Military and Veteran Support: DOD and VA Programs That Address the Effects of Combat and Transition to Civilian Life
Released: 2014-11-07T00:00:00


Highlights: section_title: Why GAO Did This Study
paragraphs: DOD and VA play key roles in offering post-combat support to servicemembers and veterans through various programs and activities. Congress mandated that GAO identify DOD and VA programs designed to address the effects of combat on servicemembers who have served during recent conflicts, assist servicemembers and veterans with the transition to civilian life, and raise public awareness of these issues.

In this report GAO identified the number of programs, including the types of services offered that: 1) address the effects of combat on post-9/11 active-duty servicemembers and their families, 2) help post-9/11 servicemembers and veterans transition to civilian life, and 3) help raise public awareness and understanding of servicemembers' and veterans' combat and transition experiences. Also, GAO examined how the lists of programs identified compare with program inventories prepared by DOD and VA pursuant to law. To address these objectives, GAO established and applied its definition of “program.” In general, GAO defined programs as federally funded, organized sets of activities agencies undertake that are directed toward specific purposes or goals and are being administered in fiscal year 2014. GAO also searched publicly available sources that contain lists of programs; sent preliminary lists of programs to DOD and VA for verification; and reviewed relevant reports and 2013 program inventories for DOD and VA.

This report contains no recommendations.

section_title: What GAO Found
paragraphs: GAO identified 99 programs provided by the Department of Defense (DOD) to help address the effects of combat on post-9/11 servicemembers, their families, or both. These programs often offer multiple types of services. The services most common are mental health and substance abuse (50), information and referral (37), and case management or care coordination (15).

GAO identified 87 programs administered either by DOD or the Department of Veterans Affairs (VA) to help post-9/11 servicemembers and veterans transition to civilian life. Some of the 87 programs offer more than one type of service, such as the Transition Assistance Program, which offers employment, education, and information on veterans' benefits, among other services (see figure).

Note: The numbers of programs by type of service do not equal 87 because some programs provide more than one service. The frequency of a type of service does not necessarily indicate its utilization.

GAO identified 12 programs administered by either DOD or VA to raise public awareness and understanding of servicemembers' and veterans' experiences in combat, coming home, and transitioning to civilian life. For example, among the nine DOD programs identified, the Briefings with the Boss program convenes employers and National Guard and Reserve members to discuss issues linked to military service and civilian employment.

The lists of programs that GAO developed using its definition are not comparable with those in DOD's 2013 program inventory and have only limited comparability with VA's 2013 program inventory. This limited comparability is primarily due to differing contexts in which the lists were compiled. While GAO's lists address specific mandated questions, DOD's and VA's lists were developed following Office of Management and Budget guidance, which generally provides flexibility in how agencies define their programs. Both DOD and VA chose to identify programs at a broad level. For example, DOD's inventory is partially organized by its strategic goals. One goal is “preserving and enhancing the all-volunteer force,” for which wounded warrior care is cited as a high priority. Under this goal, DOD lists “hospitals” and “regional defense facilities” as programs. In contrast, GAO identified individual programs, such as the Army Wounded Warrior Program and Warrior Transition Units, which were not listed in DOD's inventory.

section_title: Letter
paragraphs: To help meet the needs of post-9/11 servicemembers, veterans, and their  families, various federal agencies administer a number of programs,  many of which may experience increased demand following more than a  decade of war and as the United States military looks toward reducing the  overall size of its forces. After they leave the military, some veterans’  readjustment to civilian life will go smoothly, while others may struggle  with health problems related to their service, employment, and  relationships. In addition, researchers, media outlets, and others have  reported on a gap in public awareness and understanding of the  challenges many post-9/11 veterans face while transitioning from the  military to civilian life.

The Department of Defense (DOD) and the Department of Veterans  Affairs (VA) play key roles in offering various types of post-combat  assistance to servicemembers and veterans. DOD offers, among other  things, (1) care to wounded and injured servicemembers during their  recovery, (2) mental health counseling and suicide prevention efforts, (3)  support for military families, and (4) assistance to servicemembers who  are transitioning out of the military. VA offers veterans a wide variety of  benefits and services, including health care, counseling, education,  housing, employment-related services, and disability compensation  benefits.

