Vocational Rehabilitation: More VA and DOD Collaboration Needed to Expedite Services for Seriously Injured Servicemembers
Published: 2005-01-14T00:00:00

Fast Facts:

Highlights:
section_title: Why GAO Did This Study
paragraphs: More than 10,000 U.S. military servicemembers, including National Guard and Reserve members, have been injured in the conflicts in Afghanistan and Iraq. Those with serious injuries are likely to be discharged from the military and return to civilian life with disabilities. The Department of Veterans Affairs (VA) offers vocational rehabilitation and employment (VR&E) services to help these injured servicemembers in their transition to civilian employment. GAO has noted that early intervention--the provision of rehabilitation services as soon as possible after the onset of a disability--is a practice that significantly facilitates the return to work. GAO examined how VA expedites VR&E services to seriously injured servicemembers and the challenges VA faces in its efforts to do so.
section_title: What GAO Found
paragraphs: VA has taken steps to expedite vocational rehabilitation and employment services for servicemembers returning from Afghanistan and Iraq with serious injuries. The agency has instructed its regional offices to make seriously injured servicemembers a high priority for all VA assistance, including VR&E services, and has asked DOD to provide data that would help VA identify and monitor this population. It has also deployed additional staff to five major Army military treatment facilities where the majority of the seriously injured are treated. Pending an agreement with DOD for sharing data, VA has relied on its regional offices to learn who the seriously injured are and where they are located. We found that the regional offices we reviewed had developed information that varied in completeness and reliability. We also found that VA does not have a policy for maintaining contact with those with serious injuries who may later be ready for VR&E services but did not initially apply for VR&E. Nevertheless, some regional offices did attempt to maintain contact while other regional offices did not. VA faces significant challenges in expediting VR&E services to seriously injured servicemembers. These include: the inherent challenge that individual differences and uncertainties in the recovery process make it difficult to determine when a servicemember will be ready to consider VR&E services; DOD's concerns that VA's outreach, including early intervention with VR&E, could work at cross purposes to military retention goals for servicemembers whose discharge from military service is not yet certain; and the lack of access to data from DOD that would allow VA to readily know which servicemembers are seriously injured and where they are located. VA and DOD generally concurred with our findings and recommendations.

section_title: Letter
paragraphs: Since the onset of U.S. operations in Afghanistan in October 2001 and Iraq  in March 2003, the Department of Defense (DOD) has reported that more  than 10,000 service men and women have been injured in combat. While  many return to active duty after they are treated, others who are more  seriously injured are likely to be discharged from their military obligations  and return to civilian life with disabilities. In addition to cash  compensation, the Department of Veterans Affairs (VA) offers vocational  rehabilitation and employment (VR&E) services to help veterans with  disabilities restore their lives and participate in the civilian workforce. We  have reported that intervening early after a disabling injury increases the  likelihood that an individual will successfully return to work. Moreover,  there is growing awareness that people with disabilities can and want to  work and that changes in the nature of work and advances in assistive  technologies help them to do so. Further, as the U.S. workforce is  projected to shrink, the U.S. economy will need all who are able to  participate in the paid labor force. Because federal disability programs,  including VA’s, lack emphasis on the potential for vocational rehabilitation  to return people to work and also rely on outmoded assumptions about  the relationship between impairment and work, we have designated these  as “high-risk” programs.
In view of the importance of early intervention in returning people who  have been disabled to work, you asked that we review how quickly VA is  able to provide VR&E services to seriously injured servicemembers from  Afghanistan and Iraq who are likely to become veterans with disabilities.  We assessed (1) how VA expedites VR&E services to these seriously  injured servicemembers and (2) the challenges VA faces in its efforts to do  so.
