
servicemembers receive a separation exam. As of August 2004, only the
Army had a general separation exam requirement for retiring
servicemembers. The other military services primarily require
separation exams when the servicemember’s last physical exam or medical
assessment received during active duty is no longer considered current.
In fiscal year 2003, only an estimated 13 percent of servicemembers
who left the military received a separation exam. Consequently, the
military services may not realize resource savings by eliminating or
sharing responsibility for this exam. According to some military
officials, another challenge to establishing single separation exam
programs is that resources, such as facility space and medical
personnel, are needed for other priorities, such as ensuring that
active duty servicemembers are healthy enough to perform their duties.
Additionally, because single separation exam programs require
coordination between personnel from both VA and the military services,
military staff changes, including those due to routine rotations, can
make it difficult to maintain existing programs.
What GAO Recommends:
GAO is recommending that the Secretaries of VA and Defense develop
systems to monitor and track the progress of VA regional offices and
military installations in implementing single separation exam
programs. VA and DOD concurred with GAO’s findings and recommendation.
www.gao.gov/cgi-bin/getrpt?GAO-05-64.
To view the full product, including the scope and methodology, click on
the link above. For more information, contact Marcia Crosse at (202)
512-7119.
[End of section]
Contents:
Letter:
Results in Brief:
Background:
VA and the Military Services Have Established Some Single Separation
Exam Programs, But Program Monitoring Is Lacking Despite Plans for
Expansion:
Infrequent Use of Separation Exams Among Military Services and Other
Factors Create Challenges in Establishing Single Separation Exam
Programs:
Conclusions:
Recommendations for Executive Action:
Agency Comments:
Appendix I: Scope and Methodology:
Appendix II: DOD's Form 2697 - Report of Medical Assessment:
Appendix III: DOD's Form 2808 - Report of Medical Examination:
Appendix IV: Comments from the Department of Veterans Affairs and GAO's
Response:
GAO Comments:
Appendix V: Comments from the Department of Defense:
Appendix VI: GAO Contacts and Staff Acknowledgments38:
GAO Contacts:
Acknowledgments:
Tables:
Table 1: Individual Military Service Requirements for Evaluating
Servicemembers' Health:
Table 2: Approaches Used to Deliver Single Separation Exams at Selected
Military Installations:
Table 3: Installations That VA Incorrectly Reported as Having Single
Separation Exam Programs:
Figure:
Figure 1: Estimated Percentage of Servicemembers Who Received
Separation Exams in Fiscal Year 2003:
Abbreviations:
AFEB: Armed Forces Epidemiology Board:
BDD: Benefits Delivery at Discharge:
C&P: compensation and pension:
DMDC: Defense Manpower Data Center:
DOD: Department of Defense:
MOA: memorandum of agreement:
MOU: memorandum of understanding:
PHA: preventive health assessment:
VA: Department of Veterans Affairs:
United States Government Accountability Office:
Washington, DC 20548:
November 12, 2004:
The Honorable Duncan Hunter:
Chairman:
Committee on Armed Services:
House of Representatives:
The Honorable Christopher H. Smith:
Chairman:
Committee on Veterans' Affairs:
House of Representatives:
Servicemembers who leave the military and file disability claims with
the Department of Veterans Affairs (VA) may be subject to potentially
duplicative physical exams in order to meet requirements of both the
Department of Defense's (DOD) military services and VA.[Footnote 1] VA
requires servicemembers applying for service-connected disability
compensation to undergo a physical exam, known as a compensation and
pension (C&P) exam, in order to determine the degree of their
disability. During fiscal year 2003, about 55,500 veterans submitted
disability claims to VA within their first year of leaving the
military. Similarly, to document any potential service-related health
conditions or complaints of servicemembers leaving the military, each
of the military services requires a medical assessment, which consists
of a questionnaire and in some cases may include a physical exam.
Moreover, each military service has additional medical requirements
servicemembers must meet when they leave the military--requirements
that in some cases include a physical exam, also known as a separation
exam. In fiscal year 2003, about 176,000 servicemembers left the
military and were subject to applicable requirements.
