a

GAO

United States Government Accountability Office

Report to the Ranking Democratic 

Member, Committee on Veterans’ Affairs, 

House of Representatives

September 2004 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
What GAO Found

United States Government Accountability Office

Why GAO Did This Study

Highlights

Accountability Integrity Reliability

www.gao.gov/cgi-bin/getrpt?GAO-04-1069.

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. 

Highlights of GAO-04-1069, a report to the 

Ranking Democratic Member, Committee 

on Veterans' Affairs, House of 

Representatives 

September 2004

VA AND DEFENSE HEALTH CARE

More Information Needed to Determine If 

VA Can Meet an Increase in Demand for 

Post-Traumatic Stress Disorder Services 

DOD uses two approaches to identify servicemembers at risk for PTSD: the 

combat stress control program and the post-deployment health assessment 

questionnaire. The combat stress control program trains servicemembers to 

recognize the early onset of combat stress, which can lead to PTSD. 

Symptoms of combat stress and PTSD include insomnia, nightmares, and 

difficulties coping with relationships. To assist servicemembers in the 

combat theater, teams of DOD mental health professionals travel to units to 

reinforce the servicemembers’ knowledge of combat stress symptoms and to 

help identify those who may be at risk for combat stress and PTSD. DOD 

also uses the post-deployment health assessment questionnaire to identify 

physical ailments and mental health issues commonly associated with 

deployments, including PTSD. The questionnaire includes the following four 

screening questions that VA and DOD mental health experts developed to 

identify servicemembers at risk for PTSD: 

Have you ever had any experience that was so frightening, horrible, or 

upsetting that, in the past month, you 

• have had any nightmares about it or thought about it when you 

did not want to? 

• tried hard not to think about it or went out of your way to 

avoid situations that remind you of it? 

• were constantly on guard, watchful, or easily startled? 

• felt numb or detached from others, activities, or your 

surroundings?

VA lacks the information it needs to determine whether it can meet an 

increase in demand for VA PTSD services. VA does not have a count of the 

total number of veterans currently receiving PTSD services at its medical 

facilities and Vet Centers—community-based VA facilities that offer trauma 

and readjustment counseling. Without this information, VA cannot estimate 

the number of new veterans its medical facilities and Vet Centers could treat 

for PTSD. VA has two reports on the number of veterans it currently treats, 

with each report counting different subsets of veterans receiving PTSD 

services. Veterans who are receiving VA PTSD services may be counted in 

both reports, one of the reports, or not included in either report. VA does 

receive demographic information from DOD, which includes home 

addresses of servicemembers that could help VA predict which medical 

facilities or Vet Centers servicemembers may access for health care. By 

assuming that 15 percent or more of servicemembers who have left active 

duty status will develop PTSD, VA could use the home zip codes of 

servicemembers to broadly estimate the number of servicemembers who 

may need VA PTSD services and identify the VA facilities located closest to 

their homes. However, predicting which veterans will seek VA care and at 

which facilities is inherently uncertain, particularly given that the symptoms 

of PTSD may not appear for years. 

Post-traumatic stress disorder 

(PTSD) is caused by an extremely 

stressful event and can develop 

after the threat of death or serious 

injury as in military combat. 

Experts predict that about 15 

percent of servicemembers serving 

in Iraq and Afghanistan will 

develop PTSD. Efforts by VA to 

inform new veterans, including 

Reserve and National Guard 

members, about the expanded 

availability of VA health care 

services could result in an 

increased demand for VA PTSD 

services. GAO identified the 

approaches DOD uses to identify 

servicemembers at risk for PTSD 

and examined if VA has the 

information it needs to determine 

whether it can meet an increase in 

demand for PTSD services. GAO 

visited military bases and VA 

facilities, reviewed relevant 

documents, and interviewed DOD 

and VA officials to determine how 

DOD identifies servicemembers at 

risk for PTSD, and what 

information VA has to estimate 

demand for VA PTSD services. 

What We Recommend

GAO recommends that VA 

determine the total number of 

veterans receiving VA PTSD 

services and provide facilityspecific information to VA medical 

facilities and Vet Centers. VA 

concurred with GAO’s 

recommendation and plans to 

aggregate data on the total number 

of veterans it treats for PTSD at VA 

facilities. DOD concurred with 

GAO’s findings and conclusions. 
Page i GAO-04-1069 Post-Traumatic Stress Disorder

Contents

Letter 1

Results In Brief 3

Background 4

DOD Uses Two Approaches to Identify Servicemembers At Risk for 

PTSD 6

VA Lacks Information Needed to Determine Whether It Can Meet an 

Increase in Demand for PTSD Services 11

Conclusions 16

Recommendation for Executive Action 16

Agency Comments 16

Appendixes

Appendix I: Scope and Methodology 18

Appendix II: Department of Defense Post-Deployment Health Assessment 

Questionnaire DD-2796 20

Appendix III: Comments from the Department of Veterans Affairs 24

Appendix IV: Comments from the Department of Defense 27

Appendix V: GAO Contact and Staff Acknowledgments 28

GAO Contact 28

Acknowledgments 28

Related GAO Products 29

Figures Figure 1: DOD’s Process for “Yes” Responses to PTSD Questions on 

DD 2796 10

Figure 2: Veterans Included in VA’s Annual Reports 13

Abbreviations

DOD Department of Defense

NEPEC Northeast Program Evaluation Center

OIG Office of Inspector General

PTSD post-traumatic stress disorder

VA Department of Veterans Affairs
Page ii GAO-04-1069 Post-Traumatic Stress Disorder

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Page 1 GAO-04-1069 Post-Traumatic Stress Disorder

United States Government Accountability Office

Washington, D.C. 20548

A

September 20, 2004 Letr

The Honorable Lane Evans

Ranking Democratic Member

Committee on Veterans’ Affairs

House of Representatives

Dear Mr. Evans:

Mental health experts predict that because of the intensity of warfare in 

Iraq and Afghanistan 15 percent or more of the servicemembers returning 

from these conflicts will develop post-traumatic stress disorder (PTSD).1, 2 

This rate approximates the PTSD rate for Vietnam War veterans.3 PTSD, 

which is caused by an extremely stressful event, can develop after military 

combat and exposure to the threat of death or serious injury. Symptoms of 

PTSD, which may appear within months or be delayed for years after the 

stressful event, include insomnia, intense anxiety, nightmares about the 

event, and difficulties coping with work, family, and social relationships. 

Although there is no cure for PTSD, experts believe that early identification 

and treatment of PTSD symptoms may lessen the severity of the condition 

and improve the overall quality of life for servicemembers and veterans. If 

left untreated, PTSD can lead to substance abuse, severe depression, and 

suicide. 

