Department of Veterans Affairs 

Office of Inspector General 

Informational Report

Quantitative Assessment of Care 

Transition: The Population-Based LC 

Database 

Report No. 07-00380-202 September 13, 2007

VA Office of Inspector General 

Washington, DC 20420 
To Report Suspected Wrongdoing in VA Programs and Operations 

Call the OIG Hotline – (800) 488-8244 
Quantitative Assessment of Care Transition: the Population-Based LC Database 

Executive Summary 

In March 2005, the Undersecretary of Defense for Personnel and Readiness 

requested that the Department of Defense (DoD) Office of Inspector General 

(OIG) perform an independent review of the care transition process for injured 

Service members returning from Operation Iraqi Freedom (OIF) and Operation 

Enduring Freedom (OEF). In July 2006, the DoD OIG and Veterans Affairs (VA) 

OIG entered into an interagency agreement to jointly evaluate the medical care 

transition process for injured service members from DoD to VA. Prior to this, 

only a very limited quantitative characterization of care transition issues was 

possible using available government data. 

To quantitatively characterize the care transition process, we used relevant data 

files from both DoD and VA sources to create an analytical database (called the 

LC database) that incorporates details about all 494,147 service members 

discharged during July 1, 2005—September 30, 2006. In this report, we describe 

the LC database, including an overview of its structure, the methodology used to 

create it, data confidentiality issues, its limitations, and its analytic potential for 

research and other applications. We believe this provides background for 

understanding and interpreting ongoing and planned studies using this unique 

database. We also present selected descriptive statistics of veterans who comprise 

the database population. 

VA Office of Inspector General i 
DEPARTMENT OF VETERANS AFFAIRS 

Office of Inspector General 

Washington, DC 20420 

SUBJECT: Informational Report – Quantitative Assessment of Care Transition: 

The Population-Based LC Database 

Purpose 

On March 10, 2005, the Undersecretary of Defense for Personnel and Readiness 

requested that the Department of Defense (DoD) Office of Inspector General (OIG) 

perform an independent review of the care transition process for injured Service members 

returning from Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF). 

On July 24, 2006, the DoD OIG and Veterans Affairs (VA) OIG entered into an 

interagency agreement to jointly evaluate the medical care transition process for injured 

service members from DoD to VA. 

Background 

Prior to this current endeavor, only a very limited quantitative characterization of care 

transition issues was possible using available government data (including Government 

Accountability Office (GAO) reports, Veterans Health Administration (VHA) Office of 

Public Health and Environmental Hazards data, and the Report of the President’s 

Commission on Care for America’s Returning Wounded Warriors / July 2007 and 

references within). There were no databases or files that integrated treatment and other 

pertinent information collected by both DoD and VA on service members who were 

discharged or released1

 from active military duty. To quantitatively characterize the care 

transition process, we used relevant data files from both DoD and VA sources to create 

an analytical database (hereafter referred to as the LC database) that incorporates details 

about all 494,147 service members discharged during July 1, 2005—September 30, 2006. 

Derived from more than 30 files provided by VA and DoD, the LC database incorporates 

information about these veterans regarding Reserve/National Guard status, referral to the 

Physical Evaluation Board (PEB) for the appropriate military service, military medical 

treatment and other care funded by DoD, OEF/OIF status, application for VA health care 

and other benefits, VA medical treatment and other care funded by VA, and veterans 

 

1

 In this report the terms “discharged,” “released,” and “separated” are used synonymously. 

VA Office of Inspector General 1 
Quantitative Assessment of Care Transition: the Population-Based LC Database 

vital status. To our knowledge, this is the first and the only available population-based 

database that provides the opportunity to systematically address transition issues, and 

thus fills a critical gap in the understanding of service members’ experiences with 

transition to civilian life. This population-based approach eliminates potential bias in the 

selection of study subjects. 

In this report, we describe the LC database, including an overview of its structure, the 

methodology used to create it, data confidentiality issues, its limitations, and its analytic 

potential for research and other applications. We believe this provides background for 

understanding and interpreting ongoing and planned studies using this unique database. 

We also present selected descriptive statistics of veterans who comprise the database 

population. 

Methods 

LC Database Population File (ALLID) 

The LC database population consists of all service members who were discharged from 

active military duty during July 1, 2005—September 30, 2006, inclusive. 

In order to establish the population of veterans, three military discharge files were used: 

• Veterans Assistance Discharge System (VADS) 

• Beneficiary Identification Record Locator Subsystem (BIRLS) 

• VA/DOD Identity Repository (VADIR). 

VADS files are maintained by the Veterans Benefits Administration (VBA) of VA. 

