RETURNED PEACE 

CORPS VOLUNTEERS

Labor and Peace 

Corps Need Joint 

Approach to Monitor 

Access to and Quality 

of Health Care 

Benefits

Report to Congressional Committees

November 2012

GAO-13-27

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United States Government Accountability Office

GAO
United States Government Accountability Office

Highlights of GAO-13-27, a report to 

congressional committees

November 2012

RETURNED PEACE CORPS VOLUNTEERS 

Labor and Peace Corps Need Joint Approach to 

Monitor Access to and Quality of Health Care 

Benefits 

Why GAO Did This Study

Peace Corps volunteers who suffer a 

service-connected illness or injury are 

eligible to receive certain health care 

and other benefits under FECA—a 

workers’ compensation program 

administered by DOL. FECA provides 

health care benefits—reimbursements 

for medical expenses—to federal 

employees and volunteers for illnesses 

or injuries that DOL determines are 

service-connected.

GAO was mandated to report on the 

access and quality of health care 

benefits for Peace Corps volunteers. 

This report (1) identifies the health care 

and other benefits provided to 

volunteers from 2009 through 2011 

under the FECA program, and (2) 

examines the extent to which DOL and 

the Peace Corps use available agency 

information to monitor the accessibility 

and quality of FECA health care 

benefits provided to volunteers. GAO 

reviewed agency documents, 

interviewed agency officials, and 

analyzed DOL data. GAO developed a 

framework with four areas to define 

access and quality and examined 

available information in these areas 

that could be used for monitoring.

What GAO Recommends

GAO recommends that the Secretary 

of Labor and the Director of the Peace 

Corps jointly develop and implement 

an approach for working together to 

use available agency information to 

monitor the access to and quality of 

FECA benefits provided to volunteers.

Neither DOL nor the Peace Corps 

indicated whether or not they agreed 

with GAO’s recommendation. Instead, 

the agencies provided additional 

context related to the provision of 

FECA benefits.

What GAO Found

From 2009 through 2011, the Department of Labor (DOL) provided a total of 

about $36 million in Federal Employees’ Compensation Act (FECA) benefits—

health and other benefits—for Peace Corps volunteers who have returned from 

service abroad (volunteers). Specifically, DOL provided about $22 million in 

health care benefits for these volunteers in the form of reimbursements for 

medical expenses related to service-connected injuries and illnesses, and 

$13.8 million in other benefits, such as reimbursement for travel expenses 

incurred when seeking medical care. During this period, approximately 1,400 

volunteers each year received these health care benefits under the FECA 

program. The most common types of medical conditions for which DOL provided 

reimbursements were mental, emotional, and nervous conditions; dental; 

other/nonclassified diseases; and infectious or parasitic diseases. These four 

medical conditions accounted for more than a quarter of all medical 

reimbursements for volunteers under FECA from 2009 through 2011. 

In general, neither DOL nor the Peace Corps use all available information in the 

four areas GAO reviewed to monitor access and quality of FECA benefits for 

volunteers. GAO found that the Peace Corps uses information in just one of the 

areas—volunteers’ awareness of the FECA program; however, in general, 

neither agency uses information in the remaining three areas. These areas are 

(1) information on volunteers’ knowledge of FECA program and application 

requirements, such as required medical documentation; (2) information on DOL’s 

timeliness in reviewing FECA applications and reimbursing medical expenses, 

and on the level of customer satisfaction; and (3) availability of FECA-registered 

medical providers. By not using information available to the agencies, DOL and 

the Peace Corps are missing an opportunity to determine whether, or to what 

extent, volunteers face access and quality issues in the FECA program. For 

example, DOL and the Peace Corps may not be able to determine the extent to 

which there are limitations in the availability of FECA-registered providers for 

certain medical specialties.

DOL and the Peace Corps each have certain responsibilities related to the 

provision of FECA benefits for eligible volunteers, and each has information that 

could be used for monitoring. From DOL’s perspective, volunteers do not 

represent a large proportion of the overall FECA population. However, FECA is a 

relatively larger issue from the Peace Corps’ perspective. The volunteers are a 

unique population compared to others who receive benefits under FECA, and the 

FECA costs associated with volunteers represent a growing portion of the Peace 

Corps’ annual budget. Neither agency has all the information GAO reviewed, and 

the agencies generally do not work together to use available information to 

monitor the accessibility and quality of FECA benefits for volunteers. As a result, 

DOL and the Peace Corps are missing an opportunity to make use of the 

available information to help ensure the accessibility and quality of FECA 

benefits for volunteers.

View GAO-13-27. For more information, 

contact Linda T. Kohn at (202) 512-7114 or 

kohnl@gao.gov.
Page i GAO-13-27 Returned Peace Corps Volunteers

Letter 1 

Background 6

From 2009 through 2011, DOL Provided about $36 Million in Health 

Care and Other Benefits for Volunteers 9

The Peace Corps Uses Information on Volunteers’ Awareness of 

FECA, but Neither DOL Nor the Peace Corps Use Other 

Available Information to Monitor Access and Quality 12

Conclusions 18

Recommendation for Executive Action 19

Agency Comments and Our Evaluation 19

Appendix I Comments from the Peace Corps 23

Appendix II GAO Contact and Staff Acknowledgments 25

Tables

Table 1: The Medical Conditions for Which the Department of 

Labor (DOL) Made Reimbursements for Returned Peace 

Corps Volunteers under the Federal Employees’ 

Compensation Act (FECA), 2009 through 2011 10

Table 2: Extent to Which Available Information Is Used by the 

Department of Labor (DOL) and the Peace Corps to 

Monitor Accessibility and Quality of Federal Employees’ 

Compensation Act (FECA) Benefits for Returned Peace 

Corps Volunteers 13

Contents
Page ii GAO-13-27 Returned Peace Corps Volunteers

Abbreviations

DOL Department of Labor

FECA Federal Employees’ Compensation Act 

GPRA Government Performance and Results Act of 1993

OMB Office of Management and Budget

OWCP Office of Workers’ Compensation Programs

POWER Protecting Our Workers and Ensuring Reemployment

This is a work of the U.S. government and is not subject to copyright protection in the 

United States. The published product 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.
Page 1 GAO-13-27 Returned Peace Corps Volunteers

United States Government Accountability Office

Washington, DC 20548

November 19, 2012

Congressional Committees

Founded in 1961, the Peace Corps’ mission is to help host countries meet 

their needs for trained personnel while promoting mutual understanding 

between Americans and other peoples. Peace Corps volunteers commit 

to 2-year assignments in host communities in various countries, where 

they work on projects such as teaching English, strengthening farmer 

cooperatives, or building sanitation systems. As of July 2012, over 

200,000 Peace Corps volunteers have served in 139 countries.