The Department of Veterans Affairs (VA) has intensified its efforts to 

inform new veterans from the Iraq and Afghanistan conflicts about the 

health care services—including treatment for PTSD—it offers to eligible 

veterans. 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. Concerns have been raised about whether VA can 

provide PTSD services for a new influx of veterans, while at the same time 

continuing these services for veterans that VA currently treats for PTSD. 

1

Servicemembers include active duty members of the Army, Marines, Air Force, and Navy 

and members of the Reserves and National Guard. 

2

Hoge, Charles W., MD 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

Kulka, R., et.al. Trauma and the Vietnam War Generation: Report of Findings from the 

National Vietnam Veterans Readjustment Study. (New York: 1990). 
Page 2 GAO-04-1069 Post-Traumatic Stress Disorder

You asked that we review the Department of Defense’s (DOD) efforts to 

identify servicemembers who have served in Iraq and Afghanistan and are 

at risk for PTSD, and VA’s efforts to ensure that PTSD services are available 

for all veterans. Specifically, we identified the approaches DOD uses to 

identify servicemembers who are at risk for PTSD. We also examined if VA 

has the information it needs to determine whether it can meet an increase 

in demand for VA PTSD services. 

To determine the approaches DOD uses to identify servicemembers who 

are at risk for PTSD, we reviewed documents, interviewed DOD officials, 

and visited a military installation for each of DOD’s uniform services, some 

of which had large numbers of servicemembers returning from Iraq and 

Afghanistan. We have reviewed how well DOD’s uniform services 

implemented these approaches in previous work and did not address that 

issue in this review.4

 To determine whether VA has the information it needs 

to estimate the future demand for VA PTSD services, we interviewed VA 

headquarters and facility officials to discuss the number of veterans 

receiving treatment for PTSD and future demand for these services in areas 

of the country where large numbers of servicemembers were returning 

from Iraq and Afghanistan. To obtain additional information on identifying 

and treating veterans with PTSD, we interviewed VA’s PTSD experts at the 

National Center for PTSD.5

 We reviewed VA’s annual capacity reports, 

which include information on the number of seriously mentally ill veterans 

receiving PTSD services. We also reviewed the findings of the VA Office of 

Inspector General (OIG) who is responsible for reporting to Congress on 

the accuracy of VA’s capacity reports. We did not include data from VA’s 

annual capacity reports because the OIG found that the data were not 

sufficiently reliable. We also interviewed VA headquarters and facility 

officials and DOD officials to determine what information they share about 

returning servicemembers. For a complete description of our scope and 

4

Previous GAO reports have addressed DOD’s compliance with screening requirements for 

returning servicemembers deployed outside of the U.S.: GAO, Defense Health Care: Quality 

Assurance Process Needed to Improve Force Health Protection and Surveillance, GAO-03-

1041 (Washington, D.C.: Sept. 19, 2003) and Defense Health Care: DOD Needs to Improve 

Force Health Protection and Surveillance Processes, GAO-04-158T (Washington, D.C.: Oct. 

16, 2003).

5

The Veterans’ Health Care Act of 1984 required the establishment of the National Center on 

PTSD (now known as National Center for PTSD) as a research and education organization 

within VA. See Pub. L. No. 98-528, § 110(c), 98 Stat. 2686, 2692 (codified at 38 U.S.C. § 1712A 

note). The Center advances the clinical care and social welfare of veterans through 

research, education, and training clinicians in the causes, diagnosis, and treatment of PTSD, 

but does not provide clinical care for veterans.
Page 3 GAO-04-1069 Post-Traumatic Stress Disorder

methodology, see appendix I. Our work was conducted from May through 

September 2004 in accordance with generally accepted government 

auditing standards.

Results In Brief DOD uses two approaches to identify servicemembers at risk for PTSD: the 

combat stress control program and the post-deployment health assessment 

questionnaire. The combat stress control program trains servicemembers 

to recognize the early symptoms of combat stress, which can be a 

precursor to PTSD. To assist servicemembers in the combat theater, teams 

of DOD mental health professionals travel to units to reinforce the 

servicemembers’ knowledge of combat stress symptoms and to help 

identify those who may be at risk for combat stress or PTSD. DOD uses the 

post-deployment health assessment questionnaire to identify physical 

ailments and mental health issues commonly associated with deployments, 

including PTSD. The questionnaire includes four screening questions that 

VA and DOD mental health experts developed to identify servicemembers 

who may be at risk of developing PTSD. DOD generally requires 

servicemembers deployed outside of the United States to complete this 

questionnaire within 30 days before leaving a deployment location or 

within 5 days after returning to the United States. Completed 

questionnaires must be reviewed by a DOD clinical provider, who 

interviews servicemembers to determine if further medical evaluation is 

necessary. 

VA lacks the information it needs to determine whether it can meet an 

increase in demand for VA PTSD services. VA does not have a count of the 

total number of veterans currently receiving PTSD services at its medical 

facilities and Vet Centers—community-based VA facilities that offer trauma 

and readjustment counseling. Without this information, VA cannot estimate 

the number of additional veterans its medical facilities and Vet Centers 

could treat for PTSD. A VA official told us that a count of the total number 

of veterans with a diagnosis of PTSD who receive VA services at medical 

facilities could be obtained from VA’s existing database. However, this 

database does not include Vet Centers’ information because this 

information is kept separate from the medical facilities’ data. VA has two 

reports on the number of veterans it currently treats, with each report 

counting different subsets of veterans receiving PTSD services. Veterans 

who are receiving VA PTSD services may be counted in both reports, one of 

the reports, or not included in either report. For example, veterans 

receiving PTSD services exclusively in Vet Centers may not be counted in 

either report. On the other hand, VA does have information it can use to 
Page 4 GAO-04-1069 Post-Traumatic Stress Disorder

broadly estimate the number of servicemembers who may access VA health 

care, including PTSD services. In September 2003, DOD provided VA with 

demographic information on servicemembers from the Iraq and 

Afghanistan conflicts who have left active duty status and are eligible for 

VA health care. The demographic information includes the names and 

home addresses of servicemembers. In July 2004, VA provided this 

information to its facilities for planning future services for additional 

veterans. By assuming that 15 percent or more of returning 

servicemembers will develop PTSD, based on the predictions of mental 

health experts, VA and its facilities could use DOD’s demographic 

information to broadly estimate demand for PTSD services. However, 

predicting which veterans will seek VA care and at which facilities is 

inherently uncertain, particularly given that the symptoms of PTSD may 

not appear for years. Based on DOD’s demographic information, some VA 

medical facility officials expressed concern about their ability to meet an 

increase in demand for VA PTSD services from servicemembers returning 

from Iraq and Afghanistan.