To instill a more coordinated and crosscutting perspective to federal  performance, among other aims, the GPRA Modernization Act of 2010  (GPRAMA) was enacted.Management and Budget (OMB) coordinate with federal agencies to  develop federal government priority goals, including outcome-oriented  goals covering a limited number of cross-cutting policy areas; (2) federal   GPRAMA requires that (1) the Office of  agencies, in developing their own performance plans, describe how they  will work with other agencies to achieve their performance goals; and, (3)  OMB make publicly available a list of all federal programs identified by  agencies, including information about the purposes of each program, how  it contributes to the agency’s mission, and recent funding information.  OMB published the lists of programs—referred to as program  inventories—developed by 24 federal agencies, including DOD and VA, in  May 2013.

Apart from the GPRAMA inventories, Congress mandated that we provide  a comprehensive list of DOD and VA programs that address a range of  challenges that servicemembers and veterans who have served during  recent conflicts may face. This report identifies: 1.  the number of DOD programs addressing the effects of combat on  post-9/11 active-duty servicemembers and their families,  2.  the number of DOD and VA programs to help post-9/11 active-duty  servicemembers transition and veterans readjust to civilian life, and  3.  the number of DOD and VA programs to help raise public awareness  and understanding of post-9/11 active-duty servicemembers’ and  veterans’ combat and readjustment experiences.

In addition, in light of our prior work, we examined:  4.  how the lists of programs identified by GAO compare with program  inventories prepared by DOD and VA pursuant to the GPRA  Modernization Act of 2010.

This report also provides a description of the types of services provided  by the programs identified in objectives 1-2.

To address objectives 1-3, we identified DOD and VA programs through  the following four-step process:  (1) We established a definition for “program” by reviewing our prior work  and other relevant studies on related programs for servicemembers and  veterans who have served in recent conflicts. We also obtained input  from our internal (GAO) experts as well as officials from DOD and VA. In  general, we defined programs as federally funded, organized sets of  activities directed toward specific purposes or goals that agencies  undertake and are being administered in fiscal year 2014. Given this  definition, we included activities that were not formally labeled as a  program, such as the Integrated Disability Evaluation System (IDES) and  the Mobile Vet Centers. We further scoped this definition for each  objective as follows:

Objective 1: DOD or military services’ programs that address the  effects of combat—including physical, mental, or social heath—on  post-9/11 active-duty servicemembers or their spouses or  dependents.

Objective 2: DOD, military services, or VA programs that focus  primarily on helping active duty servicemembers transition or veterans  readjust to civilian life.

Objective 3: DOD, military services, or VA programs that focus  primarily on raising civilian public awareness of the combat  experiences of servicemembers and the readjustment experiences of  veterans.  (We further elaborate on these definitions in appendix I. )  (2) We identified publicly available sources that contain lists of relevant  programs, such as the National Resource Directory and Catalog of  Federal Domestic Assistance (CFDA). based on discussions with DOD and VA officials and internal GAO  experts as well as through online searches. (See app. I for a description  of the sources we used.)  (3) We used the definitions and sources from steps 1 and 2 to review and  identify the relevant programs for our lists.

The National Resource Directory is a partnership among DOD, VA, and the Department  of Labor that seeks to connect wounded and other servicemembers, veterans, their  families, and caregivers to programs and services that support them. The CFDA is a  General Services Administration database of federal programs, projects, services, and  activities that provide assistance or benefits to the American public. (4) We sent our preliminary lists of programs to officials at DOD and VA  for comment and verification, and we modified the lists accordingly.

This four-step process identified 170 separate programs, although some  of them are relevant to more than one objective. Specifically, 26 programs  are included in more than one objective, such as the Air Force Wounded  Warrior Program (AFW2) that addresses the effects of combat and helps  wounded and injured servicemembers transition to civilian life. In addition,  to present our results, we developed categories to group the types of  services provided by the programs. Because some programs offer more  than one type of service, programs can fall into more than one category  or service type.