1 After 

completing their service with the Peace Corps, volunteers typically return 

to the United States.2

Returned volunteers who suffer a service-connected illness or injury are 

eligible to receive compensation for certain medical expenses as well as 

other benefits under the Federal Employees’ Compensation Act (FECA).

In this report, we generally refer to returned Peace 

Corps volunteers as volunteers.

3

The FECA program is a federal workers’ compensation program 

administered by Department of Labor’s (DOL) Office of Workers’ 

Compensation Programs (OWCP). The FECA program provides health 

care benefits—in the form of reimbursement for medical expenses—to 

federal employees and Peace Corps volunteers for illnesses or injuries 

that DOL determines were sustained while in the performance of an 

employee’s duty.4

 

1

The Peace Corps received an appropriation of $375 million in fiscal year 2012.

In addition to these health care benefits, the FECA 

program provides other benefits for federal employees, including Peace 

Corps volunteers, who are injured or become ill while performing their 

duties. These benefits include reimbursement for travel expenses related 

to obtaining medical treatment and wage-loss compensation—that is, 

disability payments—for those who are temporarily unable to perform 

their duties.

2

According to the Peace Corps, about 4,000 volunteers per year completed their Peace 

Corps service from 2009 through 2011. 

3

5 U.S.C. §§ 8101 et seq.

4

The Peace Corps Act provides that its volunteers shall not be deemed federal employees 

except as specified by statute. 22 U.S.C. § 2504(a). FECA provides that it is applicable to 

Peace Corps volunteers with certain exceptions. 5 U.S.C. § 8142(b).

 
Page 2 GAO-13-27 Returned Peace Corps Volunteers

The Peace Corps and DOL each have certain responsibilities related to 

the provision of FECA benefits for eligible volunteers who return from 

service abroad. Specifically, the Peace Corps is responsible for informing 

volunteers that they may be eligible for FECA benefits, assisting in the 

application process, and paying DOL back annually for FECA benefits 

provided to volunteers. DOL is responsible for administering the program 

by reviewing and approving applications for FECA benefits and for 

providing reimbursements for the costs of medical care and other 

expenses for service-connected injuries or illnesses. Given their 

responsibilities, it is important that DOL and the Peace Corps periodically 

monitor the accessibility and quality of the program for the volunteers.5

Peace Corps volunteer advocates have raised several questions 

regarding whether volunteers have access to timely, high-quality health 

care and other benefits under FECA for service-connected injuries and 

illnesses. For example, these advocates have asked whether volunteers 

are made aware of FECA benefits, whether they report injuries or 

illnesses,6 and whether they can locate or access medical providers.7

 

5

Federal internal control standards call for agencies to establish policies and 

procedures—including conducting ongoing monitoring of agency activities and effective 

information sharing throughout the organization—to provide reasonable assurance that 

agency objectives are being met. See GAO, Standards for Internal Control in the Federal 

Government, 

Advocates also raised questions about whether volunteers face 

challenges during the FECA application process, such as dealing with 

multiple agencies—the Peace Corps and DOL.

GAO/AIMD-00-21.3.1 (Washington, D.C.: November 1999). The Office of 

Management and Budget’s (OMB) Circular No. A-123 also defines management’s 

responsibility for internal control in federal agencies on the basis of GAO’s standards. See 

OMB Circular No. A-123, (Revised): Management’s Responsibility for Internal Control 

(Dec. 21, 2004).

6

According to a Peace Corps volunteer advocate, some volunteers who are victims of 

sexual or other assaults may not report illnesses or injuries to the Peace Corps staff incountry or at close-of-service because the volunteer is ashamed or fearful of filing a 

report. As a result, the volunteer may be unable to gather the required medical evidence 

while in-country to support their FECA application and thereby establish a service 

connection.

7

Volunteers are responsible for finding medical providers who have registered for the 

FECA program. According to DOL officials, to be considered a FECA-registered provider, 

a provider must (a) enroll in the program, (b) be state licensed, and (c) accept DOL’s 

terms of payment for the FECA program.
Page 3 GAO-13-27 Returned Peace Corps Volunteers

In response to the questions raised by advocates, the House Committee 

on Foreign Affairs convened a hearing in May 2011. Subsequently, the 

Kate Puzey Peace Corps Volunteer Protection Act of 2011 was enacted 

in November 2011.8 Among other things, the law requires that GAO 

examine the accessibility and quality of the health care services provided 

through DOL to volunteers who return from service abroad in the Peace 

Corps.9

1. identify the health care and other benefits provided by DOL to 

returned Peace Corps volunteers from 2009 through 2011 under the 

FECA program, and

In this report we

2. examine the extent to which DOL and the Peace Corps use available 

agency information to monitor the accessibility and quality of FECA 

health care benefits provided to returned Peace Corps volunteers.

To identify the health care and other benefits provided to volunteers by 

DOL under the FECA program from 2009 through 2011, we reviewed 

agency documents, such as those that describe FECA benefits provided 

to volunteers. We also conducted an analysis of DOL’s claims data from 

the FECA chargeback database on the reimbursements for medical 

expenses that DOL, under the FECA program, made on behalf of federal 

agencies from 2009 through 2011.10 We analyzed these data to identify 

(1) the number of volunteers receiving FECA benefits each year, (2) the 

total amount of reimbursements DOL made for medical expenses, (3) the 

types of injuries and illnesses for which volunteers received health care 

benefits—reimbursements for medical expenses—and (4) the other 

benefits provided under FECA.11

 

8

Pub. L. No. 112-57, 125 Stat. 737 (codified at 22 U.S.C. §§ 2507a et seq.). Kate Puzey 

was a volunteer who was murdered in 2009 during her service in Benin. 

We also identified the total amount of 

9

22 U.S.C. § 2507i(b).

10The costs of reimbursement of health care and other expenses for work-related injuries, 

illnesses, and deaths are assigned to employing agencies annually using the FECA 

chargeback mechanism. Each year OWCP furnishes each agency with a statement 

summarizing the costs for injuries and illnesses suffered by its employees. 