To help VA better estimate the number of additional veterans it could treat 

for PTSD and to plan for the future demand for VA PTSD services, we 

recommend that VA determine the total number of veterans receiving VA 

PTSD services and provide facility-specific information to VA medical 

facilities and Vet Centers. VA and DOD commented on a draft of this 

report. In its comments VA concurred with our recommendation and 

acknowledged that more coordinated efforts are needed to improve its 

existing PTSD data. VA stated that it plans to aggregate at the national level 

the number of veterans receiving PTSD services at VA medical facilities and 

Vet Centers. DOD concurred with the findings and conclusions in this 

report and provided technical comments on the report, which we 

incorporated as appropriate.

Background PTSD can develop following exposure to life-threatening events, natural 

disasters, terrorist incidents, serious accidents, or violent personal assaults 

like rape. PTSD is the most prevalent mental disorder arising from combat. 

People who experience stressful events often relive the experience through 

nightmares and flashbacks, have difficulty sleeping, and feel detached or 

estranged. These symptoms may occur within the first 4 days after 

exposure to the stressful event or be delayed for months or years. 

Symptoms that appear within the first 4 days after exposure to a stressful 

event are generally diagnosed as acute stress reaction or combat stress. If 
Page 5 GAO-04-1069 Post-Traumatic Stress Disorder

the symptoms of acute stress reaction or combat stress continue for more 

than 1 month, PTSD is diagnosed. 

PTSD services are provided in VA medical facilities and VA community 

settings. VA medical facilities offer PTSD services as well as other services, 

which range from complex specialty care, such as cardiac or spinal cord 

injury, to primary care. VA’s community settings include more than 800 

community-based outpatient clinics and 206 Vet Centers. Communitybased outpatient clinics are an extension of VA’s medical facilities and 

mainly provide primary care services.6

 Vet Centers offer PTSD and family 

counseling, employment services, and a range of social services to assist 

veterans in readjusting from wartime military service to civilian life. Vet 

Centers also function as community points of access for many returning 

veterans, providing them with information and referrals to VA medical 

facilities. Vet Centers were established as entities separate from VA 

medical facilities to serve Vietnam veterans, who were reluctant to access 

health care provided in a federal building. As a result, Vet Centers are not 

located on the campuses of VA medical facilities. 

VA has specialized PTSD programs that are staffed by clinicians who have 

concentrated their clinical work in the area of PTSD treatment. VA 

specialized PTSD programs are located in 97 VA medical facilities and 

provide services on an inpatient and outpatient basis. VA PTSD services 

include individual counseling, support groups, and drug therapy and can be 

provided in non-specialized clinics, such as general mental health clinics.

Veterans who served in any conflict after November 11, 1998 are eligible for 

VA health care services for any illness, including PTSD services, for 2 years 

from the date of separation from military service, even if the condition is 

not determined to be attributable to military service.7

 This 2-year eligibility 

includes those Reserve and National Guard members who have left active 

6

Veterans treated at community-based outpatient clinics are included in the medical 

facility’s count of veterans treated for PTSD.

7

See 38 U.S.C. § 1710(e)(1)(D); VHA Directive 2004-017, Establishing Combat Veteran 

Eligibility. Conflicts are situations in which the servicemembers are subjected to danger 

comparable to the danger encountered in combat with enemy armed forces during a period 

of war, as determined by the Secretary of VA. Veterans who served on active duty in combat 

operations during a period of war after the Persian Gulf War will also be eligible for care 

under section 1710(e)(1)(D). Eligibility under 38 U.S.C. § 1710(e)(1)(D) does not extend, 

however, to veterans whose disabilities are found to have resulted from a cause other than 

the service described in the statute. 
Page 6 GAO-04-1069 Post-Traumatic Stress Disorder

duty and returned to their units. After 2 years, these veterans will be 

subject to the same eligibility rules as other veterans, who generally have to 

prove that a medical problem is connected to their military service or have 

relatively low incomes. In July 2004, VA reported that so far 32,684 or 15 

percent of veterans who have returned from service in Iraq or Afghanistan, 

including Reserve and National Guard members, have accessed VA for 

various health care needs. 

DOD and VA have formed a Seamless Transition Task Force with the goal 

of meeting the needs of servicemembers returning from Iraq and 

Afghanistan who will eventually become veterans and may seek health care 

from VA. To achieve this goal, DOD and VA plan to improve the sharing of 

information, including individual health information, between the two 

departments in order to enhance VA’s outreach efforts to identify and serve 

returning servicemembers, including Reserve and National Guard 

members, in need of VA health care services. Since April 2003, VA requires 

that every returning servicemember from the Iraq and Afghanistan conflicts 

who needs health care services receive priority consideration for VA health 

care appointments.8

DOD Uses Two 

Approaches to Identify 

Servicemembers At 

Risk for PTSD 

DOD uses two approaches to identify servicemembers who may be at risk 

of developing PTSD: the combat stress control program and the postdeployment health assessment questionnaire. DOD’s combat stress control 

program identifies servicemembers at risk for PTSD by training all 

servicemembers to identify the early onset of combat stress, which if left 

untreated, could lead to PTSD. DOD uses the post-deployment health 

assessment questionnaire to screen servicemembers for physical ailments 

and mental health issues commonly associated with deployments, 

including PTSD. The questionnaire contains four screening questions that 

were developed jointly by DOD and VA mental health experts to identify 

servicemembers at risk for PTSD. 

8

Servicemembers who served in the Iraq and Afghanistan conflicts do not have priority over 

veterans with service-connected disabilities.
Page 7 GAO-04-1069 Post-Traumatic Stress Disorder

DOD Trains 

Servicemembers to Identify 

Symptoms That Could Lead 

to PTSD

DOD’s combat stress control program identifies servicemembers at risk for 

PTSD by training all servicemembers to identify the early onset of combat 

stress symptoms, which if left untreated, could lead to PTSD. The program 

is based on the principle of promptly identifying servicemembers with 

symptoms of combat stress in a combat theater, with the goal of treating 

and returning them to duty.9

 This principle is consistent with the views of 

PTSD experts, who believe that early identification and treatment of 

combat stress symptoms may reduce the risk of PTSD. To assist 

servicemembers in the combat theater, teams of DOD mental health 

professionals travel to units to reinforce the servicemembers’ knowledge of 

combat stress symptoms and to help identify those who may be at risk for 

combat stress or PTSD. The teams may include psychiatrists, 

psychologists, social workers, nurses, mental health technicians, and 

chaplains. DOD requires that the effectiveness of the combat stress control 

program be monitored on an annual basis. 