We did not analyze these DOD and VA programs to identify any  instances of fragmentation, overlap, duplication, or gaps in benefits or  services. Our scope for the first three objectives was limited to identifying  DOD and VA programs based on the types of service provided. In  addition, in carrying out this four-step process, we did not conduct an  independent legal analysis of the statutory or regulatory basis or  requirements for any of the programs we identified.

To address the fourth objective, we compared the lists of programs that  we generated under objectives 1-3 with DOD and VA’s 2013 GPRAMA  program inventories to identify similarities and differences between the  agencies’ inventories and our lists. Also, we drew upon our prior work on  agencies’ GPRAMA program inventories.

We conducted our work from March 2014 to November 2014 in  accordance with generally accepted government auditing standards.  Those standards require that we plan and perform the audit to obtain  sufficient, appropriate evidence to provide a reasonable basis for our  findings and conclusions based on our audit objectives. We believe that  the evidence obtained provides a reasonable basis for our findings based  on our audit objectives.
subsections: section_title: Background
paragraphs: During the last decade of U.S. military operations, servicemembers have  experienced numerous deployments, which increase the risk for  posttraumatic stress disorder (PTSD) and traumatic brain injury (TBI), two  common conditions that many post-9/11 servicemembers and veterans   Additionally, more seriously wounded servicemembers survive  suffer.their injuries—injuries that in previous wars would have been fatal—given  improvements to body armor and military medicine, but may be left with  significant disabilities.

Less than 1 percent of the American population has served on active duty  in an all-volunteer, professional military—an historic low—resulting in a  so-called “military-civilian” gap. While Americans generally hold the  military in high regard, there is a reported lack of awareness and  understanding of the difficult challenges many post-9/11 servicemembers  have faced while transitioning from the military to civilian life.
subsections: section_title: Federal Assistance to Servicemembers, Veterans, and Their Families
paragraphs: DOD and VA play key roles in offering assistance to servicemembers,  veterans, and their families. In particular, DOD has a role in preparing  servicemembers, including those who have served from 9/11 onward, for  careers beyond the military and helping them transition from active duty  to veteran status. After servicemembers separate from the military, VA’s  role is generally to help veterans readjust to civilian life. VA provides  health care and other benefits to veterans who have served in all conflicts  and wars, such as World War II; Vietnam; and Operation Enduring  Freedom, Operation Iraqi Freedom, and Operation New Dawn or  OEF/OIF/OND.

DOD and VA have coordinated in assisting servicemembers and veterans  and have jointly developed and implemented policies for the care,  management, and transition of recovering servicemembers. These  policies address certain issues such as care coordination and the  disability evaluation process. In a subsequent but related effort, in May  2012, a joint entity known as the DOD/VA Warrior Care & Coordination  Task Force began an inventory of DOD and VA programs and  established the Interagency Care Coordination Committee (IC3) to guide  the development of shared care coordination policies and practices.  Additionally, DOD, VA and other agency partners administer the  Transition Assistance Program (TAP), which provides counseling to  departing servicemembers, and offers employment assistance and  information on federal veteran benefits, among other things.to the revised TAP as Transition, Goals, Plans, Success (Transition  GPS).

Our past reports, as well as reports by others, have highlighted issues  surrounding DOD and VA programs, including issues concerning  fragmentation, overlap, and duplication; lack of coordination; and  challenges in providing some benefits and services.have recommended in two GAO reports that DOD and VA need to better  integrate care coordination and case management programs to reduce  duplication and better assist recovering servicemembers, veterans, and  their families by helping to ensure the continuity of their care. In response,  a joint DOD-VA council approved the implementation of specific initiatives  that are intended to improve care coordination procedures by facilitating  communication between departments and eliminating duplicative efforts.  As of September 2014, the departments had not fully implemented these  initiatives, according to a senior DOD official. As previously noted, this  report does not address fragmentation, overlap, and duplication in  benefits or services.