To address these objectives, we reviewed VA’s formal and informal  procedures for expediting VR&E services to seriously injured  servicemembers returning from Afghanistan and Iraq. We reviewed  applicable laws and regulations. We interviewed officials at VA’s central  office and at 12 of VA’s 57 regional offices. Five of these offices are located  near the five major Army medical treatment facilities treating the majority  of the seriously injured Army servicemembers: Brooke Army Medical  Center at Fort Sam Houston, Texas; Darnall Army Community Hospital at  Fort Hood, Texas; Eisenhower Army Medical Center at Fort Gordon,  Georgia; Madigan Army Medical Center at Fort Lewis, Washington; and  Walter Reed Army Medical Center in Washington, D.C. The corresponding  VA regional offices are Houston and Waco, Texas; Atlanta, Georgia;  Seattle, Washington; and Washington, D.C. We selected the other seven  regional offices based on Army data indicating that servicemembers  injured in Afghanistan and Iraq are being treated at military treatment  facilities in their regions. They are Buffalo, New York; Denver, Colorado;  Muskogee, Oklahoma; Nashville, Tennessee; New Orleans, Louisiana;  Wichita, Kansas; and Winston-Salem, North Carolina. Our findings for  these regional offices cannot be generalized to all of VA’s regional offices.  We focused on Army servicemembers, including activated National Guard  and Reserve, because they constituted the majority of servicemembers  wounded in Afghanistan and Iraq. In addition, we visited Walter Reed  Army Medical Center in Washington, D.C., where most seriously injured  Army servicemembers are initially treated. We also interviewed DOD  officials about their efforts to work with VA on the transition of injured  servicemembers being discharged from active duty. We conducted our  work between April 2004 and November 2004 in accordance with generally  accepted government auditing standards.
subsections: section_title: Background
paragraphs: VA’s VR&E program is designed to ensure that veterans with disabilities  find meaningful work and achieve maximum independence in daily living.  In 2004, VA estimates that it spent more than $670 million on its VR&E  program to serve about 73,000 participants. This represents about 2  percent of VA’s $37 billion budget for nonmedical benefits, most of which  involves cash compensation for veterans with disabilities.
VR&E services include vocational counseling, evaluation, and training that  can include payment for tuition and other expenses for education, as well  as job placement assistance. Interested veterans generally apply for VR&E  services after they have applied and qualified for disability compensation  based on a rating of their service-connected disability. This disability  rating—ranging from 0 to 100 percent in 10 percent increments—entitles  veterans to monthly cash payments based on their average loss in earning  capacity resulting from a service-connected injury or combination of  injuries. To be entitled to VR&E services, veterans with disabilities  generally must have at least a 20 percent disability rating and an  employment handicap as determined by a vocational rehabilitation  counselor. Although cash compensation is not available to  servicemembers until after they separate from the military, they can  receive VR&E services prior to separation under certain circumstances.  To make these services available prior to discharge, VA expedites the  determination of eligibility for VR&E by granting a preliminary rating,  known as a memorandum rating.
VA’s outreach to servicemembers who plan to apply for veterans’ disability  compensation has been part of its transition assistance program, which  was established in 1990. Either in group sessions or in one-on-one  encounters, VA provides servicemembers with information about  disability benefits and services, which includes the VR&E program, and  offers assistance in applying for them. In addition, VA administers a pre- discharge program that expedites the disability compensation claims  processing for servicemembers who are pending discharge. This program  also helps VR&E staff identify those who could benefit from vocational  rehabilitation and employment services. VA has recently included  activated National Guard and Reserve members in its outreach efforts.
Servicemembers injured in Iraq and Afghanistan are surviving injuries that  would have been fatal in past conflicts, due, in part, to advanced  protective equipment and medical treatment. However, the severity of  their injuries can result in a lengthy transition from injured servicemember  to veteran. Initially, most seriously injured servicemembers, including  activated National Guard and Reserve members, are brought to Landstuhl  Regional Medical Center in Germany for treatment. From there, they are  transported to the appropriate U.S. medical facilities, which are usually  major military treatment facilities (MTFs) but may also be VA medical  centers. According to DOD officials, once stabilized and discharged from  the hospital, servicemembers usually relocate to be closer to their homes  or military bases and are treated as outpatients by the closest VA or  military hospital. (See fig. 1.) At this point, the military generally begins to  assess whether the servicemember will be able to remain in the military, a  process that could take months to complete. The process can take even  longer if the servicemember appeals the military’s initial disability  decision.
In response to recommendations made by the VA Vocational  Rehabilitation and Employment Task Force, VA is beginning to change its  approach to VR&E to better reflect contemporary views of disability. The  Secretary of Veterans Affairs established this external task force in 2003 to  conduct a comprehensive review of VA’s VR&E program. In addition,  faced with the immediate need to provide benefits and services to a new  generation of veterans with disabilities, VA in August 2003 formed an  internal task force to develop and implement policies to improve the  transition of injured servicemembers back to civilian life. Known as the  Seamless Transition Task Force, it included ad hoc participation from  DOD. Although this task force’s initial priority was to ensure the  continuity of medical care for injured servicemembers as they transition  from military to VA health care, it has also coordinated efforts to ensure  access to all other VA benefits, including VR&E services.
