GAO 

United States Government Accountability Office

Report to Congressional Committees

RECOVERING 

SERVICEMEMBERS 

DOD and VA Have 

Jointly Developed the 

Majority of Required 

Policies but 

Challenges Remain 

July 2009 

GAO-09-728 
What GAO Found

United States Government Accountability Office

Why GAO Did This Study

Highlights

Accountability Integrity Reliability

July 2009

RECOVERING SERVICEMEMBERS 

DOD and VA Have Jointly Developed the Majority of 

Required Policies but Challenges Remain 

Highlights of GAO-09-728, a report to 

congressional committees 

The National Defense 

Authorization Act for Fiscal Year 

2008 (NDAA 2008) requires the 

Departments of Defense (DOD) 

and Veterans Affairs (VA) to jointly 

develop and implement 

comprehensive policies on the 

care, management, and transition 

of recovering servicemembers. The 

Wounded, Ill, and Injured Senior 

Oversight Committee (SOC)—

jointly chaired by DOD and VA 

leadership—has assumed 

responsibility for these policies. 

The NDAA 2008 also requires GAO 

to report on the progress DOD and 

VA make in jointly developing and 

implementing the policies. This 

report focuses on the joint 

development of the policies. 

Implementation of the policies will 

be addressed in future reports. 

Specifically, this report provides 

information on (1) the progress 

DOD and VA have made in jointly 

developing the comprehensive 

policies required by the NDAA 2008 

and (2) the challenges DOD and VA 

are encountering in the joint 

development of these policies. 

GAO determined the current status 

of policy development by assessing 

the status reported by SOC officials 

and analyzing supporting 

documentation. To identify 

challenges, GAO interviewed the 

Acting Under Secretary of Defense 

for Personnel and Readiness, the 

Executive Director and Chief of 

Staff of the SOC, the departmental 

co-leads for most of the SOC work 

groups, the Acting Director of 

DOD’s Office of Transition Policy 

and Care Coordination, and other 

knowledgeable officials. 

DOD and VA have made substantial progress in jointly developing policies 

required by sections 1611 through 1614 of the NDAA 2008 in the areas of 

(1) care and management, (2) medical and disability evaluation, (3) return to 

active duty, and (4) transition of care and services received from DOD to VA. 

Overall, GAO’s analysis showed that as of April 2009, 60 of the 76 policy 

requirements GAO identified have been completed and the remaining 16 

policy requirements are in progress. DOD and VA have completed all of the 

policy development requirements for medical and physical disability 

evaluations, including issuing a report on the feasibility and advisability of 

consolidating the DOD and VA disability evaluation systems, although the 

pilot for this approach is still ongoing. DOD has also completed establishing 

standards for returning recovering servicemembers to active duty. More than 

two-thirds of the policy development requirements have been completed for 

the remaining two policy areas—care and management and the transition of 

recovering servicemembers from DOD to VA. Most of these requirements 

were addressed in a January 2009 DOD memorandum that was developed in 

consultation with VA. DOD officials reported that more information will be 

provided in a subsequent policy instruction, which is to be issued in August 

2009. VA also plans to issue related policy guidance in the fourth quarter of 

2009. 

DOD and VA officials told GAO that they have experienced numerous 

challenges as they worked to jointly develop policies to improve the care, 

management, and transition of recovering servicemembers. According to 

officials, these challenges contributed to the length of time required to issue 

policy guidance, and in some cases the challenges have not yet been 

completely resolved. For example, the SOC must still standardize key 

terminology relevant to policy issues affecting recovering servicemembers. 

DOD and VA agreement on key definitions for what constitutes “mental 

health,” for instance, is important for developing policies that define the 

scope, eligibility, and service levels for recovering servicemembers. Recent 

changes affecting the SOC may also pose future challenges to policy 

development. Some officials have expressed concern that DOD’s recent 

changes to staff supporting the SOC have disrupted the unity of command 

because SOC staff now report to three different officials within DOD and VA. 

However, it is too soon to determine how well DOD’s staffing changes will 

work. Additionally, according to DOD and VA officials, the SOC’s scope of 

responsibilities appears to be in flux. While the SOC will remain responsible 

for policy matters for recovering servicemembers, a number of policy issues 

may now be directed to the DOD and VA Joint Executive Council. Despite this 

uncertainty, DOD and VA officials told GAO that the SOC’s work groups 

continue to carry out their roles and responsibilities. 

GAO provided a draft of this report to DOD and VA for comment. VA provided 

technical comments, which GAO incorporated as appropriate. DOD and VA 

did not provide other comments. 

View GAO-09-728 or key components.

For more information, contact Randall B. 

Williamson at (202) 512-7114 or 

williamsonr@gao.gov. 
Page i GAO-09-728 

Contents 

Letter 1

Background 4

DOD and VA Have Completed the Majority of the Requirements to 

Jointly Develop Policies on Care and Management, Medical and 

Disability Evaluation, Return to Active Duty, and the Transition 

from DOD to VA 10

DOD and VA Officials Experienced Challenges during Joint 

Development of Required Policies 17

Agency Comments and Our Evaluation 22

Appendix I Summary of Selected Requirements from the 

National Defense Authorization Act for Fiscal 

Year 2008 25 

Appendix II GAO Contact and Staff Acknowledgments 32 

Tables 

Table 1: Overview of the Senior Oversight Committee’s Lines of 

Action (LOA) 7

Table 2: Summary of the NDAA 2008 Requirements to Jointly 

Develop Comprehensive Policy for Improving Care and 

Management, Medical and Disability Evaluation, Return-toDuty Decisions, and Transition of Recovering 

Servicemembers in Sections 1611 through 1614 8

Table 3: Summary of Status of DOD and VA Progress to Jointly 

Develop Policy for Improving Care and Management, 

Medical and Disability Evaluation, Return-to-Duty 

Decisions, and Transition of Recovering Servicemembers 

Required by the NDAA 2008 Sections 1611 through 1614, as 

of April 2009 10

Table 4: Status of Requirements to Address the Care and 

Management of Recovering Servicemembers, as of April 

2009 11

Table 5: Status of Requirements to Address the Medical Evaluation 

and Disability Evaluation of Recovering Servicemembers, 

as of April 2009 13

Table 6: Status of Requirement to Address the Standards for 

Return-to-Duty Decisions, as of April 2009 14

 DOD and VA Joint Policy Development 
Table 7: Status of Requirements to Address the Transition of 

Recovering Servicemembers, as of April 2009 16

Table 8: Requirements to Address the Care and Management of 

Recovering Servicemembers, as Outlined in Section 

1611(a)(2)(A), with Specific Requirements Enumerated in 

Section 1611 25

Table 9: Requirements to Address the Medical and Disability 

Evaluations of Recovering Servicemembers, as Outlined in 

Section 1611(a)(2)(B), with Specific Requirements 

Enumerated in Section 1612 28

Table 10: Requirement to Address Standards for Return-to-Duty 

Decisions, as Outlined in Section 1611(a)(2)(C), with 

Specific Requirements Enumerated in Section 1613 29

Table 11: Requirements to Address the Transition of Recovering 

Servicemembers, as Outlined in Section 1611(a)(2)(D), 

with Specific Requirements Enumerated in Section 1614 30

Abbreviations 

DOD Department of Defense 

DTM Directive-Type Memorandum 

IPO Interagency Program Office 

LOA Lines of Action 

NDAA 2008 National Defense Authorization Act for Fiscal Year 2008 

OEF Operation Enduring Freedom 

OIF Operation Iraqi Freedom 

PTSD post-traumatic stress disorder 

SOC Wounded, Ill, and Injured Senior Oversight Committee 

TBI traumatic brain injury 

VA Department of Veterans Affairs 

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Page ii GAO-09-728 DOD and VA Joint Policy Development
Page 1 GAO-09-728 

 

United States Government Accountability Office

Washington, DC 20548 

 

July 8, 2009 

Congressional Committees 

Over 1.6 million U.S. troops have deployed in Operation Enduring 

Freedom (OEF) and Operation Iraqi Freedom (OIF) since October 2001.1,2

In May 2009, the Department of Defense (DOD) reported that over 34,000 

servicemembers have been wounded in action since the onset of these 

conflicts.3

 Because of improved battlefield medicine, those who might 

have died in past conflicts are now surviving, many with multiple serious 

injuries such as amputations, traumatic brain injury (TBI), and posttraumatic stress disorder (PTSD). Beyond adjusting to their injuries, 

recovering servicemembers may face additional challenges, including 

difficulties managing their outpatient recovery process, difficulties 

navigating the military’s disability evaluation system, and problems 

transitioning between care provided by DOD and care provided by the 

Department of Veterans Affairs (VA). 