11When analyzing these data, we selected all claims—or FECA applications—with an 

adjudication status of compensable, which identifies the number of claims that were 

approved for FECA benefits. Medical reimbursements and medical conditions are 

associated with individual FECA claims submitted by volunteers that have been approved 

by DOL. Some volunteers may be approved for multiple FECA claims.
Page 4 GAO-13-27 Returned Peace Corps Volunteers

wage-loss compensation and reimbursements DOL made to volunteers 

for travel expenses from 2009 through 2011. We compared the types of 

injuries and illnesses for which volunteers received health care benefits 

and the demographic and other characteristics of volunteers to other 

recipients of FECA benefits. In addition, we interviewed DOL and Peace 

Corps agency officials about the benefits provided to volunteers under 

FECA and the types of injuries or illnesses reported by volunteers.

To assess the reliability of DOL’s FECA data, we reviewed prior GAO 

work using DOL’s FECA chargeback database—which is used to track 

FECA costs for employing agencies, such as the Peace Corps—and 

obtained information from agency officials knowledgeable about the 

database. We performed data quality checks to assess the reliability of 

the FECA chargeback database received from DOL. These data quality 

checks involved an assessment to identify missing or incorrect entries or 

outliers. On the basis of the information we obtained and analyses we 

conducted, we determined that the data we used were sufficiently reliable 

for the purposes of this report.

To identify the extent to which DOL and the Peace Corps use available 

agency information to monitor the accessibility and quality of FECA health 

care benefits provided to volunteers, we developed a framework with four 

key areas to define accessibility and quality and that could be used to 

monitor the accessibility and quality of FECA benefits. Because the FECA 

program is a workers’ compensation program and not a health care 

delivery program, DOL does not deliver or actively manage the health 

care services received by returned volunteers. Therefore, we did not 

assess the quality of health care services delivered by medical providers 

to volunteers. Rather, we examined volunteers’ access to FECA benefits 

and the quality of the FECA workers’ compensation program using the 

following four areas: (1) volunteers’ awareness of the FECA program, 

including their general awareness of the FECA program and knowledge 

of the specific health care benefits available under FECA; (2) volunteers’ 

knowledge of FECA program and application requirements, including 

knowledge of the FECA eligibility requirements and the documentation 

that is typically required by DOL to make a FECA application decision; (3) 

DOL’s timeliness in reviewing FECA applications and providing 

reimbursement for health and other benefits, including average time to 

review and approve or deny a FECA application, average time to provide 

reimbursement for submitted medical claims, and the level of customer 
Page 5 GAO-13-27 Returned Peace Corps Volunteers

satisfaction with the FECA program;12 and (4) availability of FECAregistered medical providers, including the ability of volunteers to access 

these providers.13

We interviewed officials and reviewed documentation about the 

information available to DOL and the Peace Corps for monitoring access 

and quality of the FECA program, including information related to our four 

key areas. For example, we examined: (1) the Peace Corps’ policies on 

informing volunteers of their rights to FECA benefits to determine what 

information is available on volunteers’ awareness of the FECA program, 

and (2) letters sent by DOL to volunteers whose FECA applications were 

denied.14 We synthesized the information provided by agency officials to 

determine the extent to which the two agencies use information in the four 

areas to monitor the accessibility and quality of FECA benefits for 

volunteers. Because the Peace Corps and DOL both have certain 

responsibilities related to the provision of FECA benefits for eligible 

volunteers who return from service abroad, we also looked at the extent 

to which the Peace Corps and DOL work together by sharing this 

information.15

 

12To calculate DOL’s timeliness in reviewing FECA applications, we selected only the 

initial, or first, adjudication of a FECA application. We calculated the time it took DOL to 

process the receipt of the initial FECA application and then approve or deny the claim.

13As part of our review of FECA-registered providers, we examined an online provider 

search tool published by DOL. When doing so, we followed the instructions provided on 

the tool, which state that users are recommended to enter either the state, the city and 

state, or the zip code to define the search area. Users are also recommended to leave the 

field “provider specialty” blank. 

14We reviewed about 30 percent of the denial letters sent to volunteers from 2009 to 2011. 

These letters were randomly selected and provided to us by the Peace Corps. These 

letters include a summary of the volunteer’s reported injury as well as the reason(s) for 

denying the FECA application. 

15In prior work, GAO identified eight key practices that can help enhance and sustain 

collaboration—broadly defined as any joint activity that is intended to produce more public 

value than could be produced when the organizations act alone—among federal agencies. 

For example, agencies should agree on roles and responsibilities and identify and address 

needs by leveraging resources. See GAO, Results-Oriented Government: Practices That 

Can Help Enhance and Sustain Collaboration among Federal Agencies, GAO-06-15

(Washington, D.C.: Oct. 21, 2005).
Page 6 GAO-13-27 Returned Peace Corps Volunteers

We conducted this performance audit from March 2012 to November

2012, in accordance with generally accepted government auditing 

standards. Those standards require that we plan and perform the audit to 

obtain sufficient, appropriate evidence to provide a reasonable basis for 

our findings and conclusions based on our audit objectives. We believe 

that the evidence obtained provides a reasonable basis for our findings 

and conclusions based on our audit objectives.

After volunteers separate from the Peace Corps they typically return to 

the United States, and may transition into new employment. As they 

make this employment transition, the Peace Corps offers various health 

care services and benefits to returned volunteers. First, each volunteer 

receives a close-of-service medical evaluation that assesses their health 

status as they complete their service. The Peace Corps also has a 

contract with an insurance company to make a health insurance policy—

AfterCorps16—available for volunteers to purchase. This policy covers 

non-service-connected illnesses or injuries. The Peace Corps also pays 

for certain health examinations for 6 months after a volunteer’s service is 

completed. Finally, volunteers may also be eligible for reimbursements 

under the FECA program for medical expenses associated with serviceconnected illnesses or injuries, such as those identified during the 

physical conducted at the close-of-service medical evaluation.

The FECA program provides health benefits—reimbursement for medical 

expenses related to illnesses or injuries that DOL determines are service 

connected—as well as other benefits, such as wage-loss (death and 

disability) compensation. To receive benefits through FECA, a volunteer 

must establish that, among other things, he or she was in the 

 

16AfterCorps is a private health insurance policy that covers non-service-connected 

medical problems. The Peace Corps enrolls all volunteers after their close-of-service and 

pays for the first month of coverage. Volunteers are eligible to extend their coverage for up 

to 18 months. This is a medical policy and does not include routine dental coverage.