We have previously reported on the importance of early intervention to  maximize the work potential of individuals with disabilities. We have also  reported, however, that current federal disability programs offer little  opportunity for early intervention with individuals who apply for  compensation. These programs require lengthy assessments in which  applicants must focus on demonstrating their work limitations rather than  their abilities and potential to work. Consequently, vocational  rehabilitation is typically introduced late in the process. Furthermore, we  have designated federal disability programs, including VA’s, as high-risk  programs because they lack emphasis on the potential for vocational  rehabilitation to return people to work and also rely on outmoded  assumptions about the relationship between impairment and work.
section_title: VA Has Taken Steps to Expedite Vocational Rehabilitation and Employment Services for Seriously Injured Servicemembers
paragraphs: VA has instructed its regional offices to make seriously injured  servicemembers a high priority for all VA assistance and asked DOD to  provide data that would ensure VA’s ability to identify and monitor this  population. Because many seriously injured servicemembers are initially  treated at major military treatment facilities, VA has deployed staff to  these sites to provide information on all veterans’ benefits, including  VR&E services. To ensure the identification and monitoring of all seriously  injured servicemembers, VA initiated a memorandum of agreement  proposing that DOD share a range of information, including the names of  those with serious injuries, their medical condition, and their military  status. As of December 2004, a formal agreement with DOD had not been  reached. In the meantime, VA has instructed its regional offices to develop  local liaison with DOD in order to identify and assist seriously injured  servicemembers. The 12 regional offices we reviewed have developed  information of varying completeness and reliability. However, once  regional offices have identified and contacted seriously injured  servicemembers, VA has no policy for VR&E staff to maintain contact with  those individuals who do not apply for VR&E services while in the hospital  or after they return home. Nevertheless, some regional offices reported  maintaining contact with these servicemembers while others did not.
subsections: section_title: VA Has Instructed Its Regional Offices to Make Seriously Injured Servicemembers a High Priority and Asked DOD for Data to Help Identify Them
paragraphs: In a September 2003 letter, VA instructed its regional offices to provide  priority consideration and assistance to seriously injured servicemembers  returning from Afghanistan and Iraq. VA specifically instructed regional  offices to focus on servicemembers whose disabilities are definitely or  likely to result in military separation. Minimally, this includes  servicemembers with injuries DOD has classified as “very serious,”  “serious,” or in a “special category.” In this letter, VA instructed its  regional offices to assign a case manager to each seriously injured  servicemember who applies for disability compensation. In addition, VA  noted the particular importance of early intervention for those who are  seriously injured and emphasized that seriously injured servicemembers  applying for VR&E should receive the fastest possible service. Moreover,  VA reminded VR&E staff that they can initiate evaluation and counseling  and, in some cases, authorize training before a servicemember is  discharged.
Since most seriously injured servicemembers are initially treated at major  MTFs, VA has detailed staff to these facilities. These staff have included  VA social workers and disability compensation benefits counselors. In  addition to these staff, at Walter Reed, where the largest number of  seriously injured servicemembers has been treated, VA’s Washington D.C.  regional office has since 2001 provided a vocational rehabilitation  counselor to work with hospitalized patients.
To identify and monitor those whose injuries may result in a need for VA  services, including vocational rehabilitation, VA has asked DOD to share  data about injured servicemembers. VA has been working to develop a  formal agreement with DOD on what specific information to share. In the  spring of 2004, VA submitted a draft memorandum of agreement to DOD’s  Office of the Assistant Secretary of Defense for Health Affairs proposing  that DOD provide lists of all injured servicemembers admitted to MTFs. In  addition, VA requested personal identifying information, medical  information, and DOD’s injury classification for each listed  servicemember. VA also requested monthly lists of servicemembers being  evaluated for medical separation from military service. Several VA officials  and regional office staff we interviewed said that systematic information  from DOD would provide them with a way to more reliably identify and  monitor seriously injured servicemembers. As of December 2004, a formal  agreement with DOD was still pending.
section_title: VA Regional Offices Have Relied on Local Liaisons with MTFs In Order to Identify Seriously Injured Servicemembers Who May Need Assistance
paragraphs: In the absence of a formal arrangement to ensure that DOD provides data  on seriously injured servicemembers, VA has relied on its regional offices  to obtain information about them. In its September 2003 letter, the agency  asked the regional offices to coordinate with staff at MTFs and VA medical  centers in their areas to ascertain the identities, medical conditions, and  military status of the seriously injured. While VA officials reported to us  that they had provided veterans’ benefits information to injured  servicemembers, they did not have complete and reliable data as to how  many of these were seriously injured.
