RECOVERING 

SERVICEMEMBERS 

AND VETERANS

Sustained Leadership 

Attention and 

Systematic Oversight 

Needed to Resolve 

Persistent Problems 

Affecting Care and 

Benefits

Report to Congressional Committees

November 2012

GAO-13-5

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United States Government Accountability Office

GAO
United States Government Accountability Office

Highlights of GAO-13-5, a report to 

congressional committees

November 2012

RECOVERING SERVICEMEMBERS AND 

VETERANS

Sustained Leadership Attention and Systematic 

Oversight Needed to Resolve Persistent Problems 

Affecting Care and Benefits

Why GAO Did This Study

The National Defense Authorization

Act for Fiscal Year 2008 required DOD 

and VA to jointly develop and 

implement policy on the care, 

management, and transition of 

recovering servicemembers. It also 

required GAO to report on DOD’s and 

VA’s progress in addressing these 

requirements. This report specifically 

examines (1) the extent to which DOD 

and VA have resolved persistent 

problems facing recovering 

servicemembers and veterans as they 

navigate the recovery care continuum, 

and (2) the reasons DOD and VA 

leadership have not been able to fully 

resolve any remaining problems. To 

address these objectives, GAO visited 

11 DOD and VA medical facilities 

selected for population size and range 

of available resources and met with 

servicemembers and veterans to 

identify problems they continue to face. 

GAO also reviewed documents related 

to specific DOD and VA programs that 

assist recovering servicemembers and 

veterans and interviewed the 

leadership and staff of these programs 

to determine why problems have not 

been fully resolved.

What GAO Recommends

GAO recommends that DOD provide 

central oversight of the military 

services’ wounded warrior programs 

and that DOD and VA sustain highlevel leadership attention and 

collaboration to fully resolve identified 

problems. DOD partially concurred with 

the recommendation for central 

oversight of the wounded warrior 

programs, citing issues with common 

eligibility criteria and systematic 

monitoring. DOD and VA both 

concurred with the recommendation for 

sustained leadership attention. 

What GAO Found

Deficiencies exposed at Walter Reed Army Medical Center in 2007 served as a 

catalyst compelling the Departments of Defense (DOD) and Veterans Affairs 

(VA) to address a host of problems for wounded, ill, and injured servicemembers 

and veterans as they navigate through the recovery care continuum. This 

continuum extends from acute medical treatment and stabilization, through 

rehabilitation to reintegration, either back to active duty or to the civilian 

community as a veteran. In spite of 5 years of departmental efforts, recovering 

servicemembers and veterans are still facing problems with this process and may 

not be getting the services they need. Key departmental efforts included the 

creation or modification of various care coordination and case management 

programs, including the military services’ wounded warrior programs. However, 

these programs are not always accessible to those who need them due to the 

inconsistent methods, such as referrals, used to identify potentially eligible 

servicemembers, as well as inconsistent eligibility criteria across the military 

services’ wounded warrior programs. The departments also jointly established an 

integrated disability evaluation system to expedite the delivery of benefits to 

servicemembers. However, processing times for disability determinations under 

the new system have increased since 2007, resulting in lengthy wait times that 

limit servicemembers’ ability to plan for their future. Finally, despite years of 

incremental efforts, DOD and VA have yet to develop sufficient capabilities for 

electronically sharing complete health records, which potentially delays 

servicemembers’ receipt of coordinated care and benefits as they transition from 

DOD’s to VA’s health care system.

Collectively, a lack of leadership, oversight, resources, and collaboration has 

contributed to the departments’ inability to fully resolve problems facing 

recovering servicemembers and veterans. Initially, departmental leadership 

exhibited focus and commitment—through the Senior Oversight Committee—to 

addressing problems related to case management and care coordination, 

disability evaluation systems, and data sharing between DOD and VA. However, 

the committee’s oversight waned over time, and in January 2012, it was merged 

with the VA/DOD Joint Executive Council. Whether this council—which has 

primarily focused on long-term strategic planning—can effectively address the 

shorter-term policy focused issues once managed by the Senior Oversight 

Committee remains to be seen. Furthermore, DOD does not provide central 

oversight of the military services’ wounded warrior programs, preventing it from 

determining how well these programs are working across the department. 

However, despite these shortcomings, the departments continue to take steps to 

resolve identified problems, such as increasing the number of staff involved with 

the electronic sharing of health records and the integrated disability evaluation 

process. Additionally, while the departments’ previous attempts to collaborate on 

how to resolve case management and care coordination problems have largely 

been unsuccessful, a joint task force established in May 2012 is focused on 

resolving long-standing areas of disagreement between VA, DOD, and the 

military services. However, without more robust oversight and military service 

compliance, consistent implementation of policies that result in more effective 

case management and care coordination programs may be unattainable.

View GAO-13-5. For more information, contact 

Randall B. Williamson at (202) 512-7114 or 

williamsonr@gao.gov.
Page i GAO-13-5 Recovering Servicemembers and Veterans

Letter 1 

Background 6

DOD and VA Have Not Fully Resolved Persistent Problems with 

Case Management and Care Coordination, Disability Evaluation 

Systems, and Electronic Sharing of Health Records 15

DOD and VA Have Not Fully Resolved Long-standing Problems 

Due to Deficiencies in Leadership and Oversight, Resources, and 

Collaboration 26

Conclusions 44

Recommendations for Executive Action 45

Agency Comments and Our Evaluation 46

Appendix I Enrollment and Populations for Select Department of Defense and 

Department of Veterans Affairs Programs 54

Appendix II Medical Category Assignment Process for Care Coordination 

Programs 77

Appendix III Comments from the Department of Defense 79

Appendix IV Comments from the Department of Veterans Affairs 85

Appendix V GAO Contact and Staff Acknowledgments 92

Related GAO Products 93

Tables

Table 1: Military Services’ Wounded Warrior Programs: Types of 

Services Provided 13

Table 2: Eligibility Criteria for Military Services’ Wounded Warrior 

Programs 19

Contents
Page ii GAO-13-5 Recovering Servicemembers and Veterans

Table 3: Military Services’ Wounded Warrior Program Efforts to 

Measure Program Performance 33

Table 4: Military Services’ Wounded Warrior Programs: Enrollment 

for Fiscal Year 2011 55

Table 5: Army Warrior Care and Transition Program Enrollment 

Populations and Characteristics, Fiscal Years 2008 through 

2011 58

Table 6: Army Wounded Warrior Program Enrollment Populations 

and Characteristics, Fiscal Years 2008 through 2011 60

Table 7: Navy Safe Harbor Program Enrollment Populations and 

Characteristics, Fiscal Years 2008 through 2011 62

Table 8: Air Force Wounded Warrior Program Enrollment 

Populations and Characteristics, Fiscal Years 2008 through 

2011 64

Table 9: Air Force Recovery Care Program Enrollment Populations 

and Characteristics, Fiscal Years 2008 through 2011 65

Table 10: Marine Corps Wounded Warrior Regiment Enrollment 

Populations and Characteristics, Fiscal Years 2008 through 

2011 67

Table 11: United States Special Operations Command’s Care 

Coalition Enrollment Populations and Characteristics, 

Fiscal Years 2008 through 2011 69

Table 12: Operation Enduring Freedom/Operation Iraqi Freedom/ 

Operation New Dawn (OEF/OIF/OND) Care Management 

Program Enrollment Populations and Characteristics, 

Fiscal Years 2008 through 2011 71

Table 13: Federal Recovery Coordination Program (FRCP) 

Enrollment Populations and Characteristics, Fiscal Years 

2008 through 2011 73

Table 14: Referral Information Routinely Tracked by DOD and VA 

Case Management and Care Coordination Programs 75

Figures

Figure 1: Timeline of Key Events in the 2-Year Period Following the 

Walter Reed Army Medical Center Media Reports 8

Figure 2: Original Senior Oversight Committee Organizational 

Chart, including the Lines of Action (LOA) Workgroups 9

Figure 3: The Department of Defense’s Vision of the Assignment 

Process for the Recovery Coordination Program and the 

Federal Recovery Coordination Program 78
Page iii GAO-13-5 Recovering Servicemembers and Veterans

Abbreviations

DOD Department of Defense

Dole-Shalala Commission President’s Commission on Care for 

 America’s Returning Wounded

 Warriors

FRCP Federal Recovery Coordination

 Program

IDES Integrated disability evaluation system

LOA Line of Action

MTF military treatment facility

NDAA 2008 National Defense Authorization Act for

 Fiscal Year 2008

OEF Operation Enduring Freedom

OIF Operation Iraqi Freedom

OND Operation New Dawn

PTSD posttraumatic stress disorder

RCP Recovery Coordination Program

Recovering Warrior Task Force Department of Defense Task Force on

 the Care, Management, and

 Transition of Recovering Wounded,

 Ill, and Injured Members of the

 Armed Forces

Senior Oversight Committee Wounded, Ill, and Injured Senior

 Oversight Committee

TBI traumatic brain injury

VA Department of Veterans Affairs

VAMC Department of Veterans Affairs Medical 

 Center

WWCTP Office of Wounded Warrior Care and 

 Transition Policy

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United States. The published product may be reproduced and distributed in its entirety 

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Page 1 GAO-13-5 Recovering Servicemembers and Veterans

United States Government Accountability Office

Washington, DC 20548

November 16, 2012

Congressional Committees

A series of media reports in early 2007 disclosed troublesome 

deficiencies in the provision of outpatient services at Walter Reed Army 

Medical Center in Washington, D.C.1 These reports prompted broader 

questions about whether the Departments of Defense (DOD) and 

Veterans Affairs (VA) were fully prepared to meet the needs of the 

growing number of servicemembers and veterans returning from recent 

conflicts. Several review groups were subsequently tasked with 

investigating the reported problems and identifying recommendations.2

These groups identified common areas of concern including: inadequate 

case management to ensure continuity of care,3 confusing disability 

evaluation systems, and insufficient sharing of servicemembers’ health 

records and other data between DOD and VA—all long-standing 

problems that we have reported on extensively.4

To elevate the response to concerns raised by these review groups, DOD 

and VA established the Wounded, Ill, and Injured Senior Oversight 

Committee (Senior Oversight Committee) in May 2007. The committee 

was intended to operate on a short-term basis to review and implement 

 

1

“Soldiers Face Neglect, Frustration at Army’s Top Medical Facility,” Washington Post

(Washington, D.C.: Feb. 18, 2007); “The Other Walter Reed: The Hotel Aftermath,” 

Washington Post (Washington, D.C.: Feb. 19, 2007); and “Hospital Investigates Former 

Aid Chief,” Washington Post (Washington, D.C.: Feb. 20, 2007).

2

Independent Review Group, Rebuilding the Trust: Report on Rehabilitative Care and 

Administrative Processes at Walter Reed Army Medical Center and National Naval 

Medical Center (Arlington, Va.: April 2007); Task Force on Returning Global War on Terror 

Heroes, Report to the President (April 2007); President’s Commission on Care for 

America’s Returning Wounded Warriors, Serve, Support, Simplify (July 2007); Veterans’ 

Disability Benefits Commission, Honoring the Call to Duty: Veterans’ Disability Benefits in 

the 21st Century (October 2007); and Department of Defense Office of the Inspector 

General, Department of Veterans Affairs Office of the Inspector General, DOD/VA Care 

Transition Process for Service Members Injured in OIF/OEF (June 2008).

3

According to the Case Management Society of America, case management is defined as 

a collaborative process of assessment, planning, facilitation, and advocacy for options and 

services to meet an individual’s health needs through communication and available 

resources to promote high quality, cost-effective outcomes.

4

See list of related GAO products at the end of this report.

 
 

Page 2 GAO-13-5 Recovering Servicemembers and Veterans

the recommendations made by the various review groups and improve 

seamlessness in the provision of care for recovering servicemembers and 

veterans.5 It was cochaired by the Deputy Secretaries of Defense and 

Veterans Affairs and included the military service Secretaries and other 

high-ranking officials within the departments. Congress subsequently 

passed the National Defense Authorization Act for Fiscal Year 2008 

(NDAA 2008) requiring the Secretary of Defense and the Secretary of 

Veterans Affairs to jointly develop and implement policy, to the extent 

feasible, to improve the care, management, and transition of recovering 

servicemembers.6

Despite actions taken by DOD and VA to address the problems identified 

at Walter Reed in 2007, concerns remain that recovering servicemembers 

and veterans continue to face many of the same problems as they did in 

2007 navigating the recovery care continuum, from acute medical 

treatment and stabilization, through rehabilitation, to reintegration—either 

back to active duty or to the civilian community as a veteran. In 2009, 

Congress required DOD to establish a task force to assess the

effectiveness of DOD programs and policies developed to assist 

recovering servicemembers and to make recommendations for 

continuous improvements of such policies and programs.

Because of its related ongoing work, the Senior 

Oversight Committee also assumed responsibility for addressing these 

requirements.

7 The DOD Task 

Force on the Care, Management, and Transition of Recovering Wounded, 

Ill, and Injured Members of the Armed Forces—referred to as the 

Recovering Warrior Task Force—issued its first report in September 

2011;8 it contained 21 recommendations on a variety of issues affecting 

recovering servicemembers.9

 

5

In this report, we will use the term “recovering servicemembers” to denote wounded, ill, 

and injured servicemembers.

Additionally, congressional committees held 

6

Pub. L. No. 110-181, § 1611, 122 Stat. 3, 433 (2008).

7

National Defense Authorization Act for Fiscal Year 2010, Pub. L. No. 111-84, § 724, 

123 Stat. 2190, 2389 (2009).

8

Department of Defense Task Force on the Care, Management, and Transition of 

Recovering Wounded, Ill, and Injured Members of the Armed Forces, Department of 

Defense Recovering Warrior Task Force 2010-2011 Annual Report (September 2011).

9

To understand how VA interacts with servicemembers, the Recovering Warrior Task 

Force reviewed VA programs, including those that assist servicemembers with the 

transition from DOD’s to VA’s health care system.
 

Page 3 GAO-13-5 Recovering Servicemembers and Veterans

multiple hearings in 2010 and 2011 that highlighted ongoing difficulties 

facing these servicemembers and veterans, including issues with 

duplication and poor coordination among case management and care 

coordination programs,10 delays in completing the disability evaluation 

process, and the lack of full interoperability between DOD’s and VA’s 

computer systems.11

The NDAA 2008 required that we report on DOD’s and VA’s progress in 

developing and implementing joint policy on issues related to the care, 

management, and transition of recovering servicemembers.12 As 

discussed with the committees of jurisdiction, we have reviewed and 

reported on the departments’ progress with respect to various topic areas. 

This review, which is focused on the continuity of care for recovering 

servicemembers and veterans, is the latest in our body of work.13

1. the extent to which DOD and VA have resolved persistent problems 

facing recovering servicemembers and veterans as they navigate the 

recovery care continuum and

In this 

review, we are reporting on

2. the reasons DOD and VA leadership have not been able to fully 

resolve any remaining problems.

 

10According to the National Coalition on Care Coordination, care coordination is a clientcentered, assessment-based interdisciplinary approach to integrating health care and 

social support services in which an individual’s needs and preferences are assessed, a 

comprehensive care plan is developed, and services are managed and monitored by an 

identified care coordinator.

11See Hearing on the Federal Recovery Coordination Program: From Concept to Reality, 

Subcommittee on Health, Committee on Veterans’ Affairs, House of Representatives 

(May 13, 2011); and Review of the VA and DOD Integrated Disability Evaluation System, 

Hearing before the Committee on Veterans’ Affairs, United States Senate (Nov. 18, 2010).

12Pub. L. No. 110-181, § 1615(d), 122 Stat. 2, 447.

13GAO has produced a body of work assessing progress made to improve care, 

management, and transition of recovering servicemembers, including: Recovering 

Servicemembers: DOD and VA Have Made Progress to Jointly Develop Required Polices 

but Additional Challenges Remain, GAO-09-540T (Washington, D.C.: Apr. 29, 2009); 

Recovering Servicemembers: DOD and VA Have Jointly Developed the Majority of 

Required Policies but Challenges Remain, GAO-09-728 (Washington, D.C.: July 8, 2009); 

DOD and VA Health Care: Federal Recovery Coordination Program Continues to Expand 

but Faces Significant Challenges, GAO-11-250 (Washington, D.C.: Mar. 23, 2011); DOD 

and VA Health Care: Action Needed to Strengthen Integration across Care Coordination 

and Case Management Programs, GAO-12-129T (Washington, D.C.: Oct. 6, 2011).
 

Page 4 GAO-13-5 Recovering Servicemembers and Veterans

To respond to these objectives, we interviewed the directors of the 

following case management and care coordination programs,

14

• the Army Warrior Care and Transition Command’s Warrior Transition 

Units and the Army Wounded Warrior Program,

including

• the Navy Safe Harbor Program,

• the Air Force Recovery Care Program and the Air Force Wounded 

Warrior Program,

• the Marine Corps Wounded Warrior Regiment,

• the United States Special Operations Command’s Care Coalition,

• the Federal Recovery Coordination Program, and

• VA’s Operation Enduring Freedom/Operation Iraqi Freedom/ 

Operation New Dawn (OEF/OIF/OND) Care Management Program.

We collected data for each of these programs, such as the number of 

enrollees over time. (See app. I for data on enrollment and population 

characteristics for these programs.) We also reviewed documents 

describing the scope, mission, and leadership of these selected 

programs.

In addition, we took the following steps to determine the extent to which 

DOD and VA have resolved persistent problems affecting recovering 

servicemembers and veterans along the recovery care continuum:

• We visited a judgmental sample of 11 DOD military treatment facilities 

(MTF) and VA Medical Centers (VAMC) to identify variations in how 

care coordination and case management programs are being 

operated at the local level. We focused on Army and Marine Corps 

MTFs because, collectively, the wounded warrior programs for these 

military services serve more than 70 percent of the wounded, ill, and 

injured servicemember and veteran population. We selected facilities 

 

14We selected key care coordination and case management programs that provide 

assistance to recovering servicemembers and veterans—many of which were created or 

modified after Walter Reed media reports. These programs have also been the subject of 

prior reviews by GAO and others.
 

Page 5 GAO-13-5 Recovering Servicemembers and Veterans

that provide or have access to significant medical and rehabilitation 

resources as well as facilities that have fewer medical or rehabilitation 

resources. The sites we visited included MTFs at Fort Bragg (N.C.), 

Fort Knox (Ky.), Fort Carson (Colo.), Fort Belvoir (Va.), Fort Meade 

(Md.), Walter Reed National Military Medical Center (Md.), Camp 

Lejeune (N.C.), and Quantico (Va.), and VAMCs in Richmond, 

Virginia; Denver, Colorado; and the District of Columbia. At these 

facilities, we met with local leadership officials and the officials 

responsible for managing the facilities’ case management and care 

coordination programs, and we obtained information on how these 

programs were working as well as the types of problems that 

recovering servicemembers and veterans continue to face. While at 

these facilities, we met with recovering servicemembers and veterans 

to obtain information about their experiences.

• We interviewed officials from military and veteran advocacy groups to 

obtain their members’ perspective on any problems that persist in 

navigating the recovery care continuum.

• We interviewed the director of the VA Liaison for Healthcare Program 

to understand VA’s role in assisting recovering servicemembers’ 

transition from DOD’s to VA’s health care system.

• We met with members of the Recovering Warrior Task Force, 

reviewed relevant task force documentation, and attended its public 

meetings to obtain information about problems they identified that 

affect recovering servicemembers and veterans.

• We reviewed published and ongoing studies and GAO reports15

describing problems that recovering servicemembers and veterans 

face, including issues related to the disability evaluation system and 

the electronic sharing of health records between DOD and VA.

To identify the reasons why DOD and VA leadership have not fully 

resolved any remaining problems facing recovering servicemembers and 

veterans, we reviewed relevant documentation to identify the roles of 

DOD and VA offices that coordinate or oversee case management or 

care coordination programs, their placement within their respective 

departments, and whether and how these offices monitor the 

 

15See list of related GAO products. 
 