DOD Uses the PostDeployment Questionnaire 

to Identify Servicemembers 

At Risk for PTSD

DOD generally uses the post-deployment health assessment questionnaire, 

DD 2796, to identify servicemembers at risk for PTSD following 

deployment outside of the United States.10 (See app. II for a copy of the DD 

2796.) DOD requires certain servicemembers deployed to locations outside 

of the United States to complete a DD 2796 within 30 days before leaving a 

deployment location or within 5 days after returning to the United States.11 

This applies to all servicemembers returning from a combat theater, 

including Reserve and National Guard members. 

The DD 2796 is a questionnaire used to determine the presence of any 

physical ailments and mental health issues commonly associated with 

deployments, any special medications taken during deployment, and 

9

If a servicemember’s symptoms persist, the servicemember is transferred to a medical 

facility where specialty care is available.

10The questionnaire is used to satisfy the requirement for post-deployment mental health 

assessments established by the National Defense Authorization Act for Fiscal Year 1998. See 

Pub. L. No. 105-85, § 765(a)(1), 111 Stat. 1629, 1826 (adding new section 1074f(b) to title 10, 

United States Code).

11Servicemembers who are deployed for 30 or more continuous days to locations without 

permanent treatment facilities are required to complete DD 2796. Servicemembers who are 

deployed to locations with permanent treatment facilities are not required to complete the 

questionnaire because these locations are not high risk for environmental or occupational 

exposures.
Page 8 GAO-04-1069 Post-Traumatic Stress Disorder

possible environmental or occupational exposures. The DD 2796 includes 

the following four screening questions that VA and DOD mental health 

experts developed to identify servicemembers at risk for PTSD: 

Once completed, the DD 2796 must be initially reviewed by a DOD health 

care provider, which could range from a physician to a medic or 

corpsman.12 Figure 1 illustrates DOD’s process for completion and review 

of the DD 2796. The form is then reviewed, completed, and signed by a 

health care provider, who can be a physician, physician assistant, nurse 

practitioner, or an independent duty medical technician or corpsman. This 

health care provider reviews the completed DD 2796 to identify any “yes” 

responses to the screening questions—including questions related to 

PTSD—that may indicate a need for further medical evaluation. The review 

is to take place in a face-to-face interview with the servicemember and be 

conducted either on an individual basis, as we observed at the Army’s Fort 

Lewis in Washington, or in a group setting, as we found at the Marine 

Corps’ Camp Lejeune in North Carolina. If a servicemember answers “yes” 

to a PTSD question, the health care provider is instructed to gather 

additional information from the servicemember and use clinical judgment 

to determine if the servicemember should be referred for further medical 

evaluation to a physician, physician’s assistant, nurse, or an independent

Have you ever had any experience that was so frightening, 

horrible, or upsetting that, in the past month, you

• have had any nightmares about it or thought about it when you did not 

want to?

• tried hard not to think about it or went out of your way to avoid 

situations that remind you of it?

• were constantly on guard, watchful, or easily startled?

• felt numb or detached from others, activities, or your surroundings?

12Medics and corpsmen are enlisted personnel who have been trained to give first aid and 

basic medical treatment, especially in combat situations. 
Page 9 GAO-04-1069 Post-Traumatic Stress Disorder

duty medical technician.13,14 To document completion of the DD 2796, DOD 

requires that the questionnaire be placed in the servicemember’s 

permanent medical record and a copy sent to the Army Medical 

Surveillance Activity, which maintains a database of all servicemembers’ 

completed health assessment questionnaires.15

13Independent duty medical technicians are enlisted personnel who receive advanced 

training and are certified to provide treatment and prescribe medications within defined 

parameters. 

14Reserve and National Guard members who are referred for further medical evaluation may 

remain on active duty status until the medical problem is treated and resolved or the 

condition becomes stable.

15The Army has lead responsibility for DOD’s medical surveillance and operates a 

centralized data repository. 
Page 10 GAO-04-1069 Post-Traumatic Stress Disorder

Figure 1: DOD’s Process for “Yes” Responses to PTSD Questions on DD 2796

Source: GAO analysis based on the Department of Defense, Enhanced Post-Deployment Health Assessments, April 2003, and interviews 

with DOD officials.

Documentation completed. 

Process ends.

Copy of completed DD 2796 sent to 

Army Medical Surveillance Activity DD

2796

Servicemember completes 

DOD's Post-Deployment 

Health Assessment 

Questionnaire (DD 2796) 

within 30 days before 

leaving deployment 

location

DD

2796

Servicemember 

completes DD 2796 

within 5 days after 

returning to 

the United States DD

2796

Completed DD 2796 placed in servicemember's 

permanent medical record

Clinical provider gathers additional information and may 

refer servicemember for further evaluation

Clinical provider notes that servicemember had a 

'Yes' answer to at least 1 of 4 screening questions 

about post-traumatic stress disorder

Servicemember has face-to-face with clinical provider 

who reviews and signs DD 2796

- or -

Medical 

Record 

DD 2796 
Page 11 GAO-04-1069 Post-Traumatic Stress Disorder

The National Defense Authorization Act for Fiscal Year 1998 required DOD 

to establish a quality assurance program to ensure, among other things, 

that post-deployment mental health assessments are completed16 for 

servicemembers who are deployed outside of the United States. 

Completion of the DD 2796 is tracked as part of this quality assurance 

program.17 DOD delegated responsibility for developing procedures for the 

required quality assurance program to each of its uniform services. The 

uniform services have given unit commanders the responsibility to ensure 

completion of the DD 2796 by all servicemembers under their command. To 

ensure the DD 2796 is completed, one DOD official we interviewed told us 

that servicemembers would not be granted leave to go home until the DD 

2796 was completed. Another official told us that Reserve and National 

Guard members would not be given their active duty discharge paperwork 

until the DD 2796 was completed. 

VA Lacks Information 

Needed to Determine 

Whether It Can Meet an 

Increase in Demand for 

PTSD Services

VA does not have all the information it needs to determine whether it can 

meet an increase in demand for VA PTSD services. VA does not have a 

count of the total number of veterans currently receiving PTSD services at 

its medical facilities and Vet Centers. Without this information, VA cannot 

estimate the number of veterans its medical facilities and Vet Centers could 

treat for PTSD. VA could use demographic information it receives from 

DOD to broadly estimate the number of servicemembers who may access 

VA health care, including PTSD services. By assuming that 15 percent or 

more of returning servicemembers will develop PTSD, VA could use the 

demographic information to broadly estimate demand for PTSD services. 