VADS captures information from copies of the Certificate of Release or Discharge from 

Active Duty (known as DD Form 214 or simply DD214), issued by DoD to service 

members upon their separation from DoD. VADS then disseminates this information to 

be used for determining and processing benefits and entitlements that the VA is 

responsible for administering to veterans. Reserve and National Guard members may be 

issued multiple DD214 forms, one for each time that they were released from active duty. 

BIRLS files are also maintained by VBA. The primary purpose of BIRLS is to track 

folder location and provide information about veterans and their beneficiaries. BIRLS 

files are updated daily by VADS files. In addition, they also contain DD214 information 

entered by the staff at VBA Regional (field) Offices. Only verified BIRLS DD214 data 

were used when establishing the LC database population. 

VADIR data files for Active Component and Reserve (including National Guard) 

Component were requested from the Office of Information and Technology of VA. The 

VADIR database was established to support a One VA/DoD data-sharing initiative in 

order to consolidate data transfers between DoD and VA. DoD’s Defense Manpower 

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Quantitative Assessment of Care Transition: the Population-Based LC Database 

Data Center (DMDC) stages shared data as defined in a Memorandum of Understanding 

(MOU), and transmits data to VADIR. The VADIR data are used to assist in determining 

veteran benefits. 

DD214 records with discharge/release date from active duty (DD214 date) from July 1, 

2005—September 30, 2006 were extracted from VADS, BIRLS, and VADIR files, 

separately. Because VADIR files lacked DD214 dates, the Active Duty End Date (for the 

Active Component file) and Activation End Date (for the Reserve/National Guard 

Component file) were used as the DD214 date. If more than one record exists for a 

unique Social Security Number (SSN) in a file (as a result of multiple DD214 forms 

issued to a same person), the record with most current DD214 date was kept. SSNs were 

first checked for validity in terms of being 9 digits, and records with invalid SSNs were 

excluded from further consideration. 

The kept discharge records (one per unique SSN) from each of the military discharge 

files were then merged by SSN to build the LC database population file, ALLID. If more 

than one record exists (as a result of the same SSN being captured in more than one 

military discharge file), the ALLID file kept the record that contained the most current 

DD214 date. Thus, the ALLID file kept only unique SSNs, with one data record for each 

person (SSN). 

The ALLID file captures information from military discharge files on sex, date of birth, 

pay grade, separation type (VADIR files do not contain this information), character of 

service, service branch, and etc., in addition to the DD214 date. These data elements 

were first converted to a common coding scheme if different coding methods were used 

in VADS, BIRLS, or VADIR files. Consistency of these (non-missing) data values was 

then checked if they were available from more than one discharge file. If they were 

inconsistent for a given person, the non-missing value that was most frequently agreed on 

was used. If there was no such agreement, the non-missing value was used from the files 

in the following prescribed order: VADS, BIRLS, and VADIR. 

In addition, the ALLID file contains information regarding Reserve/National Guard 

status, referrals to PEB, military medical treatment and other care funded by DoD, 

OEF/OIF status, application for VA health care and other benefits, VA medical treatment 

and other care funded by VA, and veterans’ vital status. These data elements were 

derived and rolled up from the LC database master files that were built based on more 

than 30 files provided by VA and DoD. 

LC Database Master Files 

Master files were built from their corresponding original source data files by keeping 

only relevant data records for those included in the population file ALLID. Master files 

deleted personal identifiable information and kept most of data elements in the original 

source data files. If necessary, special coding schemes used in different original files 

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Quantitative Assessment of Care Transition: the Population-Based LC Database 

were first converted to a common code, and then prescribed business rules were applied 

to cope with inconsistent information from multiple file sources. In addition to original 

data elements, master files also created their derived variables. In contrast to the 

population file, ALLID, these master files may contain multiple records corresponding to 

a same person. 

The ALLID file and its associated master files were all de-identified by removing 

personal identifiable information and assigning a study identification number (ID). 

Veterans included in the database were distinguished within each file and linked among 

different files by their own unique ID. The ID was assigned specifically for this project, 

which was unrelated to individual’s personal identifier, SSN. 

DoD Medical Treatment Master Files

Five DoD medical treatment clinic master files have been built: 

• DoD Inpatient 

• DoD Outpatient 

• TriCare Inpatient 

• TriCare Outpatient 

• Deployment 

These clinical master files contain all the medical visits information of all persons in 

ALLID who had been treated by DoD (including TriCare) from October 1, 2004—

September 30, 2006. The sources of these master files are the 5 corresponding types of 

treatment files provided by DoD Patient Administration System and Biostatistics Activity 

at San Antonio, Texas. 

In addition, each of the clinic master files contains 11 diagnosis-specific indicators, 

which were considered as either severely injured or common chronic conditions, for 

every record in the file. These indicators were created based on the existence of 

following specific diagnosis codes of International Classification of Disease, Ninth 

Revision (ICD-9) on treatment records: The codes are as follows. 