Page 6 GAO-13-5 Recovering Servicemembers and Veterans

performance of the programs we reviewed. We also obtained information 

about organizational and program changes, including officials’ views 

about the potential impact of these changes. We also interviewed key 

DOD and VA leadership officials, such as the Deputy Assistant Secretary 

of Defense for Wounded Warrior Care and Transition Policy, VA’s Chief 

of Staff, and former and current officials from the departments’ 

coordinating and oversight offices, including the Senior Oversight 

Committee, DOD’s Office of Wounded Warrior Care and Transition 

Policy, the Interagency Program Office, and the VA/DOD Collaboration 

Service, which is an office within VA. To obtain information about recent 

efforts DOD and VA have initiated to address problems facing 

servicemembers and veterans, we interviewed DOD and VA officials 

participating in these activities, including officials involved in the DOD and 

VA Warrior Care and Coordination Taskforce. We also reviewed the 

documentation available regarding the departments’ recent efforts;

however, we predominately relied on testimonial evidence provided by 

these officials.

The NDAA 2008 also requires us to certify whether we had timely access 

to sufficient information to make informed judgments on the matters 

covered by our report. We were provided sufficient information in a timely 

manner to assess the extent to which DOD and VA have resolved 

persistent problems facing recovering servicemembers and veterans as 

they navigate the recovery care continuum and the reasons DOD and VA 

leadership have not been able to fully resolve any remaining problems.

We conducted this performance audit from July 2011 through September 

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.

Review groups identified significant problems after the media reports 

concerning Walter Reed. Initial efforts to respond to these problems were 

primarily coordinated through the Senior Oversight Committee, and DOD 

and VA undertook additional efforts to respond to these problems.

Background 
 

Page 7 GAO-13-5 Recovering Servicemembers and Veterans

Following the revelations at Walter Reed, several review groups noted 

significant problems that may arise during servicemembers’ recovery from 

wounds, illnesses, and injuries.16 Some of these problems involve the 

provision of appropriate medical care, while others involve the acquisition 

of needed DOD and VA benefits. In 2007, one of the review groups, the 

President’s Commission on Care for America’s Returning Wounded 

Warriors—commonly referred to as the Dole-Shalala Commission—noted 

that recovering servicemembers depend on the effective and efficient 

provision of medical services and benefits across the recovery care 

continuum,17

• recovery, when wounded, ill, and injured servicemembers are 

stabilized and receive acute inpatient medical treatment at an MTF, 

VAMC, or private medical facility;

which is separated into three phases:

• rehabilitation, when recovering servicemembers with complex trauma, 

such as missing limbs, receive medical and rehabilitative care; and

• reintegration, when servicemembers either return to active duty or to 

the civilian community as veterans.

A recovering servicemember or veteran may not experience the recovery 

care continuum as a linear process, and may move back and forth across 

the continuum over time, depending on his or her medical needs. For 

example, a servicemember who has transitioned to the rehabilitation 

phase may go back to the recovery phase if there is a need to return to 

an MTF to obtain acute medical care, such as a surgical procedure.

DOD and VA took a number of steps to address the problems identified 

by the review groups that investigated the issues raised by the Walter 

Reed media reports. As an initial step, the departments established the 

 

16The terms “wounded, ill, and injured” are used by DOD and VA as general 

classifications of servicemembers or veterans with regard to their medical condition. 

“Wounded” generally means any injury inflicted by an external force during combat. “Ill 

and injured” refers to any illness or injury in the line of duty that may render the 

servicemember medically unfit to perform the duties of his or her office, grade, rank, or 

rating.

17President’s Commission on Care for America’s Returning Wounded Warriors, Serve, 

Support, Simplify. 

Review Groups Identified 

Problems across the 

Recovery Care Continuum

Initial Efforts to Address 

Problems Were 

Coordinated by the Senior 

Oversight Committee
 

Page 8 GAO-13-5 Recovering Servicemembers and Veterans

Senior Oversight Committee to coordinate and oversee DOD’s and VA’s 

efforts to jointly resolve these problems. Through this committee, DOD 

and VA created programs and initiatives to assist recovering 

servicemembers and veterans as they navigate the recovery care 

continuum. Key efforts included the establishment of the integrated 

disability evaluation system (IDES), the Federal Recovery Coordination 

Program (FRCP), the Recovery Coordination Program (RCP), and the 

Interagency Program Office. (See fig. 1.)

Figure 1: Timeline of Key Events in the 2-Year Period Following the Walter Reed Army Medical Center Media Reports

a

Several review groups, including the Dole-Shalala Commission, were tasked with investigating the 

problems reported at Walter Reed Army Medical Center in Washington, D.C., and identifying 

recommendations. The other review groups included the Independent Review Group, Rebuilding the 

Trust: Report on Rehabilitative Care and Administrative Processes at Walter Reed Army Medical 

Center and National Naval Medical Center (Arlington, Va.: April 2007); Task Force on Returning 

Global War on Terror Heroes, Report to the President (April 2007); Veterans’ Disability Benefits 

Commission, Honoring the Call to Duty: Veterans’ Disability Benefits in the 21st Century (October 

2007); and Department of Defense Office of the Inspector General, Department of Veterans Affairs 

Office of the Inspector General, DOD/VA Care Transition Process for Service Members Injured in 

OIF/OEF (June 2008).

Senior Oversight Committee. The Senior Oversight Committee was 

responsible for ensuring that the recommendations—which totaled more 

than 600 from the various review groups—were properly reviewed, 

coordinated, implemented, and resourced. Supporting the Senior 

Oversight Committee was an Overarching Integrated Product Team, the 

membership of which included the Assistant Secretaries of Defense, the 

military departments’ Assistant Secretaries for Manpower and Reserve 

Affairs, and various senior officials from DOD and VA. This team 

coordinated, integrated, and synchronized the work of the eight “Lines of 

Action” (LOA) that focused on specific issues, including case 

management, disability evaluation systems, and data sharing between 

DOD and VA. (See fig. 2.)
 

Page 9 GAO-13-5 Recovering Servicemembers and Veterans

Figure 2: Original Senior Oversight Committee Organizational Chart, including the Lines of Action (LOA) Workgroups

Each LOA included representation from DOD, including each military 

service, and VA. They performed the bulk of the work to address the 

issues and recommendations of the various review groups, including 

establishing plans, setting and tracking milestones, and identifying and 

enacting early and short-term solutions. More specifically, the LOAs were 

as follows:

• LOA 1—Disability Evaluation: Responsible for addressing efforts to 

reform the DOD and VA disability evaluation systems.

• LOA 2—Traumatic Brain Injury (TBI)/Post Traumatic Stress Disorder 

(PTSD): Responsible for addressing issues related to TBI/PTSD.

• LOA 3—Case Management: Responsible for addressing issues 

related to the care, management, and transition of recovering 

servicemembers from recovery to rehabilitation and reintegration.

• LOA 4—DOD/VA Data Sharing: Responsible for addressing issues 

regarding the electronic exchange of DOD and VA health records.

• LOA 5—Facilities: Responsible for addressing issues relating to 

military and VA medical facilities.
 

Page 10 GAO-13-5 Recovering Servicemembers and Veterans

• LOA 6—”Clean Sheet” Review: Developed recommendations to 

improve care and benefits without the constraints of existing laws, 

regulations, organizational roles, personnel constraints, or budgets.

• LOA 7—Legislation and Public Affairs: Responsible for addressing 

legal and other issues for policy development.

• LOA 8—Personnel, Pay, and Financial Support: Responsible for 

addressing compensation and benefit issues.

Some of the key efforts initiated out of the LOAs included the 

establishment of an integrated disability evaluation system, care 

coordination programs, and steps towards the electronic exchange of 

DOD and VA health records—a responsibility that was later assumed by 

the Interagency Program Office.

DOD/VA Integrated Disability Evaluation System. Through LOA 1, DOD 

and VA jointly began to develop and pilot IDES to improve the disability 

evaluation process by eliminating duplication in DOD’s and VA’s separate 

evaluation systems and expediting the receipt of VA benefits. Specifically, 

IDES merges DOD’s and VA’s separate medical exams for 

servicemembers into a single exam process; consolidates DOD’s and 

VA’s separate disability rating decisions into a single VA rating decision; 

and provides staff to perform outreach and nonclinical case management

and explain VA results and processes to servicemembers. By October 

2011, DOD and VA had fully deployed IDES at 139 MTFs in the United 

States and several other countries.

Care Coordination Programs. LOA 3 took the lead role in addressing 

problems with uncoordinated case management for recovering 

servicemembers and veterans through the establishment of two care 

coordination programs—the FRCP and the RCP. The FRCP was based 

on a recommendation from the Dole-Shalala Commission that a single 

individual—a recovery coordinator—would work with existing DOD and 

VA case managers to ensure that servicemembers had the resources 

needed for their care. LOA 3 designed the FRCP to assist “severely” 

wounded, ill, and injured OEF and OIF18

 

18OEF, which began in October 2001, supports combat operations in Afghanistan and 

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

and other locations. Since September 1, 2010, OIF is referred to as Operation New Dawn 

(OND).

servicemembers, veterans, and 
 

Page 11 GAO-13-5 Recovering Servicemembers and Veterans

their families with access to care, services, and benefits. This population 

includes servicemembers and veterans who suffer from traumatic brain 

injuries, amputations, burns, spinal cord injuries, visual impairment, and 

PTSD. The program uses federal recovery coordinators to monitor and 

coordinate clinical services, including facilitating and coordinating medical 

appointments, and nonclinical services, such as providing assistance with 

obtaining financial benefits or special accommodations, needed by 

program enrollees and their families. Federal recovery coordinators, who 

are senior-level registered nurses and licensed clinical social workers, 

were intended to serve as the single point of contact among all of the 

case managers of DOD, VA, and other governmental and 

nongovernmental programs19

LOA 3 subsequently developed the RCP in response to a requirement in 

the NDAA 2008. The RCP is a DOD-specific program that uses recovery 

care coordinators to coordinate nonclinical services and resources for 

“seriously” wounded, ill, and injured servicemembers who may return to 

active duty, unlike those categorized as “severely” wounded, ill, and 

injured, who are not likely to return to duty and would be served by the 

FRCP. The military services were responsible for separately 

implementing the RCP through each of their existing wounded warrior 

programs as a means of providing care coordination services to program 

enrollees.

that provide services directly to 

servicemembers and veterans. Although the FRCP was designed as a 

joint program, it is administered by VA, and the federal recovery 

coordinators are VA employees.

Electronic Sharing of Health Records. LOA 4 was focused on addressing 

issues related to the electronic exchange of DOD and VA health records. 

However, this effort was superseded by the NDAA 2008,20 which required 

the establishment of the Interagency Program Office to serve as a single 

point of accountability for both departments in the development and 

implementation of interoperable electronic health records.21

 

19Federal Recovery Coordinators are intended to coordinate all care and benefits for their 

enrollees, including coordinating assistance from private sector programs.

Although 

DOD and VA retained the responsibility for the development and 

20Pub. L. No. 110-181, § 1635, 122 Stat. 3, 460-63.

21Interoperability is the ability of two or more systems or components to exchange 

information and to use the information that has been exchanged.
 

Page 12 GAO-13-5 Recovering Servicemembers and Veterans

management of the information technology systems, the Interagency 

Program Office was responsible for ensuring the implementation of an 

electronic health records system or capabilities that allowed for the 

complete sharing of health care information for the provision of clinical 

care. In October 2011, the Interagency Program Office also became 

accountable for DOD’s and VA’s work on developing an integrated 

electronic health records system that both departments would use for 

their beneficiaries.

In addition to the Senior Oversight Committee’s efforts, DOD, its military 

services, and VA developed or modified a number of programs and 

initiatives to assist recovering servicemembers and veterans in navigating 

the recovery care continuum.

Military Services’ Wounded Warrior Programs. The military services’ 

wounded warrior programs were established to assist recovering 

servicemembers22 during their recovery, rehabilitation, and initial 

reintegration back to active duty or to civilian life. Most of these programs 

provide nonclinical case management services to the recovering 

servicemembers; that is, they help to resolve issues related to finances, 

benefits and compensation, administrative and personnel paperwork, 

housing, and transportation. In addition, the wounded warrior programs 

serve as the central point of access to other types of services or 

resources that support recovering servicemembers, such as clinical case 

management, care coordination, and career, education, and readiness 

services. (See table 1.) If a wounded warrior program does not directly 

provide a service or resource, it can facilitate servicemembers’ access to 

that service or resource. Although the wounded warrior programs were 

intended mainly to provide services to recovering servicemembers, all but 

one of the programs continue to assist individuals after they have 

transitioned to veteran status. 

 

22Recovering servicemembers include those who are wounded, ill, or injured in a combat 

zone or due to an incident that occurred in the United States or overseas while in active 

status.

Additional Efforts by DOD 

and VA to Address 

Problems Facing 

Recovering 

Servicemembers and 

Veterans
 

Page 13 GAO-13-5 Recovering Servicemembers and Veterans

Table 1: Military Services’ Wounded Warrior Programs: Types of Services Provided

Types of services provided

Military services’ wounded 

warrior program

Clinical case 

management

Nonclinical case 

management 

Care 

coordination

Career, 

education, and 

readinessa

Army

Army Warrior Care and Transition 

Program: Warrior Transition Units and 

Community-Based Warrior Transition 

Unitsb

  

Army Warrior Care and Transition 

Program: Army Wounded Warrior 

Program 

 

Navy/Coast Guard

Navy Safe Harbor Program  

Air Force

Air Force Wounded Warrior Program  

Air Force Recovery Care Program  

Marine Corps

Marine Corps Wounded Warrior 

Regiment

  

United States Special Operations Command

United States Special Operations 

Command’s Care Coalition

  

Source: GAO analysis of military services’ wounded warrior program information.

Notes: The characteristics listed in this table are general characteristics of each program; individual 

circumstances may affect the services provided by specific programs. For the purposes of this report, 

clinical case management services include services such as scheduling medical appointments and 

providing outreach education about medical conditions such as PTSD. Nonclinical case management 

services include services such as assisting servicemembers with financial benefits and accessing 

accommodations for families.

a

Career, education, and readiness services are provided through programs such as the Warrior 

Athlete Reconditioning Program and DOD’s Operation Warfighter Program and Education and 

Employment Initiative. The Warrior Athlete Reconditioning Program enhances recovery by engaging 

wounded, ill, and injured servicemembers in individualized physical and cognitive activities outside of 

traditional therapy settings. Operation Warfighter is a federal internship program for wounded, ill, and 

injured servicemembers that places them in supportive work settings to prepare them to return to 

active duty or to transition into jobs in the government or private sector. To access the Operation 

Warfighter Program a recovering servicemember has to be enrolled in a military service wounded 

warrior program. In addition, the military services’ wounded warrior programs facilitate access to other 

programs such as the Warrior Athlete Reconditioning Program.

b

A warrior transition unit is technically an Army brigade, battalion, or company that provides command 

and control, administrative support, primary care and case management and other services to 

support soldiers and their families during recovery, rehabilitation, and transition back to active duty or 

to civilian life. For the purposes of this report, we are categorizing it as a wounded warrior program.
 

Page 14 GAO-13-5 Recovering Servicemembers and Veterans

VA Transition Programs. VA’s Liaison for Healthcare Program and its

OEF/OIF/OND Care Management Program assist recovering 

servicemembers with transitioning from DOD’s to VA’s health care 

system. As of August 2012, the Liaison for Healthcare Program employed 

33 liaisons at 18 MTFs nationwide.

23 After a DOD or VA treatment team 

determines that a recovering servicemember is medically ready to 

transition to a VAMC, a VA liaison facilitates the transfer from an MTF to 

a VAMC closest to their homes or to the most appropriate locations for 

the specialized services their medical condition requires. VA liaisons 

follow recovering servicemembers as they enter the VA health care 

system, ensuring that their first VA appointments are scheduled. 

Thereafter, the VA OEF/OIF/OND Care Management Program team 

assigned to each recovering individual coordinates the individual’s care at 

the VAMC and provides ongoing follow-up.24 Each VAMC has an 

OEF/OIF/OND Care Management Program team in place to coordinate 

patient care activities.

 

23According to a VA official, in fiscal year 2013, VA will hire 10 additional liaisons and 

expand the number of MTFs where liaisons will be located to 21.

24The VA OEF/OIF/OND Care Management Program screens all returning combat 

veterans to determine if case management services are required.
 

Page 15 GAO-13-5 Recovering Servicemembers and Veterans

Recovering servicemembers’ access to case management and care 

coordination programs has been impeded by two main factors—(1) the 

limited ability to identify and refer those servicemembers who could 

benefit from enrollment in the programs along with officials’ reluctance to 

refer them, and (2) variations in eligibility criteria among the military 

services’ wounded warrior programs, resulting in access disparities for 

similarly situated recovering servicemembers.25

We found that referrals may be lacking or delayed (1) from military 

service unit commanders to wounded warrior programs; (2) from 

wounded warrior programs to the FRCP; and (3) for certain groups of 

servicemembers, such as those with “invisible injuries” as well as 

members of the National Guard and Reserve.

Referral to the military services’ wounded warrior programs. The military 

services’ wounded warrior programs primarily use referrals to identify 

recovering servicemembers that might be eligible for enrollment. 

However, we found that the methods for referral, which include casualty 

reports and direct referrals, are imprecise, such that all servicemembers 

 

25Not all wounded, ill, and injured servicemembers and veterans are eligible for access to 

these programs. Most military service wounded warrior programs only serve those who 

are “seriously” and “severely” wounded, ill, and injured.

DOD and VA Have 

Not Fully Resolved 

Persistent Problems 

with Case 

Management and Care 

Coordination, 

Disability Evaluation 

Systems, and 

Electronic Sharing of 

Health Records

Recovering 

Servicemembers and 

Veterans Do Not Always 

Have Access to the Case 

Management and Care 

Coordination Programs 

Designed to Assist Them

Recovering Servicemembers 

Are Not Always Identified and 

Referred to Programs That May 

Benefit Them 
 

Page 16 GAO-13-5 Recovering Servicemembers and Veterans

who could benefit from being enrolled in these programs are not 

necessarily identified and referred.

Officials from three wounded warrior programs told us that casualty 

reports are the primary method for receiving referrals.26

According to wounded warrior program officials, referrals to wounded 

warrior programs also can be made directly from unit command staff and 

other sources, including staff at the MTF where a recovering 

servicemember is receiving treatment or through self-referrals.

Casualty reports 

are initial alerts to military personnel, including wounded warrior program 

officials, that a servicemember has been injured. These reports can be 

initiated by unit commands or other military personnel as a method of 

referral to the wounded warrior programs. However, wounded warrior 

program officials from four wounded warrior programs told us that 

casualty reports are not created after every injury or may be created late 

in a servicemember’s recovery. In particular, some of these officials said 

that military service unit command staff may delay or not create casualty 

reports for servicemembers not injured in combat, such as for injuries that 

occur stateside or while on leave, because servicemembers’ units may 

not find out about such incidents immediately.

27

 

26Casualty reports, including personnel casualty reports, are electronic messages that 

contain casualty information including type of injury, where the injury occurred, and 

location of the injured servicemember.

These 

referrals also may not be made in a timely manner. Specifically, unit 

command staff may not refer potentially eligible servicemembers to 

wounded warrior programs because either they want to “take care of their 

own” or because they are not well informed about the programs and the 

services they provide, according to wounded warrior program officials. 

For example, a wounded warrior program official told us that he identified 

a servicemember who had sustained a gunshot wound to the head but 

was still assigned to his combat unit. This official explained that even 

though the servicemember was receiving treatment, he could have 

benefited from being enrolled in the wounded warrior program because of 

the additional assistance it provides, including nonclinical case 

management and care coordination services. Additionally, several 

recovering servicemembers told us that they encountered difficulties in 

27We found that referrals by unit command staff are most likely, because they have the 

most knowledge about servicemembers’ conditions, injuries, and treatment locations.
 

Page 17 GAO-13-5 Recovering Servicemembers and Veterans

their recovery as a result of staying in their units and not being referred to 

a wounded warrior program earlier. For example, a recovering 

servicemember told us that despite having been recently discharged from 

a hospital for arm injuries, he was required to operate a floor buffing 

machine in his unit, which was difficult for him as a result of his injuries. 

He did not receive rehabilitative treatment for his injuries until he was 

assigned to a wounded warrior program. Furthermore, we found that most 

of the military services’ wounded warrior programs do not always track 

the number of referrals to their programs, including data on whether or 

not servicemembers referred to the programs were actually enrolled. (See 

table 14 in app. I for additional information about referral data.) Without 

this information, it is not clear whether all those who could benefit from a 

wounded warrior program are being enrolled.