Although the purpose and scope of the physical exams administered by
the military services differ from those administered by VA, the
military services and VA developed a way to coordinate their physical
exam requirements, prevent duplication, and streamline the process for
servicemembers who are leaving the military and filing disability
claims. In 1994, VA and the Army initiated a multiyear pilot program
that concluded that a program consisting of one physical exam could be
designed to meet both the military services' requirements for
servicemembers leaving the military and VA's requirements for
determining disability. VA and the Army also concluded that such a
program would encourage a more efficient use of VA and military
resources, improve the timeliness of disability claims processing, and
offer convenience to servicemembers. Based on the findings of the pilot
program, in 1998, VA's Under Secretary for Health and DOD's Acting
Assistant Secretary of Defense for Health Affairs signed a memorandum
of understanding (MOU) that directed local VA offices and military
medical facilities to work together to establish single separation exam
programs.
To target servicemembers who are preparing to leave the military and
intend to file a disability claim, VA is working with the military
services to establish single separation exam programs at military
installations that have a Benefits Delivery at Discharge (BDD) program.
The BDD program is a joint VA/DOD initiative designed to streamline
servicemembers' transition from active duty to veterans' status. At
military installations with BDD programs, VA personnel educate
servicemembers about VA disability benefits and help them apply for
benefits before they leave military service--a process that is
otherwise initiated after servicemembers leave the military. BDD
programs, which are designed for servicemembers who have between 60 and
180 days remaining on active duty, are usually located at military
installations that have large numbers of servicemembers leaving the
military. At BDD sites that have single separation exam programs,
servicemembers typically receive a single separation exam after they
submit their disability claims paperwork. As of August 2004, VA
reported there were BDD programs at 139 military
installations.[Footnote 2]
You asked us to provide information on how VA and DOD's military
services are collaborating to provide single separation exams for
servicemembers who leave the military and intend to apply for service-
connected disability compensation.[Footnote 3] This report examines (1)
VA's and the military services' efforts to establish single separation
exam programs, and (2) the challenges to establishing single separation
exam programs.
To identify VA's and the military services' efforts to establish single
separation exam programs, we obtained information on VA's and the
military services' medical requirements involving physical exams or
other medical evaluations, and we interviewed officials from the Office
of the Assistant Secretary of Defense for Health Affairs, the military
services' Surgeons General, and VA. We also obtained a list of military
installations that VA reported as having single separation exam
programs. We used this list to select eight installations that
represented each branch of the military services to further evaluate
VA's and the military services' efforts to establish these programs. We
did not verify whether the remaining installations on VA's list had
operational programs in place, and we are only reporting on how
programs were operating at these eight selected installations. To
identify the challenges to establishing single separation exam
programs, we interviewed VA officials from 15 locations whose regions
included military installations with at least 500 servicemembers who
left the military in fiscal year 2003.[Footnote 4] We also visited
seven military installations that were not administering single
separation exam programs to learn why such programs were not in place.
These seven installations represented each of the military services and
had at least 500 servicemembers leaving the military during fiscal year
2003. In addition, we obtained data on the number of disability claims
filed, the number of separations from the military, the estimated
number of separation exams provided by the military services, and the
average costs of VA and DOD physical exams. We assessed the reliability
of these data and determined that they were sufficiently reliable for
our purposes. Our work was performed from January 2004 through November
2004 in accordance with generally accepted government auditing
standards. For more details on our scope and methodology, see appendix
I.
Results in Brief:
Since 1998, VA and the military services have collaborated to establish
single separation exam programs. However, while we were able to verify
that the program was being delivered at some military installations,
DOD, its military services, and VA either could not provide information
on program locations or provided us with inaccurate information. As of
May 2004, VA reported that 28 of 139 military installations with BDD
programs also had single separation exam programs that used one of five
basic approaches to deliver an exam that met both VA's and the military
services' requirements. However, when we evaluated 8 of the 28
installations, we found that 4 of the installations did not actually
have programs in place. Nonetheless, VA and DOD leadership continue to
encourage the establishment of single separation exam programs and have
recently drafted a new memorandum of agreement (MOA) that is intended
to replace the 1998 MOU. Like the original MOU, the draft MOA delegates
responsibility for establishing single separation exam programs to
local VA and military installations, depending on available resources.