In response to guidance by VA’s central office, every regional office has  designated a coordinator to serve as a point of contact with MTFs and VA  medical centers, as well as other VA regional offices, in order to monitor  injured servicemembers as they relocate across the country. When  servicemembers are discharged from an MTF, VA officials told us that the  affiliated VA regional office coordinator notifies the coordinator in the  region to which the person relocates. The new coordinator contacts the  seriously injured servicemember to discuss any claims that have been filed  and to provide those who have not already done so an opportunity to  apply for other benefits, including VR&E services. Regional officials we  interviewed reported that they have followed VA’s instructions to keep  updated logs of all contacts they have with seriously injured  servicemembers. Regional offices are required to send these logs to VA’s  central office, which uses them to monitor outreach.
In our review of 12 regional offices, we found that they have developed  different information sources resulting in varying levels of information on  seriously injured servicemembers. The nature of the local relationships  between VA staff and military staff at MTFs was a key factor in the  completeness and reliability of the information that the military provided.  For example, the military MTF staff at one regional office provided VA  staff with only the names of new patients with no indication of the severity  of their condition or the theater from which they were returning. Another  regional office reported receiving lists of servicemembers for whom the  Army has initiated a medical separation in addition to lists of patients with  information on the severity of their injuries. Some regional offices were  able to capitalize on longstanding informal relationships. For example, the  VA coordinator responsible for identifying and monitoring the seriously  injured at one regional office had served as an Army nurse at the local  MTF and was provided all pertinent information. In contrast, staff at  another regional office reported that local military staff did not until  recently provide them with information on seriously injured  servicemembers admitted to the MTF.
Once they have identified the seriously injured servicemembers, regional  office staff reported that they are largely following outreach, coordination,  and case management procedures outlined in VA’s September 2003  guidance. Under these procedures, disability compensation benefit  counselors usually conduct VA’s initial outreach by contacting  hospitalized servicemembers to provide information on all veterans’  benefits, including VR&E. Traditionally responsible for taking applications  and processing disability compensation claims, these staff members are  neither vocational rehabilitation experts nor are they generally trained to  work with persons who have serious injuries. Accordingly, VA reported  that it has begun requiring all staff members who provide in-person or  telephone outreach to receive training on how to interact with seriously  injured servicemembers. VR&E staff reported that they generally rely on  the benefits counselors to notify them of injured servicemembers at MTFs  who are interested in or who apply for VR&E. Only then would a  vocational rehabilitation counselor or counseling psychologist usually  contact the hospitalized servicemember to begin counseling and  evaluation. In one regional office, VR&E staff said that they do not contact  injured servicemembers until they apply for services and obtain a  memorandum rating establishing their eligibility.
The Washington, D.C. regional office has assigned a vocational  rehabilitation counselor to be available on site at Walter Reed Army  Medical Center, where a large number of seriously injured  servicemembers are treated. Although VA also deployed benefits  counselors to Walter Reed who are responsible for outreach activities and  the provision of information on all VA benefits, the VR&E counselor works  with hospitalized patients specifically to offer and provide vocational  counseling and evaluation. She reported attempting to contact all patients  within 48 hours of their arrival and visiting them routinely thereafter to  establish rapport. Her primary mission is to work with servicemembers  who will need to prepare for civilian employment, although she told us  that her early intervention efforts could also help servicemembers who are  able to remain in the military.