Referral to the FRCP. In addition to problems with referrals to wounded 

warrior programs, wounded warrior program officials sometimes delay or 

fail to make referrals of potentially eligible servicemembers to the FRCP, 

which coordinates care across the departments and throughout the 

recovery care continuum. As we have previously reported, the FRCP 

relies predominantly on referrals from other sources, including wounded 

warrior program officials and clinical treatment teams, because it does not 

have a systematic way to identify potential enrollees.28 Referrals to the 

FRCP are important because federal recovery coordinators are intended 

to provide continuity of care throughout servicemembers’ recovery, 

starting with their initial treatment at an MTF and throughout the recovery 

care continuum. They can also assist in facilitating recovering 

servicemembers’ access to VA services and benefits while 

servicemembers are still on active duty, according to VA officials.29

Referrals for certain servicemember populations. We found that certain 

servicemember populations may be at greater risk for not being identified 

for DOD and VA case management and care coordination programs. 

However, we found that officials from wounded warrior programs view the 

jointly created and established FRCP as a VA program and, therefore, 

delay their referrals until it is certain that the servicemember will become 

a veteran.

 

28GAO-11-250. 

29Servicemembers are eligible for certain VA benefits while still on active duty, including 

access to treatment at specialized VA facilities and grants for home and car modifications.
 

Page 18 GAO-13-5 Recovering Servicemembers and Veterans

Specifically, according to wounded warrior program officials, 

servicemembers who have undiagnosed, “invisible” wounds, such as

PTSD and TBI, may be at greater risk of not being referred to a wounded 

warrior program or the FRCP until it becomes apparent that the 

servicemember cannot be deployed. For example, a servicemember told 

us that although he was experiencing anxiety every time he put on his 

uniform, it was not until he had a severe anxiety attack, as a result of his 

PTSD, that he was hospitalized and then referred to a wounded warrior 

program. According to officials representing military advocacy 

organizations, National Guard and Reserve servicemembers may be 

particularly reluctant to identify injuries and illnesses because they are 

eager to return home and do not want to be delayed at the installation for 

an evaluation of any conditions they may have. However, these officials 

said that when these servicemembers have been deactivated and 

problems manifest themselves later on, they may experience difficulties 

establishing that their injuries or illnesses are a result of their service in 

the military, which could make it difficult for them to access services and 

programs provided by DOD and VA.

Because of variations in eligibility criteria among the military services’ 

wounded warrior programs, DOD cannot assure that similarly situated 

servicemembers have equitable access to these programs, leading to 

disparities in the level of assistance provided across the military services. 

(See table 2.) For example, servicemembers can only be eligible for the 

Air Force Wounded Warrior Program if they have a combat-related injury 

or illness, whereas servicemembers with combat or non-combat-related 

injuries or illnesses can be eligible for the Army’s Warrior Transition Units.

Recovering Servicemembers’ 

Access to the Military Services’ 

Wounded Warrior Programs Is 

Likely to Be Inequitable Due to 

Variations in Their Eligibility 

Criteria
 

Page 19 GAO-13-5 Recovering Servicemembers and Veterans

Table 2: Eligibility Criteria for Military Services’ Wounded Warrior Programs

Military services’ wounded warrior program Eligibility criteria

Army

Army Warrior Care and Transition Program: 

Warrior Transition Units and Community-Based 

Warrior Transition Units 

Serves servicemembers who require at least 6 months of rehabilitative care 

and complex medical managementa

Army Warrior Care and Transition Program: 

Army Wounded Warrior Program 

Serves “severely” wounded, ill, and injured servicemembers in the warrior 

transition units who have, or are expected to receive, a physical evaluation 

disability ratingb of 30 percent or greater in one or more specific categories or a 

combined rating of 50 percent or greater for conditions that are combat-related

Navy/Coast Guard

Navy Safe Harbor Program Serves “seriously” wounded, ill, and injured sailors and coast guardsmen not 

likely to return to duty in 180 days and likely to be medically retired, as well as 

high-risk wounded, ill, and injured sailors that have less serious health 

concerns

Air Force

Air Force Wounded Warrior Program Serves servicemembers with a combat-related injury or illness that requires 

long-term carec as well as examinations to determine fitness for duty

Air Force Recovery Care Program Serves all servicemembers who are “seriously”d ill and injured either in a 

combat-related incident or in a non-combat-related incident 

Marine Corps

Marine Corps Wounded Warrior Regiment Serves wounded, ill, and injured servicemembers who require more than 90 

days of medical treatment or rehabilitation. A recovering servicemember also 

may be assigned to the Wounded Warrior Regiment when:

• the unit command cannot support transportation requirements to the 

military treatment facility,

• the Marine cannot serve a function in the unit command due to his/her 

injuries or illness, or

• the Marine has three or more medical appointments per week.

United States Special Operations Command

United States Special Operations Command’s 

Care Coalition

Assists Special Forces servicemembers who are

• wounded, injured, or ill evacuated from a combat area;

• wounded, injured, or ill returned to duty or redeployed; or

• injured or ill whose injury or illness is not combat-related.

Source: GAO analysis of military services’ wounded warrior program information.

a

Reservists in need of definitive medical treatment for conditions caused or aggravated while on 

active duty or training status are also eligible.

b

After medical examinations are conducted to determine a servicemember’s ability to continue to 

serve in the military, decisions are made about the servicemember’s fitness for duty and about a 

servicemember’s disability rating, which determines the DOD and VA benefits he or she can receive.

c

According to an Air Force Wounded Warrior Program official, the program does not define long-term 

care or provide criteria related to the time needed for recovery.

d

According to an Air Force Recovery Care Program official, a servicemember is designated as 

“seriously’ ill or injured on the basis of a medical diagnosis made by Air Force medical staff when 

referred to the program; the program does not make this designation.
 

Page 20 GAO-13-5 Recovering Servicemembers and Veterans

As a result of these differences in eligibility criteria, recovering 

servicemembers in one military service may qualify for entry in their 

wounded warrior program while similarly situated servicemembers in 

another military service do not have access to their program. 

Consequently, according to wounded warrior program officials, some 

recovering servicemembers do not have access to services that would 

otherwise be available to them, including the RCP and Operation 

Warfighter.30 Additionally, because wounded warrior programs facilitate 

access to other programs and services, including the VA Liaison for 

Healthcare Program and the Warrior Athlete Reconditioning Program,31

not being eligible for a particular wounded warrior program could preclude 

a servicemember from receiving the services of these other programs.32

DOD is aware of inconsistencies in eligibility criteria among the military 

services’ wounded warrior programs and the potential for disparities in the 

provision of services and assistance that may result. DOD has not taken 

action to correct this, however, despite the identification of this issue as a 

potential problem for recovering servicemembers by a congressionally 

mandated DOD task force. Specifically, in its 2011 annual report to 

Military coalition officials who advocate for recovering servicemembers 

and their families told us the lack of standardization across similar 

programs, such as the military services’ wounded warrior programs, is 

one of the main reasons recovering servicemembers “fall through the 

cracks” or do not get the services that they need when they are 

navigating the recovery care continuum.

 

30Operation Warfighter is a DOD-sponsored internship program for wounded, ill, and 

injured servicemembers who are at MTFs. Operation Warfighter is designed to provide 

recuperating servicemembers with meaningful activity outside of the hospital environment 

that assists in their wellness and offers a formal means of transition back to the civilian 

workforce. Open to active duty, National Guard and Reserve components, Operation 

Warfighter represents an opportunity for servicemembers in a medical hold status to build 

their resumes, explore employment interests, develop job skills, and gain valuable work 

experience that will prepare them for the future (see www.militaryhomefront.dod.mil). 

31The Warrior Athlete Reconditioning program provides recreational activities and 

competitive athletic opportunities to recovering servicemembers to improve their physical 

and mental quality of life throughout the continuum of recovery and transition. The 

program is designed to enhance recovery by engaging recovering servicemembers in 

physical and cognitive activities outside of traditional therapy settings.

32Servicemembers do not have to be enrolled in or attached to a wounded warrior 

program to participate in the VA Liaison for Healthcare Program or the Warrior Athlete 

Reconditioning Program. 
 

Page 21 GAO-13-5 Recovering Servicemembers and Veterans

congressional committees, the Recovering Warrior Task Force noted that 

as a result of differences in eligibility criteria among the military services, 

certain subpopulations of recovering servicemembers may be at a 

disadvantage.33 In response to this report, DOD stated that although there 

are no DOD-wide criteria for entry into wounded warrior programs, the 

individual military services already have policies in place as a result of the 

flexibility given to them by DOD.

Although IDES provides improved timeliness over the separate DOD and 

VA disability evaluation systems, processing times have continued to 

increase since its implementation in November 2007, resulting in 

frustration and uncertainty for servicemembers going through the 

process. In a May 2012 hearing,34 we testified that the average number of 

days for servicemembers to complete the IDES process and receive VA 

benefits increased from 283 in fiscal year 2008 to 394 in fiscal year 2011 

for active duty cases (compared to the goal of 295 days) and from 297 to 

420 for reserve cases, respectively (compared to the goal of 305 days).35

While there are many reasons for increases in processing times,36

 

33Recovering Warrior Task Force, Department of Defense Recovering Warrior Task Force 

2010-2011 Annual Report.

recovering servicemembers and wounded warrior program officials told 

us that extended timelines in the IDES process and the lack of a firm 

completion date limits recovering servicemembers’ ability to plan for their 

future. Several recovering servicemembers said that not being given a 

timeframe for completion of the IDES process is frustrating, particularly 

when their own providers are unable to obtain additional information on 

34GAO, Military Disability System: Preliminary Observations on Efforts to Improve 

Performance, GAO-12-718T (Washington, D.C.: May 23, 2012). For additional 

information about IDES, see reports listed on the related products page.

35The fiscal year 2008 and 2011 averages include only those servicemembers who 

completed IDES and received VA benefits. The averages do not include other outcomes, 

such as servicemembers who were found fit and returned to duty. Not all reservists 

complete the VA benefit phase and thus DOD does not apply the 30-day goal for this 

phase to reservists. For those reservists who do go through the VA benefits phase, this 

time is reflected in the overall time in IDES.

36As we have previously testified, other reasons that could impact the increase in IDES 

processing times include large case loads and insufficient staff to complete a stage of 

IDES in a timely manner.

Delays in DOD’s and VA’s 

Integrated Disability 

Evaluation System Persist, 

Limiting Recovering

Servicemembers’ Ability to 

Plan for Their Future
 

Page 22 GAO-13-5 Recovering Servicemembers and Veterans

the status of their case. For example, a servicemember told us that after 

going through the IDES process, receiving a rating, and filing an appeal 

over a year ago, he still did not know the status of his case, negatively 

affecting his ability to plan for his future. Similarly, a wounded warrior 

program official also told us that her program has had several 

servicemembers lose job opportunities because they applied for positions 

thinking that they would be through the IDES process by a certain date, 

but when that date was pushed back, the employers rescinded their 

offers.

Wounded warrior program officials from some of the sites we visited told 

us that extended waiting periods resulting from the disability process also 

may lead to some recovering servicemembers engaging in negative 

behavior, including drug use. Wounded warrior program officials told us 

that after waiting for so long in the wounded warrior barracks due to the 

lengthy disability process, servicemembers can get depressed, resist or 

just stop going to medical appointments, and stop working on their 

recovery. Similarly, the DOD Inspector General has reported that lengthy 

IDES processing times has contributed to a negative and even 

counterproductive environment, which was not conducive to 

servicemembers’ recovery and transition.37

Conversely, the servicemembers could take actions that may impact their 

own processing times in IDES and, therefore, their length of stay in a 

wounded warrior program. We found that some servicemembers may 

appeal their disability decisions to prolong their own recovery and 

transition out of the military. According to wounded warrior program 

To prevent these problems, 

we found that two wounded warrior programs require recovering 

servicemembers to participate in programs such as the Warrior Athlete 

Reconditioning Program and Operation Warfighter. A recovering 

servicemember told us that soon after being assigned to the wounded 

warrior program, he was referred to the Warrior Athlete Reconditioning 

Program, which gave him something to do other than “sitting around.” 

Another recovering servicemember told us that the Warrior Athlete 

Reconditioning Program is an effective motivator for recovery.

 

37Department of Defense Office of the Inspector General, Special Plans and Operations, 

Assessment of DOD Wounded Warrior Matters-Camp Lejeune (March 2012) and

Department of Defense Office of the Inspector General, Special Plans and Operations, 

Assessment of DOD Wounded Warrior Matters-Wounded Warrior Battalion-West 

Headquarters and Southern California Units (August 2012).
 

Page 23 GAO-13-5 Recovering Servicemembers and Veterans

officials from some of the sites we visited, some servicemembers resist 

their transfer out of the wounded warrior program and the military 

because they want to continue to take advantage of the opportunities and 

services available to them, including the financial security of a regular 

paycheck. For example, a wounded warrior program official and a VA 

official told us that some servicemembers will purposefully miss 

appointments to delay the IDES process because they feel that they are 

not ready to leave the program.

The departments have not yet developed sufficient capability to 

electronically share servicemembers’ and veterans’ complete health 

records, which can delay the receipt of care and benefits for recovering 

servicemembers and veterans. As we have previously reported, for over a 

decade DOD and VA have undertaken several efforts to improve the 

ability of their information technology systems to electronically share 

health records.38

We found that although DOD and VA care providers were expected to 

have access to some electronic health record information across the 

departments, the DOD and VA care providers that we spoke to still did 

not have the ability to electronically share complete health records for 

recovering servicemembers who were transferring between DOD’s and 

VA’s health care systems, and therefore they had to use other methods. 

For example, the Federal Health Information Exchange, 

which was started in 2001 and completed in 2004, allows DOD to 

electronically transfer servicemembers’ health information to VA when 

they leave active duty. In addition, the departments’ Bidirectional Health 

Information Exchange was established in 2004 to allow clinicians in both 

departments to view limited health information on patients who receive 

care from both departments. More recently, the departments have 

undertaken two new joint initiatives, the Virtual Lifetime Electronic Record 

and an integrated electronic health records system, in an effort to 

increase electronic health record interoperability and modernize their 

systems. 

 

38See, for example, GAO, Electronic Health Records: DOD and VA Efforts to Achieve Full 

Interoperability Are Ongoing; Program Office Management Needs Improvement, 

GAO-09-775 (Washington, D.C.: July 28, 2009); Electronic Health Records: DOD and VA 

Interoperability Efforts Are Ongoing; Program Office Needs to Implement Recommended 

Improvements, GAO-10-332 (Washington, D.C.: Jan. 28, 2010) and Electronic Health 

Records: DOD and VA Should Remove Barriers and Improve Efforts to Meet Their 

Common System Needs, GAO-11-265 (Washington, D.C.: Feb. 2, 2011).

DOD and VA Have Yet to 

Develop Sufficient 

Capability to 

Electronically Share 

Health Records, 

Potentially Delaying 

Servicemembers’ Receipt 

of Coordinated Care and 

Benefits 
 

Page 24 GAO-13-5 Recovering Servicemembers and Veterans

For example, wounded warrior program and VA officials told us that they 

had to resort to copying and faxing recovering servicemembers’ health 

records to VAMC staff in preparation for a servicemember’s transition 

from DOD’s to VA’s health care system because there was not an 

automatic, electronic way to transfer them. In addition to copying and 

faxing health records, according to VA officials we spoke with, DOD and 

VA staff may hold a video-teleconference between the transferring MTF 

and receiving VA health care facilities to exchange information. 

In addition, wounded warrior program and VA officials who help 

servicemembers transition from DOD to VA told us that they only share 

with VA facilities the health records necessary for the treatment of a 

recovering servicemember’s current condition. As a result, 

servicemembers’ and veterans’ complete health records are not always 

shared between departments when transferring facilities, and ultimately, 

the responsibility to collect and provide a complete health record to the 

VA facility can fall on the recovering servicemember and veteran.39

Both departments have needed to create programs and provide staff to 

assist recovering servicemembers during their transition from a DOD MTF 

to a VAMC. For example, VA Liaisons and DOD nurse case managers 

help recovering servicemembers transition from DOD to VA by 

assembling their health records and sharing them with the VAMC where 

the servicemember will be receiving treatment. According to DOD and VA 

A VA 

official told us that this process can be complicated because DOD 

separately maintains servicemembers’ inpatient, outpatient, and 

behavioral health records and does not have a single database that can 

identify all of the medical facilities where a servicemember received 

treatment. Further, according to VA and DOD officials, delaying the 

collection and assembly of a servicemember’s complete medical history 

until the start of the disability process could result in servicemembers 

having to be reexamined when they are demobilized, needing to establish 

that their injuries were connected to their time in the military, thus possibly 

delaying a servicemember’s or veteran’s receipt of VA benefits.

 

39DOD policy requires that, upon retirement, discharge, or end of active obligated service, 

records be transferred to the VA Records Management Center if the servicemember is not 

applying for VA benefits or the appropriate VA Regional Office if the servicemember has 

applied or plans to apply for VA benefits. Department of Defense, Service Treatment 

Record (STR) and Non-Service Treatment Record (NSTR) Life Cycle Management, DOD 

Instruction 6040.45, Enclosure 3, (Oct. 28, 2010). The transfer of records from DOD to a 

VA medical facility is achieved under different procedures.
 

Page 25 GAO-13-5 Recovering Servicemembers and Veterans

staff that assist servicemembers in their transition from one system to 

another, DOD nurse case managers at installations that do not have VA 

Liaisons do not always have the same knowledge of VA services and 

benefits, and may not be informed of the appropriate referral methods or 

contacts used by VA Liaisons to provide a servicemember with a 

seamless transition to a VAMC. A DOD official told us that at locations 

where the VA Liaison program is not available, the transition process for 

recovering servicemembers from DOD to VA is more difficult. This official 

understood how to properly transfer servicemembers’ records from the 

DOD facility to the receiving VA facility only because of past VA 

experience.
 

Page 26 GAO-13-5 Recovering Servicemembers and Veterans

The lack of leadership and program oversight has limited DOD’s and VA’s 

ability to effectively manage programs created to serve recovering 

servicemembers and veterans. Two bodies established to oversee these 

programs, the Senior Oversight Committee and the Office of Wounded 

Warrior Care and Transition Policy (WWCTP),40

Before the Senior Oversight Committee was consolidated into the Joint 

Executive Council

lacked consistent 

leadership attention and oversight capabilities. In addition, DOD does not 

have a central office that oversees or collects common data on the 

military services’ wounded warrior programs.

41

 

40In 2008, DOD established the Office of Transition Policy and Care Coordination which 

was renamed the Office of Wounded Warrior Care and Transition Policy (WWCTP). 

Reporting to the Under Secretary of Defense for Personnel and Readiness, up until June 

2012, WWCTP served as a single, centralized office for developing policy, coordinating 

interagency collaboration, and conducting outreach to address the broad set of issues 

confronted by wounded, ill and injured service members and their families. WWCTP also 

provided program oversight for the integrated disability evaluation system process and 

care coordination.

in early 2012, it had already lost many of the 

characteristics that had made it a strong decision making and oversight 

body for the programs and initiatives created to assist recovering 

servicemembers and veterans. What had originally made it strong were

41The Joint Executive Council was established by law in November 2003 to provide senior

leadership for collaboration and resource sharing between DOD and VA. Through a joint 

strategic planning process, the Joint Executive Council recommends to the Secretaries 

the strategic direction for the joint coordination and sharing efforts between the two 

departments and oversees the implementation of those efforts.

DOD and VA Have 

Not Fully Resolved 

Long-standing 

Problems Due to 

Deficiencies in 

Leadership and 

Oversight, Resources, 

and Collaboration

Lack of Leadership and 

Oversight Has Limited 

DOD’s and VA’s Ability to 

Effectively Manage 

Programs for Recovering 

Servicemembers and 

Veterans

Strength of Senior Oversight 

Committee Leadership Waned
 

Page 27 GAO-13-5 Recovering Servicemembers and Veterans

• high-level leadership participation without substitution of lower-ranking 

officials,

• rapid policy development and quick decision making, and

• rigorous monitoring to hold the military services and the two 

departments accountable for needed actions.

Sustaining the Senior Oversight Committee’s original momentum over 

time became difficult, and its waning influence and effectiveness became 

evident in a number of ways:

• Starting in December 2008, the Senior Oversight Committee 

experienced leadership changes, including the departure of its 

cochairs, the Deputy Secretaries,42 as well as turnover in some of its 

key staff. According to a former Senior Oversight Committee 

executive, the personal commitment and strong relationship between 

the Deputy Secretaries who initially cochaired the Senior Oversight 

Committee served as a unifying and confidence building force that 

was not replicated by subsequent leadership, while leadership 

turnover in the DOD offices supporting the Senior Oversight 

Committee negatively impacted its ability to function effectively.