Questions were raised in the media and by Congress about whether DOD 

and VA are prepared to meet the needs of the increasing number of 

recovering servicemembers and veterans. In February 2007, a series of 

Washington Post articles disclosed deficiencies in the provision of 

outpatient services at Walter Reed Army Medical Center, including poor 

living conditions at Walter Reed, a confusing disability evaluation system, 

and servicemembers remaining in outpatient status for months and 

sometimes years without a clear understanding about their plan of care or 

the future of their military service. Various review groups investigated the 

challenges that DOD and VA faced in providing care to recovering 

servicemembers and made a number of recommendations to address the 

problems they identified. Shortly after the media disclosures, we testified 

1

Terri Tanielian and Lisa H. Jaycox, Invisible Wounds of War, Psychological and Cognitive 

Injuries, Their Consequences, and Services to Assist Recovery (Santa Monica, Calif.: 

RAND Corporation, 2008). 

2

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

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

other locations. 

3

DOD, Operation Iraqi Freedom (OIF) U.S. Casualty Status, Operation Enduring 

Freedom (OEF) U.S. Casualty Status, www.defenselink.mil/news/casualty.pdf. (accessed 

May 14, 2009). 

 DOD and VA Joint Policy Development 
 

about the challenges facing recovering servicemembers during their 

recovery process.4

In May 2007, DOD and VA established the Wounded, Ill, and Injured Senior 

Oversight Committee (SOC) to address the problems that had been 

identified with the care of recovering servicemembers.5

 The committee is 

co-chaired by the Deputy Secretaries of DOD and VA and includes military 

service Secretaries and other high-ranking officials within both 

departments. One of the SOC’s primary responsibilities is to oversee the 

development of policies in response to the recommendations of the review 

groups that studied the issues associated with recovering servicemembers’ 

health care and benefits. SOC officials sign and issue interim policy 

guidance, which is then developed by DOD and VA into finalized policies. 

Although DOD and VA consider the SOC’s policies to be official, in this 

report we refer to them as interim because they must still be finalized and 

implemented by DOD and VA. 

The National Defense Authorization Act for Fiscal Year 2008 (NDAA 2008), 

which was enacted in January 2008, requires DOD and VA, to the extent 

feasible, to jointly develop and implement a comprehensive policy on 

improvements to the care, management, and transition of recovering 

servicemembers.6

 Specifically, section 1611(a) of the NDAA 2008 directs 

DOD and VA to cover four key areas—(1) care and management, 

(2) medical evaluation and disability evaluation, (3) the return of 

servicemembers to active duty, and (4) the transition of recovering 

servicemembers from DOD to VA. Because of the related ongoing work of 

the SOC, it assumed responsibility for addressing these requirements. The 

NDAA 2008 also requires that we report on the progress DOD and VA 

make in developing and implementing the comprehensive policy.7

 This 

report is focused on the status of the development of the comprehensive 

policy, which includes the development of multiple policies that are 

further enumerated in sections 1611 through 1614 of the law. 

 

4

GAO, DOD and VA Health Care: Challenges Encountered by Injured Servicemembers 

during Their Recovery Process, GAO-07-589T (Washington, D.C.: Mar. 5, 2007) and DOD 

and VA Health Care: Challenges Encountered by Injured Servicemembers during Their 

Recovery Process, GAO-07-606T (Washington, D.C.: Mar. 8, 2007). 

5

For this report, hereafter, we refer to the Wounded, Ill, and Injured Senior Oversight 

Committee as the Senior Oversight Committee. 

6

Pub. L. No. 110-181, 122 Stat. 3. 

7

Pub. L. No. 110-181, § 1615(d), 122 Stat. 3, 447. 

Page 2 GAO-09-728 DOD and VA Joint Policy Development
 

Implementation of the policies will be addressed in a series of future 

reports. 

Specifically, we assessed (1) the progress DOD and VA have made in 

jointly developing comprehensive policies for recovering servicemembers 

in the areas of care and management, medical and disability evaluation, 

return to active duty, and transition from care and services received from 

DOD to VA as required by sections 1611 through 1614 of the NDAA 2008 

and (2) the challenges DOD and VA are encountering in the joint 

development of these policies. We testified on these issues on April 29, 

2009, before the Personnel Subcommittee of the Senate Armed Services 

Committee.8

To assess the extent to which DOD and VA have made progress in 

developing the required policies, we asked SOC representatives to report 

on the status of policy development for the 76 individual requirements that 

we identified in sections 1611 through 1614 of the NDAA 2008, which we 

grouped into 14 categories.9

 (See app. I for a summary of these 

requirements and categories.) We also asked the SOC representatives to 

provide documentation to substantiate the status of each requirement, and 

we verified the reported status of each requirement by reviewing this 

documentation. We determined whether each of the requirements (1) had 

been completed, (2) was in progress, or (3) had not been acted upon. We 

considered a requirement to have been “completed” if a document had 

been signed and approved by DOD, VA, or both, at the SOC level, that 

contained standards, guidelines, or procedures that addressed the 

requirement, even if DOD, VA, or both plan to issue additional policies on 

the subject.10 We considered a requirement to be “in progress” if 

documentation demonstrated that work had been initiated to develop 

standards, guidelines, or procedures that addressed the requirement. We 

considered a requirement not to have been acted upon if no action had 

been taken to develop standards, guidelines, or procedures that addressed 

 

8

GAO, 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). 

9

We defined an individual requirement as a provision within sections 1611 through 1614 

related to the policy required by 1611(a) that directs DOD, VA, or both to take a specific 

action or to include a specific criterion in their policy. The SOC’s legal counsel reviewed 

these requirements and our groupings, and agreed with our approach. 

10Completed policy guidance also included interim policy guidance signed by the SOC. 

Page 3 GAO-09-728 DOD and VA Joint Policy Development
 

the requirement. We based our review in part on the interim policy 

documents signed by DOD and VA officials working through the SOC. In 

some cases, interim policy documents were signed by officials of both 

departments, and in other cases, the documents were signed by officials of 

one department, depending upon the requirement. Interim policy 

documents could be in the form of memoranda of agreement, memoranda 

of understanding, directives, decision- or directive-type memoranda, 

instructions or policy memoranda, or other guidelines or forms of 

guidance. In addition, we conducted follow-up interviews with DOD and 

VA officials when we needed clarification on the reported progress or 

additional documentation. We did not, however, evaluate the quality of the 

policy documents we reviewed or the extent to which these policies have 

been implemented. To identify the challenges DOD and VA encountered in 

jointly developing the required policies, we interviewed officials from both 

departments to obtain an account of their experiences in the policy 

development process. In conducting our work, we interviewed the Acting 

Under Secretary of Defense for Personnel and Readiness, the Executive 

Director and Chief of Staff of the SOC, the departmental co-leads for most 

of the SOC work groups, the Acting Director of DOD’s Office of Transition 

Policy and Care Coordination, and other knowledgeable DOD and VA 

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 DOD and VA’s progress in jointly developing policies as 

well as the challenges DOD and VA are encountering in developing 

policies. 

We conducted our work from May 2008 through July 2009 in accordance 

with all sections of GAO’s Quality Assurance Framework that are relevant 

to our objectives. The framework requires that we plan and perform the 

engagement to obtain sufficient and appropriate evidence to meet our 

stated objectives and to discuss any limitations in our work. We believe 

that the information and data obtained, and the analysis conducted, 

provide a reasonable basis for any findings and conclusions in this 

product. 

Over the past 8 years, DOD has designated over 34,000 servicemembers 

involved in OEF and OIF as wounded in action. The severity of injuries 

can result in a lengthy process for a patient to either return to duty or to 

transition to veteran status. The most seriously injured servicemembers 

Background 

Page 4 GAO-09-728 DOD and VA Joint Policy Development
 

from these conflicts usually receive care at Walter Reed Army Medical 

Center or the National Naval Medical Center.11 According to DOD officials, 

once they are stabilized and discharged from the hospital, servicemembers 

may relocate closer to their homes or military bases and be treated as 

outpatients by the closest military or VA facility. 

Recovering servicemembers potentially navigate two different disability 

evaluation systems that serve different purposes. DOD’s system serves a 

personnel management purpose by identifying servicemembers who are 

no longer medically fit for duty. If a servicemember is found unfit because 

of medical conditions incurred in the line of duty, the servicemember is 

assigned a disability rating and can be discharged from duty. This 

disability rating, along with years of service and other factors, determines 

subsequent disability and health care benefits from DOD. Under VA’s 

system, disability ratings help determine the level of disability 

compensation a veteran receives and priority status for enrollment for 

health care benefits. To determine eligibility for disability compensation, 

VA evaluates all claimed medical conditions, whether they were evaluated 

previously by the military service’s evaluation process or not. If VA finds 

that a veteran has one or more service-connected disabilities that together 

result in a final rating of at least 10 percent,12 VA will pay monthly 

compensation and the veteran will be eligible to receive a higher priority 

status for health care benefits enrollment. 

