United States Government Accountability Office

GAO Testimony 

Before the Subcommittee on Oversight 

and Investigations, Committee on 

Veterans’ Affairs, House of 

Representatives

DOD AND VA HEALTH 

CARE 

Challenges Encountered by 

Injured Servicemembers 

during Their Recovery 

Process 

Statement of Cynthia A. Bascetta 

Director, Health Care 

For Release on Delivery

Expected at 3:30 p.m. EST 

Thursday, March 8, 2007

 

GAO-07-606T 
What GAO Found

United States Government Accountability Office

Why GAO Did This Study

Highlights

Accountability Integrity Reliability

March 8, 2007

DOD AND VA HEALTH CARE 

Challenges Encountered by Injured 

Servicemembers during Their Recovery 

Process 

Highlights of GAO-07-606T, a testimony 

before the Subcommittee on Oversight 

and Investigations, Committee on

Veterans’ Affairs, House of 

Representatives 

As of March 1, 2007, over 24,000

servicemembers have been

wounded in action since the onset 

of Operation Enduring Freedom 

(OEF) and Operation Iraqi

Freedom (OIF), according to the 

Department of Defense (DOD). 

GAO work has shown that 

servicemembers injured in combat 

face an array of significant medical

and financial challenges as they

begin their recovery process in the 

health care systems of DOD and 

the Department of Veterans Affairs 

(VA). 

GAO was asked to discuss 

concerns regarding DOD and VA 

efforts to provide medical care and 

rehabilitative services for 

servicemembers who have been 

injured during OEF and OIF. This 

testimony addresses (1) the 

transition of care for seriously 

injured servicemembers who are 

transferred between DOD and VA 

medical facilities, (2) DOD’s and 

VA’s efforts to provide early 

intervention for rehabilitation for 

seriously injured servicemembers, 

(3) DOD’s efforts to screen

servicemembers at risk for posttraumatic stress disorder (PTSD) 

and whether VA can meet the

demand for PTSD services, and 

(4) the impact of problems related

to military pay on injured 

servicemembers and their families. 

This testimony is based on GAO 

work issued from 2004 through

2006 on the conditions facing 

OEF/OIF servicemembers at the 

time the audit work was 

completed. 

Despite coordinated efforts, DOD and VA have had problems sharing 

medical records for servicemembers transferred from DOD to VA medical 

facilities. GAO reported in 2006 that two VA facilities lacked real-time access 

to electronic medical records at DOD facilities. To obtain additional medical 

information, facilities exchanged information by means of a time-consuming 

process resulting in multiple faxes and phone calls. 

In 2005, GAO reported that VA and DOD collaboration is important for 

providing early intervention for rehabilitation. VA has taken steps to initiate 

early intervention efforts, which could facilitate servicemembers’ return to 

duty or to a civilian occupation if the servicemembers were unable to remain

in the military. However, according to DOD, VA’s outreach process may 

overlap with DOD’s process for evaluating servicemembers for a possible 

return to duty. DOD was also concerned that VA’s efforts may conflict with 

the military’s retention goals. In this regard, DOD and VA face both a 

challenge and an opportunity to collaborate to provide better outcomes for 

seriously injured servicemembers. 

DOD screens servicemembers for PTSD but, as GAO reported in 2006, it 

cannot ensure that further mental health evaluations occur. DOD health care 

providers review questionnaires, interview servicemembers, and use clinical 

judgment in determining the need for further mental health evaluations. 

However, GAO found that 22 percent of the OEF/OIF servicemembers in 

GAO’s review who may have been at risk for developing PTSD were referred 

by DOD health care providers for further evaluations. According to DOD 

officials, not all of the servicemembers at risk will need referrals. However, 

at the time of GAO’s review DOD had not identified the factors its health 

care providers used to determine which OEF/OIF servicemembers needed 

referrals. Although OEF/OIF servicemembers may obtain mental health 

evaluations or treatment for PTSD through VA, VA may face a challenge in 

meeting the demand for PTSD services. VA officials estimated that follow-up 

appointments for veterans receiving care for PTSD may be delayed up to 

90 days. 