Background 

FECA Eligibility
Page 7 GAO-13-27 Returned Peace Corps Volunteers

performance of duty at the time the illness or injury occurred.17 Under the 

FECA program, volunteers are considered to be in the performance of 

duty 24 hours a day while abroad during the period of their Peace Corps 

service. DOL requires that if an illness or injury is first discovered after a 

volunteer has returned from service, then the medical evidence must 

show that the injury or illness was sustained while overseas or in the 

performance of duty.18 In order to be eligible for FECA health care 

benefits for preexisting illnesses or injuries—a condition that existed prior 

to service—the volunteer’s medical evidence must demonstrate that the 

volunteer’s service was the proximate cause of or aggravated, 

accelerated, or precipitated the illness or injury.19 Further, volunteers 

must apply for FECA benefits within 3 years of the date of injury or illness, 

or within 3 years after they recognize that a health condition is serviceconnected.20 In 2010, the FECA program provided about $2.8 billion in 

health and other benefits to about 251,000 federal and postal 

employees—including volunteers—who suffered a service related illness 

or injury.21

 

17DOL requires claimants to meet the following five criteria when establishing eligibility for 

FECA benefits: (1) claim is filed within a 3-year statutory time period, (2) the injured or 

deceased was a federal employee, (3) an injury, disease, or death occurred, (4) the injury, 

disease, or death occurred in the performance of duty, and (5) the resulting medical 

condition was caused by the injury, disease, or death. See 20 C.F.R. § 10.115 (2012). 

Though not generally deemed federal employees, Peace Corps volunteers are eligible for 

FECA benefits. 5 U.S.C. § 8142(b).

18The FECA program requires that claimants submit a medical report from the attending 

physician. 20 C.F.R. § 10.115 (2012). The FECA physician definition includes surgeons, 

podiatrists, dentists, clinical psychologists, optometrists, chiropractors, and osteopathic 

practitioners and does not include nurse practitioners or physicians’ assistants. 5 U.S.C. 

§ 8101(2). Further, DOL requires that the medical report include, among other things, a 

formal diagnosis, which is used to guide DOL in assigning a medical diagnosis that is 

used as the basis for reimbursement.

1920 C.F.R. § 10.730(c) (2012).

205 U.S.C. § 8122.

21GAO, Federal Employees’ Compensation Act: Benefits for Retirement-Age 

Beneficiaries, GAO-12-309R (Washington, D.C.: Feb. 6, 2012).
Page 8 GAO-13-27 Returned Peace Corps Volunteers

Volunteers who apply for FECA benefits typically go through the following 

steps:

1. Each volunteer is informed of the availability of FECA benefits at the 

close-of-service medical evaluation.

a. Each volunteer is expected to receive a close-of-service medical 

evaluation that assesses his or her health status prior to leaving 

service to document any service-connected illnesses or injuries. 

Should a volunteer terminate service early—before completing his 

or her assignment—the volunteer will also undergo a complete 

medical and dental exam to identify any unmet health care needs 

and potential medical issues.

2. Volunteers complete a FECA application and submit it to DOL through 

the Peace Corps’ Post-Service Unit.22

a. The Peace Corps—through its Post-Service Unit—assists 

volunteers applying for benefits by helping them to complete the 

appropriate forms and providing the appropriate medical evidence 

from volunteers’ Peace Corps medical records.23

b. The Peace Corps’ Post-Service Unit sends all FECA 

applications—which includes information on the injury or illness 

reported by the volunteer—to DOL for review and eligibility 

determination.

3. FECA applications submitted for volunteers are reviewed by DOL, and 

the agency then makes an eligibility determination.

a. For those applications that do not include sufficient information 

and require further development, volunteers are given 

approximately 30 days to submit additional information to support 

their request for FECA benefits. If the additional information 

submitted is sufficient, the application is approved. If the additional 

 

22Volunteers seeking FECA benefits are required to complete form CA-1 or form CA-2.

23The Peace Corps maintains medical records for any injury or illness reported during a 

volunteer’s service. In addition, any injury or illness noted at the close-of-service medical 

evaluation is documented in the volunteer’s medical record, which is included in the FECA 

application should a volunteer apply for FECA benefits.

Application Process for 

FECA Program Benefits 

for Volunteers

Preapplication

Application Review
Page 9 GAO-13-27 Returned Peace Corps Volunteers

information is not sufficient, the FECA application is denied and 

medical treatment is not authorized.

b. For those applications that are approved, DOL assigns a medical 

diagnosis on the basis of medical evidence submitted in the FECA 

application. This assigned medical diagnosis defines the medical 

treatment and services for which the volunteer is eligible for FECA 

reimbursement.

4. Typically, after benefits are approved by DOL, a volunteer obtains 

health care services through a medical provider. After receiving these 

services, the volunteer or the volunteer’s medical provider submits a 

bill to DOL for reimbursement.24

5. On an annual basis, DOL requires the Peace Corps to pay DOL back 

for these reimbursements.

DOL provides reimbursement for 

medical expenses.

From 2009 through 2011, DOL provided a total of about $36 million in 

FECA benefits for volunteers, providing about $22 million in health care 

benefits—reimbursements for medical expenses to treat serviceconnected injuries and illnesses for Peace Corps volunteers—and 

$13.8 million in other benefits. During this period, almost 1,400 volunteers 

each year received health care benefits.25 The average reimbursement 

for medical expenses per volunteer was about $5,000 in 2009, and about 

$5,600 in 2011.26

 

24Peace Corps officials told us that volunteers may choose not to wait for DOL’s approval 

of their FECA application before receiving medical care; however, any related medical 

expenses are not reimbursable by DOL if the FECA application is ultimately denied.

The most-common medical conditions for which DOL 

provided health care benefits—reimbursements for medical services—

were mental, emotional, and nervous conditions; dental; 

25Medical reimbursements and medical conditions are associated with individual FECA 

claims—or applications—submitted by volunteers that have been approved by DOL. 

Some volunteers may be approved for multiple FECA claims. This happens infrequently—

for up to about 5 percent of the approved application from 2009 through 2011. For the 

purpose of our reporting, we refer to the number of approved FECA claims as the number 

of volunteers. 