Efforts to Address the 

Care and Benefits for 

Recovering 

Servicemembers 

Efforts have been taken to address the deficiencies reported at Walter 

Reed related to the care provided and the transition of recovering 

servicemembers. After the press reports about Walter Reed, several highlevel review groups were established to study the care and benefits 

provided to recovering servicemembers by DOD and VA. In addition, two 

previously-established review groups were already examining related 

issues. The studies produced from all of these groups, released from 

April 2007 through June 2008, contained over 400 recommendations 

covering a broad range of topics, including case management, disability 

 

11These servicemembers may also receive care at Balboa Naval Hospital in San Diego, 

California, or at Brooke Army Medical Center in San Antonio, Texas. 

12VA determines the degree to which veterans are disabled in 10 percent increments on a 

scale of 0 to 100 percent. 

Page 5 GAO-09-728 DOD and VA Joint Policy Development
 

evaluation systems, data sharing between the departments, and the need 

to better understand and diagnose TBI and PTSD.13

In May 2007, DOD and VA established the SOC as a temporary, 1-year 

committee with the responsibility for addressing recommendations from 

these reports. To conduct its work, the SOC established eight work groups 

called lines of action (LOA). Each LOA is co-chaired by representatives 

from DOD and VA and has representation from each military service. LOAs 

are responsible for specific issues, such as disability evaluation systems 

and case management. (See table 1 for an overview of the LOAs.) The 

committee was originally intended to expire May 2008 but it was extended 

to January 2009. Then, the NDAA 2009 extended the SOC through 

December 2009.14

 

13The reports are as follows: Independent Review Group, Rebuilding the Trust: Report on 

Rehabilitative Care and Administrative Processes at Walter Reed Army Medical Center 

and National Naval Medical Center (April 2007); Task Force on Returning Global War on 

Terror Heroes, Report to the President (April 2007); Department of Defense Task Force on 

Mental Health, An Achievable Vision: Report of the Department of Defense Task Force on 

Mental Health (June 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 Inspectors General, Department of Defense, Department of Veterans 

Affairs, DOD/VA Care Transition Process for Service Members Injured in OIF/OEF (June 

2008). 

14Duncan Hunter National Defense Authorization Act for Fiscal Year 2009, Pub. L. No. 110-

417, § 726, 122 Stat. 4356, 4509 (2008). 

Page 6 GAO-09-728 DOD and VA Joint Policy Development
 

Table 1: Overview of the Senior Oversight Committee’s Lines of Action (LOA) 

LOA Responsibilities 

LOA 1: 

Disability Evaluation System 

Addresses efforts to reform the DOD and VA 

disability evaluation systems. 

LOA 2: 

Traumatic Brain Injury (TBI)/Post 

Traumatic Stress Disorder (PTSD) 

Addresses issues related to TBI/PTSD. 

LOA 3: 

Case Management 

Addresses care, management, and transition of 

recovering servicemembers from recovery to 

rehabilitation and reintegration. 

LOA 4: 

DOD/VA Data Sharing 

Addresses issues regarding the electronic 

exchange of DOD and VA health records. 

LOA 5: 

Facilities 

Addresses issues relating to military and VA 

medical facilities. 

LOA 6: 

Clean Sheet Review 

Develops recommendations to improve care 

and benefits without the constraints of existing 

laws, regulations, organizational roles, 

personnel constraints, or budgets.a

LOA 7: 

Legislation and Public Affairs 

Addresses legal and other issues for policy 

development. 

LOA 8: 

Personnel, Pay, and Financial Support 

Addresses compensation and benefit issues. 

Source: GAO analysis of Senior Oversight Committee (SOC) documents and interviews with SOC officials. 

a

As of February 2008, LOA 6 completed its responsibilities with the issuance of a report of its 

recommendations to improve the support and care for recovering servicemembers and veterans. 

In addition to addressing the published recommendations, the SOC 

assumed responsibility for addressing the policy development and 

reporting requirements contained in the NDAA 2008. Section 1611(a) of 

the NDAA 2008 directs DOD and VA, to the extent feasible, to develop and 

implement a comprehensive policy covering four areas—(1) care and 

management, (2) medical evaluation and disability evaluation, (3) the 

return of servicemembers to active duty, and (4) the transition of 

recovering servicemembers from DOD to VA. The specific requirements 

for each of these four areas are further enumerated in sections 1611 

through 1614 of the law and include the development of multiple policies. 

Table 2 summarizes the requirements for the jointly developed policies. 

Page 7 GAO-09-728 DOD and VA Joint Policy Development
 

Table 2: Summary of the NDAA 2008 Requirements to Jointly Develop Comprehensive Policy for Improving Care and 

Management, Medical and Disability Evaluation, Return-to-Duty Decisions, and Transition of Recovering Servicemembers in 

Sections 1611 through 1614 

Key areas of policy development Summary of requirement 

Care and management of recovering servicemembers 

(section 1611) 

Requires DOD and VA to develop policies to address several aspects of 

access to health care and other assistance, including the training of health 

care professionals, waiting times, patient tracking, and family support. 

Medical evaluation and disability evaluation of 

recovering servicemembers (section 1612) 

Requires DOD to develop policies for improved medical evaluations, and 

DOD and VA to develop policies for improved disability evaluations and 

report to Congress on the feasibility and advisability of consolidating their 

disability evaluation systems. 

Return of servicemembers who have recovered to 

active duty (section 1613) 

Requires DOD to establish standards for determinations by the military 

departments on the return of recovering servicemembers to active duty. 

Transition of recovering servicemembers from receipt 

of care and services through DOD to receipt of care 

and services through VA (section 1614) 

Requires DOD and VA to jointly develop and implement procedures and 

standards for the transition of servicemembers from health care and 

treatment provided through DOD to care, treatment, and rehabilitation 

provided through VA. 

Source: GAO analysis of sections 1611 through 1614 of the NDAA 2008. 

Selected Initiatives of the 

SOC 

Since its inception, the SOC has completed many initiatives, such as 

establishing the Defense Centers of Excellence for Psychological Health 

and Traumatic Brain Injury and creating a National Resource Directory, 

which is an online public resource for recovering servicemembers, 

veterans, and their families.15 In addition, the SOC supported the 

development of several programs to improve the care, management, and 

transition of recovering servicemembers, including the disability 

evaluation system pilot and the Federal Recovery Coordination Program. 

These programs are currently in pilot or beginning phases. 

• Disability evaluation system pilot: DOD and VA are piloting a joint 

disability evaluation system to improve the timeliness and resource use of 

their separate disability evaluation systems. Key features of the pilot 

include a single physical examination conducted to VA standards to be 

used by a medical evaluation board to document medical conditions that 

may limit a servicemember’s ability to serve in the military, a single source 

disability rating prepared by VA for use by both DOD and VA in 

determining disability benefits, and additional outreach and nonclinical 

case management provided by VA staff at the DOD pilot locations to 

 

15See www.nationalresourcedirectory.org. 

Page 8 GAO-09-728 DOD and VA Joint Policy Development
 

explain VA results and processes to servicemembers. DOD and VA 

anticipate a final report on the pilot in August 2009. 

• Federal Recovery Coordination Program: In 2007, DOD and VA 

established the Federal Recovery Coordination Program in response to the 

report by the President’s Commission on Care for America’s Returning 

Wounded Warriors, commonly referred to as the Dole-Shalala 

Commission. The commission’s report highlighted the need for better 

coordination of care and additional support for families. The Federal 

Recovery Coordination Program serves the most severely injured or ill 

servicemembers. These servicemembers are highly unlikely to be able to 

return to duty and may have to adjust to permanent disabling conditions. 

The program was created to provide uniform and seamless care, 

management, and transition of recovering servicemembers and their 

families by assigning recovering servicemembers to coordinators who 

manage the development and implementation of a recovery plan. Each 

servicemember enrolled in the Federal Recovery Coordination Program 

has a Federal Individual Recovery Plan, which tracks care, management, 

and transition through recovery, rehabilitation, and reintegration. 

Although the Federal Recovery Coordination Program is operated as a 

joint DOD and VA program, VA is responsible for the administrative duties 

and program personnel are employees of the agency. 

Beyond these specific initiatives, the SOC took responsibility for issues 

related to electronic health records through the work of LOA 4, the SOC’s 

work group focused on DOD and VA data sharing. This LOA also 

addressed issues more generally focused on joint DOD and VA data needs, 

including overseeing the development of components for the disability 

evaluation system pilot and the individual recovery plans for the Federal 

Recovery Coordination Program. LOA 4’s progress on these issues was 

monitored and overseen by the SOC. The NDAA 2008 established an 

interagency program office (IPO) to serve as a single point of 

accountability for both departments in the development and 

implementation of interoperable electronic health records.16,17

Subsequently, management oversight of many of LOA 4’s responsibilities 

were transferred to the IPO. Also, the IPO’s scope of responsibility was 

 

16Pub. L. No. 110-181, § 1635, 122 Stat. 3, 460-63. 