GAO’s 2006 testimony pointed out problems related to military pay have 

resulted in debt and other hardships for hundreds of sick and injured 

servicemembers. Some servicemembers were pursued for repayment of 

military debts through no fault of their own. As a result, servicemembers 

have been reported to credit bureaus and private collections agencies, been 

prevented from getting loans, gone months without paychecks, and sent into 

financial crisis. In a 2005 testimony GAO reported that poorly defined 

requirements and processes for extending the active duty of injured and ill 

reserve component servicemembers have caused them to be inappropriately 

dropped from active duty, leading to significant gaps in pay and health 

insurance for some servicemembers and their families.

www.gao.gov/cgi-bin/getrpt?GAO-07-606T.

To view the full product, including the scope 

and methodology, click on the link above. 

For more information, contact Cynthia A. 

Bascetta at (202) 512-7101 or 

bascettac@gao.gov. 
Mr. Chairman and Members of the Subcommittee: 

I am pleased to be here today to discuss health care and other services for 

U.S. military servicemembers wounded during Operation Enduring 

Freedom (OEF) or Operation Iraqi Freedom (OIF).1

 On March 1, 2007, the 

Department of Defense (DOD) reported that over 24,000 servicemembers 

have been wounded in action since the onset of the two conflicts. In 2005,

DOD reported that about 65 percent of the OEF and OIF servicemembers 

wounded in action were injured by blasts and fragments from improvised 

explosive devices, land mines, and other explosive devices. More recently, 

DOD estimated in 2006 that as many as 28 percent of those injured by 

blasts and fragments have some degree of trauma to the brain. These 

injuries often require comprehensive inpatient rehabilitation services to 

address complex cognitive and physical impairments. In addition to their 

physical injuries, OEF/OIF servicemembers who have been injured in 

combat may also be at risk for developing mental health impairments, 

such as post-traumatic stress disorder (PTSD), which research has shown 

to be strongly associated with experiencing intense and prolonged 

combat.2

While servicemembers are on active duty, DOD decides where they 

receive their care—at a military treatment facility (MTF), from a TRICARE 

civilian provider,3

 or at a Department of Veterans Affairs (VA) medical 

facility. From the OEF and OIF conflict areas, seriously injured 

servicemembers are usually brought to Landstuhl Regional Medical Center 

in Germany for treatment. From there, they are usually transported to 

MTFs located in the United States, with most of the seriously injured 

admitted to Walter Reed Army Medical Center or the National Naval 

 1

OEF, which began in October 2001, supports combat operations in Afghanistan and other 

locations, and OIF, which began in March 2003, supports combat operations in Iraq and 

other locations. 

2

Charles W. Hoge et al., “Combat Duty in Iraq and Afghanistan, Mental Health Problems, 

and Barriers to Care,” The New England Journal of Medicine, 351 (2004): 13-22. 

3

DOD provides health care through TRICARE—a regionally structured program that uses 

civilian contractors to maintain provider networks to complement health care services 

provided at MTFs. 

Page 1 GAO-07-606T
Medical Center, both of which are in the Washington, D.C., area.4

 Once the 

servicemembers are medically stabilized, DOD can elect to send those 

with traumatic brain injuries and other complex trauma, such as missing 

limbs, to one of the four polytrauma rehabilitation centers (PRC)5

operated by VA for medical and rehabilitative care. The PRCs are located 

at VA medical centers in Palo Alto, California; Tampa, Florida; 

Minneapolis, Minnesota; and Richmond, Virginia. While many 

servicemembers who receive such rehabilitative services return to active 

duty after they are treated, others who are more seriously injured are 

likely to be discharged from their military obligations and return to civilian 

life with disabilities. 

Our work has shown that servicemembers injured in combat face an array 

of significant medical and financial challenges as they begin their recovery 

process in the DOD and VA health care systems. In light of these 

challenges and recent media reports that have highlighted unsanitary and

decrepit living conditions at the Walter Reed Army Medical Center,6

 you 

asked us to discuss concerns we have identified regarding DOD and VA 

efforts to provide medical care and rehabilitative services for 

servicemembers who have been injured during OEF and OIF. Specifically, 

my remarks today will focus on (1) the transition of care for seriously 

injured OEF/OIF servicemembers—those with traumatic brain injuries or 

other complex trauma, such as missing limbs—who are transferred 

between DOD and VA medical facilities; (2) DOD’s and VA’s efforts to 

provide early intervention for rehabilitation services as soon as possible 

after the onset of a disability for seriously injured servicemembers; 