• As we have previously reported, the Senior Oversight Committee also 

began to encounter challenges when DOD “disrupted the unity of 

command” by changing the organizational structure of the committee 

and realigning and incorporating the committee’s staff and 

responsibilities into existing or newly created DOD and VA offices, 

such as WWCTP.43

 

42With the change of presidential administration in January 2009, the Deputy Secretary of 

Defense and Deputy Secretary of Veterans Affairs were replaced.

Officials formerly involved with the committee told 

us that the new staffing arrangement did not adequately support the 

committee’s efforts, and VA did not provide full-time staff members to 

support the committee, as it had in the past. Later in October 2008, 

VA established the Office of VA/DOD Collaboration Services, and VA 

supported Senior Oversight Committee efforts, along with broader 

collaboration efforts, through this separate office.

43GAO-09-728. 
 

Page 28 GAO-13-5 Recovering Servicemembers and Veterans

• The committee began meeting less frequently. For example, in 

contrast to weekly meetings held during its initial year of operation, in 

fiscal year 2011, the committee met less than 11 hours in total.

• Top DOD leadership no longer consistently attended Senior Oversight 

Committee meetings. According to a former Senior Oversight 

Committee official, the second Deputy Secretary of Defense to 

cochair the committee sent the Deputy Undersecretary of Defense for 

Personnel and Readiness to represent DOD in his place.

• The Senior Oversight Committee no longer made relatively quick 

decisions. According to former Senior Oversight Committee executive 

and support staff, frequent substitutions by lower-ranking officials at 

Senior Oversight Committee meetings no longer allowed for quick 

decision making and transformed Senior Oversight Committee 

meetings into informational briefings.

• The Senior Oversight Committee no longer tracked or monitored 

progress of its policy initiatives or assigned tasks. According to a 

former LOA cochair and a cognizant support staff member, by 2011 

the Senior Oversight Committee was no longer routinely using a 

tracking mechanism to hold the departments accountable for 

completing appointed tasks. Later that year, the Recovering Warrior 

Task Force reported that the Senior Oversight Committee no longer 

had a formal mechanism for assessing the status of the committee’s 

initiatives and goals, leaving no way to determine whether initiatives 

or goals had been partially or fully implemented or met.

In its September 2011 report, the Recovering Warrior Task Force 

recommended combining the Senior Oversight Committee and Joint 

Executive Council to improve effectiveness and reduce redundancies as 

both entities had similar membership and operating structures. In January 

2012, the Joint Executive Council cochairs agreed to consolidate the two 

groups. The Senior Oversight Committee’s working groups for care 

coordination and the integrated disability evaluation system were 

realigned within the Joint Executive Council, and a Wounded, Ill, and 

Injured Council was established under the Joint Executive Council to 

oversee emerging issues for recovering servicemembers and veterans.

Whether the Joint Executive Council can effectively address the issues 

once managed by the Senior Oversight Committee has yet to be seen. 

Several DOD and VA officials expressed concern to us about the ability of 

the Joint Executive Council to focus on rapid, short-term policy decision 
 

Page 29 GAO-13-5 Recovering Servicemembers and Veterans

making rather than the longer-term strategic planning role that it has 

traditionally played. For example, according to a DOD official, historically, 

the Joint Executive Council has not been able to drive policy decision 

making, and therefore, issues that should have been decided by the Joint 

Executive Council were taken directly to the Secretaries for resolution, 

raising doubts about the ability of the Joint Executive Council to function 

effectively. A former Senior Oversight Committee executive noted that the 

Joint Executive Council cochairs are not of equivalent rank, another 

challenge that may serve as a barrier to the council’s ability to make 

decisions and drive policy changes. Specifically, the VA cochair is the 

Deputy Secretary, who has control over all relevant offices within VA, 

while the DOD cochair is the Deputy Undersecretary of Defense for 

Personnel and Readiness, whose responsibilities include establishing

health and benefit policies affecting recovering servicemembers and 

directing the military services to comply with such policies but lacks 

authority in enforcing the military services’ implementation of these 

policies. The Recovering Warrior Task Force also cited concerns about 

the rank of the DOD cochair of the Joint Executive Council, stating that a 

higher level of leadership is needed to sustain departmental attention on 

key initiatives such as IDES and electronic health records.44

In 2008, WWCTP became responsible for overseeing the RCP among 

other programs that provide assistance to recovering servicemembers. 

However, WWCTP’s ability to oversee the RCP, including its ability to 

monitor program performance and ensure compliance with DOD policy, is 

limited by its lack of operational authority, such as budget and tasking 

authority, over the military services that implement the program. 

According to WWCTP officials, this lack of operational authority 

challenges WWCTP’s ability to direct the military services on their 

implementation of the program. For example, although WWCTP has been 

responsible for RCP oversight since 2008, the office was not able to 

collect basic program data, such as monthly enrollment numbers, on a 

Furthermore, 

as of August 2012, DOD officials told us that the Joint Executive Council

is operating under the original procedures that were in place prior to the 

entities merging. As a result, it is unclear at this time how the Joint 

Executive Council will provide oversight and accountability for issues 

once addressed by the Senior Oversight Committee.

 

44Department of Defense Task Force on the Care, Management, and Transition of 

Recovering Wounded, Ill, and Injured Members of the Armed Forces, Department of 

Defense Recovering Warrior Task Force 2011-2012 Annual Report (August 2012).

WWCTP Lacks Authority and 

Leadership to Provide 

Oversight for Care 

Coordination
 

Page 30 GAO-13-5 Recovering Servicemembers and Veterans

consistent basis until October 2011. According to a WWCTP official, 

although WWCTP requested monthly data submissions from the military 

services, the information was provided on an ad hoc basis; sometimes 

the services would submit it, and other times they would not. Datacollection efforts still remain a challenge for WWCTP. For example, the 

Army’s Wounded Warrior Program, which serves as the Army’s care 

coordination program, only agrees to share partial data with WWCTP, 

arguing that the Army is only obligated to share data on servicemembers 

served by WWCTP-contracted personnel.

Getting the military services to implement consistent care coordination 

policies also poses a challenge for WWCTP. WWCTP officials said that 

while WWCTP can develop policy to guide the military services, the 

military services may interpret that policy and implement their programs 

differently. Consequently, some DOD officials assert that the military 

services have not consistently implemented the RCP in accordance with 

DOD policy—an observation that is shared by the Recovering Warrior 

Task Force.45 DOD policy requires that care coordination should be 

provided to those who are “seriously” and “severely” wounded, ill, and 

injured, but the Army only provides care coordination to recovering 

servicemembers who are “severely” wounded, ill, and injured.46

Some WWCTP officials with whom we spoke expressed the view that the 

military services have been inconsistent in their cooperation with 

WWCTP, with cooperation being better on issues that represent priorities 

of top leadership. Specifically, WWCTP officials told us that top DOD 

leadership has not been pressured to resolve lingering care coordination 

issues as much as other more visible issues, such as IDES and electronic 

medical record interoperability problems confronting the departments. 

Consequently, WWCTP officials said that the military services cooperate 

with WWCTP’s efforts to oversee IDES and to monitor whether the 

military services achieve their goals for timely completion of the IDES 

As a 

result, some servicemembers who could benefit from having someone 

coordinate their care and benefits as they navigate the recovery care 

continuum do not have access to those services.

 

45Recovering Warrior Task Force, Department of Defense Recovering Warrior Task Force 

2011-2012 Annual Report. 

46Department of Defense, Recovery Coordination Program, DOD Instruction 1300.24, 

(Dec. 1, 2009). 
 

Page 31 GAO-13-5 Recovering Servicemembers and Veterans

process. Although these goals have not consistently been achieved,47

In addition to limited operational authority over the military services, 

turnover in leadership and other staffing changes have also limited 

WWCTP’s ability to provide consistent direction and oversight for the 

RCP, according to WWCTP officials. Specifically:

the 

officials told us that military service cooperation has not been an 

impediment to overseeing IDES as it has been for overseeing care 

coordination. Conversely, the military services have not been as inclined 

to cooperate with WWCTP on its oversight of the RCP relative to these 

other issues.

• Three different DOD officials have led WWCTP since its inception in 

2008. According to WWCTP staff, each of these officials had different 

visions and priorities for the office, which led to disruptions in RCP 

oversight. For example, a major oversight initiative—to collect 

satisfaction survey data across the RCP—was abandoned when a 

new official was appointed. In addition, the RCP has been led by three 

different directors, with the most recent director leaving in June 2012.

• In September through December 2011, WWCTP’s contracted staffing 

was temporarily reduced by 70 percent when a contract expired and 

was not immediately renewed, according to DOD. Staff reductions 

primarily impacted WWCTP’s ability to oversee the RCP, since many 

RCP support staff members were lost. For example, according to a 

WWCTP official, the office was no longer able to make monitoring 

visits to the RCP program sites. However, in July 2012 a contract was 

awarded that allowed WWCTP to engage additional staff to support 

the RCP, according to a WWCTP official.

• In June 2012, DOD changed the name of the WWCTP office to the 

Office of Warrior Care Policy and moved it under the Assistant 

Secretary of Defense for Health Affairs. According to a DOD official, 

the change was made as part of a realignment of DOD’s 

organizational structure in response to statutory requirements.48

 

47See GAO, Military and Veterans Disability System: Pilot Has Achieved Some Goals, but 

Further Planning and Monitoring Needed, 

An 

GAO-11-69 (Washington, D.C.: Dec . 6, 2010); 

Military and Veterans Disability System: Worldwide Deployment of Integrated System 

Warrants Careful Monitoring, GAO-11-633T (Washington, D.C.: May 4, 2011); and 

GAO-12-718T. 

48See Pub. L. No. 111-84, § 906, 123 Stat. 2190, 2425 (2009).
 

Page 32 GAO-13-5 Recovering Servicemembers and Veterans

official in Health Affairs said that the move will be beneficial because it 

will provide greater access to resources, including human resources 

and information technology, among others. However, it is too early to 

determine the full effect of this change.

There is currently no central office or authority that oversees or collects 

common data on the military services’ wounded warrior programs, 

preventing DOD from both assessing how well the programs are working 

across the department and leveraging the strengths of each program by 

sharing proven best practices across the military services. 

Each of the military service Secretaries created their own wounded 

warrior programs to meet their military service’s unique needs. Because 

each service developed its own policy to govern its wounded warrior 

programs and no central, unified DOD policy exists to govern these 

programs, no central DOD office—such as WWCTP—may direct how 

these programs operate. This lack of central oversight over the wounded 

warrior programs has been one of the main reasons for the large 

discrepancies between these programs. The 2011 Recovering Warrior 

Task Force report recommended that the Secretary of Defense enforce 

the existing policy guidance regarding the Army’s and Marines’ wounded 

warrior transition units’ entrance criteria. However, in its response to this 

recommendation, DOD supported the military service Secretaries’ 

discretion in establishing their own policies in this regard, saying that 

there is no central DOD policy on the establishment of transition units and 

entrance criteria, and that the policies were established by the 

Secretaries for their specific populations.

While no common data are collected on the performance of wounded 

warrior programs across the military services, each individual program 

has initiated internal efforts to collect and analyze performance data. The 

type and quality of data vary by program, however. For example, the 

largest of the wounded warrior programs, the Army Warrior Care and 

Transition Program, has collected wounded warrior program performance 

survey data on a continuous basis since March 2007 and has developed 

outcome measures to determine the impact of its services. However, 

smaller programs, such as the Air Force Wounded Warrior Program and 

the United States Special Operations Command’s Care Coalition have 

measured baseline program satisfaction levels, but they do not have 

additional years of survey data to monitor any changes over time. (See 

table 3 for information about the types of performance data collected by 

each of the wounded warrior programs.)

Wounded Warrior Programs 

Lack Central Oversight 
 

Page 33 GAO-13-5 Recovering Servicemembers and Veterans

Table 3: Military Services’ Wounded Warrior Program Efforts to Measure Program Performance

Military services’ wounded 

warrior program

Satisfaction surveys: 

Measures customer 

satisfaction with program

Performance metrics: 

Measures whether 

program meets target 

output goals

Outcome measures: 

Measures whether program 

achieves desired impact

Army

Army Warrior Care and Transition 

Program 

  

Army Wounded Warrior Program   

Navy/Coast Guard

Navy Safe Harbor Program  

Air Force

Air Force Wounded Warrior Program a

Air Force Recovery Care Program a 

Marine Corps

Marine Corps Wounded Warrior 

Regiment

  

United States Special 

Operations Command

United States Special Operations 

Command’s Care Coalition

 b

Source: GAO analysis of interviews with military services’ wounded warrior program officials and program documentation.

a

Although the Air Force Wounded Warrior and Recovery Care Programs’ initial satisfaction survey 

was completed in October 2011, the survey results have not been released as of August 9, 2012.

b

The United States Special Operations Command’s Care Coalition has performance metrics for its 

Recovery Program.

Some DOD officials with whom we spoke questioned why common 

measures have not been developed. For example, a DOD official in 

charge of wounded warrior care at an MTF suggested developing a 

measurement tool to determine what aspects of the programs help 

recovering servicemembers. Another DOD official involved with wounded 

warrior program performance measurement commented that it is common 

practice for DOD to share performance measurement practices and 

standard metrics across the military services.

In September 2011, citing wide disparity across the military services in 

their implementation of wounded warrior programs and policies, the 

Recovering Warrior Task Force made four recommendations for creating 
 

Page 34 GAO-13-5 Recovering Servicemembers and Veterans

common standards to ensure parity in the programs and services 

provided to recovering servicemembers across DOD.49 For example, the 

first recommendation called for a common nomenclature, or consistent 

definitions to be used in DOD policy to identify recovering 

servicemembers who may require and be eligible for assistance. The task 

force concluded that common definitions are needed to promote 

consistent levels of care among the military services and would better 

enable DOD to compare across programs and identify best practices. In 

its response to the task force, DOD acknowledged that some of these 

recommendations were valid and that DOD should take actions to 

address them. However, at the time of the Recovering Warrior Task 

Force’s 2012 report, these recommendations had not been implemented, 

and the task force is continuing to follow DOD’s efforts to implement 

them.50 Moreover, even if DOD decided to take some actions in this 

regard, it is unclear who would have responsibility for addressing them, 

since there is no central oversight office or authority for these programs.

In addition to problems with leadership and oversight of care coordination 

and case management programs, DOD and VA have a longstanding track 

record of insufficient staffing to address delays in disability determinations 

and insufficient staffing and control over the budget to oversee the 

development of systems with improved capabilities for electronically 

sharing health records.51

 

49Recovering Warrior Task Force, Department of Defense Recovering Warrior Task Force 

2010-2011 Annual Report.

50Recovering Warrior Task Force, Department of Defense Recovering Warrior Task Force 

2011-2012 Annual Report. 

51See GAO-11-69; GAO-11-633T; GAO-12-718T; Electronic Health Records: DOD and 

VA Have Increased Their Sharing of Health Information, but More Work Remains, 

GAO-08-954 (Washington, D.C.: July 28, 2008); Electronic Health Records: DOD’s and 

VA’s Sharing of Information Could Benefit from Improved Management, GAO-09-268

(Washington, D.C.: Jan. 28, 2009); Information Technology: Challenges Remain for VA’s 

Sharing of Electronic Health Records with DOD, GAO-09-427T (Washington, D.C.: 

Mar. 12, 2009); GAO-09-775; and GAO-10-332. 

Insufficient Staffing and 

Budget Control Have 

Contributed to DOD’s and 

VA’s Inability to Resolve 

Delays with Disability 

Determinations and 

Electronically Share 

Health Records
 

Page 35 GAO-13-5 Recovering Servicemembers and Veterans

Insufficient staffing across both departments has affected DOD’s and 

VA’s ability to reduce disability determination delays and meet their IDES 

timeliness goals. We raised concerns about staffing in 2010, when we 

reported that DOD and VA did not sufficiently staff many key positions in 

the IDES process, including DOD board liaisons, who counsel 

servicemembers and ensure that documentation submitted for 

consideration is complete and accurate, and medical evaluation board 

physicians, who review medical and service records to identify conditions 

that limit a servicemember’s ability to serve in the military.52 In 2012, we 

continued to report evidence of staffing shortages, including high 

caseloads for DOD board liaisons and VA case managers as well as 

insufficient numbers of physicians to write narrative summaries needed to 

complete the medical evaluation board stage of the IDES process in a 

timely manner.53

Delays in the disability determination process are expected to continue. 

VA anticipates a much larger caseload of all disability and other benefit 

claims in the near future, not just those claims associated with IDES 

cases. Specifically, a high-level VA official told us that new laws, such as 

the Veterans Opportunity to Work Act,

Some recovering servicemembers told us they do not 

receive sufficient support from their DOD board liaisons, and that there 

are not enough liaisons to efficiently meet the needs of all the recovering 

servicemembers going through the IDES process.

54

DOD and VA are working to address staffing challenges in some of the 

IDES processes that are most delayed. We have previously reported that 

the Army, for example, is in the midst of a major hiring initiative to 

increase staffing dedicated to its medical evaluation boards, which will 

will encourage all transitioning 

servicemembers—not just those going through the IDES process—to 

claim VA benefits. This official also told us that DOD and VA have a much 

larger problem to address as a surge of 300,000 servicemembers begin 

to transition into the VA system as troops return home from Iraq and 

Afghanistan. Without adequate planning and adequate resources, these 

servicemembers may experience much longer processing times in the

disability benefits systems.

 

52GAO-11-69. 

53GAO-12-718T. 

54Veterans Opportunity to Work (VOW) to Hire Heroes Act, Pub. L. No. 112-56, tit. II, 125 

Stat. 712 (2011).

Insufficient Staffing 

Contributed to Delays in 

Disability Determinations
 

Page 36 GAO-13-5 Recovering Servicemembers and Veterans

include additional DOD board liaisons and medical evaluation board 

physician positions.55

The Interagency Program Office was established by law

Additionally, VA officials said that the agency has 

added staffing to its IDES rating sites to handle the demand for 

preliminary disability ratings, rating reconsiderations, and final benefit 

decisions, which has increased the number of preliminary VA ratings 

completed and slightly improved processing times. But it is too early to tell 

the extent to which VA’s efforts will continue to improve processing times. 

56

The Interagency Program Office’s initial charter limited its ability to 

exercise authority over DOD and VA. Specifically, the charter stated that 

control of the budget, contracts, and technical development remained 

wholly within the two departments’ program offices. The charter conveyed 

no authority in these areas to the Interagency Program Office. As a 

former Interagency Program Office official testified in July 2011, the office 

lacked control of budgeting and contracting necessary to achieve its 

intended purpose, and without this, it could not sufficiently oversee the 

departments’ efforts and compliance with the requirements in NDAA 

2008.

to serve as a 

single point of accountability for joint DOD and VA efforts to implement 

fully interoperable electronic health record systems or capabilities, but this 

office was not given sufficient staffing or budget control by DOD and VA 

to effectively facilitate the departments’ efforts. According to an 

Interagency Program Office official, the office was never fully staffed and 

was challenged by a high degree of turnover in staffing and leadership 

that served in a temporary or acting capacity.

57 As a result, each department continued to pursue separate 

strategies, rather than a unified interoperable approach, according to this 

former official.

 

55GAO, Military System: Improved Monitoring Needed to Better Track and Manage 

Performance. GAO-12-676 (Washington, D.C.: Aug. 28, 2012).

56See Pub. L. No. 110-181, § 1635, 122 Stat. 3, 460-63 (2008).

57Legislative Hearing on H.R. 2383, H.R. 2388, H.R. 2243 and H.R. 2470, Before the 

Subcommittee on Oversight and Investigations of the Committee on Veterans Affairs, 

112th Cong. (July 20, 2011) (statement of Debra M. Filippi, former Director, U.S. 

Department of Defense/U.S. Department of Veterans Affairs Interagency Program Office).

Lack of Staffing and Budget 

Control Limited Progress on 

Electronic Health Records 

Sharing
 

Page 37 GAO-13-5 Recovering Servicemembers and Veterans

The Interagency Program Office was rechartered in October 2011 and 

provided an expanded staff and new authorities under the charter, 

including control over the budget. According to Interagency Program 

Office officials, when hiring under the new charter is completed, the office 

will have a staff of 236 personnel, more than seven times the number of 

staff originally allotted to the office by DOD and VA.58

With the enhanced charter, as well as plans for an expanded staff to 

oversee the implementation of a single joint electronic health record 

system, the Interagency Program Office will have more resources to draw 

upon and support department interoperability initiatives. However, it is still 

too early to determine whether this investment of resources will be 

sufficient to meet the office’s goals for 2017.

