GAO-04-294R Defense Health Care 

United States General Accounting Office 

Washington, DC 20548 

November 25, 2003 

The Honorable Lane Evans 

Ranking Democratic Member 

Committee on Veterans Affairs 

House of Representatives 

Subject: Veterans Affairs: Post-hearing Questions Regarding the Departments of 

Defense and Veterans Affairs Providing Seamless Health Care Coverage to 

Transitioning Veterans

Dear Mr. Evans: 

On October 16, 2003, I testified before your Subcommittee’s hearing on Hand-off 

or Fumble: Are DOD and VA Providing Seamless Health Care Coverage to 

Transitioning Veterans?1

 This letter responds to your request that we provide 

answers to follow-up questions from the hearing. Your questions, along with my 

responses, follow. 

1. “Is there any reason for us to be optimistic that DOD [Department of 

Defense] is in better compliance with force protections and surveillance 

policies for Operation Iraqi Freedom than it was for Operation Enduring 

Freedom and Operation Joint Guardianship? Why or why not?”

Answer: We believe that strong leadership and appropriate follow-through are key 

to improving compliance. We are encouraged that the compliance problems we 

found for Operation Enduring Freedom and Operation Joint Guardian prompted the 

Assistant Secretary of Defense for Health Affairs and the military services’ Surgeons 

General to promptly take a number of actions to help ensure compliance with DOD’s 

force health protection and surveillance policies. As you know, we recommended 

that DOD establish an effective quality assurance program that will ensure 

compliance with these policies for all servicemembers.2

 In commenting on our 

report, the Assistant Secretary of Defense stated that his office had already 

established a quality assurance program for pre-deployment and post-deployment 

health assessments and that the services have implemented their quality assurance 

programs. As you know, Operation Iraqi Freedom is an ongoing operation with 

deployments of servicemembers who presumably are covered by the new quality 

assurance programs. On the basis these actions, we are optimistic that progress is 

 

1

 See U.S. General Accounting Office: Defense Health Care: DOD Needs to Improve Force Health 

Protection and Surveillance Processes, GAO-04-158T (Washington, D.C.: Oct. 16, 2003). 2

 See U.S. General Accounting Office: Defense Health Care: Quality Assurance Process Needed to 

Improve Force Health Protection and Surveillance, GAO-03-1041 (Washington, D.C.: Sept. 19, 2003). 
Page 2 GAO-04-294R Defense Health Care 

occurring. However, the extent of compliance can be determined only from an 

examination of servicemembers’ medical records. 

2. “You still believe DOD lacks data on troop locations that obviously calls 

into question its ability to provide effective surveillance. It won’t have a 

system in place until 2007 at the earliest. How could that impair VA’s 

[Department of Veterans Affairs] ability to determine presumption of 

service-connection and effective treatments for exposures?” 

Answer: Knowing which servicemembers were at certain locations at specific times 

in the theater of operations is important for determining their possible exposures to 

chemical, biological, or environmental health hazards that DOD may know about 

currently or later discover. Without this exposure information, it would likely be 

more problematic for VA to determine a presumption of service-connection and to 

ascertain whether treatments are appropriate. 

3. “Has anything improved since your last report on compliance with policies 

on force protection and surveillance?”

Answer: When we issued our May 1997 report,3

 DOD had not finalized its draft joint 

medical surveillance policy. DOD subsequently finalized its joint medical 

surveillance policy in August 1997. Although there are some methodological 

differences between our May 1997 and September 2003 reports, it is clear that force 

health protection and surveillance compliance problems continue in several areas. 

However, there appears to be some improvement in DOD’s collection of predeployment blood serum samples from deploying servicemembers. Specifically, we 

reported, in our May 1997 report, that 9.3 percent of the 26,000 servicemembers who 

had deployed to Bosnia did not have a blood serum sample on file. In contrast, nearly 

100 percent of our samples for deployments examined in our September 2003 report 

had blood serum samples on file. 

_ _ _ _ _ 

We are sending copies of this report to the Secretary of Veterans Affairs, the Office of 

the Secretary of Defense, and other interested parties. We will also make copies 

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

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

 

3

 See U.S. General Accounting Office: Defense Health Care: Medical Surveillance Improved Since 

Gulf War, but Mixed Results in Bosnia, GAO/NSIAD-97-136 (Washington, D.C.: May 13, 1997). 
Page 3 GAO-04-294R Defense Health Care 

If you have any questions about this report or need additional information, please call 

me at (757) 552-8100. 

Sincerely yours, 

Neal P. Curtin 

Director, Operations and Readiness Issues 

(350473) 
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