(3) DOD’s efforts to screen OEF/OIF servicemembers at risk for PTSD and 

 4

Other MTFs that received OEF/OIF servicemembers include Brooke Army Medical Center 

(San Antonio, Texas), Dwight David Eisenhower Army Medical Center (Augusta, Georgia),

Madigan Army Medical Center (Tacoma, Washington), Darnall Army Community Hospital 

(Fort Hood, Texas), Evans Army Community Hospital (Fort Carson, Colorado), and the 

Naval Hospital Camp Pendleton (Camp Pendleton, California). 

5

The Veterans Health Programs Improvement Act of 2004, Pub. L. No. 108-422, § 302, 118

Stat. 2379, 2383-86, mandated that VA establish centers for research, education, and clinical 

activities related to complex multiple trauma associated with combat injuries. In response 

to that mandate, VA established PRCs at four VA medical facilities with expertise in 

traumatic amputation, spinal cord injury, traumatic brain injury, and blind rehabilitation. A 

PRC addresses the rehabilitation needs of the combat injured in one setting and in a

coordinated manner. 

6

See, for instance, Dana Priest and Anne Hull, “Soldiers Face Neglect, Frustration at Army’s

Top Medical Facility,” The Washington Post (Feb. 18, 2007). 

Page 2 GAO-07-606T
whether VA can meet the demand for PTSD services; and (4) the impact of

problems related to military pay on injured servicemembers and their 

families. 

My testimony is based on issued GAO work.7

 The information I am 

reporting today reflects the conditions facing OEF/OIF servicemembers at

the time the audit work was completed and illustrates the types of 

problems injured servicemembers encountered during their healing and 

rehabilitation process. To complete the work for these products, we 

visited DOD and VA facilities, reviewed relevant documents, analyzed 

DOD data, and interviewed DOD and VA officials. Our work was 

performed in accordance with generally accepted government auditing 

standards. 

In summary, DOD and VA have made various efforts to provide medical 

care and rehabilitative services for OEF/OIF servicemembers. The 

departments established joint programs to facilitate the transfer of injured 

servicemembers from DOD facilities to VA medical facilities, assess 

whether servicemembers will be able to remain in the military, and assign 

VA social workers to selected MTFs to coordinate the transfers. DOD has 

also established a program to screen servicemembers after their 

deployment outside of the United States has ended to assess whether they 

are at risk for PTSD. However, we found several problems in the efforts to 

provide health care and rehabilitative services for OEF/OIF 

servicemembers. For example, DOD and VA had problems sharing medical 

records and questions arose about the timing of VA’s outreach to 

servicemembers whose discharge from military service was not certain. 

Furthermore, we found that DOD cannot provide reasonable assurance 

that OEF/OIF servicemembers who need referrals for mental health 

evaluations receive them. Finally, problems related to military pay have 

resulted in overpayments and debt for hundreds of sick and injured 

servicemembers. 

 7

See Related GAO Products at the end of this statement. 

Page 3 GAO-07-606T
In our June 2006 report, we found that DOD and VA had taken actions to 

facilitate the transition of medical and rehabilitative care for seriously 

injured servicemembers who were being transferred from MTFs to PRCs.8

For example, in April 2004, DOD and VA signed a memorandum of 

agreement that established referral procedures for transferring injured 

servicemembers from DOD to VA medical facilities. DOD and VA also 

established joint programs to facilitate the transfer to VA medical 

facilities, including a program that assigned VA social workers to selected 

MTFs to coordinate transfers. 

Despite these coordination efforts, we found that DOD and VA were 

having problems sharing the medical records VA needed to determine 

whether servicemembers’ medical conditions allowed participation in VA’s 

vigorous rehabilitation activities. DOD and VA reported that as of 

December 2005 two of the four PRCs had real-time access to the electronic 

medical records maintained at Walter Reed Army Medical Center and only 

one of the two also had access to the records at the National Naval 

Medical Center. In cases where medical records could not be accessed 

electronically, the MTF faxed copies of some medical information, such as

the patient’s medical history and progress notes, to the PRC. Because this 

information did not always provide enough data for the PRC provider to 

determine if the servicemember was medically stable enough to be 

admitted to the PRC, VA developed a standardized list of the minimum 

types of health care information needed about each servicemember 

transferring to a PRC. Even with this information, PRC providers 

frequently needed additional information and had to ask for it specifically. 