In addition, the 

charter provides the Interagency Program Office with the authority to 

lead, oversee, and manage budget and contracting for electronic health 

record sharing efforts. According to Interagency Program Office officials, 

budget control is the essential component for overseeing progress and 

ensuring accountability for the departments’ efforts.

59 For example, despite the 

provision of additional resources, Interagency Program Office officials told 

us that as of July 2012, the office is staffed at approximately 48 percent 

and that hiring additional staff in time to meet appointed implementation 

deadlines remains one of its biggest challenges.

Since the inception of the RCP in 2008, the FRCP and RCP care 

coordination programs have conflicted with one another and with other 

case management programs that provide services to recovering 

servicemembers and veterans. Conflicting issues have arisen as to what 

populations they serve, the specific services each would provide, and 

when each program would get involved in the servicemembers’ recovery 

process. Aligning and integrating these programs with one another—

especially the FRCP with the RCP—has proven to be a major challenge 

for DOD and VA. While the departments are developing an interagency 

strategy for minimizing duplication between DOD’s and VA’s care 

coordination and case management programs, the success of this effort 

 

58As we reported in 2008, the Interagency Program Office was in the process of recruiting 

about 30 permanent staff members (see GAO-08-954). 

59According to DOD and VA officials, the departments have identified 54 joint capabilities 

that will be implemented by the end of fiscal year 2017.

Despite Repeated 

Attempts, DOD and VA 

Have Failed to Effectively 

Collaborate to Align Their 

Care Coordination 

Programs; New Efforts Are 

Under Way
 

Page 38 GAO-13-5 Recovering Servicemembers and Veterans

will depend upon achieving cooperation between the departments—which 

has been elusive for many years—as well as with the military services.

With the creation of the RCP, the FRCP was no longer the single point of 

contact with respect to servicemembers’ care coordination, and early on, 

there were concerns and some confusion about how the FRCP and the 

RCP would align without creating overlapping and duplicative services. 

Shortly after the RCP was established, DOD sent a report to 

congressional committees outlining a medical category assignment 

process that was based on the severity of each servicemember’s medical 

condition, along with input from the servicemember and his or her unit 

commander, to determine whether servicemembers would be directed to 

either the FRCP or to the RCP for care coordination services. In concept, 

the medical category assignment process would have resulted in 

wounded, ill, and injured servicemembers being assigned to one of three 

categories: “mild,” “serious,” or “severe.” Under this approach, the FRCP 

would provide care coordination services for “severely” wounded, ill, and 

injured servicemembers and the RCP would serve those who were 

“seriously” wounded, ill, and injured. (See app. II for additional information 

on the intended medical category assignment process for DOD and VA 

care coordination programs.)

Despite DOD’s attempt to define the populations served by the FRCP and 

the RCP, neither the military services’ wounded warrior programs, which 

implement the RCP, nor VA, which administers the FRCP, implemented 

DOD’s assignment process. Instead, these programs expanded their 

enrollment to include both “seriously” and “severely” recovering 

servicemembers and veterans, which resulted in both programs serving 

the same populations, thereby setting up the likelihood of overlap and 

duplication of services. As we have previously reported, this duplication 

issue is compounded by the numerous other programs that also provide 

services to recovering servicemembers and veterans and have

overlapping roles as well. It is not uncommon for recovering 

servicemembers to be enrolled in more than one case management or 

care coordination program and end up with multiple care coordinators and 

case managers—each of whom develop different care plans for the same 

servicemember. The care plans may even conflict with one another, 

which could conceivably adversely affect the servicemember’s recovery 

process. In fact, in the course of previous work, we found instances 

where inadequate information exchange and poor coordination between 
 

Page 39 GAO-13-5 Recovering Servicemembers and Veterans

these programs resulted not only in duplication of effort and overlap of 

services, but also confusion and frustration for servicemembers and their 

families.60

Although DOD and VA have not yet aligned care coordination policy for 

the FRCP and RCP, we have found indications that care coordinators and 

case managers at some locations have been cooperating to some degree 

and trying to work more closely with one another. In the course of our 

visits to 11 DOD and VA facilities during this review, we found that care 

coordinators and case managers in many locations had attempted—with 

some success—to clarify their roles and to limit the degree of overlap and 

duplication in the services they provide to recovering servicemembers 

and veterans. However, such local attempts to improve the degree of 

cooperation and coordination among the programs are not systemic and 

depend on individual personalities and circumstances. They may not be 

sustainable without agreement by DOD and VA and the alignment of 

policy governing case management and care coordination programs.

In addition, DOD and VA officials acknowledge that the 

multiplicity of care coordination and case management programs causes 

confusion even among members of care coordination teams. In October 

2011, we recommended that the Secretaries of Defense and Veterans 

Affairs direct the Senior Oversight Committee to expeditiously develop 

and implement a plan to strengthen functional integration across all DOD 

and VA care coordination and case management programs to reduce 

redundancy and overlap.

Another critical issue on which DOD and VA have disagreed pertains to 

the stage in a servicemember’s recovery when the FRCP should get 

involved in the coordination of services. Because the FRCP depends on 

referrals from other programs as a basis for becoming involved with 

recovering servicemembers, this can be a significant issue. Currently, 

neither DOD nor VA policy clearly defines when referrals are to be made; 

consequently, most wounded warrior programs delay referrals to the 

FRCP until it becomes clear that the servicemember will be separated 

from the military. Senior DOD officials stated that wounded warrior 

program officials justify this practice on the basis that referring a recently 

wounded servicemember to the FRCP—a VA-operated program—sends 

a negative message to a recovering servicemember that his or her 

military career has ended, even though the FRCP was designed as a joint 

 

60GAO-12-129T. 
 

Page 40 GAO-13-5 Recovering Servicemembers and Veterans

program. Additionally, the belief among the military that they should “take 

care of their own,” contributes to the reluctance to involve the FRCP. On 

their part, VA maintains that its point of engagement should be in the 

early stage of medical treatment to build rapport and trust and to begin 

coordinating the services needed by severely wounded servicemembers.

Despite multiple efforts over the last several years to align their care 

coordination and case management programs, DOD and VA have failed 

to implement lasting measures to resolve underlying problems concerning 

the aligning of roles and responsibilities of the FRCP, RCP, and case 

management programs. Previous attempts include the following:

• December 2010. The Senior Oversight Committee directed its case 

management work group to perform a feasibility study of 

recommendations on the governance, roles, and mission of DOD and 

VA care coordination. However, no action was taken by the committee 

and care coordination was subsequently removed from the Senior 

Oversight Committee’s agenda as other issues were given higher 

priority.

• March 2011. WWCTP sponsored a joint summit that included officials 

from VA and the military services to review DOD and VA care 

coordination issues. Although this collaboration resulted in the 

development of five recommendations related to care coordination, no

agreement was reached by the departments to jointly implement 

them. A DOD participant told us that VA did not agree with the 

recommendations, and a VA official involved in the summit concurred, 

alleging that the recommendations appeared to suggest eliminating 

overlap and duplication between the FRCP and RCP by ending the 

FRCP.

• May 2011. Concerned with overlap and duplication between the DOD 

and VA care coordination programs, the House Committee on 

Veterans Affairs, Subcommittee on Health directed the Deputy 

Secretaries of DOD and VA to provide an analysis of how the FRCP 

and RCP could be integrated under a “single umbrella” by June 20, 

2011. In the absence of such a response, the subcommittee 

scheduled a congressional hearing and requested that options for

addressing this issue be presented. Following the notification of the 

hearing, the departments developed a joint letter and submitted it to 

the subcommittee in September 2011. This letter, however, did not 

identify or outline options for aligning the FRCP and the RCP. In a 

hearing held by the subcommittee in early October 2011, neither VA 

nor DOD outlined definitive plans to address this issue.
 

Page 41 GAO-13-5 Recovering Servicemembers and Veterans

• September 2011. The Recovering Warrior Task Force issued the first 

of four annual reports that included 21 recommendations, including a 

recommendation that the roles of care coordinators be clarified. In 

DOD’s official response to congressional committees, the Under 

Secretary of Defense stated that the department would implement the 

Recovering Warrior Task Force’s recommendations. However, a 

Recovering Warrior Task Force member stated that the Recovering 

Warrior Task Force concluded that in most cases DOD has not made 

significant changes to its programs to achieve the outcomes intended 

by the recommendations. In August 2012, the Recovering Warrior 

Task Force reported that DOD has fully implemented only 2 of the 21 

recommendations.61 However, a DOD official whose office is 

responsible for coordinating DOD’s responses to the Recovering 

Warrior Task Force’s recommendations stated that DOD is in the 

process of addressing several more of the 2011 Recovering Warrior 

Task Force recommendations.

• October 2011–April 2012. VA declined DOD’s requests to discuss 

care coordination and case management policy issues during this 

period, according to DOD and VA senior officials, because VA had 

established its own task force to conduct an internal review of its care 

coordination and case management activities, including the FRCP.62

 

61The Recovery Warrior Task Force also reported that DOD has partially addressed an 

additional 6 recommendations and noted that 13 recommendations remain open.

After completing its initial assessment, VA briefed WWCTP officials on 

the process it was using to review its care coordination and case 

management activities, but chose not to discuss realignment of the 

FRCP and RCP at that time, according to DOD officials who attended 

this briefing. Instead, the VA Chief of Staff said that he approached 

the Army’s Warrior Transition Command—which has the largest 

number of recovering servicemembers—to propose developing 

guidelines for better integrating Army’s wounded warrior program with 

the FRCP, including identifying when the Army’s wounded warrior 

programs should refer a recovering servicemember to the FRCP, and 

replacing multiple care coordination plans with a single, 

comprehensive planning document. However, a high-level DOD

official criticized this initiative as a tactic to minimize central input from 

62Responding to a recommendation of a consulting firm that advised VA on its care 

coordination and case management policy, the VA Chief of Staff directed that VA conduct 

a department-wide inventory and review of its existing care coordination and case 

management programs and personnel.
 

Page 42 GAO-13-5 Recovering Servicemembers and Veterans

the Office of the Secretary of Defense and pointed out that this effort 

would result in an agreement with only a single military branch. In 

contrast, VA’s Chief of Staff told us that VA took this approach in the 

hope that if an agreement could be reached with Army, the other 

military branches would follow suit.

More recently, in May 2012, VA and DOD developed a new task force, 

the VA/DOD Warrior Care and Coordination Task Force, which 

represents an effort to comprehensively address problems caused by the 

lack of integration between DOD’s and VA’s care coordination and case 

management programs. The task force has developed recommendations 

that are intended to achieve a coordinated, interdepartmental approach to 

care coordination and case management programs, according to a task 

force official. On August 10, 2012, the task force presented the following 

recommendations to the Joint Executive Council for its consideration:

• establish and charter an interagency governance structure 

responsible for coordinating VA and DOD policy,

• establish and charter an interagency care coordination community of 

practice,63

• align the FRCP to function in a consultant and resource-facilitator role,

• clarify the lead coordinator role and responsibilities for executing a 

recovering servicemember’s comprehensive plan,

• identify the business requirements for technical tools to support the 

interagency comprehensive plan, and

• accelerate existing information-sharing efforts for care coordination.

The Joint Executive Council provisionally approved the six 

recommendations, but withheld final approval pending receipt of 

additional information from the task force, such as an estimate of 

resources required to implement the recommendations, as well as 

details of the proposed interagency governance structure. The Joint 

 

63Communities of practice are groups of people who engage, through regular interaction 

with one another, in a process of collective learning in a shared domain of human 

endeavor. 
 

Page 43 GAO-13-5 Recovering Servicemembers and Veterans

Executive Council instructed the task force to present the additional 

information to them in another decision briefing, which was scheduled for 

September 20, 2012. Absent final approval from the Joint Executive 

Council, the task force’s next step was to hold a status briefing for the 

DOD and VA Secretaries on September 10, 2012, to discuss the task 

force’s recommended course of action for care coordination.

Given the inability of past task forces to effect changes that better align 

DOD and VA care coordination and case management policies, it is too 

soon to determine the full effect of the departments’ efforts to manage 

care coordination services regarding outcomes for recovering 

servicemembers and veterans. Although VA and DOD appear to be 

moving in a positive direction on care coordination, notable barriers 

remain:

• There is concern as to whether the Joint Executive Council can 

effectively lead the effort to realign VA’s and DOD’s care coordination 

policy. Some high-ranking and cognizant DOD officials we talked with 

expressed concerns that the recently merged Joint Executive Council 

may not have the capability to effectively monitor the actions taken by 

DOD and VA to implement the task force’s recommendations. Some 

officials we talked with viewed the council as taking too long to resolve 

issues due to both the infrequency of its meetings64 and the difficulties 

DOD and VA members have in agreeing with one another.

• Following approval of its recommended course of action, task force 

documents indicate that a detailed plan will be completed by July 

2013. VA’s task force cochair stated that some aspects of the planned 

changes could take years to implement, particularly as they transition 

existing enrollees of programs affected by significant revisions. For 

example, VA intends to conduct a case-by-case review of every 

FRCP enrollee before modifying the FRCP to function in a consultant 

and resource-facilitator role, according to VA’s Task Force cochair.

• One of the most fundamental challenges to resolving care 

coordination problems is the issue of obtaining the cooperation of the 

military services to implement a new approach to care coordination 

and case management, especially in light of past difficulties of working 

in concert with DOD and VA programs and policies. DOD and VA 

 

64The Joint Executive Council meets on a bimonthly basis.
 

Page 44 GAO-13-5 Recovering Servicemembers and Veterans

leadership officials stated that even if new solutions and policies were 

to be approved by the departments, changes would be made only if 

the individual military services implement the new policies as directed 

by the Secretary of Defense. Several DOD and VA officials identified 

concurrence and support of the military services as the most difficult 

element to achieve. Ultimately, the military services’ compliance with

the departments’ agreed-upon strategy for care coordination and case 

management programs will determine how seamlessly recovering 

servicemembers and veterans will be able to navigate the recovery 

care continuum.

The deficiencies exposed at Walter Reed in 2007 served as a catalyst 

compelling DOD and VA to address a host of problems that complicate 

the course of a wounded, ill, and injured servicemember’s recovery, 

rehabilitation, and return to active duty or civilian life. We believe strongly 

and have reported already that fixing the long-standing and complex 

problems highlighted in the wake of the Walter Reed media accounts as 

expeditiously as possible is critical to ensuring high-quality care for 

returning servicemembers and veterans. We continue to believe that the 

departments’ success ultimately depends on sustained attention, 

systematic oversight, and sufficient resources from both DOD and VA. 

However, this has not yet occurred, and as a result, after 5 years, 

recovering servicemembers and veterans are still facing problems as they 

navigate the recovery care continuum, including access to some of the 

programs designed to assist them. The transition period from DOD’s to 

VA’s health care system is particularly critical, as servicemembers 

continue to experience delays in the disability evaluation system and the 

departments continue to use methods other than a common information 

technology system to share servicemembers’ health information. Until 

these problems are resolved, recovering servicemembers and veterans 

may still face difficulties getting the services they need to maximize their 

potential when they return to active duty or transition to civilian life.

Initially, departmental leadership exhibited focus and commitment—

through the Senior Oversight Committee—to addressing problems related 

to case management and care coordination, disability evaluation systems, 

and data sharing between DOD and VA. However, over time, waning 

leadership attention, a failure to oversee critical wounded warrior 

functions and programs, limited resources, and the inability to achieve a 

collaborative environment— particularly with care coordination—have 

impeded the departments’ ability to fully resolve these problems. A key 

element in resolving current care coordination issues in particular is 

Conclusions 
 

Page 45 GAO-13-5 Recovering Servicemembers and Veterans

eliciting the cooperation of the military services, which are responsible for 

implementing various wounded warrior programs and ensuring that these 

programs operate as intended—which has sometimes not been the case, 

as with the RCP. Also, absent clear direction and central oversight and 

accountability among the military services’ wounded warrior programs, 

true cooperation and program effectiveness may be in jeopardy.

We believe that at the heart of the problem is the need for strong and 

unwavering leadership to bring about changes that best serve our 

nation’s recovering servicemembers and veterans. This leadership should 

be united across both DOD and VA and centered on the individual 

servicemember’s or veteran’s recovery. Many task forces—including the 

VA/DOD Warrior Care and Coordination Task Force and the Recovering 

Warrior Task Force—have already attempted to bring a spirit of 

cooperativeness and clear direction and purpose among the different 

programs providing services to this population. However, to date, these 

efforts have not fully resolved key issues, and our nation’s recovering 

servicemembers and veterans continue to face obstacles and challenges, 

especially as they transition from DOD’s to VA’s health care system. 

Certainly, the fluidity and focus of the departments’ leadership over the 

last several years, especially related to care coordination, have added to 

the challenges of developing consistent policy, effective oversight, and 

mechanisms to monitor progress and hold programs accountable. The 

departments have recently taken steps to improve problems related to 

care coordination, disability evaluations, and the electronic sharing of 

health records, through concerted efforts to coordinate on policy, increase 

staffing resources, and provide control over the budget, respectively. 

However, it is too early to determine the effectiveness of these efforts, 

and sustained leadership attention will be critical to their success. The 

need to fully resolve remaining problems is urgent as there will be an 

increasing demand for services from both DOD and VA as the current 

conflicts come to an end. If not resolved now, these same problems will 

persist into the future for recovering servicemembers and veterans.

To ensure that servicemembers have equitable access to the military 

services’ wounded warrior programs, including the RCP, and to establish 

central accountability for these programs, we recommend that the 

Secretary of Defense establish or designate an office to centrally oversee 

and monitor the activities of the military services’ wounded warrior 

programs to include the following:

Recommendations for 

Executive Action
 

Page 46 GAO-13-5 Recovering Servicemembers and Veterans

• Develop consistent eligibility criteria to ensure that similarly situated 

recovering servicemembers from different military services have 

uniform access to these programs.

• Direct the military services’ wounded warrior programs to fully comply 

with the policies governing care coordination and case management 

programs and any future changes to these policies.

• Develop a common mechanism to systematically monitor the 

performance of the wounded warrior programs—to include the 

establishment of common terms and definitions—and report this 

information on a biannual basis to the Armed Services Committees of 

the House of Representatives and the Senate.

To ensure that persistent challenges with care coordination, disability 

evaluation, and the electronic sharing of health records are fully resolved, 

we recommend that the Secretaries of Defense and Veterans Affairs 

ensure that these issues receive sustained leadership attention and 

collaboration at the highest levels with a singular focus on what is best for 

the individual servicemember or veteran to ensure continuity of care and 

a seamless transition from DOD to VA. This should include holding the 

Joint Executive Council accountable for

• ensuring that key issues affecting recovering servicemembers and 

veterans get sufficient consideration, including recommendations 

made by the Warrior Care and Coordination Task Force and the 

Recovering Warrior Task Force;

• developing mechanisms for making joint policy decisions;

• involving the appropriate decision-makers for timely implementation of 

policy; and

• establishing mechanisms to systematically oversee joint initiatives and 

ensure that outcomes and goals are identified and achieved.

DOD and VA reviewed a draft of this report and provided comments, 

which are reprinted in appendixes III and IV. DOD and VA also provided 

technical comments, which we incorporated as appropriate. 

Agency Comments 

and Our Evaluation
 

Page 47 GAO-13-5 Recovering Servicemembers and Veterans

DOD concurred with specific components of our first recommendation 

regarding the establishment of central accountability for the military 

services’ wounded warrior programs. In particular, DOD agreed that a 

single office should have oversight responsibility for the military services’ 

wounded warrior programs and that these programs should fully comply 

with the policies governing care coordination and case management 

programs and any future changes to these policies. 

However, DOD only partially concurred with other components of our first 

recommendation—that DOD develop consistent eligibility criteria for 

enrollment in wounded warrior programs and that DOD establish a 

common mechanism to systematically monitor the performance of these 

programs. In its comments, DOD explained that the three military service 

Secretaries should have the ability to control entrance criteria into their 

wounded warrior programs and added that it does not believe that 

differences in eligibility criteria for these programs results in noticeable 

differences in access to these programs by recovering servicemembers 

or their families. DOD did not offer a rationale, however, as to why the 

military service Secretaries should unilaterally determine eligibility criteria 

for their wounded warrior programs, other than to suggest that flexibility is 

important and necessary. Moreover, as we have reported, DOD does not 

systematically assess or monitor these programs across the department, 

and as a result, we believe that DOD has no basis to assert that there are 

no noticeable differences in access to these programs. Overall, we 

believe that similarly situated wounded, ill, and injured servicemembers 

should be given the same access to wounded warrior programs and the 

assistance these programs provide, regardless of their branch of military 

service. 