• Traumatic Brain Injury (TBI)

310.2 Post-traumatic encephalopathy, post-concussion. 

800.xx–804xx Skull fracture. 

850.xx Concussion. 

851.xx Cerebral laceration and contusion. 

852.xx Subarachnoid, subdural, and extradural hemorrhage. 

853.xx Other and unspecified intracranial hemorrhage following injury. 

854.xx Intracranial injury of other and nonspecified injury. 

950.xx Injury to optic nerve and pathways. 

VA Office of Inspector General 4 
Quantitative Assessment of Care Transition: the Population-Based LC Database 

• Post-Traumatic Stress Disorder (PTSD)

309.81 

• Amputation

887.xx Arm and/or hand. 

896.xx Foot. 

897.xx Leg. 

• Blindness

369.xx Blindness and low vision. 

377.75 Cortical blindness. 

• Major Depression

296.2 Major depressive disorder, single episode. 

296.3 Major depressive disorder, recurrent episode. 

• Spinal Cord Injury (SCI)

806.xx 

952.xx 

• Diseases of the Musculoskeletal System and Connective Tissue (Pain)

710.xx 

739.xx 

excluding: 

710 Diffuse diseases of connective tissue. 

712 Crystal arthropathies. 

713 Arthropathy associated with other disorders classified elsewhere. 

714 Rheumatoid arthritis and other inflammatory polyarthropathies. 

720 Ankylosing spondylitis and other inflammatory spondylopathies. 

725 Polymyalgia rheumatica. 

733 Osteoporosis. 

• Asthma

493.xx 

• Acute Myocardial Infarction (AMI)

410.xx Acute myocardial infarction. 

411.xx Other acute and subacute forms of ischemic heart diseases. 

• Diabetes Mellitus

250.xx 

VA Office of Inspector General 5 
Quantitative Assessment of Care Transition: the Population-Based LC Database 

• Substance Abuse

303.xx Alcohol dependence syndrome. 

304.xx Drug dependence. 

305.0, 305.2 – 305.9 Nondependent abuse of drugs. 

These diagnosis-specific indicators and their corresponding diagnosis dates were rolled 

up to ALLID. Diagnosis date was the hospital discharge date for the inpatient treatment 

and the admission date for the outpatient visit. If a patient had more than one diagnosis 

date for a diagnosis-specific indicator in a file or in different files, the latest diagnosis 

date was used and the corresponding diagnosis date with the indicator was rolled up to 

the ALLID file. Two latest diagnosis dates were rolled up that corresponded to a 

diagnosis-specific indicator: one was the latest diagnosis date before their DD214 date of 

separation from DoD, another was the latest diagnosis date before September 30, 2006 

(independent of individual’s DD214 date). The second date (regardless of DD214 date) 

was especially relevant because some service members might receive specialty care (such 

as for TBI) from VA before their separation from DoD. 

To keep track of the master files from which the diagnosis was taken, the source file 

information for each of the 11 diagnosis-specific indicators was combined with the 

diagnosis-specific indicator to create the corresponding diagnosis-specific categorical 

indicators before they were rolled up to ALLID. For example, in the master files, an 

indicator of PTSD was added to each record based on the presence (PTSD=1) or absence 

(PTSD=0) of the ICD-9 code of 309.8 in that record. In the ALLID file, the existence of 

PTSD code and which of the five master files contained the code was combined to create 

a categorical indicator that takes more than just 0 or 1 to keep tracking which master files 

contained the code. For example, in the ALLID file, PTSD=0 indicates that the 

discharged service member was not found being diagnosed with PTSD in any of the five 

types of DoD treatment files; PTSD=1 means that the member was found as being 

diagnosed with PTSD in DoD Outpatient file only; and PTSD=11 specifies that the 

member was found being diagnosed with PTSD in TriCare Outpatient and in both DoD 

Inpatient and Outpatient files. 

Two indicators of any DoD medical treatment and their corresponding dates were also 

created and rolled up to ALLID. One indicator was for receiving any DoD care that 

occurred from October 1, 2004—September 30, 2006. Another indicator was for any 

care that occurred before separation from DoD, that is, from October 1, 2004, to the day 

prior to the individual’s DD214 date. If more than one diagnosis date existed for a 

treatment indicator in a master clinic file or in different master clinic files, the latest 

treatment date was used as the corresponding treatment date when the DoD treatment 

indicator was rolled up to the ALLID file. 