For example, if the PRC provider notices that the servicemember is on a 

particular antibiotic therapy, the provider may request the results of the 

most recent blood and urine cultures to determine if the servicemember is 

medically stable enough to participate in strenuous rehabilitation 

activities. According to PRC officials, obtaining additional medical 

information in this way, rather than electronically, is very time consuming 

and often requires multiple phone calls and faxes. VA officials told us that 

the transfer could be more efficient if PRC medical personnel had realtime access to the servicemembers’ complete DOD electronic medical 

records from the referring MTFs. However, problems existed even for the

two PRCs that had been granted electronic access. During a visit to those 

DOD and VA Have 

Taken Actions to 

Facilitate the Transfer 

of Servicemembers 

but Experienced 

Problems in 

Exchanging Health 

Care Information 

 8

GAO, VA and DOD Health Care: Efforts to Provide Seamless Transition of Care for OEF 

and OIF Servicemembers and Veterans, GAO-06-794R (Washington, D.C.: June 30, 2006). 

Page 4 GAO-07-606T
PRCs in April 2006, we found that neither facility could access the records 

at Walter Reed Army Medical Center because of technical difficulties. 

As discussed in our January 2005 report, the importance of early 

intervention for returning individuals with disabilities to the workforce is 

well documented in vocational rehabilitation literature.9

 In 1996, we 

reported that early intervention significantly facilitates the return to work 

but that challenges exist in providing services early.

10 For example, 

determining the best time to approach recently injured servicemembers 

and gauge their personal receptivity to considering employment in the 

civilian sector is inherently difficult. The nature of the recovery process is 

highly individualized and requires professional judgment to determine the 

appropriate time to begin vocational rehabilitation. Our 2007 High-Risk 

Series: An Update designates federal disability programs as “high risk” 

because they lack emphasis on the potential for vocational rehabilitation

to return people to work.11 

DOD and VA

Collaboration Is 

Important for Early 

Intervention for 

Rehabilitation 

In our January 2005 report, we found that servicemembers whose 

disabilities are definitely or likely to result in military separation may not 

be able to benefit from early intervention because DOD and VA could 

work at cross purposes. In particular, DOD was concerned about the 

timing of VA’s outreach to servicemembers whose discharge from military

service is not yet certain. DOD was concerned that VA’s efforts may 

conflict with the military’s retention goals. When servicemembers are 

treated as outpatients at a VA or military hospital, DOD generally begins to

assess whether the servicemember will be able to remain in the military. 

This process can take months. For its part, VA took steps to make 

seriously injured servicemembers a high priority for all VA assistance. 

Noting the importance of early intervention, VA instructed its regional 

offices in 2003 to assign a case manager to each seriously injured 

servicemember who applies for disability compensation. VA had detailed 

 9

GAO, Vocational Rehabilitation: More VA and DOD Collaboration Needed to Expedite 

Services for Seriously Injured Servicemembers, GAO-05-167 (Washington, D.C.: Jan. 14, 

2005). 

10We also reported on early intervention in GAO, SSA Disability: Return-to-Work 

Strategies from Other Systems May Improve Federal Programs, GAO/HEHS-96-133 

(Washington, D.C.: July 11, 1996). 

11GAO, High-Risk Series: An Update, GAO-07-310 (Washington, D.C.: January 2007). 

Page 5 GAO-07-606T
staff to MTFs to provide information on all veterans’ benefits, including 

vocational rehabilitation, and reminded staff that they can initiate 

evaluation and counseling, and, in some cases, authorize training before a 

servicemember is discharged. While VA tries to prepare servicemembers 

for a transition to civilian life, VA’s outreach process may overlap with 

DOD’s process for evaluating servicemembers for a possible return to 

duty. 

In our report, we concluded that instead of working at cross purposes to 

DOD goals, VA’s early intervention efforts could facilitate servicemembers’ 

return to the same or a different military occupation, or to a civilian 

occupation if the servicemembers were not able to remain in the military. 