However, the draft MOA also contains a specific implementation goal
that all BDD sites should have single separation exam programs in place
by December 31, 2004--an ambitious plan given the seemingly low rate of
program implementation since 1998 and the lack of accurate information
on existing programs.
Several challenges impede the establishment of single separation exam
programs. The predominant challenge is that the military services may
not benefit from a program designed to eliminate the need for two
separate physical exams because they usually do not require that
servicemembers receive a separation exam. As of August 2004, only the
Army had a general separation exam requirement for retiring
servicemembers. The other military services primarily require
separation exams when the servicemember's last physical exam or medical
assessment received during active duty is no longer considered current.
In fiscal year 2003, only an estimated 13 percent of servicemembers who
left the military received a separation exam. Consequently, the
military services may not realize resource savings by eliminating or
sharing responsibility for this exam. According to some military
officials, another challenge to establishing single separation exam
programs is that resources, such as facility space and medical
personnel, are needed for other priorities, such as ensuring that
active duty servicemembers are healthy enough to perform their duties.
Additionally, because single separation exam programs require
coordination between personnel from both VA and the military services,
military staff changes, including those due to routine rotations, can
make it difficult to maintain existing programs.
We are making a recommendation that the Secretary of VA and the
Secretary of Defense develop systems to monitor and track the progress
of VA regional offices and military installations in implementing
single separation exam programs at BDD sites. In commenting on a draft
of this report, VA and DOD concurred with the report's findings and
recommendation.
Background:
The military services and VA have medical requirements that
servicemembers must meet when leaving the military and applying for VA
disability compensation. These requirements include a medical
assessment; a service-specific separation exam, which is given to some
servicemembers; and a VA C&P exam. The single separation exam program
is designed to provide a single physical exam that can be used to meet
the physical exam requirements of the military services and VA.
The Military Services' Requirements for Medical Assessments and
Separation Exams:
In response to a 1994 memorandum from the Assistant Secretary of
Defense for Health Affairs, all of the military services require a
medical assessment of all servicemembers leaving the military,
including those that retire or complete their tour of active
duty.[Footnote 5] This assessment, which is used to evaluate and
document the health of these servicemembers, consists of a standard
two-page questionnaire asking servicemembers about their overall
health, medical and dental histories, current medications, and other
health-related topics.[Footnote 6] (See app. II for DOD's medical
assessment form--DD Form 2697.) Military medical personnel, who could
include a physician, a physician's assistant, or a nurse practitioner,
are required to review the questionnaire with the servicemember. If the
questionnaire indicates the presence of an illness, injury, or other
medical problem, the reviewer is required to ensure that the
servicemember's medical or dental records document the problem. In
addition, depending on the servicemember's responses or based on the
reviewer's judgment that additional information is needed, the health
assessment could result in a physical exam--one focused on a particular
health issue or issues in order to supplement information disclosed on
the questionnaire. Furthermore, the medical assessment asks if the
servicemember intends to file a claim for disability with VA.
Servicemembers who answer "yes" on the assessment form will be given a
clinically appropriate assessment or exam if the servicemember's last
physical exam received during active duty is more than 12 months old or
if new symptoms have appeared since the last active duty exam.[Footnote
7]
In addition, the Army, Navy, Air Force, and Marines[Footnote 8] require
some of their servicemembers to undergo separation exams when they
leave the military. Separation exams consist of a clinical evaluation
by a medical provider and could include various diagnostic tests, such
as a urinalysis, a hearing test, and a vision test. Separation exams,
as well as other physical exams the military services conduct, are
documented on a three-page standard DOD form. (See app. III for DOD's
report of medical examination--DD Form 2808.) According to DOD, the
average cost for a physical exam given by the military services is
about $125, exclusive of any diagnostic tests that may also be
conducted.[Footnote 9]
The requirements determining which servicemembers must receive
separation exams vary by military service and other factors. The Army
requires that its retirees receive separation exams, although the Army
does not usually require this for servicemembers who are completing
their tours of active duty. The other military services do not require
separation exams for most servicemembers, except for those whose last
physical exam or assessment they received during active duty is out of
date. (See table 1 for each military service's medical evaluation
requirements.) Further, all of the military services also require
separation exams for certain occupational specialties. For example, the
military services require separation exams for servicemembers who have
worked with hazardous materials. Finally, any servicemember can request
and receive a separation exam.
entitled 'VA and DOD Health Care: Efforts to Coordinate a Single
Physical Exam Process for Servicemembers Leaving the Military' which
was released on November 12, 2004.