In 2009, volunteers received medical reimbursements of $6.5 million, volunteers received 

$7.7 million in 2010, and volunteers received $7.6 million in 2011.

26In this report we do not adjust the reimbursements for medical expenses for inflation.

Reimbursement for Medical

Expenses

From 2009 through 

2011, DOL Provided 

about $36 Million in 

Health Care and Other 

Benefits for 

Volunteers 
Page 10 GAO-13-27 Returned Peace Corps Volunteers

other/nonclassified diseases; and infectious or parasitic diseases.27

Table 1: The Medical Conditions for Which the Department of Labor (DOL) Made Reimbursements for Returned Peace Corps 

Volunteers under the Federal Employees’ Compensation Act (FECA), 2009 through 2011

These four medical conditions represented about 40 percent of all 

medical conditions and accounted for about $5.9 million—or more than a 

quarter—of all medical reimbursements for volunteers under FECA 

between 2009 and 2011. See table 1 for the medical conditions for which 

DOL provided reimbursements for volunteers under FECA.

Medical condition Frequency

Amount reimbursed 

(dollars in millions a b Percentage of total ) reimbursement (percent)

Mental, emotional, or nervous conditions 466 $3.3 15.2%

Dental 417 0.4 1.8

Other/nonclassified diseases 388 c 1.3 6.1

Infectious or parasitic diseases 336 0.8 3.8

Pain, swelling, stiffness, or redness in joint 278 1.0 4.8

Sprain or strain of ligament, muscle, tendon (not back) 247 1.6 7.5

Fracture 199 1.2 5.6

Pregnancy 136 0.5 2.1

Musculoskeletal Condition 119 1.0 4.6

Skin Condition 110 0.07 0.3

Other 1,371 d 10.5 48.2

Total 4,067 $21.9 100%

Source: GAO analysis of DOL data.

a

The frequency represents the number of times a medical condition or nature of injury is recorded as 

the basis for FECA reimbursement. We used the recorded nature of injury as a proxy for medical 

condition because it provided the best link to reimbursements made on behalf of volunteers. 

Volunteers can receive reimbursement for more than one condition, thus the number of conditions 

may exceed the number of volunteers who received FECA benefits.

b

Dollar amounts may not add to the total due to rounding.

c

Other/nonclassified diseases are illness or injuries that generally do not fit neatly into the existing 

illness and injury categories used by DOL.

d

These represent all other medical conditions for which volunteers received reimbursements.

In addition to health care benefits, volunteers also received other 

benefits—such as wage-loss compensation and reimbursement for travel 

to receive medical treatment. Specifically, from 2009 through 2011, these 

 

27Other/nonclassified diseases are illness or injuries that generally do not fit neatly into the 

existing illness and injury categories used by DOL.
Page 11 GAO-13-27 Returned Peace Corps Volunteers

other benefits received by volunteers totaled about $13.8 million.28 In

2011, the total reimbursements for both health care and other benefits 

were about $12 million, which represents about 3.3 percent of the Peace 

Corps’ 2012 appropriation of $375 million. According to Peace Corps 

officials, these health care and other expenses represent a growing 

portion of its annual budget. These officials explained that from 2009 

through 2011 these expenses have increased a total of approximately 

7.2 percent.29

Volunteers who received FECA benefits from 2009 through 2011 are 

unique in several ways when compared to other recipients of these 

benefits.30

In addition, the medical conditions for which volunteers received FECA 

benefits were different than those for others who received FECA benefits. 

For example, volunteers were more likely than others to receive FECA 

benefits for mental, emotional, or nervous conditions; dental conditions; 

other/nonclassified diseases; and infectious or parasitic diseases. While 

these four medical conditions represented 40 percent of the conditions for 

volunteers, they represented less than 2 percent for the others receiving 

FECA benefits.

Specifically, our analysis of DOL’s FECA program claims data 

found that the volunteers were generally younger and more likely to be 

female when compared to others who received benefits under the FECA 

program. Volunteers were, on average, 12 years younger than others 

who received FECA benefits. About two-thirds of volunteers receiving 

FECA benefits were female, whereas less than half of others receiving 

FECA benefits were female. These differences in age and gender are 

consistent with the overall demographics of these two populations—the 

volunteers and federal workers.

 

28Volunteers received other benefits totaling about $4.6 million in 2009, $4.7 million in 

2010, and $4.4 million in 2011.

29In contrast, DOL officials stated that costs for the overall FECA population increased an 

average of 5 percent each year over the last several years.

30For purposes of analyzing medical conditions, other recipients of benefits under FECA 

do not include the State Department. However, when comparing volunteers to State 

Department employees who received FECA benefits we saw similar results to those we 

found when comparing volunteers to other recipients of benefits under FECA. 
Page 12 GAO-13-27 Returned Peace Corps Volunteers

The Peace Corps uses information it has to monitor volunteers’ 

awareness of the FECA program; however, in general, neither DOL nor 

the Peace Corps use information in the remaining three areas in our 

review to monitor the accessibility and quality of FECA benefits for 

volunteers. These areas are (1) information on volunteers’ knowledge of 

FECA program and application requirements, such as medical 

documentation that is required to be submitted with an application; 

(2) information on DOL’s timeliness in reviewing FECA applications and 

reimbursing medical expenses, and on the level of customer satisfaction 

with the FECA program; and (3) information on the availability of FECAregistered medical providers.31 Table 2 summarizes the extent to which 

DOL and the Peace Corps use information available in the four key areas 

to monitor the accessibility and quality of FECA benefits for volunteers.

 

31The information in the four areas we identified does not represent a comprehensive list 

of all types of information that could be used to monitor the accessibility and quality of the 

FECA program for volunteers. 

The Peace Corps Uses 

Information on 

Volunteers’ 

Awareness of FECA, 

but Neither DOL Nor 

the Peace Corps Use 

Other Available 

Information to 

Monitor Access and 

Quality
Page 13 GAO-13-27 Returned Peace Corps Volunteers

Table 2: Extent to Which Available Information Is Used by the Department of Labor (DOL) and the Peace Corps to Monitor 

Accessibility and Quality of Federal Employees’ Compensation Act (FECA) Benefits for Returned Peace Corps Volunteers

Agency with information on 

volunteers

Type of information DOL Peace Corps

Do the agencies use 

the information to 

monitor access and 

quality? 