In this regard, the prospect for early intervention with vocational 

rehabilitation presents both a challenge and an opportunity for DOD and 

VA to collaborate to provide better outcomes for seriously injured 

servicemembers. 

In our May 2006 report, we described DOD’s efforts to identify and 

facilitate care for OEF/OIF servicemembers who may be at risk for PTSD.12

To identify such servicemembers, DOD uses a questionnaire, the DD 2796, 

to screen OEF/OIF servicemembers after their deployment outside of the

United States has ended. The DD 2796 is used to assess servicemembers’ 

physical and mental health and includes four questions to identify those 

who may be at risk for developing PTSD. We reported that according to a 

clinical practice guideline jointly developed by DOD and VA, 

servicemembers who responded positively to at least three of the four 

PTSD screening questions may be at risk for developing PTSD. DOD health 

care providers review completed questionnaires, conduct face-to-face 

interviews with servicemembers, and use their clinical judgment in 

determining which servicemembers need referrals for further mental 

health evaluations.13,14 OEF/OIF servicemembers can obtain the mental 

DOD Screens 

Servicemembers for 

PTSD after 

Deployment, but DOD 

and VA Face 

Challenges Ensuring 

Further PTSD 

Services 

 12GAO, Post-Traumatic Stress Disorder: DOD Needs to Identify the Factors Its Providers 

Use to Make Mental Health Evaluation Referrals for Servicemembers, GAO-06-397

(Washington, D.C.: May 11, 2006). 

13Health care providers that review the DD 2796 may include physicians, physician 

assistants, nurse practitioners, or independent duty medical technicians—enlisted 

personnel who receive advanced training to provide treatment and administer medications. 

14DOD’s referrals are used to document DOD’s assessment that servicemembers are in need

of further mental health evaluations. 

Page 6 GAO-07-606T
health evaluations, as well as any necessary treatment for PTSD, while 

they are servicemembers—that is, on active duty—or when they transition 

to veteran status if they are discharged or released from active duty. 

Despite DOD’s efforts to identify OEF/OIF servicemembers who may need 

referrals for further mental health evaluations, we reported that DOD 

cannot provide reasonable assurance that OEF/OIF servicemembers who 

need the referrals receive them. Using data provided by DOD,15 we found 

that 22 percent, or 2,029, of the 9,145 OEF/OIF servicemembers in our 

review who may have been at risk for developing PTSD were referred by 

DOD health care providers for further mental health evaluations. Across 

the military service branches, DOD health care providers varied in the 

frequency with which they issued referrals to OEF/OIF servicemembers 

with three or more positive responses to the PTSD screening questions------

the Army referred 23 percent, the Air Force about 23 percent, the Navy 

18 percent, and the Marines about 15 percent. According to DOD officials, 

not all of the OEF/OIF servicemembers with three or four positive 

responses on the screening questionnaire need referrals. As directed by 

DOD’s guidance for using the DD 2796, DOD health care providers are to 

rely on their clinical judgment to decide which of these servicemembers 

need further mental health evaluations. However, at the time of our review

DOD had not identified the factors its health care providers used to 

determine which OEF/OIF servicemembers needed referrals. Knowing 

these factors could explain the variation in referral rates and allow DOD to

provide reasonable assurance that such judgments are being exercised 

appropriately.

16 We recommended that DOD identify the factors that DOD 

health care providers used in issuing referrals for further mental health 

evaluations to explain provider variation in issuing referrals. DOD 

concurred with the recommendation.

 15In our review we analyzed computerized data provided by DOD to identify 178,664 

OEF/OIF servicemembers who were deployed in support of OEF/OIF from October 1, 2001, 

through September 30, 2004, and who have since been discharged or released from active 

duty. These servicemembers had answered the four PTSD screening questions on the 

DD 2796 and had a record of their completed questionnaire available in a DOD 

computerized database. We found that DOD data indicated 9,145 of the 178,664 

servicemembers in our review may have been at risk for developing PTSD.

16The John Warner National Defense Authorization Act for Fiscal Year 2007 required DOD 

to develop guidelines for mental health referrals, as well as mechanisms to ensure proper 

training and oversight, by April 2007. Pub. L. No. 109-364, § 738, 120 Stat. 2083, 2303-4. 