In addition to the five clinical master files, we also built the DoD medical treatment 

demographic master file. This file held static (unchanging) demographical data based on 

information from all five types of DoD treatment files (Inpatient, Outpatient, TriCare 

VA Office of Inspector General 6 
Quantitative Assessment of Care Transition: the Population-Based LC Database 

Inpatient, TriCare Outpatient, and Deployment). First, within each type of file, the 

demographic data element was taken from the latest treatment record that contained a 

non-missing value for that specific data item, as we reasoned it was likely that the static 

demographic data item was modified because of corrections to previously collected 

incorrect information. Because medical records contain missing values for some of their 

data elements, the non-missing values of different demographic data elements for a 

patient may come from different treatment records within a file. For example, the 

information on race for John Smith may be taken from his (latest) June 28, 2006, 

outpatient record, while the ethnicity information may be taken from his (earlier) May 8, 

2006, outpatient record, as a result of missing the ethnicity information on his (latest) 

June 28, 2006 record. The demographic information taken from each of five types of 

treatment files were converted into a common coding scheme if necessary. For example, 

several different categories of Hispanic ethnicity were re-coded to a single indicator to 

establish coding consistency across different treatment files. Then, the values from 

different files for a same patient’s demographic data item were merged, and the derived 

data value was the non-missing one that was most frequently agreed upon. If there was 

no such an agreement, the non-missing value was taken from the file in the following 

prescribed order: TriCare Inpatient, TriCare Outpatient, DoD Inpatient, DoD Outpatient, 

and Deployment. These DoD demographic data were also rolled up to ALLID. 

VA Medical Treatment Master Files

VA medical treatment clinic master files and the demographic master file were built in a 

similar approach as described for the DoD treatment master files. Four VA medical 

treatment clinic master files were built based on corresponding VA treatment files: 

• VA Inpatient (Patient Treatment files). 

• VA Outpatient (National Patient Care files). 

• Fee Basis Inpatient. 

• Fee Basis Outpatient. 

These VA clinical master files include medical visit information of all persons in ALLID 

who had sought VA medical care from July 1, 2005—to June 30, 2007. 

In contrast to DoD treatment, if a VA patient had more than one diagnosis date for a 

diagnosis-specific indicator in VA master files, then the earliest, rather than the latest VA 

diagnosis date was used, and the corresponding diagnosis date when the indicator was 

rolled up to the ALLID file. Two earliest VA diagnosis dates were rolled up that 

corresponded to each of the 11 VA diagnosis-specific indicators: one was the earliest 

diagnosis date after the individual’s DD214 date; another was the earliest diagnosis date 

from July 1, 2005, regardless of the DD214 date. The second date (regardless of DD214 

date) was necessary because VA might send veterans to DoD for its specialty care. 

Similarly, the earliest dates were used for any VA treatment indicators (that is., first time 

receiving any VA treatment from July 1, 2005, or from individual’s DD214 date, to 

VA Office of Inspector General 7 
Quantitative Assessment of Care Transition: the Population-Based LC Database 

June 30, 2007). In essence, all DoD treatment indicators are associated with dates of last 

time treated at DoD and all VA indicators are associated with dates of first time treated at 

VA. We reasoned that the time segment between the last treatment at DoD and the first 

treatment at VA would be the more relevant measure when evaluating timeliness of care 

transition. 

Besides DoD treatment indicator counterparts, two additional special indicators and their 

corresponding dates were created in VA master treatment clinic files and then rolled up to 

ALLID. One indicator was for first time seeking any VA care from July 1, 2005— 

June 30, 2007. Another one was for first time seeking any VA care from the individual’s 

DD214 date to June 30, 2007. In contrast to other treatment indicators, these two 

indicators of seeking VA care made no distinction between encounters (where at least 

one ICD-9 code recorded in the corresponding medical record) and “occasions of 

services.” An occasion of service was defined by VHA as the health service provided to 

a VA patient without the presence of a decision-making provider, so that there were no 

ICD-9 codes recorded for the service. Examples of occasions of service were laboratory 

tests, radiology exams, and EKGs. Indicators of seeking VA care were created with the 

same approach as creating indicators of VA treatment, except that medical records 

without any ICD-9 codes were excluded when creating treatment indicators, and they 

were included when creating indicators for seeking care. Indicators of seeking care were 

created in an attempt to capture the earliest VA effort of providing health care services to 

service members who were newly separated from DoD. The indicators would be a 

relevant overall measure of timeliness of care transition that was not limited only to 

treatment. 

The derived VA demographic data elements which were brought forward to ALLID were 

the most current available non-missing value that was most frequently agreed upon 

among the four types of VA treatment files. If there was no such an agreement, the most 

current available non-missing value was used that was taken from in the following 

prescribed file order: VA Inpatient, VA Outpatient, Fee Basis Inpatient, and Fee Basis 

Outpatient. 

PEB Master File

Service members who have a serious illness or injury may be referred to a PEB for 

possible medical discharge from active military duty. A service member may be referred 

to a PEB more than once. The PEB master file included every person who was in both 

the ALLID file and in the PEB file provided by DoD. The DoD PEB file contained dates 

submitted for PEB evaluation. These PEB dates ranged from September 2005—January 

2007. The master file used the earliest PEB date if more than one PEB record was found 

in the DoD PEB file (as a result of more than one PEB process). A service member was 

considered as having had PEB referral only if the individual’s (earliest) PEB date 

occurred before the individual’s DD214 date. The indicator of referral to PEB and its 

corresponding referral date were rolled up to the ALLID file. 