This text file was formatted by the U.S. Government Accountability
Office (GAO) to be accessible to users with visual impairments, as part
of a longer term project to improve GAO products' accessibility. Every
attempt has been made to maintain the structural and data integrity of
the original printed product. Accessibility features, such as text
descriptions of tables, consecutively numbered footnotes placed at the
end of the file, and the text of agency comment letters, are provided
but may not exactly duplicate the presentation or format of the printed
version. The portable document format (PDF) file is an exact electronic
replica of the printed version. We welcome your feedback. Please E-mail
your comments regarding the contents or accessibility features of this
document to [email protected].
This is a work of the U.S. government and is not subject to copyright
protection in the United States. It may be reproduced and distributed
in its entirety without further permission from GAO. Because this work
may contain copyrighted images or other material, permission from the
copyright holder may be necessary if you wish to reproduce this
material separately.
Report to Congressional Requesters:
United States Government Accountability Office:
GAO:
November 2004:
VA and DOD Health Care:
Efforts to Coordinate a Single Physical Exam Process for Servicemembers
Leaving the Military:
GAO-05-64:
GAO Highlights:
Highlights of GAO-05-64, a report to congressional requesters
Why GAO Did This Study:
Servicemembers who leave the military and file disability claims with
the Department of Veterans Affairs (VA) may be subject to potentially
duplicative physical exams in order to meet requirements of both the
Department of Defense’s (DOD) military services and VA. To streamline
the process for these servicemembers, the military services and VA have
attempted to coordinate their physical exam requirements by developing
a single separation exam program. In 1998, VA and DOD signed a
memorandum of understanding (MOU) instructing local units to establish
single separation exam programs. This report examines (1) VA’s and the
military services’ efforts to establish single separation exam
programs, and (2) the challenges to establishing single separation exam
programs. To obtain this information, GAO interviewed VA and military
service officials about establishing the program; evaluated existing
programs at selected military installations; and visited selected
installations that did not have programs.
What GAO Found:
Since 1998, VA and the military services have collaborated to establish
single separation exam programs. However, while we were able to verify
that the program was being delivered at some military installations,
DOD, its military services, and VA either could not provide information
on program locations or provided us with inaccurate information. As of
May 2004, VA reported that 28 military installations had single
separation exam programs that used one of five basic approaches to
deliver an exam that met both VA’s and the military services’
requirements. However, when we evaluated 8 of the 28 installations, we
found that 4 of the installations did not actually have programs in
place. Nonetheless, VA and DOD leadership continue to encourage the
establishment of single separation exam programs and have recently
drafted a new memorandum of agreement (MOA) that is intended to replace
the 1998 MOU. Like the original MOU, the draft MOA delegates
responsibility for establishing single separation exam programs to
local VA and military installations, depending on available resources.
However, the draft MOA also contains a specific implementation goal
that selected military installations should have single separation exam
programs in place by December 31, 2004. This would require
implementation at 139 installations—an ambitious plan given the
seemingly low rate of program implementation since 1998 and the lack of
accurate information on existing programs.
Several challenges impede the establishment of single separation exam
programs. The predominant challenge is that the military services may
not benefit from a program designed to eliminate the need for two
separate physical exams because they usually do not require that
servicemembers receive a separation exam. As of August 2004, only the
Army had a general separation exam requirement for retiring
servicemembers. The other military services primarily require
separation exams when the servicemember’s last physical exam or medical
assessment received during active duty is no longer considered current.