However, predicting which veterans will seek VA care and at which 

facilities is inherently uncertain, particularly given that the symptoms of 

PTSD may not appear for years. 

16See Section 765(a)(1), 111 Stat. at 1826 (codified at 10 U.S.C. § 1074f(d)).

17In September 2003, we found that DOD had not established an effective quality assurance 

program and recommended that this be done. See GAO-03-1041.
Page 12 GAO-04-1069 Post-Traumatic Stress Disorder

VA Does Not Have 

Information on the Total 

Number of Veterans 

Currently Receiving PTSD 

Services 

VA does not have a count of the total number of veterans currently 

receiving PTSD services at its medical facilities and Vet Centers. Without 

this information, VA cannot estimate the number of additional veterans its 

facilities could treat for PTSD. On August 27, 2004, a Northeast Program 

Evaluation Center (NEPEC) official told us that a count of the total number 

of veterans with a diagnosis of PTSD who receive VA services at medical 

facilities could be obtained from VA’s existing database. However, this 

database does not include Vet Centers’ information because this 

information is kept separate from the medical facilities’ data. 

VA publishes two reports that contain information on some of the veterans 

receiving PTSD services at its medical facilities. Neither report includes all 

veterans receiving PTSD services at VA medical facilities and Vet Centers. 

VA’s annual capacity report, which is required by law,18 provides data on 

VA’s most vulnerable populations, such as veterans with spinal cord 

injuries, blind veterans, and seriously mentally ill veterans with PTSD.19

The NEPEC annual report mainly provides data on veterans with a primary 

diagnosis of PTSD.20 VA has not developed a methodology that would allow 

it to count the number of veterans receiving PTSD services at its medical 

facilities and Vet Centers. 

The PTSD data used in VA’s annual capacity report and the data used in 

NEPEC’s annual report are drawn from different—though not mutually 

exclusive—subgroups of veterans receiving PTSD services at VA’s medical 

facilities. VA developed criteria that allow it to determine which veterans 

should be included in each subgroup. VA’s criteria, which differ in each 

report, are based on the type and frequency of mental health services 

provided to veterans with PTSD at its medical facilities. (See Figure 2 for 

the veterans included in each of VA’s annual reports.)

18See 38 U.S. C. § 1706(b)(5).

19Seriously mentally ill veterans are those diagnosed with a mental, behavioral or emotional 

disorder of sufficient duration to substantially interfere with one or more life activities, 

including basic daily living skills such as eating, bathing, or dressing.

20Department of Veterans Affairs, The Long Journey Home XII Treatment of Posttraumatic 

Stress Disorder in the Department of Veterans Affairs: Fiscal Year 2003 Service Delivery 

and Performance, Northeast Program Evaluation Center, VA Connecticut Healthcare 

System (Connecticut: April 2004). The Northeast Program Evaluation Center, a division of 

the National Center for PTSD, monitors and evaluates the implementation and performance 

of VA’s specialized PTSD programs. 
Page 13 GAO-04-1069 Post-Traumatic Stress Disorder

Figure 2: Veterans Included in VA’s Annual Reports

Note: Analysis of VA’s Fiscal Year 2002 “Maintaining Capacity to Provide for the Specialized Treatment 

and Rehabilitative Needs of Disabled Veterans” and NEPEC’s “Long Journey Home XII Treatment of 

Posttraumatic Stress Disorder in the Department of Veterans Affairs: Fiscal Year 2003 Service Delivery 

and Performance.” Examples of VA specialized mental health services include PTSD and substance 

abuse.

a

This refers to Table E1 in Appendix E of The Long Journey Home XII Treatment of Posttraumatic 

Stress Disorder in the Department of Veterans Affairs: Fiscal Year 2003 Service Delivery and 

Performance Northeast Program Evaluation Center, VA Connecticut Healthcare System (Connecticut: 

April 2004).

Veterans who are receiving VA PTSD services may be counted in both 

reports, only counted in the NEPEC report, or not included in either report. 

For example, a veteran who is seriously mentally ill and has a primary 

diagnosis of PTSD is counted in both reports. On the other hand, a veteran 

who has a primary diagnosis of PTSD but is not defined as seriously 

mentally ill is counted in the NEPEC report but not in the capacity report. 

Finally, a veteran who is receiving PTSD services only at a Vet Center is not 

counted in either report. 

Capacity Veterans who are seriously mentally ill with PTSD, which is equivalent to: report 

or

or

and

or

and

or

Veterans who have a primary diagnosis of PTSD in an outpatient setting NEPEC 

reporta

Source: GAO analysis 

6 or more outpatient 

visits to VA specialized 

mental health services 

hospitalized psychiatric 

service for a mental 

health disorder

2 visits to a VA 

PTSD outpatient 

clinic

primary 

diagnosis of 

PTSD

received care in a 

PTSD outpatient 

clinic

received care in a 

PTSD inpatient 

service

inpatient in a VA 

residential care 

program for a mental 

health disorder
Page 14 GAO-04-1069 Post-Traumatic Stress Disorder

Furthermore, both the VA OIG and VA’s Committee on Care of Veterans 

with Serious Mental Illness have found inaccuracies in the data used in VA’s 

annual capacity report.21For example, OIG found inconsistencies in the 

PTSD program data reported by some VA medical facilities. OIG found that 

some medical facilities reported having active PTSD programs, although 

the facilities reported having no staff assigned to these programs. 

Additionally, the Committee on Care of Veterans with Serious Mental 

Illness, commenting on VA’s fiscal year 2002 capacity report, stated the data 

VA continues to use for reporting information on specialized programs are 

inaccurate and recommended changes in future reporting.22, 23 VA agreed 

with OIG that the data were inaccurate and is continuing to make changes 

to improve the accuracy of the data in its annual capacity report. VA’s fiscal 

year 2003 capacity report to Congress is currently undergoing review by 

OIG, which informed us that VA has not incorporated all of the changes 

necessary for OIG to certify that the report is accurate. OIG further stated 

that it will continue to oversee this process. 