17Interoperability is the ability of two or more systems or components to exchange 

information and to use the information that has been exchanged. 

Page 9 GAO-09-728 DOD and VA Joint Policy Development
 

broadened to include personnel and benefits data sharing between DOD 

and VA. 

As of April 2009, DOD and VA have completed 60 of the 76 requirements 

we identified for jointly developing policies for recovering 

servicemembers on (1) care and management, (2) medical and disability 

evaluation, (3) return to active duty, and (4) servicemember transition 

from DOD to VA. The two departments have completed all requirements 

for developing policy for two of the policy areas—medical and disability 

evaluation and return to active duty. Of the 16 requirements that are in 

progress, 10 are related to care and management and 6 are related to 

servicemembers transitioning from DOD to VA. (See table 3.) 

DOD and VA Have 

Completed the 

Majority of the 

Requirements to 

Jointly Develop 

Policies on Care and 

Management, Medical 

and Disability 

Evaluation, Return to 

Active Duty, and the 

Transition from DOD 

to VA 

Table 3: Summary of Status of DOD and VA Progress to Jointly Develop Policy for Improving Care and Management, Medical 

and Disability Evaluation, Return-to-Duty Decisions, and Transition of Recovering Servicemembers Required by the NDAA 

2008 Sections 1611 through 1614, as of April 2009 

Policy area 

Number of 

requirements

Requirements 

completed

Requirements

 in progress Overall status 

1. Care and management of recovering 

servicemembers (section 1611) 

38 28 10 ◓

2. Medical evaluation and disability evaluation of 

recovering servicemembers (section 1612) 

18 18 0 ●

3. Return of servicemembers who have recovered to 

active duty (section 1613) 

1 1 0 ●

4. Transition of recovering servicemembers from 

receipt of care and services through DOD to receipt 

of care and services through VA (section 1614) 

19 13 6 ◓

Overall progress 76 60 (79 percent) 16 (21 percent) ◓

Source: GAO analysis of information from the Senior Oversight Committee. 

Key: 

● Complete 

◓ In progress 

Page 10 GAO-09-728 DOD and VA Joint Policy Development
 

DOD and VA Have 

Completed More Than 

Two-Thirds of the 

Requirements for the Care 

and Management of 

Recovering 

Servicemembers 

We found that more than two-thirds of the requirements for DOD’s and 

VA’s joint policy development to improve the care and management of 

recovering servicemembers have been completed, while the remaining 

requirements are in progress. (See table 4.) We identified 38 requirements 

for this policy area and grouped them into five categories. Although 28 of 

the 38 requirements had been completed, one category—improving access 

to medical and other health care services—had most of its requirements in 

progress. 

Table 4: Status of Requirements to Address the Care and Management of Recovering Servicemembers, as of April 2009 

Categories of requirements for care and management 

Number of 

requirements

Requirements 

completed 

Requirements 

in progress Overall status 

1. Develop policy for training and skills of health care 

professionals, recovery care coordinators, medical care 

case managers, and nonmedical care managersa

2 2 0 ●

2. Develop policy for recovery plans for recovering 

servicemembers and the training, duties, support, and 

supervision of recovery care coordinators, medical care 

case managers, and nonmedical care managersb

20 19 1 ◓

3. Develop policy for improved access to medical and 

other health care servicesc

10 1 9 ◓

4. Develop policy for improved outreach and services for 

family members of recovering servicemembersd

5 5 0 ●

5. Apply policy to recovering servicemembers on the 

temporary disability retired list as determined by DODe

1 1 0 ●

Overall progress 38 28 (74 percent) 10 (26 percent) ◓

Source: GAO analysis of information from the Senior Oversight Committee. 

Key: 

● Complete 

◓ In progress 

a

NDAA 2008, section 1611(d). 

b

NDAA 2008, section 1611(e)(1)– (4). 

c

NDAA 2008, section 1611(e)(5)–(11). 

d

NDAA 2008, section 1611(f), (g). 

e

NDAA 2008, section 1611(h). 

Page 11 GAO-09-728 DOD and VA Joint Policy Development
 

Most of the completed requirements were addressed in DOD’s January 

2009 Directive-Type Memorandum (DTM), which was developed in 

consultation with VA. This DTM, entitled Recovery Coordination 

Program: Improvements to the Care, Management, and Transition of 

Recovering Service Members, establishes interim policy for the 

improvements to the care, management, and transition of recovering 

servicemembers in response to sections 1611 and 1614 of the NDAA 2008. 

In consultation with VA, DOD created the Recovery Coordination Program 

in response to the NDAA 2008 requirements. This program, which was 

launched in November 2008, extended the same comprehensive 

coordination and transition support provided under the Federal Recovery 

Coordination Program to servicemembers who were less severely injured 

or ill, yet who are unlikely to return to active duty in less than 180 days. 

This program follows the same structured process as the Federal Recovery 

Coordination Program. However, DOD oversees this program and the 

coordinators are DOD employees. 

DOD’s January 2009 DTM includes information on the scope and program 

elements of the Recovery Coordination Program as well as on the roles 

and responsibilities of the recovery care coordinators, federal recovery 

coordinators, and medical care case managers and non-medical care 

managers. According to DOD officials, DOD took the lead in developing 

policy to address the requirements for care and management because it 

interpreted most of the requirements to refer to active duty 

servicemembers. 

According to DOD and VA officials, the January 2009 DTM serves as the 

interim policy for care, management, and transition until the completion of 

DOD’s comprehensive policy instruction, which is estimated to be 

completed by August 2009.18 This policy instruction will contain more 

detailed information on the policies outlined in the DTM. A VA official told 

us that VA also plans to issue related policy guidance as part of a VA 

handbook during the fourth quarter of 2009. The VA official noted that the 

final form of the policy document would correspond with DOD’s 

instruction. 

 

18DOD issues directive-type memoranda to address time-sensitive actions that affect 

current policies or that will be developed into new DOD policies. A directive-type 

memoranda establishes temporary policy and provides DOD the direction to implement the 

policy when time constraints prevent publishing a new policy or a change to an existing 

DOD policy. 

Page 12 GAO-09-728 DOD and VA Joint Policy Development
 

DOD and VA Have 

Completed All of the 

Requirements for 

Developing Policy on the 

Medical Evaluation and 

Disability Evaluation of 

Recovering 

Servicemembers 

DOD and VA have completed all of the requirements for developing policy 

to improve the medical and physical disability evaluation of recovering 

servicemembers. (See table 5.) We identified 18 requirements for this 

policy area and grouped them into three categories: (1) policy for 

improved medical evaluations, (2) policy for improved physical disability 

evaluations, and (3) reporting on the feasibility and advisability of 

consolidating DOD and VA disability evaluation systems. 

Table 5: Status of Requirements to Address the Medical Evaluation and Disability Evaluation of Recovering Servicemembers, 

as of April 2009 

Categories of requirements for medical and disability 

evaluations 

Number of 

requirements

Requirements 

completed

Requirements 

in progress Overall status 

1. Develop policy for improved medical evaluationsa8 8 0 ●

2. Develop policy for improved physical disability 

evaluationsb

8 8 0 ●

3. Report on feasibility and advisability of consolidating 

DOD and VA disability evaluation systemsc

2 2 0 ●

Overall progress 18 18 (100 percent) 0 ●

Source: GAO analysis of information from the Senior Oversight Committee. 

Key: 

● Complete 

◓ In Progress 

a

NDAA 2008, section 1612(a). 

b

NDAA 2008, section 1612(b). 

c

NDAA 2008, section 1612(c). 

DOD issued a series of memoranda that addressed the first two categories 

starting in May 2007. These memoranda, some of which were developed in 

collaboration with VA, contained policies and implementing guidance to 

improve DOD’s existing disability evaluation system. To address the third 

category in this policy area, DOD and VA have issued a report to Congress 

that describes the organizing framework for consolidating the two 

departments’ disability evaluation systems and states that the departments 

are hopeful that consolidation would be feasible and advisable even 

though the evaluation of this approach through the disability evaluation 

system pilot is still ongoing. According to a DOD official, further 

assessment of the feasibility and advisability of consolidation will be 

conducted. DOD and VA anticipate issuing a final report on the pilot in 

Page 13 GAO-09-728 DOD and VA Joint Policy Development
 

August 2009. However, as we reported in September 2008, it was unclear 

what specific criteria DOD and VA will use to evaluate the success of the 

pilot, and when sufficient data will be available to complete such an 

evaluation.19

DOD Has Completed 

Establishing Standards for 

Determining the Return of 

Recovering 

Servicemembers to Active 

Duty 

DOD has completed the requirement for establishing standards for 

determining the return of recovering servicemembers to active duty. (See 

table 6.)20

Table 6: Status of Requirement to Address the Standards for Return-to-Duty Decisions, as of April 2009 

Requirement for return-to-duty decisions 

Number of 

requirements

Requirements 

completed

Requirements 

in progress Overall status 

1. Establish standards for return-to-duty decisionsa1 1 0 ●

Overall progress 1 1 (100 percent) 0 ●

Source: GAO analysis of information from the Senior Oversight Committee. 