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Quantitative Assessment of Care Transition: the Population-Based LC Database 

Reserve Affairs Reserve/National Guard (RN) Master File

The RN master file was established using the Activation file provided by DoD Reserve 

Affairs. The Activation file provided one record for each activation of a Reserve or 

National Guard member that included in the corresponding activation start date and end 

date. The activation start dates ranged from October 1, 2001—July 2007. 

A service member was defined as having served in a Reserve/National Guard unit before 

the service member was released from active duty only if this individual’s first activation 

start date in the Activation file was earlier than the individual’s DD214 date, the 

separation date from DoD. This effectively assumes that once a service member started 

serving in a Reserve/National Guard unit, then the individual would continue the service 

only in a Reserve/National Guard unit. In other words, only members of the active 

component may later switch to the Reserve/National Guard unit, but not otherwise. This 

precludes the likelihood of members of the Reserve/National Guard unit joining an active 

component later. 

The RN master file included every person who was included in the ALLID file and 

judged as served in a Reserve/National Guard unit. The indicator for Reserve or National 

Guard members and the corresponding first and last activation start dates were rolled up 

to the ALLID file. 

VADIR RN Master File

The VADIR RN master file was created from the VADIR data file for the 

Reserve/National Guard component using the same approach as creating the RN master 

file. A service member was classified as having served in a Reserve/National Guard unit 

only if the individual’s first activation start date in the VADIR file was earlier than the 

individual’s DD214 date. The activation start dates in the VADIR Reserve/National 

Guard file ranged from October 1, 2001—January 2007. The VADIR RN master file 

included all persons who were included in the ALLID file and were judged as served in a 

Reserve/National Guard unit. The indicator for Reserve or National Guard members and 

the corresponding first and last activation start dates were rolled up to the ALLID file. 

OEF/OIF Master File

The source file for the OEF/OIF master file is the OEF/OIF file that contains the roster of 

military personnel who had served in the OEF/OIF theater and separated from active duty 

since October 1, 2001. The OEF/OIF file contains selected DoD data elements from the 

Contingency Tracking System of the DoD DMDC and the file was provided by VA. 

The OEF/OIF master file included every person who was included in the ALLID file and 

judged as having served in the OEF/OIF theater. A veteran was deemed as having served 

VA Office of Inspector General 9 
Quantitative Assessment of Care Transition: the Population-Based LC Database 

in the OEF/OIF theater only if the individual’s first deployment start date was earlier than 

the individual’s DD214 date. 

The master file contains indicators for Reserve or National Guard members based on 

information in the OEF/OIF file. In the OEF/OIF master file, a veteran was classified as 

having served in a Reserve/National Guard unit only if the individual’s first deployment 

start date in the OIF/OEF file was earlier than the individual’s DD214 date. Indicators 

for OEF/OIF and for Reserve or National Guard members and the corresponding first and 

the last deployment start dates were rolled up to the ALLID file. 

VHA National Enrollment Database (NED) Master File

The NED resulted from the Veterans’ Health Care Eligibility Reform Act of 1996 (Public 

Law 104-262), which mandated the VA to establish and implement an annual patient 

enrollment system to manage the delivery of health care services. The Health Eligibility 

Center (HEC) in Atlanta is responsible for determining eligibility of veterans for VA 

medical care. NED serves as the single primary source for storing VA healthcare 

enrollment records at a national level. It is populated on a nightly basis from enrollment 

and eligibility data residing at the HEC via a Health Level 7 (HL7) messaging interface. 

The NED was used to get an indication of if and when veterans sought VA healthcare 

benefits. Two special files were requested to be extracted from the NED: the Enrollment 

Application NED file and the Automatic Enrollment NED file. The Automatic 

Enrollment NED file included three categories of veterans who are not required to apply 

for enrollment to be eligible for VA health care. They are veterans who: 

(1) have a service-connected disability of 50 percent or more, (2) are seeking care for a 

disability the military determined was incurred or aggravated in the line of duty, but 

which VA has not yet rated, and who are within 12 months of discharge, and (3) are 

seeking care for a service-connected disability only (Federal Benefits for Veterans and 

Dependents, VA 2006 Edition). The Enrollment Application NED file contains all other 

veterans who are required to apply for enrollment for their eligibility determination (by 

completing VA Form 10-10EZ, Application for Health Benefits). Both extracted NED 

files cover the time period January 1, 2005—December 31, 2006. 