VA Has Information to 

Broadly Estimate Future 

Demand for PTSD Services 

VA has information it can use to broadly estimate what the increase in 

demand for VA PTSD services may be from returning servicemembers. In 

September 2003, DOD began providing VA with demographic information 

on servicemembers returning from the Iraq and Afghanistan conflicts who 

have left active duty status and are eligible for VA health care.24 The 

information includes name, home address including zip code, branch of 

service, and gender.25 Using servicemembers’ home zip codes could help VA 

21The VA OIG is required to examine each of VA’s annual reports on its specialized services, 

including PTSD, and submit to Congress a certification as to its accuracy. See 38 U.S.C. § 

1706(b)(5)(C). 

22The Committee on Care of Severely Chronically Mentally Ill Veterans assesses VA’s 

capability to meet the rehabilitation and treatment needs of such veterans. See 38 U.S.C. § 

7321. The Committee, established within VA, is generally referred to as the Committee on 

Care of Veterans with Serious Mental Illness.

23Department of Veterans Affairs, Capacity Report Fiscal Year 2002 (Washington, D.C.: 

May 2003).

24Not all such servicemembers are eligible for VA health care. For example, a 

servicemember who has been dishonorably discharged would not be eligible for VA 

services.

25VA has used this information to send letters to servicemembers who have left active duty 

status, informing them of their eligibility for VA’s health care services.
Page 15 GAO-04-1069 Post-Traumatic Stress Disorder

predict the facilities or Vet Centers that could experience an increase in 

demand for care. By assuming that 15 percent or more of returning 

servicemembers will eventually develop PTSD, based on the predictions of 

mental health experts, VA could use the demographic information to 

broadly estimate the number of returning servicemembers who may need 

VA PTSD services and the VA facilities located closest to servicemembers’ 

homes. However, predicting which veterans will seek VA care and at which 

facilities is inherently uncertain, particularly given that the symptoms of 

PTSD may not appear for years. 

VA headquarters received demographic information from DOD in 

September 2003; however, during our review we found that VA had not 

shared this information with its facilities. On July 21, 2004, VA provided this 

information to its medical facilities for planning future services for 

veterans returning from the Iraq and Afghanistan conflicts. However, VA 

did not provide the demographic information to Vet Centers. Officials at 

seven VA medical facilities told us that while the demographic information 

VA receives from DOD has limitations, it is the best national data currently 

available and would help them plan for new veterans seeking VA PTSD 

services. 

Officials at six of the seven VA medical facilities we visited explained that 

while they are now 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.26 In addition, some of the officials expressed concern 

about their ability to meet an increase in demand for VA PTSD services 

from servicemembers returning from Iraq and Afghanistan based on DOD’s 

demographic information. Officials are concerned because facilities have 

been directed by VA to give veterans of the Iraq and Afghanistan conflicts 

priority appointments for health care services, including PTSD service. As a 

result, VA medical facility officials estimate that follow-up appointments 

for veterans currently receiving care for PTSD may be delayed. VA officials 

estimate the delay may be up to 90 days. Veterans of the Iraq and 

Afghanistan conflicts will not be given priority appointments over veterans 

who have a service-connected disability and are currently receiving 

services.27

26One medical facility believed it could accommodate, with the facility’s current staffing 

levels, a one to two percent increase in additional veterans seeking PTSD services. 

However, it would have to restructure its PTSD services provided to current veterans.
Page 16 GAO-04-1069 Post-Traumatic Stress Disorder

Conclusions While the VA OIG continues to oversee VA’s efforts to improve the accuracy 

of data in the capacity reports, VA does not have a report that counts all 

veterans receiving VA PTSD services. Although VA can use DOD’s 

demographic information to broadly estimate demand for VA PTSD 

services, VA does not know the number of veterans it now treats for PTSD 

at its medical facilities and Vet Centers. As a result, VA will be unable to 

estimate its capacity for treating additional veterans who choose to seek 

VA’s PTSD services, and therefore, unable to plan for an increase in demand 

for these services. 

Recommendation for 

Executive Action

To help VA estimate the number of additional veterans it could treat for 

PTSD and to plan for the future demand for VA PTSD services from 

additional veterans seeking these services, we recommend that the 

Secretary of Veterans Affairs direct the Under Secretary for Health to 

determine the total number of veterans receiving VA PTSD services and 

provide facility-specific information to VA medical facilities and Vet 

Centers.

Agency Comments In commenting on a draft of this report, VA concurred with our 

recommendation and acknowledged that more coordinated efforts are 

needed to improve its existing PTSD data. VA stated that it plans to 

aggregate, at the national level, the number of veterans receiving PTSD 

services at VA medical facilities and Vet Centers. We believe VA should 

provide these data to both its medical facilities and Vet Centers so they 

have the information needed to plan for future demand for PTSD services. 

In addition, VA provided two points of clarification. First, VA stated that it 

is in the process of developing a mental health strategic plan that will 

project demand by major diagnoses and identify where projected demand 

may exceed resource availability. VA stated that future revisions to the 

mental health strategic plan would include Vet Center data. Second, VA 

stated that it would seek additional information from DOD on 

servicemembers who have served in Iraq and Afghanistan to improve its 

provision of health care services to these new veterans. VA’s written 

comments are reprinted in appendix III. DOD concurred with the findings 

27A service-connected disability is an injury or disease that was incurred or aggravated while 

on active military duty. 
Page 17 GAO-04-1069 Post-Traumatic Stress Disorder

and conclusions in this report and provided technical comments, which we 

incorporated as appropriate. DOD’s written comments are reprinted in 

appendix IV.

As agreed with your office, unless you publicly announce its contents 

earlier, we plan no further distribution of this report until 30 days after its 

date. We will then send copies of this report to the Secretary of Veterans 

Affairs and other interested parties. We also will make copies available to 

others upon request. In addition, the report will be available at no charge at 

the GAO Web site at http://www.gao.gov.

If you or your staff have any questions about this report, please call me at 

(202) 512-7101. Another contact and key contributors are listed in 

appendix V.

Sincerely yours,

Cynthia A. Bascetta

Director, Health Care—Veterans’ 

Health and Benefits Issues
Page 18 GAO-04-1069 Post-Traumatic Stress Disorder

Appendix I

Scope and Methodology ApApenednxidexiIs

To determine the approaches DOD uses to identify servicemembers who 

are at risk for PTSD, we reviewed directives on screening servicemembers 

deployed to locations outside of the United States, interviewed DOD 

officials, and visited a military installation for each of DOD’s uniformed 

services. At each of the military installations, we discussed with officials 

the steps taken by each of the uniformed services to implement DOD’s 

approaches, particularly the steps involved in completing the postdeployment health assessment questionnaire, DD 2796, as it relates to 

PTSD. How well the uniformed services implemented DOD’s approaches 

were reported in other GAO reports. The uniformed services included in 

our review were Army, Marines, Air Force, and Navy. We did not include 

the Coast Guard in this review because few Coast Guard servicemembers 

are involved in the Iraq and Afghanistan conflicts. The military installations 

visited were: Fort Lewis Army Base and Madigan Army Medical Center in 

Washington, Seymour Johnson Air Force Base in North Carolina, Camp 

Lejeune Marine Base and the Naval Hospital Camp Lejeune in North 

Carolina, and the Naval Medical Center San Diego in California. We also 

asked DOD officials whether they provide information to VA that could 

help VA plan how to meet the demand for VA PTSD services from 

servicemembers returning from the Iraq and Afghanistan conflicts. 