In fiscal year 2003, only an estimated 13 percent of servicemembers
who left the military received a separation exam. Consequently, the
military services may not realize resource savings by eliminating or
sharing responsibility for this exam. According to some military
officials, another challenge to establishing single separation exam
programs is that resources, such as facility space and medical
personnel, are needed for other priorities, such as ensuring that
active duty servicemembers are healthy enough to perform their duties.
Additionally, because single separation exam programs require
coordination between personnel from both VA and the military services,
military staff changes, including those due to routine rotations, can
make it difficult to maintain existing programs.
What GAO Recommends:
GAO is recommending that the Secretaries of VA and Defense develop
systems to monitor and track the progress of VA regional offices and
military installations in implementing single separation exam
programs. VA and DOD concurred with GAO’s findings and recommendation.
www.gao.gov/cgi-bin/getrpt?GAO-05-64.
To view the full product, including the scope and methodology, click on
the link above. For more information, contact Marcia Crosse at (202)
512-7119.
[End of section]
Contents:
Letter:
Results in Brief:
Background:
VA and the Military Services Have Established Some Single Separation
Exam Programs, But Program Monitoring Is Lacking Despite Plans for
Expansion:
Infrequent Use of Separation Exams Among Military Services and Other
Factors Create Challenges in Establishing Single Separation Exam
Programs:
Conclusions:
Recommendations for Executive Action:
Agency Comments:
Appendix I: Scope and Methodology:
Appendix II: DOD's Form 2697 - Report of Medical Assessment:
Appendix III: DOD's Form 2808 - Report of Medical Examination:
Appendix IV: Comments from the Department of Veterans Affairs and GAO's
Response:
GAO Comments:
Appendix V: Comments from the Department of Defense:
Appendix VI: GAO Contacts and Staff Acknowledgments38:
GAO Contacts:
Acknowledgments:
Tables:
Table 1: Individual Military Service Requirements for Evaluating
Servicemembers' Health:
Table 2: Approaches Used to Deliver Single Separation Exams at Selected
Military Installations:
Table 3: Installations That VA Incorrectly Reported as Having Single
Separation Exam Programs:
Figure:
Figure 1: Estimated Percentage of Servicemembers Who Received
Separation Exams in Fiscal Year 2003:
Abbreviations:
AFEB: Armed Forces Epidemiology Board:
BDD: Benefits Delivery at Discharge:
C&P: compensation and pension:
DMDC: Defense Manpower Data Center:
DOD: Department of Defense:
MOA: memorandum of agreement:
MOU: memorandum of understanding:
PHA: preventive health assessment:
VA: Department of Veterans Affairs:
United States Government Accountability Office:
Washington, DC 20548:
November 12, 2004:
The Honorable Duncan Hunter:
Chairman:
Committee on Armed Services:
House of Representatives:
The Honorable Christopher H. Smith:
Chairman:
Committee on Veterans' Affairs:
House of Representatives:
Servicemembers who leave the military and file disability claims with
the Department of Veterans Affairs (VA) may be subject to potentially
duplicative physical exams in order to meet requirements of both the
Department of Defense's (DOD) military services and VA.[Footnote 1] VA
requires servicemembers applying for service-connected disability
compensation to undergo a physical exam, known as a compensation and
pension (C&P) exam, in order to determine the degree of their
disability. During fiscal year 2003, about 55,500 veterans submitted
disability claims to VA within their first year of leaving the
military. Similarly, to document any potential service-related health
conditions or complaints of servicemembers leaving the military, each
of the military services requires a medical assessment, which consists
of a questionnaire and in some cases may include a physical exam.
Moreover, each military service has additional medical requirements
servicemembers must meet when they leave the military--requirements
that in some cases include a physical exam, also known as a separation
exam. In fiscal year 2003, about 176,000 servicemembers left the
military and were subject to applicable requirements.