The NED master file was created based on both NED file extractions. Veterans were 

classified as having sought VHA benefits if their records were found in NED, regardless 

of their eligibility determination. Date of first time seeking VHA benefits (NED date) 

was defined as the Initial Enrollment Date for those auto-enrolled veterans. For those 

who were not auto-enrolled veterans, the NED date used the non-missing date in the 

following order: Initial Enrollment Application Date, Initial Enrollment Date, and 

Enrollment Change Date. Two NED dates were derived, one for first time seeking VHA 

benefits since January 1, 2005, and another for first time seeking VHA benefits after 

individual’s DD214 date. These two NED dates would be identical if persons only 

sought first time VHA benefits after their separation from DoD. 

VA Office of Inspector General 10 
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The NED master file contained every person who was included in both the ALLID file 

and in the NED file extractions. The indicator for NED, its two corresponding NED 

dates, Enroll Priority Group and Enroll Category Type, were brought forward from the 

NED master file to ALLID. 

VBA Benefits Enrollment (WIPP) Master File

Work-In-Progress Processing (WIPP) files were used to get an indication if and when 

veterans applied for VBA benefits such as Compensation and Pension, home loans, or 

educational benefits. WIPP files are produced weekly by VBA. They are used primarily 

as a workload monitoring and management tool for benefits claims. The WIPP files 

contain information for every completed pending claim. The source of the WIPP 

transactions is the Pending Issue File (PIF) database, a temporary work area the VBA 

Regional Offices use. When a claim record is erased from the PIF—because it is either 

completed, cancelled, or cleared—the record is moved over to the WIPP file. 

The WIPP master file used WIPP files that covered the period from January 1, 2005—

June 30, 2007. Veterans were considered as having applied for VBA benefits if their 

records were found in 2005–2006 WIPP files, regardless of their application outcomes. 

Date of (first time) applying for VBA benefits (WIPP date) was defined as the claim date 

in WIPP files. Two WIPP dates were derived, one for first time applying for VBA 

benefits since January 1, 2005, another for first time applying for VBA benefit after 

individual’s DD214 date. These two WIPP dates would be identical if persons only 

sought first time VHA benefits after their separation from DoD. 

The WIPP master file contained every person who was included in both the ALLID file 

and in the WIPP files. Indicator for WIPP, its two corresponding first WIPP dates, and 

corresponding claim complete date were rolled up from the WIPP master file to ALLID. 

Vital Status Master File

Service members who died before their separation from DoD were excluded from the LC 

database population. The death master file captures deceased veterans after their 

discharge from active military duty. Veterans vital status in ALLID was determined 

based on information from both Social Security Administration (SSA) death file and VA 

vital status dataset. VA vital status file is maintained by VHA National Data Systems, a 

component of the Office of Information, Austin, TX. VA vital status file includes death 

dates only for veterans who had been entered into the VA veteran database. The SSA 

death file was not limited to VA veterans. 

The Death master file included death dates for all veterans included in ALLID and whose 

death dates were within the period July 01, 2005—June 30, 2007 from the VA Vital 

Statistic file and to August, 2007 from the SSA death file. Two death indicators were 

created and rolled up to ALLID: one for deaths occurred from July 01, 2005 (used for 

VA Office of Inspector General 11 
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VA Office of Inspector General 12 

excluding deaths before military discharge and data checks), and another for death dates 

after an individual’s DD214 date. 

Statistical Analysis

Because PEB information was available only from September 2005, analyses presented 

in this report were limited to all service members who were discharged from active 

military duty during fiscal year (FY) 2006 (October 1, 2005—September 30, 2006). In 

addition, those whose age at discharge was age 16 or under, or over 65, were excluded. 

Age at discharge was calculated based on DD214 date and date of birth. 

A service member was considered as having served in a Reserve/National Guard unit if 

Reserve/National Guard status was indicated in any of the Reserve Affairs RN, OEF/OIF, 

or VADIR RN Master files. Pay Grade was grouped into 5 categories: E1–E4, E5–E9, 

O1–O3, O5–O10, and “Other”; the “Other” group included W1–W5, codes other than 

specified above including missing Pay Grade information. Service branches of other than 

Army, Navy, Air Force, and Marine Corps, including missing branch information, were 

grouped as “Other.” 

Service Character was re-categorized as follows: 

• Honorable/General incorporates “Honorable” and “General, Under Honorable 

Conditions.” This category also includes those judged “Honorable for VA 

Purposes” by VBA. 

• Other Than Honorable.

• Bad Conduct/Dishonorable includes “Bad Conduct” and “Dishonorable” 

discharges. It also includes those judged “Dishonorable for VA Purposes” by 

VBA 

• Uncharacterized consists of those without character of service listed. 

DoD treatment counted only clinical encounters (that is, with at least one ICD-9 

diagnosis code). The “sought VA health care” category included both encounters and 

occasions of services (no ICD-9 codes). 