Other federal agencies also offer assistance to servicemembers and  veterans and bring to bear a variety of policy tools. For example, as we  have previously reported, the Department of Labor administers four  employment programs targeted to veterans. In addition, the Department of Housing and Urban Development provides permanent housing and  case management for eligible homeless veterans; and the Internal  Revenue Service administers tax expenditures, such as tax credits for  businesses hiring veterans, as well as other special tax benefits.

section_title: GPRA Modernization Act and Agency Coordination
paragraphs: With various federal programs spread across multiple federal agencies,  concerns have been raised that no full accounting of the breadth and  effectiveness of these programs exists. Among its aims, GPRAMA seeks  to instill a more coordinated and crosscutting perspective to federal  performance; that is, improving connections across organizations and  policy tools. As we have noted in our past work and OMB states in its  guidance, effective implementation of GPRAMA could play an important  role in clarifying desired outcomes, addressing program performance  spanning multiple organizations, and facilitating future actions to reduce  duplication, overlap, and fragmentation.requirements and related OMB guidance that emphasize collaboration  include:

Federal government priority goals: GPRAMA requires OMB to  coordinate with agencies to establish federal government priority  goals that include outcome-oriented goals covering a limited number  of policy areas, as well as goals for needed management  improvements across the government.

Agency priority goals: Certain agencies are required by GPRAMA to  identify from among their performance goals a limited number of  priority goals every 2 years. Each agency’s priority goals are to reflect  the agency’s highest priorities, as identified by the head of the  agency, and be informed by the federal government priority goals, as  well as input from relevant congressional committees.

Agency performance plans: Agencies’ performance plans are  required to describe how the performance goals (including priority  goals) are to be achieved, including a description of how the agency is  working with other agencies to achieve its performance goals.

Strategic reviews: In its 2012 guidance (and subsequent updates)   for implementing GPRAMA, OMB guidance directs agencies to  conduct annual strategic reviews of progress toward strategic  objectives to inform their decision making, beginning in 2014.  Agency leaders are responsible for assessing progress on each  strategic objective established in the agency strategic plan, including  mission, as well as management or crosscutting objectives. Among  other things, the reviews are intended to strengthen collaboration on  crosscutting issues by identifying and addressing crosscutting  challenges or fragmentation.

Federal program inventory: As previously noted, GPRAMA requires  OMB to make publicly available a list of all federal programs identified  by agencies, and to include the purposes of each program, how it  contributes to the agency’s mission and goals, and recent funding  information. GPRAMA also requires OMB to issue guidance to ensure  that this information presents a coherent picture of all federal  programs. OMB is taking a phased approach to implement this  provision and published the inventories developed by 24 agencies in  May 2013.

section_title: We Identified 99 DOD Programs That Address the Effects of Combat
paragraphs: Using our definition of “program,” we identified 99 healthcare and benefit  programs administered by DOD and the military services that address the  effects of combat on servicemembers, their families, or both. Some of  these 99 programs we identified share a common name, but are  independently implemented by each branch of the military service. For  example, each military service administers wounded warrior programs.  These programs provide care coordination for recovering  servicemembers and their families as they transition to and readjust to  civilian life. This population includes servicemembers and veterans who  suffer from TBI, amputations, burns, spinal cord injuries, visual  impairment, and PTSD. Over a third of the 99 programs that we identified  offer multiple types of services. A sample of programs we identified is  contained in table 1, which we categorize by type of service to illustrate  the range of services provided. The full array of programs is listed in  appendix II. In addition, a detailed, interactive list of programs is available  at http://www.gao.gov/products/GAO-15-24.

The three services most common in the 99 programs are support for  mental health and substance abuse (50), information and referral (37),  and case management or care coordination (15). The number and types  of services in the DOD programs are presented in figure 1.

In addition, for 73 of the 99 programs (about 75 percent), a  servicemember’s or veteran’s family is also eligible for the services or  benefits provided. Also, one of these 99 programs—the Federal Recovery  Coordination Program—is jointly administered by DOD and VA.

section_title: We Identified 87 DOD and VA Programs That Help Servicemembers Transition and Veterans Readjust to Civilian Life
paragraphs: Using our definition of “program,” we identified 87 programs administered  by DOD and VA that help servicemembers transition and veterans  readjust to civilian life. Some of these programs share a common name,  but are independently implemented through their respective military  service branch, such as the Yellow Ribbon Reintegration Program. As a  result, we separately counted each military service’s program. A sample  of the programs we identified is contained in Table 2, which we categorize  by type of service. The full array of programs is listed in appendix III. In  addition, a detailed, interactive list of programs is available at  http://www.gao.gov/products/GAO-15-24.