To determine whether VA has the information it needs to determine 

whether it can meet an increase in demand for PTSD services, we 

interviewed PTSD experts from the National Center for PTSD established 

within VA and members of the Under Secretary for Health’s Special 

Committee on PTSD.1

 We also visited three divisions of the National Center 

for PTSD: the Executive Division in White River Junction, Vermont; the 

Education Division in Palo Alto, California; and NEPEC in West Haven, 

Connecticut to review the Center’s reports on specialized PTSD programs. 

We also reviewed VA’s fiscal year 2001 and 2002 annual reports on VA’s 

capacity to provide services to special populations, including veterans with 

PTSD, and NEPEC’s annual reports on specialized PTSD programs to 

determine the criteria VA uses to count the number of veterans receiving 

VA PTSD services. We reviewed the findings of VA’s Committee on Care of 

Veterans with Serious Mental Illness and the VA OIG, who have reported on 

1

VA was required to establish a Special Committee on PTSD by the Veterans’ Health Care 

Act of 1984. See Section 110(b), 98 Stat. at 2691 (codified at 38 U.S.C. § 1712A note). Among 

other things, the committee assesses VA’s care of veterans who require specialized 

treatment for PTSD.
Appendix I

Scope and Methodology

Page 19 GAO-04-1069 Post-Traumatic Stress Disorder

the accuracy of VA’s annual capacity report to Congress on the number of 

veterans receiving specialized services, including PTSD services. We 

interviewed officials from each of these groups to clarify their findings. We 

did not include data from the annual capacity reports because the OIG 

reported that the data were not sufficiently reliable. We also interviewed 

the director of NEPEC to discuss the information included in NEPEC’s 

annual reports. 

To determine whether VA facilities have the information needed to 

determine whether they can meet an increase in demand for PTSD 

services, we interviewed officials at 7 VA medical facilities, and 15 Vet 

Centers located near the medical facilities to discuss the number of 

veterans currently receiving VA PTSD services and the impact that an 

increase in demand would have on these services. We also discussed DOD’s 

demographic information with four of the seven medical facilities we 

visited. We contacted VA medical facilities located in Palo Alto and San 

Diego in California; Durham and Fayetteville in North Carolina; White River 

Junction, Vermont; West Haven, Connecticut; and Seattle, Washington. We 

also contacted Vet Centers located in Vista, San Diego, and San Jose in 

California; Raleigh, Charlotte, Greenville, Greensboro, and Fayetteville in 

North Carolina; South Burlington and White River Junction in Vermont; 

Hartford, Norwich, and New Haven in Connecticut; and Seattle and 

Tacoma in Washington. 

Our work was conducted from May through September 2004 in accordance 

with generally accepted government auditing standards.
Page 20 GAO-04-1069 Post-Traumatic Stress Disorder

Appendix II

Department of Defense Post-Deployment 

Health Assessment Questionnaire DD-2796 ApendxiI

POST-DEPLOYMENT Health Assessment

Authority: 10 U.S.C. 136 Chapter 55. 1074f, 3013, 5013, 8013 and E.O. 9397

Principal Purpose: To assess your state of health after deployment outside the United States in support of military operations

and to assist military healthcare providers in identifying and providing present and future medical care to you.

Routine Use: To other Federal and State agencies and civilian healthcare providers, as necessary, in order to provide necessary

medical care and treatment.

Disclosure: (Military personnal and DoD civilian Employees Only) Voluntary. If not provided, healthcare WILL BE furnished, but

comprehensive care may not be possible.

INSTRUCTIONS: Please read each question completely and carefully before marking your selections. Provide a response 

 for each question. If you do not understand a question, ask the administrator.

Demographics

Last Name Today's Date (dd/mm/yyyy)

First Name MI Social Security Number

Name of Your Unit or Ship during this Deployment DOB (dd/mm/yyyy)

Gender Service Branch Component

Location of Operation

Name of Operation:

DD FORM 2796, APR 2003 PREVIOUS EDITION IS OBSOLETE.

Male

Female

Air Force

Army

Coast Guard

Marine Corps

Navy

Other

Active Duty

National Guard

Reserves

Civilian Government Employee

Europe

SW Asia

SE Asia

Asia (Other)

Australia South America

Africa

Central America

Unknown

Administrator Use Only

Indicate the status of each of the following:

Yes No N/A

Medical threat debriefing completed

Medical information sheet distributed

Post Deployment serum specimen collected

Date of arrival in theater (dd/mm/yyyy)

Date of departure from theater (dd/mm/yyyy)

Pay Grade

E1

E2

E3

E4

E5

E6

E8

E7

E9

O01

O02

O03

O04

O05

O06

O07

O08

O09

O10

W1

W2

W3

W4

W5

Other

North America

Other

To what areas were you mainly deployed:

(mark all that apply - list where/date arrived)

Kuwait

Qatar

Afghanistan

Bosnia

On a ship

Iraq

Turkey

Uzbekistan

Kosovo

CONUS

Other

Occupational specialty during this deployment

(MOS, NEC or AFSC)

Combat specialty:

ASD(HA) APPROVED 

33348

33348
Appendix II

Department of Defense Post-Deployment 

Health Assessment Questionnaire DD-2796

Page 21 GAO-04-1069 Post-Traumatic Stress Disorder

DD FORM 2796, APR 2003

Please answer all questions in relation to THIS deployment

Health stayed about the same or got better

Health got worse

1. Did your health change during this deployment?

2. How many times were you seen in

 sick call during this deployment? No. of times

No

Yes, reason/dates:

3. Did you have to spend one or more nights in a

 hospital as a patient during this deployment?

Smallpox (leaves a scar on the arm)

Anthrax

4. Did you receive any vaccinations just before 

 or during this deployment?

Botulism

Typhoid

Meningococcal

Other, list:

Don't know

None

PB (pyridostigmine bromide) nerve agent pill

Mark-1 antidote kit

5. Did you take any of the following medications

 during this deployment?