Page 7 GAO-07-606T
Although OEF/OIF servicemembers may obtain mental health evaluations 

or treatment for PTSD through VA when they transition to veteran status, 

VA may face a challenge in meeting the demand for PTSD services. In 

September 2004 we reported that VA had intensified its efforts to inform 

new veterans from the Iraq and Afghanistan conflicts about the health care 

services—including treatment for PTSD—VA offers to eligible veterans.17

We observed that these efforts, along with expanded availability of VA 

health care services for Reserve and National Guard members, could 

result in an increased percentage of veterans from Iraq and Afghanistan 

seeking PTSD services through VA. However, at the time of our review 

officials at six of seven VA medical facilities we visited explained that 

while they were able to keep up with the current number of veterans 

seeking PTSD services, they may not be able to meet an increase in 

demand for these services. In addition, some of the officials expressed 

concern because facilities had been directed by VA to give veterans from 

the Iraq and Afghanistan conflicts priority appointments for health care 

services, including PTSD services. As a result, VA medical facility officials 

estimated that follow-up appointments for veterans receiving care for 

PTSD could be delayed. VA officials estimated the delays to be up to 

90 days. 

As discussed in our April 2006 testimony, problems related to military pay 

have resulted in overpayments and debt for hundreds of sick and injured 

servicemembers.18 These pay problems resulted in significant frustration 

for the servicemembers and their families. We found that hundreds of 

battle-injured servicemembers were pursued for repayment of military 

debts through no fault of their own, including at least 74 servicemembers 

whose debts had been reported to credit bureaus and private collections 

agencies. In response to our audit, DOD officials said collection actions on

these servicemembers’ debts had been suspended until a determination 

could be made as to whether these servicemembers’ debts were eligible 

for relief. 

Problems Related to 

Military Pay Have 

Resulted in Debt and 

Other Hardships for 

Hundreds of Sick and 

Injured 

Servicemembers 

 17GAO, VA and Defense Health Care: More Information Needed to Determine If VA Can

Meet an Increase in Demand for Post-Traumatic Stress Disorder Services, GAO-04-1069

(Washington, D.C.: Sept. 20, 2004). 

18GAO, Military Pay: Military Debts Present Significant Hardships to Hundreds of Sick 

and Injured GWOT Soldiers, GAO-06-657T (Washington, D.C.: April 27, 2006). 

Page 8 GAO-07-606T
Debt collection actions created additional hardships on servicemembers 

by preventing them from getting loans to buy houses or automobiles or 

pay off other debt, and sending several servicemembers into financial 

crisis. Some battle-injured servicemembers forfeited their final separation 

pay to cover part of their military debt, and they left the service with no 

funds to cover immediate expenses while facing collection actions on their 

remaining debt.

We also found that sick and injured servicemembers sometimes went 

months without paychecks because debts caused by overpayments of 

combat pay and other errors were offset against their military pay.19

Furthermore, the longer it took DOD to stop the overpayments, the greater 

the amount of debt that accumulated for the servicemember and the 

greater the financial impact, since more money would eventually be

withheld from the servicemember’s pay or sought through debt collection

action after the servicemember had separated from the service. 

In our 2005 testimony about Army National Guard and Reserve 

servicemembers, we found that poorly defined requirements and 

processes for extending injured and ill reserve component 

servicemembers on active duty have caused servicemembers to be 

inappropriately dropped from active duty.20 For some, this has led to 

significant gaps in pay and health insurance, which has created financial 

hardships for these servicemembers and their families. 

Mr. Chairman, this completes my prepared remarks. I would be happy to 

respond to any questions you or other members of the subcommittee may 

have at this time. 

 19We found that after voluntary allotments and other required deductions, many times there

was no net pay due the servicemember. 

20GAO, Military Pay: Gaps in Pay and Benefits Create Financial Hardships for Injured 

Army National Guard and Reserve Soldiers, GAO-05-322T (Washington, D.C.: Feb. 17,

2005). 

Page 9 GAO-07-606T
For further information about this testimony, please contact Cynthia A. 

Bascetta at (202) 512-7101 or bascettac@gao.gov. Contact points for our 

Offices of Congressional Relations and Public Affairs may be found on the 

last page of this statement. Michael T. Blair, Jr., Assistant Director; 

Cynthia Forbes; Krister Friday; Roseanne Price; Cherie’ Starck; and 

Timothy Walker made key contributions to this statement. 