All analyses were performed using SAS statistical software (SAS Institute, Inc., Cary, 

North Carolina), version 9.1 (TS1M3). 

Results 

The LC database consists of the study population file, ALLID, and the 18 master files 

(see Figure 1 on the next page) that incorporate details about all 494,147 service 

members discharged or released from active military duty during the period July 1, 

2005—September 30, 2006. The LC database excluded 1 service member whose Social
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Quantitative Assessment of Care Transition: the Populat
Quantitative Assessment of Care Transition: the Population-Based LC Database 

Security Number was invalid (an ASCII extended character followed by 8 zeros) and 147 

service members who were dead before their DD214 date. 

Of the 494,147 in the ALLID, 391,968 service members were discharged during 

FY 2006. We excluded 10 of the 391,968 service members whose date of birth were 

unknown, 13 were under age 17 and 41 were over 65 at the discharge time from our 

analyses (A total of 64 veterans were excluded, which was less than 0.02 percent 

(64/391,968)). Thus, our analyses included 391,904 service members who were 

discharged during FY 2006 and whose age at discharge were between 17 and 65. 

Of these 391,904 service members, 332,964 (85 percent) were identified from the VADS 

file, and an additional 12,628 (3 percent) were identified in the BIRLS file, and a further 

46,312 (12 percent) were identified through VADIR. 

Table 1 (see next page) showed that the median age of the discharged 391,904 service 

members was 26 years old, that is, half of them were younger and half of them older than 

26 at their discharge time. The average age was 29.4 year. 

Approximately half (51 percent) of the discharged service members had served in 

OEF/OIF, and 31percent of them were from the Reserve Component (Reserves and 

National Guards). Approximately 15 out of 100 discharged members were female. Over 

55 percent of the veterans served in the Army, 16 percent and 15 percent were in the 

Navy and Air Force, respectively, and approximately 13 percent in the Marines. 

Approximately 89 percent of veterans were enlisted and 10 percent were officers. More 

than half (51 percent) of the service members were in the E1–E04 pay grade at the time 

of their discharge, 38 percent in the E5–E9 grade, and 5 percent each in O1–O3 grade or 

in O4–O10 grade. Less than 0.6 percent of the discharged veterans had died by June 30, 

2007. 

More than 86 percent of discharged service members earned Honorable (including 

Honorable VA Purpose), or Under Honorable, or General service character, 3 percent of 

them discharged with Other Than Honorable character, and 0.1 percent of them with Bad 

Conduct or Dishonorable conditions. Bad Conduct and Dishonorable discharges issued 

by general courts martial may bar VA benefits. Veterans separated administratively 

under Other Than Honorable conditions may request that their discharge be reviewed for 

possible re-characterization for the purpose of obtaining VA benefits. 

Service members who have a serious illness or injury may be referred to a PEB for 

possible medical discharge. Overall, approximately 2.3 percent of the service members 

discharged during FY 2006 was referred to a PEB from September 1, 2005–September 

30, 2006. 

Most of the veterans (92 percent) had received treatment while serving their active 

military duty during October 1, 2004–September 30, 2006. Over 1 percent of veterans 

VA Office of Inspector General 14 
Quantitative Assessment of Care Transition: the Population-Based LC Database 

Table 1: Characteristics of 391,904 service members discharged from 

active military service between October 1, 2005 – September 30, 2006, 

who were 17-65 years old at discharge. 

Age (years) 

 Median 26

 Mean 29.4

OEF/OIF (%) 51.0

Reserve Component (%) 

 Reserves and National Guard 31.3

Sex (%) 

 Female 14.8

 Male 83.6

 Unknown 1.6

Service Branch (%) 

 Army 55.2

 Navy 15.7

 Air Force 15.1

 Marines 12.5

 Other 1.5

Service Character (%) 

 Honorable/General 86.5

 Other Than Honorable 3.1

 Bad Conduct/Dishonorable 0.12

 Uncharacterized 10.3

Pay Grade (%) 

 E1-E4 50.7

 E5-E9 38.1

 O1-O3 5.1

 O4-O10 5.1

 Other 1.1

Referred to Physical 

 Evaluation Board (%) 2.3

Vital Status 

 Died by June 30, 2007 (%) 0.55

Treated in DoD (%)* 

 Oct. 1, 2004 – Sept. 30, 2006 92.2

 Before Military Discharge 90.9

 After Military Discharge 1.4

Sought Care in VA (%)** 

 July 1, 2005 – June 30, 2007 30.2

 After Military Discharge 27.1

 Before Military Discharge 3.1

* DoD treatment included only encounters with at least one ICD-9 

diagnosis code.

**Sought VA health care included encounters with and without ICD-9 

codes.