With respect to developing a common mechanism to systematically 

monitor the performance of the wounded warrior programs, DOD 

responded that the Interagency Care and Coordination Committee will 

conduct an inventory of all wounded warrior programs to identify 

duplication and areas for gaining efficiencies. In commenting on our 

recommendation to also report its performance information on the 

wounded warrior programs to the Armed Services Committees on a 

biannual basis, DOD stated that the department reports progress through 

the Joint Executive Council’s annual strategic planning report and any 

additional reporting would be redundant and of limited value. We 

disagree. The Joint Executive Council’s strategic planning and annual 

reports focus on joint efforts between the departments and do not report 

on the performance of the military services’ wounded warrior programs. 

Therefore, we do not believe that the performance information on the 
 

Page 48 GAO-13-5 Recovering Servicemembers and Veterans

wounded warrior programs would be redundant or of limited value given 

that the department itself is currently unable to systematically determine 

how well these programs are functioning. As we reported, one of the key 

problems hindering a department-wide assessment of these programs is 

the lack of common terms and definitions used by the military services.

Although DOD acknowledges that this is an issue, it asserts that it has 

instituted some common definitions through the Senior Oversight 

Committee and through its instruction for the RCP and that it will work 

towards a common understanding and use of these approved definitions.

Although we are aware of efforts to define some terms, on the basis of

our work, it does not appear that the military services are using them

consistently. Therefore, substantial progress towards a common 

understanding and use will be critical to the department’s ability to 

oversee these programs.

DOD did not respond directly to our recommendation for developing a 

common mechanism for performance measurement, which we found is 

not systematically conducted across the wounded warrior programs.

During our collection of performance data from the wounded warrior 

programs, we found that the programs vary in their ability to report 

performance outcome measures on the basis of what each program 

chooses to track. In addition, we found that some of the programs had 

difficulty reporting basic data, such as enrollment numbers, and only 

compiled these data following our request—sometimes taking about 

5 months to do so. Lastly, our recommendation is consistent with the call 

of the Interagency Care and Coordination Committee that the military 

programs develop more useful quantitative and qualitative metrics that 

would effectively demonstrate their performance. Until DOD takes the 

necessary steps to assess these programs department-wide, it will never 

know with certitude whether these programs are meeting the needs of its 

recovering servicemember population.

DOD and VA both concurred with our second recommendation that the 

departments ensure that care coordination, disability evaluation, and 

electronic health record sharing receive sustained leadership attention 

and collaboration at the highest levels, with a singular focus on what is 

best for the individual servicemember or veteran to ensure continuity of 

care and a seamless transition from DOD to VA. 
 

Page 49 GAO-13-5 Recovering Servicemembers and Veterans

In addition to its comments on our recommendation, VA asserted that the 

care coordination challenges facing both departments are broader and 

more complex than issues concerning just the FRCP and RCP and that 

our overall analysis and conclusions are over simplified. VA stated that 

through its recently formed task force, both departments identified over 

40 programs that provide some level of coordination or management of 

care and services across the continuum of care and acknowledged that 

there is no common operational picture that facilitates collaborative 

planning or situational awareness. We agree that the care coordination 

challenges are broader and more complex than the FRCP and RCP.

Specifically, in October 2011, we recommended that the departments 

strengthen functional integration across all care coordination and case 

management programs to reduce redundancy and overlap.65 Similarly, 

our current recommendation is broad and does not focus exclusively on 

these two programs as our review also included other programs, such as 

the military services’ wounded warrior programs, VA’s Liaison for 

Healthcare Program, and VA’s OEF/OIF/OND Care Management 

Program. The scope of our review was directed by Congress, who 

required us to report on the progress DOD and VA in implementing the 

programs involved with the care, management, and transition of 

wounded, ill, and injured servicemembers that they established. Our 

specific discussion of the FRCP and RCP served to illustrate, until 

recently, a continued lack of collaboration between the departments to 

better align these programs and better serve recovering servicemembers 

and veterans. Furthermore, during detailed discussions with top-level VA 

and DOD officials, they focused on the FRCP and RCP issue as the main 

sticking point in achieving coordination and cooperation among the two 

departments with respect to care coordination and case management. 

We are encouraged that the departments are now taking steps to identify 

all programs that need better alignment and integration. However, as we 

have stated, the key to resolving this and other problems is the need for 

strong and unwavering leadership that is united across both departments 

and focused on the individual servicemember’s or veteran’s recovery.

 

65GAO-12-129T. 
 

Page 50 GAO-13-5 Recovering Servicemembers and Veterans

VA also suggested further clarifications to our report. 

• VA suggested that we clarify that while the VA Liaison for Healthcare 

Program facilitates the transfer of recovering servicemembers from 

DOD’s to VA’s health care system, it is a DOD or VA treatment team 

that determines if the servicemember is medically ready to begin the 

transition process. VA also suggested that we add that that the 

OEF/OIF/OND Care Management Program screens all returning 

combat veterans for case management services. We incorporated 

VA’s suggested changes.

• VA disagrees with a DOD-attributed statement that the Joint 

Executive Council historically has not driven policy decision making 

and that, at times, decisions were taken directly to the DOD and VA 

Secretaries for resolution. The statement that we attribute to the DOD 

official relates to the period prior to the integration of the Senior 

Oversight Committee with the Joint Executive Council. As mentioned 

in the report, it is too early to ascertain whether the newly merged 

Joint Executive Council will be able to make decisions and drive policy 

changes in DOD and VA.

• VA provided clarification about how the Joint Executive Council is 

currently providing oversight and accountability for wounded warrior 

issues that were once addressed by the Senior Oversight Committee.

We recognize the effort that the Joint Executive Council is now 

making to track wounded warrior issues, including the integrated 

disability evaluation system and care coordination. However, we have 

not had the opportunity to review this tracking mechanism now in 

place to comment on its effectiveness.

• VA asserts that the size of the overlap between the FRCP and RCP 

population is fairly small. Although the number of seriously injured 

servicemembers may be comparatively small, this situation has been 

and continues to be a major concern in that these individuals and their 

families represent a highly vulnerable population. Further, during our 

review, one high-level DOD official we spoke with characterized the 

FRCP/RCP overlap as the most difficult policy issue to resolve. While 

we understand that DOD and VA now intend to harmonize care 

coordination policies within a broader context of interdepartmental 

care coordination and case management practice, many of the 

proposed revisions—including the role to be played by the FRCP—

are neither fully developed nor implemented by the separate DOD and 

VA programs at this time.
 

Page 51 GAO-13-5 Recovering Servicemembers and Veterans

• In our report, we explain that VA declined DOD’s requests to discuss 

care coordination and case management policy issues—for the better 

part of 1 year—on the basis that VA was conducting an internal 

review of its care coordination and case management activities. In its 

comments, VA stated that the use of the word “decline” is misleading, 

and suggested that we change our text to state that VA asked DOD to

defer collaboration until the internal review was conducted. Despite 

VA’s characterization that our statement is misleading, we maintain 

that this finding was based on remarks made by high-level DOD 

officials that were subsequently corroborated by senior VA officials.

We are sending copies of this report to appropriate congressional 

committees, the Secretary of Defense, the Secretary of Veterans Affairs, 

and other interested parties. The report also is available at no charge on 

GAO’s website at http://www.gao.gov. 

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

contact me at (202) 512-7114 or williamsonr@gao.gov. Contact points for 

our Offices of Congressional Relations and Public Affairs may be found 

on the last page of this report. Key contributors to this report are listed in 

appendix V.

Randall B. Williamson

Director, Health Care
 

Page 52 GAO-13-5 Recovering Servicemembers and Veterans

List of Committees

The Honorable Carl Levin

Chairman

The Honorable John McCain

Ranking Member

Committee on Armed Services

United States Senate

The Honorable Patty Murray

Chairman

The Honorable Richard Burr

Ranking Member

Committee on Veterans’ Affairs

United States Senate

The Honorable Daniel Inouye

Chairman

The Honorable Thad Cochran

Ranking Member

Subcommittee on Defense

Committee on Appropriations

United States Senate

The Honorable Tim Johnson

Chairman

The Honorable Mark Kirk

Ranking Member

Subcommittee on Military Construction, Veterans Affairs,

 and Related Agencies

Committee on Appropriations

United States Senate

The Honorable Howard McKeon 

Chairman

The Honorable Adam Smith

Ranking Member

Committee on Armed Services

House of Representatives
 

Page 53 GAO-13-5 Recovering Servicemembers and Veterans

The Honorable Jeff Miller

Chairman

The Honorable Bob Filner

Ranking Member

Committee on Veterans’ Affairs

House of Representatives

The Honorable C.W. Bill Young 

Chairman

The Honorable Norman Dicks

Ranking Member

Subcommittee on Defense

Committee on Appropriations

House of Representatives

The Honorable John Culberson

Chairman

The Honorable Sanford Bishop

Ranking Member

Subcommittee on Military Construction, Veterans Affairs,

 and Related Agencies

Committee on Appropriations

House of Representatives
Appendix I: Enrollment and Populations for 

Select Department of Defense and Department 

of Veterans Affairs Programs

Page 54 GAO-13-5 Recovering Servicemembers and Veterans

Both the Department of Defense (DOD) and the Department of Veterans 

Affairs (VA) operate care coordination1 and case management2 programs 

designed to assist servicemembers and veterans as they navigate the 

recovery care continuum, from acute medical treatment and stabilization, 

through rehabilitation, to reintegration—either back to active duty or to the 

civilian community as a veteran. This appendix describes selected DOD 

and VA programs and includes data on enrollment and population 

characteristics as well as the type of information each program tracks on 

referrals.

Within DOD, each military service has established its own wounded 

warrior program or a complement of programs3 to assist wounded, ill, and 

injured servicemembers during their recovery and rehabilitation, and to 

help with the transition back to active duty or to civilian life.4

 

1

According to the National Coalition on Care Coordination, care coordination is a clientcentered, assessment-based interdisciplinary approach to integrating health care and 

social support services in which an individual’s needs and preferences are assessed, a 

comprehensive care plan is developed, and services are managed and monitored by an 

identified care coordinator.

Wounded 

warrior programs range in size from the largest, the Army’s Warrior 

Transition Units and Community-Based Warrior Transition Units, with 

18,762 enrollees served in fiscal year 2011, to the smallest, the Navy 

Safe Harbor Program, with 784 enrollees served in fiscal year 2011. (See 

table 4 for a list of the DOD wounded warrior programs and enrollment for 

fiscal year 2011.)

2

According to the Case Management Society of America, case management is defined as 

a collaborative process of assessment, planning, facilitation, and advocacy for options and 

services to meet an individual’s health needs through communication and available 

resources to promote high quality, cost-effective outcomes.

3

Military services operate multiple programs that are specialized to serve different 

populations, such as the severely wounded or surviving family members. For example, 

within the Air Force’s Warrior and Survivor Care Program, the Air Force operates three 

distinct programs: (1) the Air Force Wounded Warrior Program to serve those who were 

injured in combat; (2) the Air Force Recovery Care Program to serve other seriously and 

severely wounded, ill, and injured; and (3) the Air Force Survivor Assistance Program, to 

serve surviving family members or caregivers of wounded, ill, and injured 

servicemembers.

4

For the purpose of this appendix we will be discussing seven of the case management 

and care coordination programs established by the military services to assist recovering 

servicemembers and veterans with recovery, rehabilitation, and transition either back to 

military service or to civilian life.

Appendix I: Enrollment and Populations for 

Select Department of Defense and 

Department of Veterans Affairs Programs

DOD Wounded 

Warrior Programs
Appendix I: Enrollment and Populations for 

Select Department of Defense and Department 

of Veterans Affairs Programs

Page 55 GAO-13-5 Recovering Servicemembers and Veterans

Table 4: Military Services’ Wounded Warrior Programs: Enrollment for Fiscal Year 2011 

Military services’ wounded warrior program Number enrolled, as of fiscal year 2011

Army

Army Warrior Care and Transition Program: Warrior Transition Units and 

Community-Based Warrior Transition Unitsa,b 18,762

Army Warrior Care and Transition Program: Army Wounded Warrior Programb 9,738

Navy/Coast Guard

Navy Safe Harbor Programc 784

Air Force

Air Force Wounded Warrior Programd 1,386

Air Force Recovery Care Program 1,804

Marine Corps

Marine Corps Wounded Warrior Regimente,f 2,155

United States Special Operations Commandg

United States Special Operations Command’s Care Coalition 4,570

Source: GAO analysis of military services’ wounded warrior program information.

a

Enrollment data include servicemembers who were in the Army Warrior Care and Transition 

Program at any point during the fiscal year, not the population on a specific date.

b

Enrollees may include servicemembers who are dually enrolled in the Army Warrior Care and 

Transition Program and Army Wounded Warrior Program.

c

Enrollment numbers represent all enrollees being served by the program as of December 31, rather 

than as of the end of each fiscal year.

d

Servicemembers may be dually enrolled in the Air Force Wounded Warrior Program and the Air 

Force Recovery Care Program. The enrollment data presented here only reflect servicemembers who 

are enrolled in the Air Force Wounded Warrior Program. 

e

According to a Wounded Warrior Regiment official, the Wounded Warrior Regiment does not have 

“enrollees,” rather the program assigns and attaches Marines to the program.

f

Total enrollment does not include Wounded Warrior Regiment enrollees who are not assigned or 

attached to a Wounded Warrior Regiment site. Many wounded, ill, and injured Marines are supported 

by the Wounded Warrior Regiment while remaining with their parent unit.

g Enrollees of the United States Special Operations Command’s Care Coalition Recovery Program 

may also be enrolled in a military service’s wounded warrior program on the basis of their branch of 

service, but the United States Special Operations Command’s Care Coalition Recovery Program 

takes the lead for providing nonclinical case management.

Programs differ in their organization and function. For example, two of the 

wounded warrior programs—the Army’s Warrior Transition Units and the 

Marine Corps Wounded Warrior Regiment—are organized under 

separate military commands, which means that wounded, ill, and injured 

servicemembers enrolled in these programs may be removed from their 

parent units or commands and assigned or attached to a separate unit or 
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regiment that provides command and control5 over the recovering 

servicemember as well as administrative support. These servicemembers 

may be housed in separate barracks while receiving medical care and 

waiting to transition back to active duty or civilian life. The other wounded 

warrior programs do not assign or attach servicemembers to a separate 

command structure, but provide services while recovering 

servicemembers remain with their parent units. The services provided by 

the wounded warrior programs also vary. A servicemember may receive 

either case management or care coordination services or both, depending 

on how the military service’s wounded warrior program is structured. For 

example, the Navy Safe Harbor Program only provides care coordination 

services and does not have a case management component, whereas 

the Marine Corps Wounded Warrior Regiment provides all 

servicemembers with both case management and care coordination 

services. A further distinction is whether or not a program serves veterans 

as well as servicemembers. For example, the Army Warrior Transition 

Units do not serve veterans, but eligible veterans are served through the 

Army Wounded Warrior Program. The remainder of the wounded warrior 

programs continue to provide support to any enrollee who needs services 

even after the enrollee has transitioned to veteran status.

The Army’s Warrior Care and Transition Program, which was established 

in May 2007,6 consists of two components that support the recovery 

process for wounded, ill, and injured servicemembers—the Warrior 

Transition Units7

 

5

DOD defines command and control as the exercise of authority and direction by a 

properly designated commander over assigned and attached forces in the 

accomplishment of the mission.

and the Army Wounded Warrior Program. The Army 

operates a number of warrior transition units located at Army installations 

across the country. Recovering servicemembers who are attached or 

assigned to a warrior transition unit generally are housed in barracks and 

receive medical care, rehabilitative services, professional development 

and clinical and nonclinical case management services in order to help 

6

The program was originally named the Army Medical Action Plan.

7

Warrior Transition Units are technically an Army brigade, battalion, or company that 

provides command and control, administrative support, primary care and case 

management and other services to promote readiness of soldiers and family to transition 

back to active duty or to civilian life. For the purposes of this report, we are categorizing it 

as a wounded warrior program.

Army Warrior Care and 

Transition Program
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them in their transition back to active duty or to the civilian community. 

Army Warrior Transition Units vary in size and functionality, including 

community-based warrior transition units,8 which primarily serve Reserve 

Component servicemembers.9

The Army Wounded Warrior Program

In fiscal year 2011, there were a total of 

14,906 recovering servicemembers assigned or attached to 29 warrior 

transition units and 3,856 recovering servicemembers assigned or 

attached to 10 community-based warrior transition units. (See table 5.) 

According to Army policy, recovering servicemembers assigned or 

attached to the units are expected to require 6 months or more of 

rehabilitative care or require complex medical management.

10 was established in April 2004 to 

assist severely wounded, ill, and injured servicemembers, their families, 

and caregivers. Army Wounded Warrior Program enrollees are assigned 

an Advocate who provides nonclinical care coordination services, which 

include assisting enrollees with benefit information, career guidance, 

finances, and the integrated disability evaluation system (IDES) process. 

Recovering servicemembers are eligible for Army Wounded Warrior 

Program services if they have, or are expected to receive, an Army 

disability rating of 30 percent or greater in one or more specific categories 

or a combined rating of 50 percent or greater for conditions that are the 

result of combat or are combat-related. The most severely wounded, ill, or 

injured servicemembers who are assigned to warrior transition units are 

also enrolled in the Army Wounded Warrior Program. The Army Wounded 

Warrior Program also provides services to veterans. In fiscal year 2011, 

nearly three-fourths of the population (6,953) were veterans. (See 

table 6.)

 

8

The Community-based Warrior Transition Unit Program allows servicemembers to live at 

home and perform duty at a location near home while receiving medical care.

9

Warrior transition units and community-based warrior transition units serve Active 

Component servicemembers as well as servicemembers in National Guard and Reserve 

Components, but do not serve veterans.

10The Army Wounded Warrior Program was originally named the Disabled Soldier 

Support System.
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Table 5: Army Warrior Care and Transition Program Enrollment Populations and Characteristics, Fiscal Years 2008 through 

2011

Fiscal year

2008 2009 2010 2011

Program enrollment for Warrior Transition Units and 

Community-Based Warrior Transition Units 

Total enrollmenta,b 20,878 19,238 18,647 18,762

Active Duty 13,558 11,771 9,560 9,160

National Guardc 4,761 4,839 5,860 5,857

Reservistsc 2,559 2,628 3,227 3,745

Population characteristics

Enrollees with combat-related conditionsd 2,523 2,033 1,788 1,984

Enrollees with non-combat-related conditionse 18,355 17,205 16,859 16,778

Enrollees who left the program

Returned to active dutyf 4,366 4,279 4,664 5,349

Transitioned to veteran statusg 5,125 5,938 4,027 3,448

Left for other reasonsh 146 200 159 148

Referrals

Total number of servicemembers referred to the programi 20,878 19,238 18,647 18,762

Warrior Transition Unit enrollment

Total enrollment in Warrior Transition Unitsa,b 18,038 16,203 14,921 14,906

Active Duty 13,511 11,686 9,456 9,058

National Guardc 2,864 2,807 3,336 3,354

Reservistsc 1,663 1,710 2,129 2,494

Population characteristics

Enrollees with combat-related conditionsd 2,231 1,798 1,569 1,760

Enrollees with non-combat-related conditionse 15,807 14,405 13,352 13,146

Enrollees who left the program

Returned to active dutyf 3,613 3,653 3,803 4,259

Transitioned to veteran statusg 4,706 5,445 3,700 3,167

Left for other reasonsh 139 184 146 135

Community-Based Warrior Transition Unit enrollment

Total enrollment in Community-Based Warrior Transition Unitsa,b,j 2,840 3,035 3,726 3,856

Active Duty 47 85 104 102

National Guardc 1,897 2,032 2,524 2,503

Reservistsc 896 918 1,098 1,251
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Fiscal year

2008 2009 2010 2011

Population characteristics

Enrollees with combat-related conditionsd 292 235 219 224

Enrollees with non-combat-related conditionse 2,548 2,800 3,507 3,632

Enrollees who left the program

Returned to active dutyf 753 626 861 1,090

Transitioned to veteran statusg 419 493 327 281

Left for other reasonsh 7 16 13 13

Source: GAO analysis of Army Warrior Care and Transition Program data.