The three services most common in the 87 programs are disability  benefits or services (19); employment assistance (18); and, case  management/care coordination, counseling, information and referral, as  well as physical health (the frequency for these types of services is 16).  The frequency and types of service offered across these 87 programs are  portrayed in Figure 2.

We also present the number of programs by type of service provided by  each agency in table 3.

Nine of the programs are jointly administered by DOD and VA, such as  the Pre-Discharge Program for active duty servicemembers or activated  National Guard or Reserve members. This program affords these  servicemembers the opportunity to file claims for disability compensation  up to 180 days prior to separation or retirement from active duty.

Many of the 87 programs we identified not only support servicemembers  and veterans but also their families. Of the 87 programs, 35 offer services  to the families of servicemembers and veterans, and 5 provide support to  the caregivers of wounded, injured, or disabled veterans. These  caregivers generally include family members and friends, according to a  RAND study.

section_title: We Identified 12 DOD and VA Programs That Raise Awareness and Understanding of Servicemembers’ and Veterans’ Experiences
paragraphs: Using our definition of “program,” we identified 12 programs administered  by DOD, the military services, and VA that raise awareness and  understanding of servicemembers’ and veterans’ experiences in combat  and coming home. DOD and the military services administer 9 of 12  programs, which are listed in table 4. A detailed, interactive list of  programs is also available at http://www.gao.gov/products/GAO-15-24.

section_title: Variation in Definitions Limits the Ability to Compare Our Lists with DOD and VA Inventories
paragraphs: The lists of programs that we developed are generally not comparable  with DOD’s and VA’s 2013 GPRAMA program inventories. As we  reported in October 2014, incomparability is due, in large measure, to  differences in how agencies defined their programs. OMB’s guidance for  developing the inventories allowed agencies to define their programs  using different approaches, but within a broad definition of what  constitutes a “program.”by outcomes, customers, products/services, organizational structure, or  budget structure—and notes that agencies could use a mix of these  approaches. The guidance also notes that agencies and their  stakeholders use the term “program” in different ways, and that because  agencies have varying missions and achieve their missions through  different programmatic approaches, such differences are legitimate and  meaningful.

The guidance presents possible approaches— However, as we concluded in October 2014, the flexibility afforded to  agencies limits the usefulness of the resulting inventories as a tool for  addressing crosscutting issues because the various approaches agencies  used to define their programs prevent meaningful comparisons and  connections both within and across agencies. As a result, we recommended that OMB take several actions to improve the inventories,  such as revising its program inventory guidance to direct federal agencies  to collaborate in defining and identifying programs that contribute to  common outcomes. OMB staff agreed with this recommendation and said  that they will consider how to address it as they move forward with  implementation of the program inventory. Once addressed, this  recommendation could help facilitate the creation of a more coherent  picture of all federal programs that could be used for promoting  collaboration and for identifying potential fragmentation, overlap, or  duplication, or gaps in services among federal programs or activities.

Within this report, we defined “programs” at a more detailed level than the  definition used by DOD and VA for their GPRAMA inventories; that is, we  aggregate fewer activities into a program than what is used in DOD’s and  VA’s inventories. DOD and VA described their approaches to define a  program as follows:

DOD uses its budget structures and areas related to each strategic  goal, such as Land Forces and Strategic Defense. DOD’s program  inventory is grouped and aligned to the five DOD strategic goals. The  programs are aligned to the strategic goals that they support.

VA designed its approach to closely mirror the budget structure, which  aligns to the way VA manages. The list of programs in the inventory is  intended to be recognizable to key external stakeholders, including  but not limited to Congress and veterans service organizations.