VA Office of Inspector General 15 
Quantitative Assessment of Care Transition: the Population-Based LC Database 

received health care provided by DoD. Thirty percent of veterans had sought VA health 

care during July 1, 2005–June 30, 2007. More than 3 percent of discharged veterans had 

sought VA care before their separation from DoD in FY 2006. 

Discussion 

The LC database provides us unique opportunities for systematically evaluating transition 

processes using a data-based approach. The population-based nature of the database 

eliminates potential selection bias. 

Systematic evaluation of the transition process can (1) delineate transition times and the 

extent to which they vary, and (2) explore possible sources of variation, including 

demographics, rank, diagnoses, service branch, service character, Reserve or National 

Guard status, and OIF/OEF status. Results from these analyses could allow for better 

strategic planning, improved targeting of specific groups for outreach, and identification 

of required legislative and policy changes. In addition, since non-OIF/OEF data can 

serve as a baseline to approximate peacetime circumstances, OIF/OEF data provide an 

estimation of the incremental VA workload and cost of care attributable to the conflict. 

Such an analysis could help VA and DoD to better prepare for the challenges expected in 

future hostile actions. 

Because of the huge size of the database, we split the database into the study population 

file (ALLID) and the 18 associated master files, instead of one gigantic file. This 

modular approach makes it possible for us to use the database on desktop computers 

(rather than a mainframe), so that the database can be used practically. The ALLID 

population file is a person file with only one data record for one person, whereas the 

master files are episode files where many data records may pertain to the same person. 

The ALLID file contains most commonly used information or derived data elements at 

the person level. For information other than those brought forward to ALLID, the 

relevant master files should be used to derive or extract that data. 

The LC database is limited by the availability of the data files based upon which it is 

created. For example, the original PEB data file is available starting with referral dates in 

September 2005. As a consequence, we would not know about referrals to PEB if such 

referrals occurred prior to September 1, 2005. Similarly, the Activation file from DoD 

Reserve Affairs is also not available before October 1, 2001 (as the file contains members 

of Reserve Component activated October 1, 2001, and onward). We could miscount the 

members of Reserve Component as members of Active Component had they started 

active duty earlier than October 1, 2001, although this is an unlikely circumstance for 

members discharged in FY 2006 since the duration of active duty usually is much shorter 

than 5 years for Reserve members. 

In addition, the LC database is also limited by the quality of the data files from which it is 

created. We used our pre-defined business rules to deal with possible conflicting data 

VA Office of Inspector General 16 
Quantitative Assessment of Care Transition: the Population-Based LC Database 

information because it was unrealistic for us to go back to original data collectors to 

make data correction. However, the files we used are the best currently available data 

that are also used for other DoD and VA data reporting purposes and policy development. 

Other ongoing data analyses indicate that Reserve and National Guard service members 

comprise a substantial proportion of OEF/OIF personnel and that these individuals have 

different characteristics at the time of military discharge from their Active Component 

counterparts. In follow-up reports, we will provide details about the transition 

experiences of groups of individuals with specific medical conditions by OEF/OIF and 

Reserve/National Guard status. 

We also plan to expand the LC database both backwards and forwards to include all 

service members discharged from active military service from October 1, 2001, onwards. 

This expansion would make the database more comprehensive and useful because it 

would make trending possible. 

 (original signed by:) 

JOHN D. DAIGH, JR., M.D. 

Assistant Inspector General for 

Healthcare Inspections 

VA Office of Inspector General 17 
Quantitative Assessment of Care Transition: the Population-Based LC Database

Appendix A 

OIG Contact and Staff Acknowledgments 

OIG Contact Limin X. Clegg, Ph.D. 

Senior Mathematical Statistician 

Jerome E. Herbers, M.D. 

Senior Physician 

(202) 565-8453 

Acknowledgments Patricia Christ, RN 

Joey Foley 

Jerry C. Goss 

Gilbert Melendez 

Deanna Moczygemba 

Dana L. Moore, Ph.D. 

Brenda Uptain 

VA Office of Inspector General 18 
Quantitative Assessment of Care Transition: the Population-Based LC Database

Appendix B 

Report Distribution 

VA Distribution

Office of the Secretary 

Veterans Health Administration 

Veterans Benefits Administration 

National Cemetery Administration 

Assistant Secretaries 

General Counsel 

Non-VA Distribution

House Committee on Veterans’ Affairs 

House Appropriations Subcommittee on Military Construction, Veterans Affairs, and 

Related Agencies 

House Committee on Oversight and Government Reform 

Senate Committee on Veterans’ Affairs 

Senate Appropriations Subcommittee on Military Construction, Veterans Affairs, and 

Related Agencies 

Senate Committee on Homeland Security and Governmental Affairs 

National Veterans Service Organizations 

Government Accountability Office 

Office of Management and Budget 

This report is available at http://www.va.gov/oig/publications/reports-list.asp. 

VA Office of Inspector General 19