Peace Corps volunteers’ awareness of the FECA program

Signed documentation from volunteer acknowledging informed of FECAa  Yes

Peace Corps volunteers’ knowledge of FECA program and application requirements

Statistics on the application review process, including the number of 

volunteers who were approved, needed to submit additional

documentation, and were denied



b

 No

Information on the most-common reasons for denial for volunteers, such 

as from review of those provided in denial letters

  No

Copies of application, medical recordsc, and correspondence with 

volunteers during review

 No

DOL’s timeliness in reviewing applications and reimbursing for medical expenses, and the level of customer satisfaction 

with the FECA program

Data on timeliness in reviewing FECA applications for volunteers d Partially

Statistics/data on timeliness of DOL’s reimbursement of medical 

expenses for volunteers

e

f No

Data on customer satisfaction measures for volunteers  No

Availability of FECA-registered medical providers

Registration information from all FECA-registered medical providers  No

Geographic location and medical specialty of FECA-registered medical 

providers

 Partial No g

Source: GAO review of DOL and Peace Corps information.

Notes: The Peace Corps and DOL each have certain responsibilities related to the provision of FECA 

benefits for eligible volunteers who return from service abroad. Specifically, the Peace Corps is 

responsible for informing volunteers that they may be eligible for FECA benefits, assisting in the 

application process, and paying DOL back annually for FECA benefits provided to volunteers. DOL is 

responsible for administering the program by reviewing and approving applications for benefits and 

for making reimbursements on behalf of volunteers for the costs of health and other FECA expenses.

a

Currently, volunteers’ are required to review material related to the FECA program during the 

standard close-of-service medical evaluation that assesses their health status prior to leaving service 

and sign a document acknowledging they were made aware of the FECA program.

b

Review of information on application review process—such as the number of volunteers who are 

approved, denied, and need to submit additional documentation—could provide information about the 

extent to which volunteers lack knowledge about the required medical documentation.

c

Any injury or illness noted at the close-of-service medical evaluation is documented in the volunteer’s 

medical record, which is included in the FECA application should a volunteer apply for FECA benefits.

d

DOL did not have this information specific to volunteers until requested by GAO in June 2012.

e

As part of the review of the timeliness of FECA applications, DOL has and uses the Protecting Our 

Workers and Ensuring Reemployment (POWER) Initiative metrics to monitor the Peace Corps’ timely 
Page 14 GAO-13-27 Returned Peace Corps Volunteers

submission of FECA applications. However, DOL does not use information related to DOL’s timely 

review of FECA applications for the Peace Corps population.

f

DOL did not have this information specific to volunteers until requested by GAO in June 2012.

g

Peace Corps officials told us that they have the ability to generate lists of DOL FECA-registered 

medical providers by state, zip code, and medical specialty; however, they do not use this information 

to monitor availability of FECA-registered medical providers for volunteers.

As shown in table 2, the Peace Corps uses information related to 

volunteers’ awareness of the FECA program. Specifically, to monitor 

volunteers’ awareness, the Peace Corps currently documents that 

volunteers have acknowledged that they have been informed of their 

potential eligibility for FECA during their close-of-service evaluation. 

Peace Corps officials told us the agency uses this information to help 

ensure all volunteers are made aware of their possible eligibility for FECA 

benefits.

While the Peace Corps uses information on volunteer awareness, neither 

DOL nor the Peace Corps use available information related to the 

remaining three areas of our review to monitor the accessibility and 

quality of FECA benefits for volunteers.

Volunteers’ knowledge of FECA program and application requirements. 

As table 2 shows, neither DOL nor the Peace Corps use available 

information, such as data on FECA application denial rates, and 

information on reasons for denials, in order to monitor the accessibility 

and quality of FECA benefits for volunteers.32 DOL officials told us that it 

is not their responsibility to use this information for this type of monitoring. 

However, by not using this available information to review volunteers’ 

level of knowledge of the FECA requirements, DOL and the Peace Corps 

may be unaware, for example, of the extent to which volunteers 

experience difficulties accessing FECA benefits because of limited 

understanding of certain application requirements, such as in (a) 

providing appropriate and sufficient medical evidence and (b) establishing 

a service connection for the illness or injury for which the volunteer is 

seeking FECA benefits.

 

32Our analysis of FECA claims data indicated roughly 96 percent of volunteers who 

applied were approved by DOL to receive FECA benefits, while 4 percent were not 

approved. 
Page 15 GAO-13-27 Returned Peace Corps Volunteers

According to volunteer advocates, volunteers and their physicians may 

lack knowledge of certain FECA documentation requirements, such as 

the need to include a medical diagnosis rather than just the symptoms of 

an injury or illness in the FECA application. Furthermore, our examination 

of a limited number of FECA denial letters confirms that these difficulties 

are often a contributing factor in the FECA applications that were not 

approved from 2009 through 2011.33

DOL’s timeliness in reviewing applications and reimbursing medical 

expenses, and customer satisfaction. As table 2 shows, DOL and the 

Peace Corps are not using, or are only partially using, available data on 

DOL’s timeliness in reviewing applications and reimbursing medical 

expenses, and customer satisfaction.

For example, our review of denial 

letters showed that the most-common reasons for denial were lack of 

sufficient medical documentation and inability to establish a service 

connection. Further, DOL and the Peace Corps also do not work together 

to use the information available to them on volunteers’ knowledge of 

program and application requirements.

34

 

33We reviewed about 30 percent of the denial letters sent to volunteers from 2009 to 2011. 

These letters were randomly selected by the Peace Corps, and include a summary of the 

volunteer’s reported injury as well as the reason(s) for denying the FECA application. DOL 

noted that in cases when an application lacks required documentation, volunteers are 

provided with an explanation of what additional documentation is needed, and are given 

the opportunity to provide the requested documentation.

Specifically, DOL only uses 

timeliness metrics to monitor the timeliness with which the Peace Corps 

submits FECA applications to DOL but does not conduct periodic 

examinations of timeliness of the review of volunteers’ FECA applications 

after it receives the application. Further, DOL only tracks data on 

customer satisfaction measures for all FECA recipients, but not 

specifically for volunteers. DOL explained that it does not use these 

timeliness data to monitor access and quality specifically for volunteers. 