Contacts and 

Acknowledgments 

Page 10 GAO-07-606T
Page 11 GAO-07-606T

Related GAO Products 

High-Risk Series: An Update. GAO-07-310. Washington, D.C.: January 

2007. 

VA and DOD Health Care: Efforts to Provide Seamless Transition of 

Care for OEF and OIF Servicemembers and Veterans. GAO-06-794R. 

Washington, D.C.: June 30, 2006. 

Post-Traumatic Stress Disorder: DOD Needs to Identify the Factors Its 

Providers Use to Make Mental Health Evaluation Referrals for 

Servicemembers. GAO-06-397. Washington, D.C.: May 11, 2006. 

Military Pay: Military Debts Present Significant Hardships to Hundreds 

of Sick and Injured GWOT Soldiers. GAO-06-657T. Washington, D.C.: 

April 27, 2006. 

Military Disability System: Improved Oversight Needed to Ensure 

Consistent and Timely Outcomes for Reserve and Active Duty Service 

Members. GAO-06-362. Washington, D.C.: March 31, 2006. 

Military Pay: Gaps in Pay and Benefits Create Financial Hardships for 

Injured Army National Guard and Reserve Soldiers. GAO-05-322T. 

Washington, D.C.: February 17, 2005.

Vocational Rehabilitation: More VA and DOD Collaboration Needed to 

Expedite Services for Seriously Injured Servicemembers. GAO-05-167. 

Washington, D.C.: January 14, 2005. 

VA and Defense Health Care: More Information Needed to Determine If 

VA Can Meet an Increase in Demand for Post-Traumatic Stress Disorder

Services. GAO-04-1069. Washington, D.C.: September 20, 2004. 

SSA Disability: Return-to-Work Strategies from Other Systems May 

Improve Federal Programs. GAO/HEHS-96-133. Washington, D.C.: July 11, 

1996. 

(290621) 
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. However, 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. 
GAO’s Mission The Government Accountability Office, the audit, evaluation and 

investigative arm of Congress, exists to support Congress in meeting its 

constitutional responsibilities and to help improve the performance and 

accountability of the federal government for the American people. GAO 

examines the use of public funds; evaluates federal programs and policies; 

and provides analyses, recommendations, and other assistance to help

Congress make informed oversight, policy, and funding decisions. GAO’s 

commitment to good government is reflected in its core values of 

accountability, integrity, and reliability. 

The fastest and easiest way to obtain copies of GAO documents at no cost

is through GAO’s Web site (www.gao.gov). Each weekday, GAO posts 

newly released reports, testimony, and correspondence on its Web site. To

have GAO e-mail you a list of newly posted products every afternoon, go 

to www.gao.gov and select “Subscribe to Updates.” 

The first copy of each printed report is free. Additional copies are $2 each. 

A check or money order should be made out to the Superintendent of 

Documents. GAO also accepts VISA and Mastercard. Orders for 100 or 

more copies mailed to a single address are discounted 25 percent. Orders 

should be sent to: 

U.S. Government Accountability Office 

441 G Street NW, Room LM 

Washington, D.C. 20548 

To order by Phone: Voice: (202) 512-6000 

TDD: (202) 512-2537 

Fax: (202) 512-6061 

Contact: 

Web site: www.gao.gov/fraudnet/fraudnet.htm

E-mail: fraudnet@gao.gov

Automated answering system: (800) 424-5454 or (202) 512-7470 

Gloria Jarmon, Managing Director, JarmonG@gao.gov (202) 512-4400 

U.S. Government Accountability Office, 441 G Street NW, Room 7125 

Washington, D.C. 20548 

Paul Anderson, Managing Director, AndersonP1@gao.gov (202) 512-4800

U.S. Government Accountability Office, 441 G Street NW, Room 7149 

Washington, D.C. 20548 

Obtaining Copies of 

GAO Reports and 

Testimony

Order by Mail or Phone 

To Report Fraud,

Waste, and Abuse in 

Federal Programs 

Congressional 

Relations 

Public Affairs 

PRINTED ON RECYCLED PAPER