None of the programs that we identified on our three lists matches any of  the 91 programs that DOD identified on its GPRAMA inventory. DOD’s  inventory is organized by its budget and the strategic goals contained in  its 2010 strategic plan. For instance, one goal is “preserving and  enhancing the all-volunteer force,” and as part of this goal, the strategic  plan states that “wounded warrior care” is one of DOD’s highest priorities.  Under this goal, DOD cites “hospitals and other medical activities”— including “medical care for active-duty personnel in regional defense and  non-defense facilities”—as programs. However, DOD’s list does not  contain any of the programs that we included on our lists, such as the  Army Wounded Warrior Program, the Federal Recovery Coordination  Program, or Warrior Transition Units. With regard to programs that may  raise public awareness and understanding, DOD’s inventory cites, “the  American Forces Information Service, other personnel support activities  dedicated to enhancing morale and improving community relations— including bands and choruses and ceremonial and public relations  activities.” In contrast, our list includes, for example, the Statement of  Support Program and Army National Guard Funeral and Honors program,  as noted previously in table 4.

Twenty of 49 VA (or joint DOD-VA) programs we identified that help  veterans readjust to civilian life are also listed in VA’s GPRAMA inventory.  VA’s inventory contains 93 programs. Some of the programs on both lists  include the Readjustment Counseling at Vet Centers, the Post-9/11 GI  Bill, and Vocational Rehabilitation and Employment programs. However,  VA’s inventory does not include other programs on our lists, such as the  Operation Enduring Freedom, Operation Iraqi Freedom, and Operation  New Dawn (OEF/OIF/OND) Care Management program and the  Transition Assistance Program (a joint DOD-VA program).  Only one of  the programs on our list of VA programs that raise public awareness and  understanding of veterans’ readjustment experiences is listed in VA’s  GPRAMA inventory. As noted above, such differences may be due to  differing contexts in which the respective lists were compiled. Such  differences in how federal agencies define programs go beyond DOD and  VA, as we recently reported in our review of government-wide efforts to  implement the federal program inventory.

VA’s OEF/OIF/OND Care Management program provides case management and care  coordination to recovering servicemembers and veterans, aimed at helping them access  resources within VA and the local community. This program is available at all VA Medical  Centers.

section_title: Agency Comments and Our Evaluation
paragraphs: We are not making recommendations in this report. We provided a draft  of this product to the Departments of Defense (DOD) and Veterans Affairs  (VA) for comment. DOD and VA provided written comments, which are  reproduced in appendix IV and V. DOD and VA also provided technical  comments that were incorporated, as appropriate.

DOD and VA officials suggested that we include some additional  programs. We reviewed these programs and revised the report to include  nine additional programs. The following provides more details.

In its comments submitted on October 29, 2014, DOD neither agreed nor  disagreed with our findings. In DOD’s technical comments, DOD officials  suggested that we delete the Directorate of Mental Health under the first  objective. We revised the report by removing this program because it is  an office, not a program. DOD officials also suggested that we consider  including nearly a dozen additional programs under the first or second  objectives. After reviewing these programs, we decided not to include  several of them because they did not meet the program definitions we  had developed for the objectives. However, we revised the report to  include six programs under the first or second objectives:

Under the first objective, we revised the report to include (1) the  Comprehensive Soldier Family Fitness (CSF2) program, (2) pre- deployment health assessment, (3) post-deployment health  assessment, and the (4) post-deployment health reassessment.

Under the second objective, we revised the report to include (5)  the Army Retirement Services Program and (6) the Army Soldier  for Life Program.

In its comments, VA generally concurred with our findings. VA officials  suggested additional programs for inclusion under the second objective  and provided additional information and examples of its efforts related to  employment and raising awareness of benefits available to children and  spouses of veterans. Several of these efforts do not focus primarily on  helping active duty servicemembers transition or veterans readjust to  civilian life. However, we revised the report to include (1) the Automobile  and Adaptive Equipment program, (2) Veterans Employment Center, and  (3) the VA Liaison for Healthcare Program.

We subsequently reviewed whether any of the nine additional programs  that we added to our report were included in the DOD or VA inventories.  Only one of the nine programs was included. Specifically, the Automobile  and Adaptive Equipment program was included in VA’s GPRAMA  inventory.

We are sending copies of this report to the appropriate congressional  committees, the Secretary of Defense, the Secretary of Veterans Affairs,  and other interested parties. In addition, the report is available at no  charge on the GAO website at http://www.gao.gov.