Although the purpose and scope of the physical exams administered by
the military services differ from those administered by VA, the
military services and VA developed a way to coordinate their physical
exam requirements, prevent duplication, and streamline the process for
servicemembers who are leaving the military and filing disability
claims. In 1994, VA and the Army initiated a multiyear pilot program
that concluded that a program consisting of one physical exam could be
designed to meet both the military services' requirements for
servicemembers leaving the military and VA's requirements for
determining disability. VA and the Army also concluded that such a
program would encourage a more efficient use of VA and military
resources, improve the timeliness of disability claims processing, and
offer convenience to servicemembers. Based on the findings of the pilot
program, in 1998, VA's Under Secretary for Health and DOD's Acting
Assistant Secretary of Defense for Health Affairs signed a memorandum
of understanding (MOU) that directed local VA offices and military
medical facilities to work together to establish single separation exam
programs.
To target servicemembers who are preparing to leave the military and
intend to file a disability claim, VA is working with the military
services to establish single separation exam programs at military
installations that have a Benefits Delivery at Discharge (BDD) program.
The BDD program is a joint VA/DOD initiative designed to streamline
servicemembers' transition from active duty to veterans' status. At
military installations with BDD programs, VA personnel educate
servicemembers about VA disability benefits and help them apply for
benefits before they leave military service--a process that is
otherwise initiated after servicemembers leave the military. BDD
programs, which are designed for servicemembers who have between 60 and
180 days remaining on active duty, are usually located at military
installations that have large numbers of servicemembers leaving the
military. At BDD sites that have single separation exam programs,
servicemembers typically receive a single separation exam after they
submit their disability claims paperwork. As of August 2004, VA
reported there were BDD programs at 139 military
installations.[Footnote 2]
You asked us to provide information on how VA and DOD's military
services are collaborating to provide single separation exams for
servicemembers who leave the military and intend to apply for service-
connected disability compensation.[Footnote 3] This report examines (1)
VA's and the military services' efforts to establish single separation
exam programs, and (2) the challenges to establishing single separation
exam programs.
To identify VA's and the military services' efforts to establish single
separation exam programs, we obtained information on VA's and the
military services' medical requirements involving physical exams or
other medical evaluations, and we interviewed officials from the Office
of the Assistant Secretary of Defense for Health Affairs, the military
services' Surgeons General, and VA. We also obtained a list of military
installations that VA reported as having single separation exam
programs. We used this list to select eight installations that
represented each branch of the military services to further evaluate
VA's and the military services' efforts to establish these programs. We
did not verify whether the remaining installations on VA's list had
operational programs in place, and we are only reporting on how
programs were operating at these eight selected installations. To
identify the challenges to establishing single separation exam
programs, we interviewed VA officials from 15 locations whose regions
included military installations with at least 500 servicemembers who
left the military in fiscal year 2003.[Footnote 4] We also visited
seven military installations that were not administering single
separation exam programs to learn why such programs were not in place.
These seven installations represented each of the military services and
had at least 500 servicemembers leaving the military during fiscal year
2003. In addition, we obtained data on the number of disability claims
filed, the number of separations from the military, the estimated
number of separation exams provided by the military services, and the
average costs of VA and DOD physical exams. We assessed the reliability
of these data and determined that they were sufficiently reliable for
our purposes. Our work was performed from January 2004 through November
2004 in accordance with generally accepted government auditing
standards. For more details on our scope and methodology, see appendix
I.
Results in Brief:
Since 1998, VA and the military services have collaborated to establish
single separation exam programs. However, while we were able to verify
that the program was being delivered at some military installations,
DOD, its military services, and VA either could not provide information
on program locations or provided us with inaccurate information. As of
May 2004, VA reported that 28 of 139 military installations with BDD
programs also had single separation exam programs that used one of five
basic approaches to deliver an exam that met both VA's and the military
services' requirements. However, when we evaluated 8 of the 28
installations, we found that 4 of the installations did not actually
have programs in place. Nonetheless, VA and DOD leadership continue to
encourage the establishment of single separation exam programs and have
recently drafted a new memorandum of agreement (MOA) that is intended
to replace the 1998 MOU. Like the original MOU, the draft MOA delegates
responsibility for establishing single separation exam programs to
local VA and military installations, depending on available resources.
However, the draft MOA also contains a specific implementation goal
that all BDD sites should have single separation exam programs in place
by December 31, 2004--an ambitious plan given the seemingly low rate of
program implementation since 1998 and the lack of accurate information
on existing programs.