(mark all that apply)

Anti-malaria pills

Pills to stay awake, such as dexedrine

Other, please list

Don't know

6. Do you have any of these symptoms now or did you develop them anytime during this deployment?

No Yes During Yes Now

Chronic cough

Runny nose

Fever

Weakness

Headaches

Swollen, stiff or painful joints

Back pain

Muscle aches

Numbness or tingling in hands or feet

Skin diseases or rashes

Redness of eyes with tearing

Dimming of vision, like the lights

were going out

No Yes During Yes Now

Chest pain or pressure

Dizziness, fainting, light headedness

Difficulty breathing

Still feeling tired after sleeping

Difficulty remembering

Diarrhea

Frequent indigestion

Vomiting

Ringing of the ears

No

7. Did you see anyone wounded, killed or dead during this

 deployment?

 (mark all that apply)

Yes - coalition Yes - enemy Yes - civilian

No

8. Were you engaged in direct combat where you discharged

 your weapon?

Yes ( land sea air )

No

9. During this deployment, did you ever feel that you were in

 great danger of being killed?

Yes

No

10. Are you currently interested in receiving help for a stress,

 emotional, alcohol or family problem?

Yes

None

11. Over the LAST 2 WEEKS, how often have you 

 been bothered by any of the following problems?

Some A Lot

Little interest or pleasure in

doing things

Feeling down, depressed, or

hopeless

Thoughts that you would be

better off dead or hurting

yourself in some way

33348
Appendix II

Department of Defense Post-Deployment 

Health Assessment Questionnaire DD-2796

Page 22 GAO-04-1069 Post-Traumatic Stress Disorder

DD FORM 2796, APR 2003

12. Have you ever had any experience that was so

 frightening, horrible, or upsetting that, IN THE

 PAST MONTH, you ....

No Yes

Have had any nightmares about it or thought

about it when you did not want to?

Tried hard not to think about it or went out of

your way to avoid situations that remind you

of it?

Were constantly on guard, watchful, or easily

startled?

Felt numb or detached from others, activities,

or your surroundings?

13. Are you having thoughts or concerns that ...

No Yes

You may have serious conflicts

with your spouse, family members,

or close friends?

Unsure

You might hurt or lose control

with someone?

14. While you were deployed, were you exposed to:

 (mark all that apply)

No Sometimes Often

DEET insect repellent applied to skin

Pesticide-treated uniforms

Environmental pesticides (like area fogging)

Flea or tick collars

Pesticide strips

Smoke from oil fire

Smoke from burning trash or feces

Vehicle or truck exhaust fumes

Tent heater smoke

JP8 or other fuels

Fog oils (smoke screen)

Solvents

Paints

Ionizing radiation

Radar/microwaves

Lasers

Loud noises

Excessive vibration

Industrial pollution

Sand/dust

Depleted Uranium (If yes, explain)

Other exposures

15. On how many days did you wear

 your MOPP over garments? No. of days

16. How many times did you put on

 your gas mask because of alerts and

 NOT because of exercises? No. of times

No

17. Were you in or did you enter or closely inspect any

 destroyed military vehicles?

Yes

No

18. Do you think you were exposed to any chemical, 

 biological, or radiological warfare agents during this

 deployment?

Don't know

Yes, explain with date and location

33348
Appendix II

Department of Defense Post-Deployment 

Health Assessment Questionnaire DD-2796

Page 23 GAO-04-1069 Post-Traumatic Stress Disorder

Post-Deployment Health Care Provider Review, Interview, and Assessment

SERVICE MEMBER'S SOCIAL SECURITY #

1. Would you say your health in general is:

2. Do you have any medical or dental problems that developed during this deployment?

3. Are you currently on a profile or light duty?

4. During this deployment have you sought, or do you now intend to seek, counseling or care for your mental

 health?

5. Do you have concerns about possible exposures or events during this deployment that you feel may affect

 your health?

 Please list concerns:

6. Do you currently have any questions or concerns about your health?

 Please list concerns:

After my interview/exam of the service member and review of this form, there is a need for further evaluation as indicated below. (More

than one may be noted for patients with multiple problems. Further documentation of the problem evaluation to be placed in the service

member's medical record.)

REFERRAL INDICATED FOR:

GI

GU

GYN

Mental Health

Neurologic

Orthopedic

Pregnancy

Pulmonary

Other

Comments:

I certify that this review process has been completed.

Provider's signature and stamp:

End of Health Review

Date (dd/mm/yyyy)

DD FORM 2796, APR 2003 ASD(HA) APPROVED

Yes No

Yes No

Yes No

Yes No

Yes No

Excellent Very Good Good Fair Poor

EXPOSURE CONCERNS (During deployment):

Environmental

Occupational

Combat or mission related

None

Audiology

Interview

Health Care Provider Only

Health Assessment

This visit is coded by V70.5 _ _ 6

33348

Cardiac

None

Combat/Operational Stress Reaction

Dental

Dermatologic

ENT

Eye

Family Problems

Fatigue, Malaise, Multisystem complaint
Page 24 GAO-04-1069 Post-Traumatic Stress Disorder

Appendix III

Comments from the Department of Veterans 

Affairs ApendxiI
Appendix III

Comments from the Department of Veterans 

Affairs 

Page 25 GAO-04-1069 Post-Traumatic Stress Disorder
Appendix III

Comments from the Department of Veterans 

Affairs 

Page 26 GAO-04-1069 Post-Traumatic Stress Disorder
Page 27 GAO-04-1069 Post-Traumatic Stress Disorder

Appendix IV

Comments from the Department of Defense ApendxiIV
Page 28 GAO-04-1069 Post-Traumatic Stress Disorder

Appendix V

GAO Contact and Staff Acknowledgments ApendxiV

GAO Contact Marcia A. Mann, 202-512-9526

Acknowledgments In addition to the contact named above Mary Ann Curran, Linda Diggs, 

Martha Fisher, Krister Friday, and Marion Slachta made key contributions 

to this report. 
Page 29 GAO-04-1069 Post-Traumatic Stress Disorder

Related GAO Products

Defense Health Care: DOD Needs to Improve Force Health Protection and 

Surveillance Processes. GAO-04-158T, Washington, D.C.: October 16, 2003.

Defense Health Care: Quality Assurance Process Needed to Improve 

Force Health Protection and Surveillance. GAO-03-1041, Washington, D.C.: 

September 19, 2003.

Disabled Veterans’ Care: Better Data and More Accountability Needed to 

Adequately Assess Care. GAO/HEHS-00-57, Washington, D.C.: April 21, 

2000.

(290387)
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