Notes: The Army Warrior Care and Transition Program’s Warrior Transition Units and CommunityBased Warrior Transition Units serve Active, Guard, and Reserve Component servicemembers. The 

program does not serve veterans.

a

Enrollment data include servicemembers who were in the Army Warrior Care and Transition 

Program at any point during the fiscal year, not the population on a specific date.

b

Enrollees may include servicemembers who are dually enrolled in the Army Warrior Care and 

Transition Program and the Army Wounded Warrior Program.

c

National Guard and Reservists enrolled in the Army Warrior Care and Transition Program must be 

on active-duty orders in order to participate in the program.

d

Enrollees with combat-related conditions only include those enrollees medically evacuated from a 

combat zone with identified battle injuries. Other combat-related conditions, such as posttraumatic 

stress disorder, may not have required medical evacuation from a combat zone and therefore would 

not be captured in the data provided. In addition, prior battle injuries not related to the 

servicemember’s current medical diagnosis would also be excluded from the data. Battle injury is 

defined as damage or harm sustained by personnel during or as a result of battle conditions.

e

Enrollees with non-combat-related conditions include all enrollees who were not medically evacuated 

from a combat zone and those who are identified as having nonbattle injuries.

f

Enrollees who exit the program by returning to duty also include Guard or Reserve Components who 

are released from active duty, but not medically separated from military service.

g

Enrollees who transition to veteran status include only enrollees who are medically separated from 

military service.

h

Enrollees are considered to have left the Army Warrior Care and Transition Program’s Warrior 

Transition Units for “other” reasons, including death or as a result of military legal actions. This 

category also includes those enrollees with incomplete information about why they left the program.

i

According to Army Warrior Care and Transition Program officials, the program only tracks referral 

information for program enrollees. Therefore, the program does not have data on servicemembers 

who were referred, but never enrolled into the program.

j

The Army’s Community-Based Warrior Transition Units are populated only by servicemembers who 

transfer to the Community-Based Units from their original assignment to a Warrior Transition Unit. 

According to Army Warrior Care and Transition Program officials, the first 60 days of recovery are 

typically spent in a Warrior Transition Unit. After the initial recovery period, a decision is made about 

whether the servicemember should be transferred to a community-based unit. Data provided in the 

table reflect the most recent location recorded for each enrollee.
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Table 6: Army Wounded Warrior Program Enrollment Populations and Characteristics, Fiscal Years 2008 through 2011

Fiscal year

2008 2009 2010 2011

Program enrollment for Army Wounded Warrior Program

Total enrollmenta,b 3,813 6,473 8,454 9,738

Servicemembers 2,037 3,377 3,354 2,785

Active Duty 1,249 2,252 1,954 1,210

National Guardc 562 794 985 1,091

Reservistsc 226 331 415 484

Veterans 1,776 3,096 5,100 6,953

Population characteristics

Enrollees with combat-related conditions 3,233 5,503 7,082 8,001

Enrollees with non-combat-related conditions 544 875 1,104 1,184

Enrollees with conditions not classified as either combat- or non-combat-relatedd 36 95 268 553

Enrollees who changed duty status or left the program

Returned to active dutye 117 80 59 47

Transitioned to veteran statusf 958 1,574 1,539 1,100

Left for other reasonsg 10 24 21 3 

Referrals and assists

Total number of servicemembers referred to the program 3,106 4,199 3,993 3,364

Servicemembers referred and enrolled in the program 2,037 3,377 3,354 2,785

Servicemembers referred and assisted, but not enrolled in the programh 969 822 639 579

Total number of veterans referred to the program 2,568 3,617 5,554 7,291

Veterans referred and enrolled in the program 1,776 3,096 5,100 6,953

Veterans referred and assisted, but not enrolled in the program 792 521 454 338

Source: GAO analysis of Army Wounded Warrior Program data.

a

Enrollment data include servicemembers and veterans who were served by the program at any point 

during the fiscal year, not the population being served on a specific date.

b

Enrollees also may be enrolled in the Army’s Warrior Transition Units or Community-Based Warrior 

Transition Units. 

c

Enrollment is counted in this category only for National Guard and Reservists who were on active 

duty orders during the designated fiscal year. According to Army Wounded Warrior Program officials, 

National Guard and Reservists who were demobilized previous to the designated fiscal year are 

considered veterans.

d

Enrollees considered to have “conditions not classified as either combat- or non-combat-related” 

include enrollees who have yet to complete the physical disability evaluation process and therefore 

do not have verification of whether or not their conditions are combat-related.

e

Army Wounded Warrior Program officials said that the program does not specifically track whether or 

when an enrollee returns to active duty. However, data on duty status are available for those 

enrollees who are also enrolled in the Army’s Warrior Transition Units or Community-Based Warrior 

Transition Unit, as provided in the table.
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f

Army Wounded Warrior Program officials said that the program does not specifically track whether or 

when an enrollee transitions to veteran status because it has no impact on enrollees’ eligibility for the 

program and whether they leave the program. Rather, these data have been derived by the program 

by counting the number of enrolled servicemembers who received a certificate of release or 

discharge from active duty within each fiscal year.

g

Enrollees considered to have “left for other reasons” include those who died while enrolled in the 

Army Wounded Warrior Program.

h

The data include those enrollees who were later found ineligible for the program and were 

disenrolled, but assisted during their initial period of enrollment. These ineligible enrollees were not 

included in the program’s count of total enrollees. Additionally, some servicemembers who were 

referred to the Wounded Warrior Program and provided short-term, informal assistance are not 

included in the data because they are not tracked by the program.

The Navy Safe Harbor Program office was established in 2005. Over 

time, this office expanded its reach and mission, and in 2008 the program 

became responsible for nonclinical care coordination and oversight of all 

severely (and high-risk nonseverely) wounded, ill, and injured Sailors and 

Coast Guardsmen.11 Recovering servicemembers enrolled in the program 

are assigned to nonmedical care managers who are geographically 

dispersed at major military treatment facilities and Veterans Affairs 

polytrauma medical centers. The program’s nonmedical care managers 

assist enrollees with services such as pay and personnel, legal, housing, 

as well as education and training benefits. In addition, enrollees obtain 

support from centrally located experts in transition and benefits 

assistance, such as a liaison to the Department of Labor and a Navy Staff 

Judge Advocate. Recovering servicemembers enrolled in the program are 

enrolled for life and, if desired, receive support from Navy Safe Harbor 

personnel after they transition to veteran status. (See table 7.)

 

11According to Navy Safe Harbor Program officials, the program evolved from the Navy’s 

preexisting Military Severely Injured Center & Casualty Office.

Navy Safe Harbor Program
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Table 7: Navy Safe Harbor Program Enrollment Populations and Characteristics, Fiscal Years 2008 through 2011

Fiscal year

2008 2009 2010 2011

Program enrollment for Navy Safe Harbor Program

Total enrollmenta 255 434 576 784

Servicemembers 144 236 271 391

Active Duty 77 129 152 254

Reservists 67 107 119 137

Veterans 111 198 305 393

Population characteristics

Enrollees with combat-related conditions 130 166 193 239

Enrollees with non-combat-related conditions 125 268 383 545

Enrollees who changed duty status or left the program

Returned to active duty ND ND ND 113

Transitioned to veteran status ND 91b 338b 142

Left for other reasons 0 0 0 1 

Referrals and assists

Total number of servicemembers and veterans referred to the programc 304 296 370 475

Servicemembers and veterans referred and enrolled in the program 255 179 142 208

Servicemembers and veterans referred and assisted, but not enrolled in the program 74 417 330 199

Servicemembers and veterans referred but not enrolled in or assisted by the program 0 0 2 73

Legend: ND indicates that no data are available.

Source: GAO analysis of Navy Safe Harbor Program data.

a

Enrollment numbers represent all enrollees being served by the program as of December 31, rather 

than as of the end of each fiscal year.

b

According to a Navy Safe Harbor Program official, the database used to capture information about 

the duty status of enrollees did not have the ability to track dates when servicemembers transitioned 

to veteran status until the system was upgraded in 2010. At that point, the program moved all 

enrollees who had previously medically retired to a veteran status. Therefore, the number of enrollees 

who transitioned to veteran status in fiscal year 2010 includes both servicemembers who transitioned 

to veteran status within the fiscal year and servicemembers who transitioned to veteran status during 

the previous fiscal years.

c

The database used to capture referral information for the Navy Safe Harbor Program does not 

distinguish servicemembers from veterans referred to the program. Rather, the referral information 

provided for servicemembers also includes any veterans who were referred to the program.
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The Air Force Warrior and Survivor Care Program supports wounded, ill, 

and injured servicemembers through its Air Force Wounded Warrior 

Program and the Air Force Recovery Care Program.12

The Air Force Recovery Care Program was established in November 

2008 to provide nonclinical care coordination services for seriously ill and 

injured Airmen, Air National Guard, and Reserve Component 

servicemembers. Each enrolled servicemember is assigned a care 

coordinator who oversees the coordination of services and assists 

enrollees’ with nonclinical needs, such as employment and benefits. 

These care coordinators also work with enrolled servicemembers to 

develop their recovery plans and career goals. Enrollees who have 

combat-related illness or injuries are concurrently enrolled in the Air Force 

Wounded Warrior Program. For example, in fiscal year 2011, almost 300 

Air Force Recovery Care Program enrollees were also either tracked or 

actively assisted by the Air Force Wounded Warrior Program. (See 

table 9.)

The Air Force 

Wounded Warrior Program was established in June 2005 to provide 

nonclinical case management to Airmen, Air National Guard, and 

Reserve Component servicemembers who have combat-related illnesses 

or injuries. Each enrolled servicemember is assigned a nonmedical care 

manager, who serves as an advocate for enrollees to obtain services 

from agencies and organizations that support the needs of enrolled 

servicemembers, their families and caregivers. The Air Force Wounded 

Warrior Program continues to provide services to enrollees once they 

transition to veteran status. (See table 8.)

 

12The Air Force Warrior and Survivor Care Program’s Survivor Assistance Program 

primarily provides services to the families of wounded, ill, and injured servicemembers.

Air Force Warrior and 

Survivor Care Program
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Table 8: Air Force Wounded Warrior Program Enrollment Populations and Characteristics, Fiscal Years 2008 through 2011

Fiscal year

2008 2009 2010 2011

Program enrollment for Air Force Wounded Warrior Program

Total enrollmenta 194 451 836 1,386

Servicemembers 160 388 703 1,143

Active Duty 103 256 463 783

National Guard 32 60 123 194

Reservists 25 72 117 166

Veterans 34 63 133 243

Population characteristics

Enrollees with combat-related conditions 187 442 804 1,327

Enrollees with non-combat-related conditions 7 9 32 59

Enrollees who changed duty status or left the program

Returned to active duty 4 22 65 128

Transitioned to veteran status 157 329 532 786

Referrals and assists

Total number of servicemembers referred to the program 146 357 724 1,176

Servicemembers referred and enrolled in the program 145 337 645 1,071

Servicemembers referred and assisted, but not enrolled in the programb 1 20 79 105

Servicemembers referred but not enrolled in or assisted by the program 0 0 0 0 

Total number of veterans referred to the program 34 63 133 243

Veterans referred and enrolled in the program 34 63 133 243

Veterans referred and assisted, but not enrolled in the program NA NA NA NA

Veterans referred but not enrolled in or assisted by the program 0 0 0 0 

Legend: NA indicates that the category is not applicable to the program.

Source: GAO analysis of Air Force Wounded Warrior Program data.

a

Servicemembers may be dually enrolled in the Air Force Recovery Care Program and the Air Force 

Wounded Warrior Program. The enrollment data presented here only reflect servicemembers who are 

enrolled in the Air Force Wounded Warrior Program.

b

According to Air Force Wounded Warrior Program officials, because the program only serves 

servicemembers with combat-related conditions, most referrals come from casualty reports and the 

disability evaluation process, where it is determined whether a servicemember’s wound, illness, and 

injury are combat-related. Once the determination is made, servicemembers are enrolled into the 

program.
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Table 9: Air Force Recovery Care Program Enrollment Populations and Characteristics, Fiscal Years 2008 through 2011 

Fiscal year

2008 2009 2010 2011

Program enrollment for Air Force Recovery Care Program

Total enrollmenta ND ND ND 1,804

Servicemembers ND ND ND ND

National Guard ND ND ND ND

Reservists ND ND ND ND

Veterans ND ND ND ND

Othersb ND ND ND 251

Population characteristics

Enrollees with combat-related conditions ND ND ND 316

Enrollees with non-combat-related conditions ND ND ND 782

Enrollees who changed duty status or left the program

Returned to active duty ND ND ND 288

Transitioned to veteran status ND ND ND 394

Left for other reasons ND ND ND ND

Referrals and assists

Total number of servicemembers referred to the program ND ND ND 1,804

Legend: ND indicates that no data are available.

Source: GAO analysis of Air Force Recovery Care Program data.

Notes: According to Air Force Recovery Care Program officials, the program did not routinely track 

certain data about the program, because these data were not required to be collected by the DOD 

policy that governs the program. In addition, the original Air Force Recovery Care program 

requirements did not include provisions for data collection. The officials told us that a data-collection 

tool is being developed and that requirements for data collection would be finalized by the beginning 

of July 2012. The officials anticipate the new tool will be operational by January 2013.

a

Enrollees may also be enrolled in the Air Force’s Wounded Warrior Program.

b

The Air Force Recovery Care Program serves some servicemembers from other military services.

The Marine Corps established the Wounded Warrior Regiment in May 

2007 to provide and facilitate assistance to wounded, ill, and injured 

Marines and their family members throughout the recovery process. The 

Wounded Warrior Regiment is a single command that oversees 

nonmedical care for the total Marine force, including Active Duty, 

Reserve, retired, and veteran Marines. The regiment enrolls Marines 

regardless of whether they have combat- or non-combat-related 

conditions. The regiment commands the operation of two wounded 

warrior battalions and 14 detachments located at 12 principal military 

treatment facilities and four Veterans Affairs polytrauma medical centers 

Marine Corps Wounded 

Warrior Regiment
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across the United States and overseas. A Marine enrolled in the regiment 

can either stay with his or her parent unit and be supported by the 

regiment, or be assigned or attached to one of the regiment’s battalions 

and detachments, depending on their specific needs. Generally, Marines 

who require more than 90 days of medical treatment or rehabilitation are 

assigned or attached to a battalion or detachment. The District Injured 

Support Cells Program is the component of the Wounded Warrior 

Regiment that provides services to veterans.13 District Injured Support 

Coordinators are located at 30 sites across the United States to provide 

support, including nonmedical care management to its enrollees. In fiscal 

year 2011, the District Injured Support Coordinators provided support to 

1,488 veterans. (See table 10.)

 

13District Injured Support Coordinators may also provide support to Reserve and Active 

Duty Marines in remote locations away from military or other federal resources.
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Table 10: Marine Corps Wounded Warrior Regiment Enrollment Populations and Characteristics, Fiscal Years 2008 through 

2011

Fiscal year

2008 2009 2010 2011

Program enrollment for Marine Corps Wounded Warrior Regiment

Total enrollmenta,b 810 725 634 2,155

Servicemembers 810 725 634 667

Active Duty 712 633 494 517

Reservists 98 92 140 150

Veterans served through District Injured Support Coordinatorsc ND ND ND 1,488

Population characteristics

Enrollees with combat-related conditionsd 216 105 115 224

Enrollees with non-combat-related conditionse 594 620 519 443

Enrollees who changed duty status or left the program

Returned to active duty 35 38 84 94

Transitioned to veteran status 149 266 311 366

Left for other reasonse ND ND ND ND

Referrals

Total number of servicemembers referred to the programf ND ND ND ND

Total number of veterans referred to District Injured Support Coordinatorsg ND ND ND ND

Legend: ND indicates that no data are available.

Source: GAO analysis of Marine Corps Wounded Warrior Regiment data.

a

According to a Wounded Warrior Regiment official, the Wounded Warrior Regiment does not have 

“enrollees,” rather the program assigns and attaches Marines to the program.

b

Total enrollment does not include Wounded Warrior Regiment enrollees who are not assigned or 

attached to a Wounded Warrior Regiment site. Many wounded, ill, and injured Marines are supported 

by the Wounded Warrior Regiment while remaining with their parent unit.

c

The District Injured Support Coordinators provide outreach and services to Reserve and veteran 

Marines located across the country.

d

The data in this category do not include Marines attached to the Wounded Warrior Regiment who 

may have been wounded, fallen ill, or injured in a combat zone, but who were not medically 

evacuated from a combat zone.

e

Although the Wounded Warrior Regiment was not able to provide data on the number of enrollees 

who left the Wounded Warrior Regiment for reasons other than returning to duty or transitioning to 

veteran status, according to a Wounded Warrior Regiment official, Marines attached to the Wounded 

Warrior Regiment have left the program for other reasons such as death or as a result of military legal 

actions taken against the Marine.

f

According to a Marine Corps Wounded Warrior Regiment official, although a policy exists requiring 

referral information to be collected, the policy was not always enforced. According to this official, as of 

fiscal year 2012, the data are routinely collected.

g

According to a Marine Corps Wounded Warrior Regiment official, the District Injured Support 

Coordinators initially served veterans on an ad hoc basis, so referral information was not collected.
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The United States Special Operations Command established the Care 

Coalition in August 2005 to track, support, and advocate for Special 

Operations Force’s wounded, ill, and injured servicemembers regardless 

of their duty status or whether their conditions are combat-related. (See 

table 11.) All enrollees are assigned an Advocate and are entitled to 

advocate services for life. Advocates assist enrollees with health care and 

financial benefits, transition processes, and link enrollees with needed 

government and nongovernment resources. Because the United States 

Special Operations Command’s Care Coalition serves servicemembers 

from across the military services, it serves as a liaison with, and 

complements, the military services’ wounded warrior programs. United 

States Special Operations Command’s Care Coalition enrollees are often 

concurrently enrolled in their own military service’s wounded warrior 

program. However, according to a Care Coalition official, the Care 

Coalition serves as the lead program for case management and care 

coordination for dually enrolled servicemembers.

United States Special 

Operations Command’s 

Care Coalition 
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Table 11: United States Special Operations Command’s Care Coalition Enrollment Populations and Characteristics, Fiscal 

Years 2008 through 2011

Fiscal year

2008 2009 2010 2011

Program enrollment for United States Special Operations Command’s Care Coalition

Total enrollmenta 2,277b 2,532b 3,447 4,570

Servicemembers 1,594 1,741 2,475 3,518

National Guard 113 127 154 228

Reservists 193 196 206 232

Veterans 654 722 838 893

Othersc 152 192 262 287

Population characteristics

Enrollees with combat-related conditionsd 1,693 1,803 2,415 2,879

Enrollees with non-combat-related conditionsd 736 839 1,256 1,859

Enrollees who changed duty status

Returned to active dutye 31 32 38 46

Transitioned to veteran statuse 4 23 24 48

Referrals

Total number of servicemembers referred to the programf ND ND ND ND

Total number of veterans referred to the programf ND ND ND ND

Legend: ND indicates that no data are available.

Source: GAO analysis of United States Special Operations Command’s Care Coalition data.

a

Enrollees of the United States Special Operations Command’s Care Coalition Recovery Program 

may also be enrolled in a military service’s wounded warrior program on the basis of their branch of 

service, but the United States Special Operations Command’s Care Coalition Recovery Program 

takes the lead for providing nonclinical case management.

b

According to a United States Special Operations Command’s Care Coalition official, because of a 

change in the data system used to track enrollment, enrollment numbers provided for fiscal year 2008 

include enrollees served by the program between October 1, 2007, and May 28, 2009. Enrollment 

numbers provided for fiscal year 2009 include an additional 255 servicemembers and veterans who 

enrolled in the program between May 28, 2009, and September 30, 2009.

c

Others enrolled include civilians, surviving family members, and records with unknown information. 