According to VA staff, many seriously injured servicemembers are not  ready or able to consider VR&E services when they are first contacted.  Yet, we found that VA has no policy for maintaining contact with those  servicemembers who do not apply for VR&E services when they were in  the hospital or when they returned to a home base or to their residence.  Several regional offices reported that they do not stay in contact with  these individuals while others attempt to do so in various ways. One office  said it is considering contacting them after one year. Another regional  VR&E officer reported that staff ask the servicemembers to specify when  they would like to be contacted for further information or to begin  program participation. Staff at this regional office noted that they are  strong advocates of early intervention. They said that they try to contact  servicemembers as soon as possible to establish rapport and provide  VR&E program information even before the servicemembers are  physically ready to begin developing a vocational rehabilitation plan. At  the same time, they noted that readiness to participate in VR&E varies by  individual and that professional judgment is required to balance effective  outreach with an approach that could be viewed as intrusive.
VR&E program officials noted the potential value of maintaining contact  with seriously injured servicemembers who may not initially be ready to  participate when initially contacted by VA, but they also recognized the  need to focus resources on those who do participate. Nevertheless,  officials from a veterans service organization told us that it is critical to  maintain contact with seriously injured veterans who do not initially apply  for VR&E because they may need months or even years before they are  ready. In our prior work, we have also noted that maintaining contact with  individuals who have disabilities may help encourage their return to  work.
section_title: VA Faces Significant Challenges in Expediting Services to Seriously Injured Servicemembers
paragraphs: While experts and advocates for individuals with disabilities attest to the  value of early intervention for returning people to work, VA is challenged  to reach injured servicemembers early for several reasons. First,  determining the best time to approach recently injured servicemembers  and gauge their personal receptivity to consider employment in the civilian  sector is inherently difficult. The nature of the recovery process is highly  individualized and requires professional judgment to determine the  appropriate time to begin vocational rehabilitation. Further, because VA is  trying to prepare servicemembers who are still on active duty for a  transition to civilian life, DOD is concerned that VA’s efforts may be  working at cross purposes to the military’s retention goals. Finally,  because VA lacks systematic information from DOD on seriously injured  servicemembers, VA cannot ensure that all servicemembers and veterans  who could benefit from the VR&E program have the opportunity to receive  services at the appropriate time.
subsections: section_title: Individual Differences in the Recovery Process Complicate the Timing of Early Intervention
paragraphs: Individual differences and uncertainties in the recovery process make it  inherently difficult to determine when a seriously injured servicemember  will be ready to consider vocational rehabilitation. Since the appropriate  time to intervene depends to a large extent on the individual’s medical  condition and personal readiness, the time to broach the subject of a  return to work, whether in the military or the civilian labor force, will vary.  Regional office staff reported that many servicemembers are eager to  return to military duty and do not intend to consider a career outside  military service. They also reported that many injured servicemembers  need time to recover and adjust to the likelihood that they may have to  leave the military and prepare for civilian employment.
Because of the individual differences in receptivity to VR&E, VA staff  reported needing to monitor the condition of seriously injured  servicemembers and to engage them more than once during their recovery  to be able to gauge their readiness for VR&E. One regional VR&E official  told us that VA could benefit from more collaboration with DOD medical  staff in order to make decisions on the appropriate timing of VR&E  intervention. The vocational rehabilitation counselor at Walter Reed  reported visiting servicemembers routinely, including evenings and  weekends, so that she would be available when they were ready to discuss  their need for vocational rehabilitation. For one patient, she reported  visiting him 12 times before he expressed interest in VR&E. In some  locations, VA staff reported participating in pre-discharge planning  meetings with military and medical staff, which they said helped them stay  informed about the servicemember’s condition and likely discharge and  provided an opportunity to include VR&E in their discharge planning.
section_title: VA Is Challenged by DOD’s Concern that Early Intervention Could Work at Cross Purposes to Military Retention
paragraphs: VA is also challenged by DOD’s concern that outreach about VA benefits,  including disability compensation and VR&E services, could work at cross  purposes to military retention goals. In particular, DOD expressed concern  about the timing of VA’s outreach to servicemembers whose discharge  from military service is not yet certain. To expedite VR&E services, VA’s  outreach process may overlap with the military’s process for evaluating  servicemembers for a possible return to duty. According to DOD officials,  it may be premature for VA to begin working with injured servicemembers  who may eventually return to active duty. (See fig. 2.) With advances in  medicine and prosthetic devices, many serious injuries no longer result in  work-related impairments. Army officials who track injured  servicemembers told us that many seriously injured servicemembers  overcome their injuries and return to active duty. Recognizing this  potential, both Congress and the President have recently expressed  interest in seeing the military provide the retraining needed to support the  return of injured servicemembers to their military occupations or other  occupations within the military if possible. In an attempt to enable more  amputees to return to active duty, Walter Reed Army Medical Center plans  to open a new rehabilitation center in 2005.