Key: 

● Complete 

◓ In Progress 

a

NDAA 2008, section 1613. 

On March 13, 2008, DOD issued a DTM amending its existing policy on 

retirement or separation due to a physical disability. The revised policy 

states that the disability evaluation system will be the mechanism for 

determining both retirement or separation and return to active duty 

because of a physical disability. An additional revision to the existing DOD 

policy allows DOD to consider requests for permanent limited active duty 

or reserve status for servicemembers who have been determined to be 

unfit because of a physical disability. Previously, DOD could consider such 

cases only as exceptions to the general policy. 

 

19GAO, Military Disability System: Increased Supports for Servicemembers and Better 

Pilot Planning Could Improve the Disability Evaluation Process, GAO-08-1137 

(Washington, D.C.: Sept. 24, 2008). 

20The NDAA 2008 directed the Secretary of Defense to respond to this policy requirement. 

VA does not participate in return-to-duty decisions. 

Page 14 GAO-09-728 DOD and VA Joint Policy Development
 

According to a DOD official, it is too early to tell whether the revisions will 

have an effect on retirement rates or return-to-duty rates. DOD annually 

assesses the disability evaluation system and tracks retirement and return 

to duty rates. However, because of the length of time a servicemember 

takes to move through the disability evaluation system—sometimes over a 

year—it will take a while before changes resulting from the policy 

revisions register in the annual assessment of the disability evaluation 

system. 

Over Two-Thirds of the 

Requirements for 

Improving the Transition 

of Recovering 

Servicemembers from 

DOD to VA Have Been 

Completed 

DOD and VA have completed more than two-thirds of the requirements for 

developing procedures, processes, or standards for improving the 

transition of recovering servicemembers. (See table 7.) We identified 19 

requirements for this policy area, and we grouped them into five 

categories. We found that 13 of the 19 policy requirements have been 

completed, including all of the requirements for two of the categories—the 

development of a process for a joint separation and evaluation physical 

examination and development of procedures for surveys and other 

mechanisms to measure patient and family satisfaction with services for 

recovering servicemembers. The remaining three categories contain 

requirements that are still in progress. 

Page 15 GAO-09-728 DOD and VA Joint Policy Development
 

Table 7: Status of Requirements to Address the Transition of Recovering Servicemembers, as of April 2009 

Categories of requirements for improved transition 

Number of 

requirements

Requirements 

completed 

Requirements 

in progress Overall status 

1. Develop procedures, processes, and standards for care 

coordination, benefits, and service transitiona

11 7 4 ◓

2. Develop procedures and processes for information 

sharing of military service and health recordsb

5 4 1 ◓

3. Develop a process for a joint separation and evaluation 

physical examinationc

1 1 0 ●

4. Develop procedures for surveys and other mechanisms 

to measure patient and family satisfaction with services 

for recovering servicemembersd

1 1 0 ●

5. Develop procedures to ensure the participation of 

recovering servicemembers of the National Guard or 

Reserve in the Benefits Delivery at Discharge 

Programe,f

1 0 1 ◓

Overall progress 19 13 (68 percent) 6 (32 percent) ◓

Source: GAO analysis of information from the Senior Oversight Committee. 

Key: 

● Complete 

◓ In progress 

a

NDAA 2008, section 1614(a), 1614(b)(1)-(9), (14). 

b

NDAA 2008, section 1614(b)(10)-(13), (15). 

c

NDAA 2008, section 1614(b)(16). 

d

NDAA 2008, section 1614(b)(17). 

e

NDAA 2008, section 1614(b)(18). 

f

Through the Benefits Delivery at Discharge Program, DOD and VA have made efforts to streamline 

access to veterans’ disability benefits by allowing some servicemembers to file a claim and obtain a 

single comprehensive exam prior to discharge. 

Most of the requirements for improving the transition from DOD to VA 

were addressed in DOD’s January 2009 DTM—Recovery Coordination 

Program: Improvements to the Care, Management, and Transition of 

Recovering Service Members—which establishes interim policy for the 

care, management, and transition of recovering servicemembers through 

the Recovery Coordination Program. However, we found that DOD’s DTM 

includes limited detail related to the procedures, processes, and standards 

for transition of recovering servicemembers. As a result, we could not 

always directly link the interim policy in the DTM to the specific 

requirements contained in section 1614 of the NDAA 2008. DOD and VA 

officials noted that they will be further developing the procedures, 

processes, and standards for the transition of recovering servicemembers 

in a subsequent comprehensive policy instruction, which is estimated to 

Page 16 GAO-09-728 DOD and VA Joint Policy Development
 

be completed by June 2009. A VA official reported that VA plans to 

separately issue policy guidance addressing the requirements for 

transitioning servicemembers from DOD to VA in the fourth quarter of 

2009. 

DOD and VA officials told us that they experienced numerous challenges 

as they worked to jointly develop policies to improve the care, 

management, and transition of recovering servicemembers. According to 

officials, these challenges contributed to the length of time required to 

issue policy guidance, and in some cases the challenges have not yet been 

completely resolved. In addition, recent changes to the SOC staff, 

including DOD’s organizational changes for staff supporting the SOC, 

could pose challenges to the development of policy affecting recovering 

servicemembers. 

DOD and VA Officials 

Experienced 

Challenges during 

Joint Development of 

Required Policies 

Various Challenges Arose 

during Policy Development 

DOD and VA officials encountered numerous challenges during the course 

of jointly developing policies to improve the care, management, and 

transition of recovering servicemembers, as required by sections 1611 

through 1614 of the NDAA 2008, in addition to responding to other 

requirements of the law. Many of these challenges have been addressed, 

but some have yet to be completely resolved. DOD and VA officials cited 

the following examples of issues for which policy development was 

particularly challenging. 

• Increased support for family caregivers. The NDAA 2008 includes a 

number of provisions to strengthen support for families of recovering 

servicemembers, including those who become caregivers. However, DOD 

and VA officials on a SOC work group stated that before they could 

develop policy to increase support for such families, they had to obtain 

concrete evidence of their needs. Officials explained that while they did 

have anecdotal information about the impact on families who provide care 

to recovering servicemembers, they lacked the systematic data needed for 

sound policy decisions—such as frequency of job loss and the economic 

value of family-provided medical services. A work group official told us 

that their proposals for increasing support to family caregivers were 

rejected twice by the SOC, due in part to the lack of systematic data on 

what would be needed. The work group then contracted with researchers 

to obtain substantiating evidence, a study that required 18 months to 

complete. In January 2009, the SOC approved the work group’s third 

Page 17 GAO-09-728 DOD and VA Joint Policy Development
 

proposal. A provision for caregiver benefits based on the SOC’s proposal 

was included in the NDAA 2010 bill that was introduced in May 2009.21

• Establishing standard definitions for operational terms. One of the 

important tasks facing the SOC was the need to standardize key 

terminology relevant to policy issues affecting recovering servicemembers. 

DOD took the lead in working with its military services and VA officials to 

identify and define key terms. DOD and VA officials told us that many of 

the key terms found in existing DOD and VA policy, the reports from the 

review groups, and the NDAA 2008, as well as those used by the different 

military services were not uniformly defined. Consequently, standardized 

definitions were important to promote agreement on issues such as 

• identifying the recovering servicemembers who are subject to NDAA 

2008 requirements, 

• identifying categories of servicemembers who would receive services 

from the different classes of case managers or be eligible for certain 

benefits, 

• managing aspects of the disability evaluation process, and 

• establishing criteria to guide research. 

In some cases, standardized definitions were critical to policy 

development. The importance of agreement on key terms is illustrated by 

an issue encountered by the SOC’s work group responsible for family 

support policy. In this case, before policy could be developed for 

furnishing additional support to family members that provide medical care 

to recovering servicemembers, the definition of “family” had to be agreed 

upon. DOD and VA officials said that they considered two options: to 

define the term narrowly to include a servicemember’s spouse, parents, 

and children, or to use broader definitions that included distant relatives 

and unrelated individuals with a connection to the servicemember. These 

two definitions would result in significantly different numbers of family 

members eligible to receive additional support services. DOD and VA 

officials decided to use a broader definition to determine who would be 

eligible for support. 

 

21S. 1033, 111th Cong. § 701 (2009). 