Several challenges impede the establishment of single separation exam
programs. The predominant challenge is that the military services may
not benefit from a program designed to eliminate the need for two
separate physical exams because they usually do not require that
servicemembers receive a separation exam. As of August 2004, only the
Army had a general separation exam requirement for retiring
servicemembers. The other military services primarily require
separation exams when the servicemember's last physical exam or medical
assessment received during active duty is no longer considered current.
In fiscal year 2003, only an estimated 13 percent of servicemembers who
left the military received a separation exam. Consequently, the
military services may not realize resource savings by eliminating or
sharing responsibility for this exam. According to some military
officials, another challenge to establishing single separation exam
programs is that resources, such as facility space and medical
personnel, are needed for other priorities, such as ensuring that
active duty servicemembers are healthy enough to perform their duties.
Additionally, because single separation exam programs require
coordination between personnel from both VA and the military services,
military staff changes, including those due to routine rotations, can
make it difficult to maintain existing programs.
We are making a recommendation that the Secretary of VA and the
Secretary of Defense develop systems to monitor and track the progress
of VA regional offices and military installations in implementing
single separation exam programs at BDD sites. In commenting on a draft
of this report, VA and DOD concurred with the report's findings and
recommendation.
Background:
The military services and VA have medical requirements that
servicemembers must meet when leaving the military and applying for VA
disability compensation. These requirements include a medical
assessment; a service-specific separation exam, which is given to some
servicemembers; and a VA C&P exam. The single separation exam program
is designed to provide a single physical exam that can be used to meet
the physical exam requirements of the military services and VA.
The Military Services' Requirements for Medical Assessments and
Separation Exams:
In response to a 1994 memorandum from the Assistant Secretary of
Defense for Health Affairs, all of the military services require a
medical assessment of all servicemembers leaving the military,
including those that retire or complete their tour of active
duty.[Footnote 5] This assessment, which is used to evaluate and
document the health of these servicemembers, consists of a standard
two-page questionnaire asking servicemembers about their overall
health, medical and dental histories, current medications, and other
health-related topics.[Footnote 6] (See app. II for DOD's medical
assessment form--DD Form 2697.) Military medical personnel, who could
include a physician, a physician's assistant, or a nurse practitioner,
are required to review the questionnaire with the servicemember. If the
questionnaire indicates the presence of an illness, injury, or other
medical problem, the reviewer is required to ensure that the
servicemember's medical or dental records document the problem. In
addition, depending on the servicemember's responses or based on the
reviewer's judgment that additional information is needed, the health
assessment could result in a physical exam--one focused on a particular
health issue or issues in order to supplement information disclosed on
the questionnaire. Furthermore, the medical assessment asks if the
servicemember intends to file a claim for disability with VA.
Servicemembers who answer "yes" on the assessment form will be given a
clinically appropriate assessment or exam if the servicemember's last
physical exam received during active duty is more than 12 months old or
if new symptoms have appeared since the last active duty exam.[Footnote
7]
In addition, the Army, Navy, Air Force, and Marines[Footnote 8] require
some of their servicemembers to undergo separation exams when they
leave the military. Separation exams consist of a clinical evaluation
by a medical provider and could include various diagnostic tests, such
as a urinalysis, a hearing test, and a vision test. Separation exams,
as well as other physical exams the military services conduct, are
documented on a three-page standard DOD form. (See app. III for DOD's
report of medical examination--DD Form 2808.) According to DOD, the
average cost for a physical exam given by the military services is
about $125, exclusive of any diagnostic tests that may also be
conducted.[Footnote 9]
The requirements determining which servicemembers must receive
separation exams vary by military service and other factors. The Army
requires that its retirees receive separation exams, although the Army
does not usually require this for servicemembers who are completing
their tours of active duty. The other military services do not require
separation exams for most servicemembers, except for those whose last
physical exam or assessment they received during active duty is out of
date. (See table 1 for each military service's medical evaluation
requirements.) Further, all of the military services also require
separation exams for certain occupational specialties. For example, the
military services require separation exams for servicemembers who have
worked with hazardous materials. Finally, any servicemember can request
and receive a separation exam.