Both VA and DOD officials suggested that the earliest appropriate time for  VA to intervene for regular active duty servicemembers would be when it  is clear that the servicemember will not be retained by the military.  Currently, VA can only provide VR&E services to active duty  servicemembers who are pending discharge due to a disability. VR&E  services could begin earlier for injured members of the National Guard  and Reserve since these individuals usually expect to return to their  previous civilian employment. They may need VR&E services to return to  their prior employment or to prepare for a different occupation in the  civilian economy.
section_title: VA Is Also Challenged by the Lack of Access to Systematic Data Regarding Seriously Injured Servicemembers
paragraphs: In the absence of a formal information sharing agreement with DOD, VA  does not have systematic access to DOD data about the population who  may need its services. Specifically, VA cannot reliably identify all seriously  injured servicemembers or know with certainty when they are medically  stabilized, when they are undergoing evaluation for a medical discharge,  or when they are actually medically discharged from the military. VA has  instead had to rely on ad hoc regional office arrangements at the local  level to identify and obtain specific data about seriously injured  servicemembers. While regional office staff generally expressed  confidence that the information sources they developed enabled them to  identify most seriously injured servicemembers, they have no official data  source from DOD with which to confirm the completeness and reliability  of their data nor can they provide reasonable assurance that some  seriously injured servicemembers have not been overlooked. In addition,  informal data sharing relationships could break down with changes in  personnel at either the MTF or the regional office.
DOD officials expressed their concerns about the type of information to be  shared and when the information would be shared. DOD noted that it  needed to comply with legal privacy rules on sharing individual patient  information. DOD officials told us that information could be made  available to VA “upon separation” from military service, that is, when a  servicemember enters the separation process. At this time,  servicemembers would undergo assessment by a physical evaluation  board, which DOD officials said typically takes between 30 to 90 days and  usually results in a medical discharge from the military. However, prior to  separation, information can only be provided under certain circumstances,  such as when a patient’s authorization is obtained.
section_title: Conclusions
paragraphs: VA has taken steps to help the nation’s newest generation of veterans  move forward with their lives, particularly those who return from combat  with disabling injuries. VA has made seriously injured servicemembers a  priority and, among other measures, deployed staff to major MTFs to  conduct outreach to them prior to separation. However, VA benefits  counselors are usually the first VA representatives to contact injured  servicemembers. While they may provide an overview of all VA benefits,  they may not emphasize vocational rehabilitation and employment  services.
The importance of early intervention for returning individuals with  disabilities to the workforce is well documented in the vocational  rehabilitation literature. However, the lack of an agreement with DOD for  systematic data sharing impedes VA’s attempt to identify all seriously  injured servicemembers who might benefit from such intervention. It also  poses the risk that some who are discharged with disabilities may be  overlooked and not afforded the opportunity for VR&E. As VA recognizes,  the current ad hoc approach of their regional offices for obtaining  information is not the most efficient way to proceed. Furthermore,  because individuals with disabilities vary in their readiness and need for  VR&E services, maintaining contact with them would better ensure that  VR&E staff know when the person is ready to participate. Because VA has  no policy for maintaining contact with those who do not apply for VR&E,  opportunities to rehabilitate veterans who have sustained serious injuries  in Afghanistan and Iraq may be lost.
At a time when the U.S. labor force is projected to shrink, it is imperative  that those who can work, whether in military or civilian jobs, are well  supported in their efforts to do so. VA’s early VR&E efforts, rather than  working at cross purposes to DOD goals, could facilitate servicemembers’  return to the same or different military occupation, or to a civilian  occupation, if they were not able to remain in the military. In this regard,  the prospect for early intervention with VR&E services presents both a  challenge and an opportunity for VA and DOD to collaborate to provide  better outcomes for this new generation of seriously injured  servicemembers.
section_title: Recommendations
paragraphs: To improve VA’s efforts to expedite VR&E services to seriously injured  servicemembers, we recommend that VA and DOD collaborate to reach an  agreement for VA to have access to information that both agencies agree is  needed to promote servicemembers’ recovery and return to work.