DOL also noted the level of effort required to pull out the timeliness data 

for volunteers is too extensive, and volunteers represent a small portion 

34DOL maintains metrics for measuring performance for the overall FECA program, 

including those that are part of the Protecting Our Workers and Ensuring Reemployment 

(POWER) Initiative, the Government Performance and Results Act of 1993 (GPRA), as 

amended, and measures outlined in DOL’s Operational Plan. The POWER Initiative 

established goals related to FECA—such as the timeliness of filing a FECA application. 

Under GPRA, DOL established customer satisfaction measures for the FECA program. 

Under its Operational Plan, DOL established additional timeliness and customer 

satisfaction measures, such as those to monitor the timeliness of the FECA application 

review process.
Page 16 GAO-13-27 Returned Peace Corps Volunteers

of the overall FECA population. Instead, DOL’s focus has been on using 

the data in order to monitor FECA program timeliness and customer 

satisfaction for all individuals who receive FECA benefits.35

Our review of DOL timeliness data suggests that between 2009 and 

2011, the agency met its timeliness benchmarks related to review of 

FECA applications for volunteers.

While it is 

reasonable that DOL focus on the entire FECA program, DOL and the 

Peace Corps also do not work together to use the timeliness and 

customer satisfaction information to help the Peace Corps gauge whether 

volunteers are receiving FECA benefits in a timely and satisfactory 

manner. For example, Peace Corps officials told us that a survey of 

former volunteers specifically about access and satisfaction issues would 

be useful. According to Peace Corps officials, the results of such a survey 

could help clarify whether volunteers have access to the care they need 

and what the volunteers think about the quality of the care they receive. 

Without this information, DOL and the Peace Corps may be unable to 

determine volunteers’ level of satisfaction with the FECA program.

36

Availability of FECA-registered medical providers. DOL does not use the 

information it has on FECA-registered providers to determine the 

accessibility of these providers to volunteers. FECA-registered providers 

are required to provide several pieces of information to DOL when 

registering for the FECA program, including their geographic location and 

medical specialty. DOL officials reported that they do not believe it is their 

responsibility to use the information on FECA-registered providers to 

examine the accessibility of FECA-registered providers in certain 

However, because DOL does not use 

these data to determine the timeliness in reviewing volunteers’ FECA 

applications, DOL may not be able to determine whether or to what extent 

its performance on timeliness is sustained in the future. Furthermore, a 

lack of ongoing examinations of timeliness may make it difficult for DOL to 

identify problems if they should arise in the future or to provide 

information to alleviate the concerns of advocates and Peace Corps 

officials regarding the timeliness of the review of FECA applications.

 

35DOL examines timeliness and customer satisfaction for all federal employees under 

FECA using metrics outlined in its Operational Plan.

36For example, our review of information showed that DOL reviewed about 97 percent of 

all volunteers’ applications related to traumatic cases within 45 days of receiving the 

application—meeting its benchmark to review 90 percent within that time frame. 
Page 17 GAO-13-27 Returned Peace Corps Volunteers

geographic areas and for certain medical specialties.37

DOL’s available information on FECA-registered providers suggests that 

volunteers may face some challenges accessing registered providers. 

Officials stated that although it is the responsibility of the volunteer to find 

a FECA-registered provider, DOL publishes an online search tool that 

contains a partial listing of the available FECA-registered providers as a 

service to FECA beneficiaries, including volunteers, to help locate 

providers. Officials also noted the agency does not actively manage or 

update the list.

By not using the 

information DOL has on the geographic location and medical specialty of 

FECA-registered providers, DOL and the Peace Corps cannot determine 

the extent to which there are limitations in the availability of FECAregistered providers in certain geographic areas and for certain medical 

specialties.

38 Although the online search tool is recognized by DOL as 

incomplete, it does provide some partial information about the availability 

of FECA-registered providers. We reviewed this online search tool and 

found, for example, that as of June 2012 there were no FECA-registered 

providers in the online search tool listed as mental health specialists in 

any of the 10 states with the largest population of volunteers.39

 

37DOL officials noted that under FECA a volunteer has the right to select his or her own 

physician and reiterated that it must refrain from involvement in any activity that could be 

construed as pre-selecting or creating a bias toward certain physicians. 

Peace 

Corps officials and volunteer advocates also noted there are a limited 

number of FECA-registered providers in some geographic locations and 

medical specialties. In addition, Peace Corps officials told us that they 

38Officials explained that the search tool includes a partial list of registered providers, 

including only those that are willing to have their names published. Officials stated that 

they are concerned that taking a more active role in managing providers could cause 

beneficiaries to incorrectly view physicians as working on behalf of DOL rather than 

beneficiaries.

39We reviewed the provider listing using the instructions provided by DOL at the site. 

These instructions ask the user to enter either (1) the state, (2) the city and state, or 

(3) the zip code. Users are also recommended to leave the field “provider specialty” blank.

We reviewed the 10 states with the largest population of volunteers between 2009 and 

2011—California, Colorado, Florida, Illinois, Maryland, New York, Oregon, Texas, Virginia, 

and Washington. Furthermore, the online search tool did not consistently report the 

medical specialty of providers. For example, not all medical providers clearly indicate their 

specialty in the specialty field on the online search tool making it difficult to get a sense of 

the complete number of specialists for a given area, such as mental health. DOL officials 

told us that providers are not required to include medical specialty on the form when 

registering for the online search tool.
Page 18 GAO-13-27 Returned Peace Corps Volunteers

have assisted volunteers in finding and enrolling providers, and have had 

difficulty in doing so. Although the information on FECA-registered 

providers in the online search tool that DOL provides as a resource to 

volunteers may be incomplete, it includes information that could be used 

to help identify potential access issues and areas for monitoring the 

accessibility of FECA benefits for volunteers.

The Peace Corps and DOL both have certain responsibilities related to 

the provision of FECA benefits for eligible volunteers who return from 

service abroad. Specifically, DOL administers the FECA program and the 

Peace Corps pays for the expenses incurred by volunteers in the 

program. From DOL’s perspective, volunteers do not represent a large 

proportion of the overall FECA population. However, FECA is a relatively 

larger issue from the Peace Corps’ perspective. The volunteers are a 

unique population compared to others who receive benefits under

FECA—for example, they are more likely to have mental, emotional, or 

nervous conditions that are service-connected—and, according to Peace 

Corps officials, the amount the Peace Corps pays DOL for FECA 

reimbursements represents an increasing portion of the Peace Corps’ 

annual budget. Because both of the agencies have certain responsibilities

related to the provision of FECA benefits for eligible volunteers who return 

from service abroad, it is especially important that the Peace Corps and 

DOL jointly monitor the accessibility and quality of the FECA program to 

ensure that the FECA program is achieving its intended objectives—

including ensuring that eligible volunteers receive needed FECA health 

care benefits.