According to a United States Special Operations Command’s Care Coalition official, the program 

continues to provide and track services to surviving family members after an enrolled servicemember 

or veteran has died.

d

According to a United States Special Operations Command’s Care Coalition official, data provided 

on enrollees with either combat- or non-combat-related conditions also include some servicemembers 

who were either killed in action or died while enrolled in the program, and therefore were excluded 

from the total enrollment data. In addition, officials stated that the exact count for non-combat-related 

conditions may not be accurate, due to inaccuracies in record keeping.

e

According to a United States Special Operations Command’s Care Coalition official, the program did 

not begin tracking enrollee transition status and transition dates in an accessible format until January 

2012. Therefore, information about the duty status and transition status is being updated by hand as 

an individual record is reviewed by program personnel, and the information provided may not be 

accurate.
Appendix I: Enrollment and Populations for 

Select Department of Defense and Department 

of Veterans Affairs Programs

Page 70 GAO-13-5 Recovering Servicemembers and Veterans

f

According to a United States Special Operations Command’s Care Coalition official, the program has 

several methods of receiving referrals, but its primary source of referrals comes from casualty reports. 

The program does not track referral information because the Care Coalition does not have a field in 

its database to track this information. However, this official said that the Care Coalition could access 

this information by contacting the military services.

VA operates a number of case management and care coordination 

programs that provide assistance to recovering servicemembers and 

veterans, including the Operation Enduring Freedom/Operation Iraqi 

Freedom/Operation New Dawn (OEF/OIF/OND) Care Management 

Program and the Federal Recovery Coordination Program (FRCP).14

These two programs assist wounded servicemembers and veterans to 

navigate the recovery care continuum.

The OEF/OIF/OND Care Management Program was established in March 

2007 to provide case management to wounded, ill, and injured 

servicemembers and veterans who screen positive for the need for case 

management or request case management services. (See table 12). 

Each of VA’s 152 Medical Centers (VAMC) has an OEF/OIF/OND Care 

Management team in place to manage patient care activities and ensure 

that servicemembers and veterans are receiving patient-centered, 

integrated care and benefits. Members of the OEF/OIF/OND Care 

Management team include: a Program Manager, Clinical Case Managers, 

and a Transition Patient Advocate.

 

14In addition, the Department of Veterans Affairs operates other dedicated programs and 

systems of care including Polytrauma/Traumatic Brain Injury, Spinal Cord Injury and 

Diseases, Visual Impairment, and Mental Health that provide specialized lifelong clinical 

care and care management for these special cohorts of veterans.

VA Case Management 

and Care 

Coordination 

Programs

OEF/OIF/OND Care 

Management Program
Appendix I: Enrollment and Populations for 

Select Department of Defense and Department 

of Veterans Affairs Programs

Page 71 GAO-13-5 Recovering Servicemembers and Veterans

Table 12: Operation Enduring Freedom/Operation Iraqi Freedom/ Operation New Dawn (OEF/OIF/OND) Care Management 

Program Enrollment Populations and Characteristics, Fiscal Years 2008 through 2011

Fiscal year

2008a 2009a 2010 2011

Total enrollmentb 2,463 7,048 49,145 50,255

Servicemembersc 152 590 2,069 2,505

Veterans 1,136 4,212 31,831 29,848

Othersd 1,175 2,246 15,245 17,902

Population characteristics

Enrollees with combat-related conditionse 1,214 2, 470 7,165 6,898

Enrollees with non-combat-related conditionsf 212 676 3,115 3,188

Enrollees with conditions not classified as either combat- or non-combat-relatedg 200 880 4,820 4,072

Referrals

Total number of servicemembers and veterans referred to the program by 

military treatment facilitiesh 2,130 4,474 7,172 6,686

Source: GAO analysis of OEF/OIF/OND Care Management Program data.

a

According to OEF/OIF/OND Care Management Program officials, 2008 and 2009 data only include 

severely wounded, ill, and injured because the database only tracked this subpopulation of the 

program, which was the initial focus of the program’s efforts. This population included, for example, 

those with severe burns, amputations, spinal cord injuries, or blindness, or more than one of these. 

Soon after the program was initiated, the Department of Veterans Affairs found that people returning 

from the conflicts in Iraq and Afghanistan required additional support, regardless of the severity of 

their injuries or illnesses. Therefore, policy was changed and the OEF/OIF/OND Care Management 

Program began tracking data on all those receiving case management services through their 

program.

b

Total enrollment includes those who serve or served in National Guard and Reserve Components.

c

The OEF/OIF/OND Care Management Program primarily serves veterans. Some servicemembers 

who are receiving treatment through a VA facility may also be enrolled in the program.

d

Others include enrollees with unknown military status.

e

Includes enrollees with battle injuries. According to OEF/OIF/OND Care Management Program 

officials, battle injuries are injuries sustained while in combat, such as a wound from an improvised 

explosive device.

f

Includes enrollees with nonbattle injuries. According to OEF/OIF/OND Care Management Program 

officials, nonbattle injuries can include injuries sustained in a combat zone that are not directly related 

to combat.

g

Includes enrollees with illnesses that may be classified as either combat-related or non-combatrelated. According to OEF/OIF/OND Care Management Program officials, the program tracks whether 

an enrollee’s condition is a battle injury or a nonbattle injury, but not whether an illness is related to 

combat.

h

According to OEF/OIF/OND Care Management Program officials, servicemembers and veterans are 

either referred to the program by a military treatment facility or are screened into the program when a 

servicemember or veteran initially seeks VA services at a VA treatment facility.
Appendix I: Enrollment and Populations for 

Select Department of Defense and Department 

of Veterans Affairs Programs

Page 72 GAO-13-5 Recovering Servicemembers and Veterans

The FRCP was established in January 2008. Developed as a joint 

program by DOD and VA, but administered by VA, the program was 

designed to provide care coordination services to servicemembers and 

veterans who were “severely” wounded, ill, and injured after September 

11, 2001. (See table 13.) The program uses federal recovery coordinators 

to monitor and coordinate clinical services, including facilitating and 

coordinating medical appointments, and nonclinical services, such as 

providing assistance with obtaining financial benefits or special 

accommodations, needed by program enrollees and their families. 

Federal recovery coordinators serve as the single point of contact among 

all of the case managers of DOD, VA, and other governmental and 

private case management programs that provide services directly to 

servicemembers and veterans.

FRCP 
Appendix I: Enrollment and Populations for 

Select Department of Defense and Department 

of Veterans Affairs Programs

Page 73 GAO-13-5 Recovering Servicemembers and Veterans

Table 13: Federal Recovery Coordination Program (FRCP) Enrollment Populations and Characteristics, Fiscal Years 2008 

through 2011

Fiscal year

2008 2009 2010 2011

Program enrollment for the FRCP

Total enrollment 177 522 823 1,022

Servicemembers 132 325 394 573

National Guarda 11 51 84 87

Reservistsa 7 30 45 63

Veterans 43 194 429 449

Others 2 3 0 0 

Population characteristics

Enrollees with combat-related conditions ND ND ND ND

Enrollees with non-combat-related conditions ND ND ND ND

Enrollees with conditions not classified as either combat- or non-combat-related ND ND ND ND

Referrals and assists

Total number of servicemembers referred to the program 179 257 268 362

Servicemembers referred and enrolled in the program 132 194 222 293

Servicemembers referred and assisted, but not enrolled in the program ND ND ND ND

Servicemembers referred but not enrolled in or assisted by the program 47 63 46 68

Total number of veterans referred to the program 44 171 165 119

Veterans referred and enrolled in the program 43 155 150 66

Veterans referred and assisted, but not enrolled in the program ND ND ND ND

Veterans referred but not enrolled in or assisted by the program 1 16 15 53

Legend: ND indicates that no data are available.

Source: GAO analysis of FRCP data.

a

According to an FRCP official, the total number of servicemembers who are active duty cannot be 

delineated because the National Guard and Reservist numbers are descriptive data points and do not 

designate whether the enrollee is active duty or veteran. In addition, not all National Guard and 

Reservists are included in the data due to database limitations that have since been resolved.
Appendix I: Enrollment and Populations for 

Select Department of Defense and Department 

of Veterans Affairs Programs

Page 74 GAO-13-5 Recovering Servicemembers and Veterans

DOD and VA case management and care coordination programs 

primarily identify servicemembers and veterans who may be eligible for 

enrollment through referrals. Tracking referral information, including the 

number of those who were referred and enrolled or not enrolled in the 

program, may indicate whether the programs are identifying those who 

could benefit from their services. However, fewer than half of the DOD 

and VA case management and care coordination programs that we 

reviewed track this type of referral information. (See table 14.)

Referral Information 

Tracked by DOD and 

VA Case Management 

and Care 

Coordination 

Programs
Appendix I: Enrollment and Populations for 

Select Department of Defense and Department 

of Veterans Affairs Programs

Page 75 GAO-13-5 Recovering Servicemembers and Veterans

Table 14: Referral Information Routinely Tracked by DOD and VA Case Management and Care Coordination Programs

Program

Referral information 

routinely tracked Types of referral information tracked, if any

Army

Army Warrior Care and Transition Program: 

Warrior Transition Units and CommunityBased Warrior Transition Units

√ Referral sources for program enrollees

Army Warrior Care and Transition Program: 

Army Wounded Warrior Program

√ Total number of referrals made to the program

Number of those referred to the program who were 

enrolled into the program

Number of those referred to the program who were 

enrolled and provided short-term assistance by the 

program, but who were later found ineligible for the 

program and disenrolled

Number of those referred to the program who were not 

enrolled into the program

Navy/Coast Guard

Navy Safe Harbor Program √a Total number of referrals made to the program

Number of those referred to the program who were 

enrolled into the program

Number of those referred to the program who were 

provided short-term assistance by the program, but not 

enrolled

Number of those referred to the program who were not 

enrolled into the program or provided short-term 

assistance by the program

Air Force

Air Force Wounded Warrior Program According to Air Force Wounded Warrior Program 

officials, since the program only serves servicemembers 

with combat-related conditions, most referrals come 

from casualty reports and the disability evaluation 

process, where it is determined whether a 

servicemember’s wound, illness, or injury is combatrelated.

Air Force Recovery Care Program None

Marine Corps

Marine Corps Wounded Warrior Regiment According to a Marine Corps Wounded Warrior 

Regiment official, although a policy exists requiring 

referral information to be collected, the policy was not 

always enforced.b

United States Special Operations Command
Appendix I: Enrollment and Populations for 

Select Department of Defense and Department 

of Veterans Affairs Programs

Page 76 GAO-13-5 Recovering Servicemembers and Veterans

Program

Referral information 

routinely tracked Types of referral information tracked, if any

United States Special Operations 

Command’s Care Coalition

According to a United States Special Operations 

Command’s Care Coalition official, the program does 

not track referral information because there is no field in 

its database to track this information. However, 

according to this official, the program is able to access 

this information from the individual military services.

Department of Veterans Affairs

Operation Enduring Freedom/Operation Iraqi 

Freedom/Operation New Dawn Care 

Management Program

√ Total number of referrals made to the program from 

military treatment facilities

Federal Recovery Coordination Program √ Total number of referrals made to the program

Number of those referred to the program who were 

enrolled into the program

Number of those referred to the program who were 

provided short-term assistance by the program, but not 

enrolled

Number of those referred to the program who are not 

enrolled into the program or provided short-term 

assistance by the program

Source: GAO analysis of DOD and VA data.

a

According to a Navy Safe Harbor Program official, the database used to track referral information did 

not capture accurate data until it was upgraded in 2010.

b

According to a Marine Corps Wounded Warrior Program official, as of fiscal year 2012, data on 

referral information are routinely collected.
Appendix II: Medical Category Assignment 

Process for Care Coordination Programs

Page 77 GAO-13-5 Recovering Servicemembers and Veterans

The Senior Oversight Committee intended for the Federal Recovery 

Coordination Program (FRCP) and the Recovery Coordination Program 

(RCP) to be complementary programs, specifically identifying which 

population of wounded, ill, and injured servicemembers would be 

assigned to the two programs. On the basis of work done for the 

committee, the Department of Defense (DOD) sent a report to 

congressional committees in 2008 outlining a medical category 

assignment process based on the severity of each servicemember’s 

medical condition, along with input from the servicemember and his or her 

unit commander, to determine whether servicemembers would be 

directed either to the FRCP or to the RCP programs for care coordination 

services. 

In concept, the medical category assignment process would have 

resulted in wounded, injured, or ill servicemembers being assigned to one 

of three categories. Servicemembers designated as Category 1 were 

those who were found to have mild injury or illness, who were expected to 

return to duty in less than 180 days of medical treatment, and primarily 

received local outpatient and short-term inpatient treatment and 

rehabilitation. Servicemembers designated as Category 2 were those with 

serious injury or illness, who were unlikely to return to duty in less than 

180 days, and may be medically separated from the military.1

Servicemembers designated as Category 3 were those with severe injury 

or illness, who were highly unlikely to return to duty, and were most likely 

to be medically separated from the military. The category designation was 

intended to be used to determine whether the recovering servicemember 

was subsequently referred to a care coordination program, in that 

Category 1 servicemembers would not be referred to a care coordination 

program, unless their medical or psychological conditions worsen; 

Category 2 servicemembers would be referred to the RCP; and 

Category 3 servicemembers would be referred to the FRCP. (See fig. 3.)

 

1

DOD subsequently modified the 180-day criteria to “within a time specified by his or her 

military department” to accommodate different standards used by the Marine Corps and 

the Army.

Appendix II: Medical Category Assignment 

Process for Care Coordination Programs
Appendix II: Medical Category Assignment 

Process for Care Coordination Programs

Page 78 GAO-13-5 Recovering Servicemembers and Veterans

Figure 3: The Department of Defense’s Vision of the Assignment Process for the Recovery Coordination Program and the 

Federal Recovery Coordination Program

Note: In this figure, solid arrows indicate typical or expected results and dashed arrows indicate 

alternative, but possible, outcomes.
Appendix III: Comments from the Department 

of Defense

Page 79 GAO-13-5 Recovering Servicemembers and Veterans

Appendix III: Comments from the 

Department of Defense 
Appendix III: Comments from the Department 

of Defense

Page 80 GAO-13-5 Recovering Servicemembers and Veterans
Appendix III: Comments from the Department 

of Defense

Page 81 GAO-13-5 Recovering Servicemembers and Veterans
Appendix III: Comments from the Department 

of Defense

Page 82 GAO-13-5 Recovering Servicemembers and Veterans
Appendix III: Comments from the Department 

of Defense

Page 83 GAO-13-5 Recovering Servicemembers and Veterans
Appendix III: Comments from the Department 

of Defense

Page 84 GAO-13-5 Recovering Servicemembers and Veterans
Appendix IV: Comments from the Department 

of Veterans Affairs

Page 85 GAO-13-5 Recovering Servicemembers and Veterans

Appendix IV: Comments from the 

Department of Veterans Affairs
Appendix IV: Comments from the Department 

of Veterans Affairs

Page 86 GAO-13-5 Recovering Servicemembers and Veterans
Appendix IV: Comments from the Department 

of Veterans Affairs

Page 87 GAO-13-5 Recovering Servicemembers and Veterans
Appendix IV: Comments from the Department 

of Veterans Affairs

Page 88 GAO-13-5 Recovering Servicemembers and Veterans
Appendix IV: Comments from the Department 

of Veterans Affairs

Page 89 GAO-13-5 Recovering Servicemembers and Veterans
Appendix IV: Comments from the Department 

of Veterans Affairs

Page 90 GAO-13-5 Recovering Servicemembers and Veterans
Appendix IV: Comments from the Department 

of Veterans Affairs

Page 91 GAO-13-5 Recovering Servicemembers and Veterans
Appendix V: GAO Contact and Staff 

Acknowledgments

Page 92 GAO-13-5 Recovering Servicemembers and Veterans

Randall B. Williamson, (202) 512-7114 or williamsonr@gao.gov

In addition to the contact name above, Bonnie Anderson, Assistant 

Director; Mark Bird, Assistant Director; Michele Grgich, Assistant Director; 

Jennie Apter; Frederick Caison; Heather Collins; Dan Concepcion; 

Melissa Jaynes; Deitra Lee; Mariel Lifshitz; Lisa Motley; Elise Pressma; 

and Greg Whitney made key contributions to this report.

Appendix V: GAO Contact and Staff 

Acknowledgments 

GAO Contact

Staff 

Acknowledgments 
Related GAO Products

Page 93 GAO-13-5 Recovering Servicemembers and Veterans

Military Disability System: Improved Monitoring Needed to Better Track 

and Manage Performance. GAO-12-676. Washington, D.C.: August 28, 

2012.

Military Disability System: Preliminary Observations on Efforts to Improve 

Performance. GAO-12-718T. Washington, D.C.: May 23, 2012.

More Efficient and Effective Government: Opportunities to Reduce 

Duplication, Overlap and Fragmentation, Achieve Savings, and Enhance 

Revenue. GAO-12-449T. Washington, D.C.: February 28, 2012.

2012 Annual Report: Opportunities to Reduce Duplication, Overlap and 

Fragmentation, Achieve Savings, and Enhance Revenue. 

GAO-12-342SP. Washington, D.C.: February 28, 2012.

DOD and VA Health Care: Action Needed to Strengthen Integration 

across Care Coordination and Case Management Programs. 

GAO-12-129T. Washington, D.C.: October 6, 2011.

VA and DOD Health Care: First Federal Health Care Center Established, 

but Implementation Concerns Need to Be Addressed. GAO-11-570. 

Washington, D.C.: July 19, 2011.

Federal Recovery Coordination Program: Enrollment, Staffing, and Care 

Coordination Pose Significant Challenges. GAO-11-572T. Washington, 

D.C.: May 13, 2011.

Information Technology: Department of Veterans Affairs Faces Ongoing 

Management Challenges. GAO-11-663T. Washington, D.C.: May 11, 

2011.

Military and Veterans Disability System: Worldwide Deployment of 

Integrated System Warrants Careful Monitoring. GAO-11-633T. 

Washington, D.C.: May 4, 2011.

DOD and VA Health Care: Federal Recovery Coordination Program 

Continues to Expand but Faces Significant Challenges. GAO-11-250. 

Washington, D.C.: March 23, 2011.

Electronic Health Records: DOD and VA Should Remove Barriers and 

Improve Efforts to Meet Their Common System Needs. GAO-11-265. 

Washington, D.C.: February 2, 2011.

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Related GAO Products

Page 94 GAO-13-5 Recovering Servicemembers and Veterans

Military and Veterans Disability System: Pilot Has Achieved Some Goals, 

but Further Planning and Monitoring Needed. GAO-11-69. Washington, 

D.C.: December 6, 2010.

Military and Veterans Disability System: Preliminary Observations on 

Evaluation and Planned Expansion of DOD/VA Pilot. GAO-11-191T. 

Washington, D.C.: November 18, 2010.

Electronic Health Records: DOD and VA Interoperability Efforts Are 

Ongoing; Program Office Needs to Implement Recommended 

Improvements. GAO-10-332. Washington, D.C.: January 28, 2010.

Electronic Health Records: DOD and VA Efforts to Achieve Full 

Interoperability Are Ongoing; Program Office Management Needs 

Improvement. GAO-09-775. Washington, D.C.: July 28, 2009.

Recovering Servicemembers: DOD and VA Have Jointly Developed the 

Majority of Required Policies but Challenges Remain. GAO-09-728. 

Washington, D.C.: July 8, 2009.

Recovering Servicemembers: DOD and VA Have Made Progress to 

Jointly Develop Required Policies but Additional Challenges Remain. 

GAO-09-540T. Washington, D.C.: April 29, 2009.

Army Health Care: Progress Made in Staffing and Monitoring Units that 

Provide Outpatient Case Management, but Additional Steps Needed. 

GAO-09-357. Washington, D.C.: April 20, 2009.

Electronic Health Records: DOD’s and VA’s Sharing of Information Could 

Benefit from Improved Management. GAO-09-268. Washington, D.C.: 

January 28, 2009.

Electronic Health Records: DOD and VA Have Increased Their Sharing of 

Health Information, but More Work Remains. GAO-08-954. Washington, 

D.C.: July 28, 2008.

DOD and VA: Preliminary Observations on Efforts to Improve Care 

Management and Disability Evaluations for Servicemembers. 

GAO-08-514T. Washington, D.C.: February 27, 2008.

DOD and VA: Preliminary Observations on Efforts to Improve Health Care 

and Disability Evaluations for Returning Servicemembers. 

GAO-07-1256T. Washington, D.C.: September 26, 2007.
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Page 95 GAO-13-5 Recovering Servicemembers and Veterans

DOD and VA Health Care: Challenges Encountered by Injured 

Servicemembers during Their Recovery Process. GAO-07-589T. 

Washington, D.C.: March 5, 2007.

(290934)
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