We also recommend that the Secretary of Veterans Affairs direct the  Under Secretary for Benefits to develop a policy and procedures for  regional offices to maintain contact with seriously injured servicemembers  who do not initially apply for VR&E services, in order to ensure that they  have the opportunity to participate in the program when they are ready.
section_title: Agency Comments
paragraphs: In commenting on a draft of this report, VA concurred with our findings  and recommendations. VA emphasized that access to DOD information is  crucial to promoting servicemembers’ recovery and return to work and, to  that end, is currently negotiating an agreement to allow VA to obtain  protected medical information on servicemembers prior to their discharge  for VA benefits purposes. In addition, VA noted that its follow-up policies  and procedures include sending veterans information on VR&E benefits  upon notification of a disability compensation award and 60 days later.   However, we believe a more individualized approach, such as maintaining  personal contact, could better ensure the opportunity for veterans to  participate in the program when they are ready. VA noted that it is  currently reviewing its outreach and follow-up procedures for injured  servicemembers and will make any appropriate revisions. VA’s written  comments are reprinted in appendix I.
DOD also concurred with our findings and recommendations. DOD stated  its commitment to retaining seriously injured servicemembers who are  able and willing to return to duty. DOD also noted that a draft  memorandum of agreement for information sharing between VA and DOD  is under consideration by the two departments and the military services.   DOD’s written comments are reprinted in appendix II.
As agreed with your office, unless you publicly announce the contents of  this report earlier, we plan no further distribution of this report until 30  days after the date of this letter. We will then send copies of this report to  the Secretary of Veterans Affairs, the Secretary of Defense, appropriate  congressional committees, and other interested parties. The report will  also be available on GAO’s Web site at http://www.gao.gov.
If you or your staff have any questions regarding this report, please call me  at (202) 512-7215 or Irene Chu, Assistant Director, at (202) 512-7102.
Susan Bernstein, Connie Peebles Barrow, Margaret Boeckmann, William  R. Chatlos, Clarette Kim, Joseph J. Natalicchio, and Roger Thomas also  made key contributions to this report.
section_title: Appendix I: Comments from the Department of Veterans Affairs
section_title: Appendix II: Comments from the Department of Defense
section_title: Related GAO Products
paragraphs: VA and Defense Health Care: More Information Needed to Determine if  VA Can Meet an Increase in Demand for Post-Traumatic Stress Disorder  Services. GAO-04-1069. Washington, D.C.: September 20, 2004.
VA Vocational Rehabilitation and Employment Program: GAO  Comments on Key Task Force Findings and Recommendations.   GAO-04-853. Washington, D.C.: June 15, 2004.
VA Benefits: Fundamental Changes to VA’s Disability Criteria Need  Careful Consideration. GAO-03-1172T. Washington, D.C.: September 23,  2003.
High-Risk Series: An Update. GAO-03-119. Washington, D.C.: January  2003.
Major Management Challenges and Program Risks: Department of  Veterans Affairs. GAO-03-110. Washington, D.C.: January 2003.
SSA and VA Disability Programs: Re-Examination of Disability  Criteria Needed to Help Ensure Program Integrity. GAO-02-597.  Washington, D.C.: August 9, 2002.
Military and Veterans’ Benefits: Observations on the Transition  Assistance Program. GAO-02-914T. Washington, D.C.: July 18, 2002.
SSA Disability: Other Programs May Provide Lessons from Improving  Return-to-Work Efforts. GAO-01-153. Washington, D.C.: January 12, 2001.
Vocational Rehabilitation: Opportunities to Improve Program  Effectiveness. GAO/T-HEHS-98-87. Washington, D.C.: February 4, 1998.
Veterans Benefits Administration: Focusing on Results in Vocational  Rehabilitation and Education Programs. GAO/T-HEHS-97-148.  Washington, D.C.: June 5, 1997.
Vocational Rehabilitation: VA Continues to Place Few Disabled Veterans  in Jobs. GAO/HEHS-96-155. Washington, D.C.: September 3, 1996.
SSA Disability: Return-to-Work Strategies From Other Systems May  Improve Federal Programs. GAO/HEHS-96-133. Washington, D.C: July 11,  1996.
SSA Disability: Program Redesign Necessary to Encourage Return to  Work. GAO/HEHS-96-62. Washington, D.C.: April 24, 1996.