Page 18 GAO-09-728 DOD and VA Joint Policy Development
 

Of the 41 key definitions identified for reconciliation, DOD and VA had 

concurred on 33 as of April 2009 and these 33 standardized definitions are 

now being used. Disagreement remains over the remaining definitions, 

including the definition of “mental health.” A DOD official stated that given 

the uncertainty associated with the organizational and procedural changes 

recently introduced to the SOC (which are discussed below), obtaining 

concurrence on the remaining definitions has been given lower priority. 

• Improving TBI and PTSD screening and treatment. Requirements related 

to screening and treatment for TBI and PTSD were embedded in several 

sections of the NDAA 2008, including section 1611, and were also 

discussed extensively in a task force report on mental health.22 DOD and 

VA officials told us that policy development for these issues was difficult. 

For example, during development of improved TBI and PTSD treatment 

policy, policymakers often lacked sufficient scientific information needed 

to help achieve consensus on policy decisions. Also, members of the SOC 

work group told us that they disagreed on appropriate models for 

screening and treatment and struggled to reorient the military services to 

patient-focused treatment. A senior DOD official stated that the adoption 

of patient-focused models is particularly difficult for the military services 

because, historically, the needs of the military have been given precedence 

over the needs of individual servicemembers. To address these challenges, 

the SOC oversaw the creation of the Defense Centers of Excellence for 

Psychological Health and Traumatic Brain Injury—a partnership between 

DOD and VA. While policies continue to be developed on these issues, TBI 

and PTSD policy remains a challenge for DOD and VA. However, DOD 

officials told us that the centers of excellence have made progress with 

reducing knowledge gaps in psychological health and TBI treatment, 

identifying best practices, and establishing clinical standards of care. 

• Release of psychological health treatment records to DOD by VA health 

care providers who treat members of the National Guard and Reserves. 

Section 1614 of the NDAA 2008 requires the departments to improve 

medical and support services provided to members of the National Guard 

and Reserves. In pursuing these objectives, VA faced challenges related to 

the release of medical information to DOD on reservists and National 

Guard servicemembers who have received treatment for PTSD or other 

mental health conditions from VA. DOD requests medical information 

from VA to help make command decisions about the reactivation of 

servicemembers, but VA practitioners face an ethical dilemma if the 

 

22Department of Defense Task Force on Mental Health (2007). 

Page 19 GAO-09-728 DOD and VA Joint Policy Development
 

disclosure of medical treatment could compromise servicemembers’ 

medical conditions, particularly for those at risk of suicide. The challenge 

of sharing and protecting sensitive medical information on 

servicemembers who obtain treatment at VA was reviewed by the Blue 

Ribbon Work Group on Suicide Prevention convened in 2008 at the behest 

of the Secretary of Veterans Affairs. DOD and VA are continuing their 

efforts to address the privacy rights of patients who receive medical 

services from VA while serving in the military, and to protect the 

confidential records of VA patients who may also be treated by the 

military’s health care system. The need to resolve this challenge assumes 

even greater importance in light of DOD’s and VA’s increasing capability to 

exchange medical records electronically, which will expand DOD’s ability 

to access records of servicemembers who have received medical 

treatment from VA. 

Changes to the SOC’s Staff 

and Scope of 

Responsibilities Could 

Pose Future Challenges to 

Joint Policy Development 

The SOC has experienced turnover in leadership, reconfiguration in its 

organizational structure at DOD, and changes affecting policy 

development responsibilities. These changes could pose future challenges 

to DOD’s and VA’s efforts to develop joint policy. 

The SOC has experienced leadership changes caused by the turnover in 

presidential administrations as well as turnover in some of its key staff. 

For example, the outgoing deputy secretaries of DOD and VA, who 

previously chaired the SOC, left their positions in January 2009 with the 

change in administration, and new deputy secretaries were not confirmed 

until February and April 2009. In their absence, the Secretaries of VA and 

DOD co-chaired a SOC meeting as a short-term measure. DOD also 

introduced other staffing changes to replace personnel who had been 

temporarily detailed to the SOC and needed to return to their primary 

duties. DOD had relied on temporarily-assigned staff to meet SOC staffing 

needs because the SOC was originally envisioned as a short-term effort. In 

a December 2008 memorandum, DOD outlined the realignment of its SOC 

staff. This included the transition of responsibilities from detailed, 

temporary SOC staff and executives to permanent staff in existing DOD 

offices that managed similar issues. For example, the functions of LOA 7 

(Legislation and Public Affairs) will now be overseen by the Assistant 

Secretary of Defense for Legislative Affairs, the Assistant Secretary of 

Defense for Public Affairs, and the DOD General Counsel. DOD also 

established two new organizational structures—the Office of Transition 

Policy and Care Coordination and an Executive Secretariat office. The 

Office of Transition Policy and Care Coordination oversees transition 

support for all servicemembers and serves as the permanent entity for 

issues being addressed by LOA 1 (Disability Evaluation System), LOA 3 

Page 20 GAO-09-728 DOD and VA Joint Policy Development
 

(Case Management), and LOA 8 (Personnel, Pay, and Financial Support). 

The Executive Secretariat office is responsible for performance planning, 

performance management, and SOC support functions. According to DOD 

officials, the new offices were created to establish permanent 

organizations that address a specific set of issues and to enhance 

accountability for policy development and implementation as these offices 

report directly to the Office of the Under Secretary of Defense for 

Personnel and Readiness. Currently, many of the positions in these new 

offices, including the director positions, are staffed by officials in an acting 

capacity or are unfilled. 

DOD’s changes to the SOC are important because of the potential effects 

these changes could have on the development of policy for recovering 

servicemembers. However, officials in both DOD and VA have mixed 

reactions about the consequences of these changes. Some DOD officials 

consider the organizational changes to the SOC to be positive 

developments that will enhance the SOC’s effectiveness. They point out 

that the SOC’s temporary staffing situation needed to be addressed, and 

also that the two new offices were created to support the SOC and provide 

focus on the implementation of key policy initiatives developed by the 

SOC—primarily the disability evaluation system pilot and the new case 

management programs. In contrast, others are concerned by DOD’s 

changes, stating that the new organizations disrupt the unity of command 

that once characterized the SOC’s management because personnel within 

the SOC organization now report to three different officials within DOD 

and VA. However, it is too soon to determine how well DOD’s new 

structure will work in conjunction with the SOC. DOD and VA officials we 

spoke with told us that the SOC’s work groups continue to carry out their 

roles and responsibilities. 

Finally, according to DOD and VA officials, the scope of responsibilities of 

both the SOC and the DOD and VA Joint Executive Council appear to be in 

flux and may evolve further still.23 According to DOD and VA officials, 

changes to the oversight responsibilities of the SOC and the Joint 

Executive Council are causing confusion. While the SOC will remain 

responsible for policy matters directly related to recovering 

servicemembers, a number of policy issues may now be directed to the 

Joint Executive Council, including issues that the SOC had previously 

 

23The Joint Executive Council is responsible for addressing strategic issues affecting both 

departments and developing a joint DOD/VA strategic plan. 

Page 21 GAO-09-728 DOD and VA Joint Policy Development
 

addressed. For example, management oversight of many of LOA 4’s 

responsibilities (DOD and VA Data Sharing) has transitioned from the SOC 

to the IPO, which reports primarily to the Joint Executive Council. It is not 

clear how the IPO will ensure effective coordination with the SOC’s LOAs 

for overseeing the development of information technology applications for 

the disability evaluation system pilot and the individual recovery plans for 

the Federal Recovery Coordination Program. Given that information 

technology support for two key SOC initiatives is identified in the joint 

DOD/VA Information Interoperability Plan, if the IPO and the SOC do not 

effectively coordinate with one another, the result may negatively affect 

the development of improved policies for recovering servicemembers. 

We provided a draft of this report to DOD and VA for comment. VA 

provided technical comments, which we incorporated as appropriate. 

DOD and VA did not provide other comments. 

Agency Comments 

and Our Evaluation 

We are sending copies of this report to the Secretaries of the Departments 

of Defense and Veterans Affairs, congressional committees, and other 

interested parties. The report is also available at no charge on GAO’s Web 

site at http://www.gao.gov. 

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

(202) 512-7114 or at williamsonr@gao.gov. Contact points for our Offices 

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

page of this report. GAO staff who made major contributions to this report 

Randall B. Williamson 

are listed in appendix II. 