The Peace Corps and DOL have information available to them in the four 

key areas we reviewed that could be used to monitor the accessibility and 

quality of FECA benefits for volunteers: (1) volunteers’ awareness of 

FECA; (2) volunteers’ knowledge of program and application 

requirements; (3) DOL’s timeliness in reviewing FECA applications and 

reimbursing medical expenses, and the level of customer satisfaction with 

the FECA program; and (4) availability of FECA-registered medical 

providers. However, in general, the two agencies are not using this 

information for such monitoring. For example, the agencies do not use the 

information they have to determine whether there is a gap in the number 

and geographic location of FECA-registered providers, such as the 

potential gap we identified in the number and geographic location of 

FECA-registered providers who treat mental health conditions—the most 

common medical condition for which volunteers received reimbursement.

Conclusions 
Page 19 GAO-13-27 Returned Peace Corps Volunteers

While information is available to DOL and the Peace Corps that could be 

used for monitoring, the agencies are generally not working together to 

use the available information to monitor the accessibility and quality of 

FECA benefits for volunteers. Working together is important because 

neither agency has all the information to monitor the program on its own. 

Finally, because the information we identified under the four areas is not 

a comprehensive list of all the information the agencies could use to 

monitor FECA benefits for volunteers, the Peace Corps and DOL may be 

able to identify other information that could be used for this purpose. 

Unless the two agencies work together on monitoring, they will miss the 

opportunity to make use of the available information to help ensure the 

accessibility and quality of FECA benefits for volunteers.

We recommend that the Secretary of Labor and the Director of the Peace 

Corps jointly develop and implement an approach for working together to 

use available information to monitor the access to and quality of FECA 

benefits provided to returned volunteers.

We provided a draft of this report to the Department of Labor (DOL) and 

the Peace Corps for review. Peace Corps provided written comments 

(reprinted in app. I), and both provided technical comments, which we 

incorporated as appropriate. Neither DOL nor the Peace Corps indicated 

whether or not they agreed with our recommendation. Instead, among 

other things, DOL’s technical comments identified examples of the 

agency’s collaboration with the Peace Corps to provide benefits under the 

FECA program. For example, DOL noted that officials from both agencies 

have met multiple times over the last 2 years to try to improve the 

handling of volunteers’ claims, and that DOL officials are available to work 

with the Peace Corps to improve the process of providing benefits to 

volunteers. In contrast, the Peace Corps noted specific improvements 

that it believes could assist returned volunteers, but stated that it cannot

make these reforms on its own and needs action from DOL. DOL’s and 

the Peace Corps’ comments further underscore that the two agencies do 

not have a joint approach for monitoring the quality and accessibility of 

benefits for returned volunteers under the FECA program. As a result, we 

are concerned that the two agencies are missing opportunities to 

collaborate. We also remain convinced that DOL and the Peace Corps 

should, as we recommended, work together and develop an approach for 

using available agency information to monitor the accessibility and quality 

of FECA benefits for returned volunteers. 

Recommendation for 

Executive Action

Agency Comments 

and Our Evaluation
Page 20 GAO-13-27 Returned Peace Corps Volunteers

We are sending copies of this report to the Secretary of Labor, the 

Director of the Peace Corps, and other interested parties. In addition, the 

report will be available at no charge on GAO’s website at 

http://www.gao.gov. 

If you or your staff have any questions about this report, please contact 

me at (202) 512-7114 or at kohnl@gao.gov. Contact points for our Office 

of Congressional Relations and Office of Public Affairs can be found on 

the last page of this report. Other major contributors to this report are 

listed in appendix II. 

Linda T. Kohn

Director, Health Care
Page 21 GAO-13-27 Returned Peace Corps Volunteers

List of Committees

The Honorable John F. Kerry

Chairman

The Honorable Richard G. Lugar

Ranking Member

Committee on Foreign Relations

United States Senate

The Honorable Tom Harkin

Chairman 

The Honorable Richard C. Shelby

Ranking Member

Subcommittee on Labor, Health and Human Services, 

 Education, and Related Agencies

Committee on Appropriations

United States Senate

The Honorable Patrick J. Leahy

Chairman

The Honorable Lindsey Graham

Ranking Member

Subcommittee on the Department of State, Foreign Operations, 

 and Related Programs

Committee on Appropriations

United States Senate

The Honorable Ileana Ros-Lehtinen

Chairman

The Honorable Howard Berman

Ranking Member

Committee on Foreign Affairs

House of Representatives

The Honorable Denny Rehberg

Chairman

The Honorable Rosa L. DeLauro

Ranking Member

Subcommittee on Labor, Health and Human Services, Education, 

 and Related Agencies

Committee on Appropriations

House of Representatives
Page 22 GAO-13-27 Returned Peace Corps Volunteers

The Honorable Kay Granger

Chairman

The Honorable Nita M. Lowey

Ranking Member

Subcommittee on State, Foreign Operations, and Related Programs

Committee on Appropriations

House of Representatives
Appendix I: Comments from the Peace Corps

Page 23 GAO-13-27 Returned Peace Corps Volunteers

Appendix I: Comments from the Peace Corps
Appendix I: Comments from the Peace Corps

Page 24 GAO-13-27 Returned Peace Corps Volunteers
Appendix II: GAO Contact and Staff 

Acknowledgments

Page 25 GAO-13-27 Returned Peace Corps Volunteers

Linda T. Kohn, (202) 512-7114 or kohnl@gao.gov

In addition to the contact named above, Will Simerl and Cynthia Grant, 

Assistant Directors; N. Rotimi Adebonojo; Melinda Cordero; 

Carolyn Fitzgerald; Krister Friday; Marina Klimenko; Amy Leone; and 

Jennifer Whitworth made key contributions to this report.

Appendix II: GAO Contact and Staff 

Acknowledgments 

GAO Contact

Staff 

Acknowledgments 

(291016)
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