Director, DOD and VA Health Care 

Page 22 GAO-09-728 DOD and VA Joint Policy Development
Page 23 GAO-09-728 

List of Committees 

The Honorable Carl Levin 

Chairman 

The Honorable John McCain 

Ranking Member 

Committee on Armed Services 

United States Senate 

The Honorable Daniel Akaka 

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 Kay Bailey Hutchinson 

Ranking Member 

Subcommittee on Military Construction, Veterans’ Affairs, 

 and Related Agencies 

Committee on Appropriations 

United States Senate 

The Honorable Ike Skelton 

Chairman 

The Honorable Howard McKeon 

Ranking Member 

Committee on Armed Services 

House of Representatives 

 DOD and VA Joint Policy Development 
The Honorable Bob Filner 

Chairman 

The Honorable Steve Buyer 

Ranking Member 

Committee on Veterans Affairs 

House of Representatives 

The Honorable John P. Murtha 

Chairman 

The Honorable C. W. Bill Young 

Ranking Member 

Subcommittee on Defense 

Committee on Appropriations 

House of Representatives 

The Honorable Chet Edwards 

Chairman 

The Honorable Zach Wamp 

Ranking Member 

Subcommittee on Military Construction, Veterans Affairs, 

 and Related Agencies 

Committee on Appropriations 

House of Representatives 

Page 24 GAO-09-728 DOD and VA Joint Policy Development
Appendix I: Summary of Selected 

Requirements from the National Defense Appendix I: Summary of Selected Authorization Act for Fiscal Year 2008 

Requirements from the National Defense 

Authorization Act for Fiscal Year 2008 

To summarize the status of the Departments’ of Defense (DOD) and 

Veterans Affairs (VA) efforts to jointly develop policies for each of the four 

policy areas outlined in sections 1611 through 1614 of the National 

Defense Authorization Act for Fiscal Year 2008 (NDAA 2008), we identified 

76 requirements in these sections and grouped related requirements into 

14 logical categories.1

 Tables 8 through 11 enumerate the requirements in 

each of GAO’s categories and provide the status of DOD’s and VA’s efforts 

to develop policy related to each requirement, as of April 2009. 

Table 8: Requirements to Address the Care and Management of Recovering Servicemembers, as Outlined in Section 

1611(a)(2)(A), with Specific Requirements Enumerated in Section 1611 

GAO category 

Number of NDAA 

2008 requirements 

in category Summary of NDAA 2008 requirements Status 

2 requirements 1611(d): Policy shall provide for uniform standards among the 

military departments for training and skills of health care 

professionals, recovery care coordinators, medical care case 

managers, and non-medical care managers, including tracking 

notifications made by them. The policy shall: 

Develop policy for training 

and skills of health care 

professionals, recovery 

care coordinators, 

medical care case 

managers, and nonmedical care managers 1. Ensure that health care professionals, recovery care 

coordinators, medical care case managers, and non-medical 

care managers are able to detect and report early warning 

signs of post-traumatic stress disorder or suicidal or homicidal 

thoughts or behaviors in recovering servicemembers. 

●

2. Include a mechanism or system to track the number of 

notifications made by recovery care coordinators, medical 

care case managers, and non-medical care managers to 

health care professionals regarding post-traumatic stress 

disorder or suicidal behaviors in recovering servicemembers. 

●

20 requirements 1611(e)(1)-(4): To improve the care, management, and transition 

of recovering servicemembers, the policy shall:

1. Provide for uniform standards and procedures among the 

military services for the development of a comprehensive 

recovery plan for each recovering servicemember. 

●

For recovery care coordinators: 

2. Provide for a uniform program for the assignment of recovery 

care coordinators to recovering servicemembers. 

●

Develop policy for 

recovery plans for 

recovering 

servicemembers and the 

training, duties, support, 

and supervision of 

recovery care 

coordinators, medical 

care case managers, and 

non-medical care 

managers 3. Include specified duties assigned to recovery care 

coordinators. 

●

 

1

We defined an individual requirement as a provision within sections 1611 through 1614 

related to the policy required by 1611(a) that directs DOD, VA, or both to take a specific 

action or to include a specific criterion in their policy. The SOC’s legal counsel reviewed 

these requirements and our groupings, and agreed with our approach. 

Page 25 GAO-09-728 DOD and VA Joint Policy Development 
Appendix I: Summary of Selected 

Requirements from the National Defense 

Authorization Act for Fiscal Year 2008 

GAO category 

Number of NDAA 

2008 requirements 

in category Summary of NDAA 2008 requirements Status 

4. Specify the maximum number of cases of recovering 

servicemembers assigned to a recovery care coordinator. 

◓

5. Specify standard training requirements for recovery care 

coordinators. 

●

6. Include mechanisms to ensure recovery care coordinators 

have necessary resources. 

●

7. Specify requirements for supervision of recovery care 

coordinators. 

●

For medical care case managers: 

8. Provide for a uniform program for the assignment of medical 

care case managers. 

●

9. Include specified duties assigned to medical care case 

managers. 

●

10. Specify the maximum number of cases of recovering 

servicemembers assigned to a medical care case manager. 

●

11. Specify standard training requirements for medical care case 

managers. 

●

12. Include mechanisms to ensure that medical care case 

managers have necessary resources. 

●

13. Specify requirements for supervision of medical care case 

managers. 

●

For non-medical care managers: 

14. Provide for a uniform program for the assignment of nonmedical care managers to recovering servicemembers. ●

15. Include specified duties assigned to non-medical care 

managers. 

●

16. Specify duration of non-medical care managers’ duties. ●

17. Specify the maximum number of cases of recovering 

servicemembers assigned to a non-medical care manager. 

●

18. Specify standard training requirements for non-medical care 

managers. 

●

19. Include mechanisms to ensure that non-medical care 

managers have necessary resources. 

●

20. Specify requirements for supervision of non-medical care 

managers. 

●

Develop policy for 10 requirements 1611(e)(5)-(11): Policy shall provide for: 

improved access to 

medical and other health 

care services 

1. Appropriate minimum standards for access to non-urgent 

medical care and other health care services by recovering 

servicemembers in certain settings. 

◓

2. Maximum waiting times for follow-up, specialty, diagnostic, 

and surgical care. 

◓

Page 26 GAO-09-728 DOD and VA Joint Policy Development
Appendix I: Summary of Selected 

Requirements from the National Defense 

Authorization Act for Fiscal Year 2008 

GAO category 

Number of NDAA 

2008 requirements 

in category Summary of NDAA 2008 requirements Status 

3. Recovering servicemember’s ability to waive access 

standards. 

◓

4. Assignment of recovering servicemembers to locations of 

care. 

◓

5. Reassignment of recovering servicemembers from deficient 

medical or medical support facilities. 

◓

6. Availability of transportation and subsistence when obtaining 

medical care and services. 

◓

7. Assignment of recovering servicemembers to work and duty 

compatible with their medical conditions. 

◓

8. Access to educational and vocational training and 

rehabilitation. 

●

9. Tracking the location of recovering servicemembers and their 

compliance with appointments. 

◓

10. Referral of recovering servicemembers to VA and other 

providers. 

◓

5 requirements 1611(f ) and (g): Policy shall provide or include: 

1. Providing support for family members not eligible under 

section 1672. 

●

Develop policy for 

improved outreach and 

services for family 

members of recovering 

servicemembers 2. Providing advice and training to family members for providing 

care to recovering servicemembers. 

●

3. Measuring family members’ satisfaction with quality of health 

care provided to recovering servicemembers. 

●

4. Procedures for applying for job placement services by family 

members. 

●

5. Procedures and mechanisms for outreach to recovering 

servicemembers and family members to inform them of 

policies on medical care, management and transition of 

recovering servicemembers, and responsibilities of 

recovering servicemembers and families. 

●

Apply policy to recovering 1 requirement 1611(h): 

servicemembers on the 

Temporary Disability 

Retired List as determined 

by DOD 

1. Policy required by this section shall apply to recovering 

servicemembers placed on the temporary disability retired list 

as determined by DOD. 

●

Source: GAO analysis of section 1611 of the NDAA 2008. 

Key: 

● Complete 

◓ In progress 

Page 27 GAO-09-728 DOD and VA Joint Policy Development
Appendix I: Summary of Selected 

Requirements from the National Defense 

Authorization Act for Fiscal Year 2008 

Table 9: Requirements to Address the Medical and Disability Evaluations of Recovering Servicemembers, as Outlined in 

Section 1611(a)(2)(B), with Specific Requirements Enumerated in Section 1612 

GAO category 

Number of NDAA 

2008 requirements 

in category Summary of NDAA 2008 requirements Status 

Develop policy for 8 requirements 1612(a): 

improved medical 

evaluations 1. The Secretary of Defense shall develop policy to improve processes, 

procedures, and standards for medical evaluations of recovering 

servicemembers. 

●

Policy improvements to medical evaluations shall include and 

address: 

2. Uniform application of medical evaluation policy throughout the 

military departments to recovering servicemembers in the regular 

components of the Armed Forces, National Guard, and Reserves. 

●

3. Standard criteria and definitions for determining maximum medical 

benefit 

from treatment for recovering servicemembers. 

●

4. Standard timelines for fitness-for-duty determinations, specialty care 

consultations, preparation of medical documents, and appeals of 

medical evaluation determinations. 

●

5. Procedures to ensure assignment of a physician or health care 

professional to a recovering servicemember, if requested, who is 

independent of the medical evaluation board and provides 

appropriate advice. 

●

6. Standards for qualifications and training of medical evaluation board 

personnel. 

●

7. Standards for the maximum number of recovering servicemember 

cases pending before a medical evaluation board, and procedures to 

expand on medical evaluation board if warranted. 

●

8. Standards for information provided to recovering servicemembers 

and their families regarding their rights and responsibilities in the 

medical evaluation board process. 

●

Develop policy for 8 requirements 1612(b): 

improved physical 

disability evaluations 1. The DOD and VA Secretaries shall develop policy to improve 

processes, procedures, and standards for physical disability 

evaluations of recovering servicemembers by DOD and VA. 

●

Policy to improve physical disability evaluations shall include: 

2. A clearly-defined DOD and VA process for physical disability 

determinations for recovering servicemembers. 

●

3. To the extent feasible, procedures to eliminate unacceptable 

discrepancies and improve consistency among disability ratings 

assigned by DOD and VA to recovering servicemembers of the 

Armed Forces, National Guard, and Reserves in the use by each 

military department of the VA disability rating schedule. 

●

4. Uniform timelines for appeals of disability determinations of 

recovering servicemembers. 

●

Page 28 GAO-09-728 DOD and VA Joint Policy Development
Appendix I: Summary of Selected 

Requirements from the National Defense 

Authorization Act for Fiscal Year 2008 

GAO category 

Number of NDAA 

2008 requirements 

in category Summary of NDAA 2008 requirements Status 

5. Uniform standards for qualifications and training of physical disability 

evaluation board personnel. 

●

6. Uniform standards for the maximum number of recovering 

servicemember cases pending before a physical disability evaluation 

board, and procedures to expand board. 

●

7. Uniform standards and procedures for providing legal counsel to 

recovering servicemembers undergoing physical disability evaluation.

●

8. Uniform standards on the roles and responsibilities of non-medical 

care managers and judge advocates, and the maximum number of 

recovering servicemembers assigned to judge advocates at any one 

time. 

●

2 requirements 1612(c): The DOD and VA Secretaries shall report on: 

1. The feasibility and advisability of consolidating the DOD and VA 

disability evaluation systems. 

●

Report on feasibility 

and advisability of 

consolidating DOD 

and VA disability 

evaluation processes 2. Recommendations for options for consolidating the DOD and VA 

disability evaluation systems, and recommendations for mechanisms 

to evaluate and assess progress made in consolidating the DOD and 

VA disability evaluation systems, if consolidation is considered 

feasible and advisable. 

●

Source: GAO analysis of section 1612 of the NDAA 2008. 

Key: 

● Complete 

◓ In progress 

Table 10: Requirement to Address Standards for Return-to-Duty Decisions, as Outlined in Section 1611(a)(2)(C), with Specific 

Requirements Enumerated in Section 1613 

GAO category 

Number of NDAA 

2008 requirements 

in category Summary of NDAA 2008 requirements Status 

Establish standards 1 requirement 1613: 

for return-to-duty 

decisions 1. The DOD Secretary shall establish standards for determinations by the 

military departments on the return of recovering servicemembers to 

active duty. 

●

Source: GAO analysis of section 1613 of the NDAA 2008. 

Key: 

● Complete 

◓ In progress 

Page 29 GAO-09-728 DOD and VA Joint Policy Development
Appendix I: Summary of Selected 

Requirements from the National Defense 

Authorization Act for Fiscal Year 2008 

Table 11: Requirements to Address the Transition of Recovering Servicemembers, as Outlined in Section 1611(a)(2)(D), with 

Specific Requirements Enumerated in Section 1614 

GAO category 

Number of NDAA 

2008 requirements 

in category Summary of NDAA 2008 requirements Status 

11 requirements 1614(a), (b)(1)–(9), (14): 

1. The DOD and VA Secretaries shall jointly develop uniform 

processes, procedures, and standards for the transition of 

recovering servicemembers from DOD care to VA care and 

rehabilitation. 

◓

Develop procedures, 

processes, and standards for 

care coordination, benefits, 

and service transition 

Processes, procedures, and standards shall include: 

2. Uniform patient-focused procedures. ◓

3. Procedures for identifying and tracking recovering 

servicemembers during transition, and coordinating and 

managing their care. 

●

4. Procedures for notifying VA of recovering servicemembers 

commencing the medical and the physical disability 

determination processes. 

●

5. Procedures and timelines for enrollment of recovering 

servicemembers for health care, education, rehabilitation, 

and other benefits. 

●

6. Procedures for ensuring recovering servicemembers’ access 

to vocational, educational, and rehabilitation benefits during 

transition. 

●

7. Standards for optimal location of DOD and VA liaison and 

case management personnel at DOD treatment and other 

facilities. 

◓

8. Standards and procedures for integrated medical care and 

management of recovering servicemembers during 

transition. 

●

9. Standards for preparation of detailed, written plans for 

transitioning recovering servicemembers from DOD 

treatment to VA treatment and rehabilitation. 

●

10. Procedures to ensure that each recovering servicemember 

being retired or separated receives a written transition plan 

prior to retirement or separation. 

●

11. Procedures to ensure that the VA Secretary duly considers 

statements submitted by recovering servicemembers 

regarding the transition. 

◓

5 requirements 1614(b)(10)-(13), (15): The DOD and VA Secretaries shall jointly 

develop uniform processes, procedures, and standards for: 

Develop procedures and 

processes for information 

sharing of military service and 

health records 1. Transmittal of necessary records and information of each 

recovering servicemember being retired or separated from 

DOD to VA, including military service and medical records, 

information for entitlement to transitional health care or 

benefits, and request for assistance in application for VA 

health benefits, compensation, or vocational rehabilitation. 

◓

Page 30 GAO-09-728 DOD and VA Joint Policy Development
Appendix I: Summary of Selected 

Requirements from the National Defense 

Authorization Act for Fiscal Year 2008 

GAO category 

Number of NDAA 

2008 requirements 

in category Summary of NDAA 2008 requirements Status 

2. Obtaining authorization by recovering servicemember or 

legal representative for transmittal of medical records from 

DOD to VA in accordance with the Health Insurance 

Portability and Accountability Act of 1996.a

●

3. Transmittal of address and contact information to recovering 

servicemember’s state veterans’ agency. 

●

4. Arranging a meeting between the recovering 

servicemember, his/her family members, and DOD and VA 

representatives to discuss the transfer of records to VA prior 

to such transfer with at least 30 days notice. 

●

5. Providing for VA’s access to military health records of 

recovering servicemembers receiving or who anticipate 

receiving treatment in VA facilities. 

●

Develop a process for a joint 1 requirement Subsection 1614(b)(16): 

separation and evaluation 

physical examination 1. The DOD and VA Secretaries shall jointly develop uniform 

processes, procedures, and standards for a joint physical 

examination that meets DOD requirements for separation 

and VA requirements for disability evaluations. 

●

Develop procedures for 1 requirement Subsection 1614(b)(17): 

surveys and other 

mechanisms to measure 

patient and family satisfaction 

with services for recovering 

servicemembers 

1. The DOD and VA Secretaries shall jointly develop uniform 

processes, procedures, and standards for surveys and other 

mechanisms to measure recovering servicemember and 

family satisfaction with DOD and VA care and services for 

recovering servicemembers, and to promote oversight of 

such care and services. 

●

Develop procedures to ensure 1 requirement Subsection 1614(b)(18): 

the participation of recovering 

servicemembers of the 

National Guard or Reserve in 

the Benefits Delivery at 

Discharge Programb

1. The DOD and VA Secretaries shall jointly develop uniform 

processes, procedures, and standards for ensuring that 

recovering servicemembers of the National Guard or 

Reserve participate in the Benefits Delivery at Discharge 

Program. 

◓

Source: GAO analysis of section 1614 of the NDAA 2008. 

Key: 

● Complete 

◓ In progress 

a

Pub. L. No. 104-191, 110 Stat. 1936. 

b

Through the Benefits Delivery at Discharge Program, DOD and VA have made efforts to streamline 

access to veterans’ disability benefits by allowing some servicemembers to file a claim and obtain a 

single comprehensive exam prior to discharge. 

Page 31 GAO-09-728 DOD and VA Joint Policy Development
Appendix II: 

A

GAO Contact and Staff 

cknowledgments 

Page 32 GAO-09-728 

Appendix II: GAO Contact and Staff 

Acknowledgments 

GAO Contact Randall B. Williamson, (202) 512-7114 or williamsonr@gao.gov

In addition to the contact named above, Bonnie Anderson, Assistant 

Director; Susannah Bloch; Catina Bradley; April Brantley; Frederick 

Caison; Lisa Motley; and Elise Pressma made major contributions to this 

report. 

 DOD and VA Joint Policy Development 

Acknowledgments 

(290721) 
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