If you or your staff have any questions regarding this report, please  contact me at (202) 512-7215 or sherrilla@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 are listed in appendix VI.

section_title: Appendix I: Scope and Methodology
paragraphs: This appendix summarizes our work to identify Department of Defense  (DOD) and Department of Veterans Affairs (VA) programs as well as to  compare the lists of programs that we generated under objectives 1-3  with DOD and VA’s 2013 program inventories that were included in the  Office of Management and Budget’s (OMB) program inventory compiled  in response to a requirement in the GPRA Modernization Act of 2010  (GPRAMA).
subsections: section_title: Identifying DOD and VA Programs
paragraphs: To address the first three objectives, we identified DOD and VA programs  through the following four-step process:  1.  We established a definition for “programs” to clarify the types of DOD  and VA programs and activities to be included on our lists because no  standard definition of “program” exists. Past GAO work and OMB  have defined “program” in very broad terms. For this report, our  definitions reflect the specific area of interest specified in the  mandate; therefore, we did not attempt to develop a definitive  definition. We established a definition for program by reviewing our  prior work and other relevant studies on related programs for  servicemembers and veterans who have served in recent conflicts.  We also obtained input from internal GAO experts on research  methods and federal programs for servicemembers and veterans, as  well as officials from DOD and VA. In general, we defined “programs  or activities” as a federally funded, organized set of activities directed  toward a specific purpose or goal that an agency undertakes and is  being administered in fiscal year 2014. We further scoped our  definition for each of our objectives as follows:

Objective 1: DOD or military services’ programs or activities that  address the effects of combat—including physical, mental, or social  heath—on post-9/11 active-duty servicemembers or their spouses or  dependents.

Objective 2: DOD, military services, or VA programs that focus  primarily on helping active duty servicemembers transition or veterans  readjust to civilian life.

Objective 3: DOD, military services, or VA programs that focus  primarily on raising civilian public awareness of the combat  experiences of servicemembers and the readjustment experiences of  veterans.

For the first objective, we scoped our definition of programs differently  than for the second and third objectives. Specifically, for the first  objective, although servicemembers and their spouses or dependents  must benefit from a program or activity that addresses the effects of  combat as we have defined that term, a program or activity does not have  to only benefit servicemembers that directly experience combat. For  example, the Joint Family Support Assistance Program supports military  families who are geographically dispersed from a military installation. This  program could support military families in which one or more  servicemembers are serving in a combat zone or deployed to Germany  (or other noncombat zone) while the family is living stateside. For the  second and third objectives, we defined programs as focusing primarily  on servicemember transition and veteran readjustment to civilian life as  well as efforts to raise public awareness and understanding of  servicemembers’ and veterans’ experiences in combat, coming home,  and transitioning to civilian life. An example of such a program includes  VA outreach and readjustment counseling services through Vet Centers.  VA administers other programs that provide interventions or treatments to  help certain veterans, such as the homeless and those contemplating  suicide. However, we did not include those types of programs or activities  because helping veterans readjust to civilian life is not their primary focus.

For all three objectives we excluded the following types of programs:

Programs conducting research.

Programs in which post-9/11 Iraq and Afghanistan servicemembers or  veterans are not eligible, such as efforts aimed only at veterans of  conflicts or wars prior to Operation Enduring Freedom/Operation Iraqi  Freedom/Operation New Dawn (OEF/OIF/OND).

Programs developed and administered by individual military  installations or VA hospitals specifically for the populations they serve  at those locations. For example, for the second objective we excluded  the Road to Reintegration, a program designed to serve Michigan  veterans with a network of resource providers as they return to civilian  life. Thus, our findings are limited to the national perspective.

Programs providing a one-way, passive transmission of information  (for example, a directory that lists services available).

Programs that may have been created or revised to meet our  inclusion criteria after fiscal year 2014.

The following further elaborates on these definitions.

General Definition of Terms for Objectives 1–3

DOD or military services: DOD, Office of the Secretary of Defense  (OSD) and all subordinate agencies, offices, and programs under  DOD; departments of the Army; Air Force, and Navy (including the  Marine Corps); the reserve components for each of the military  services, including the National Guard. (We exclude U.S. Coast  Guard programs because they are administered by the Department of  Homeland Security.)

VA: All VA administrations, centers, offices, and programs.

Program or activities: Federally funded, organized set of activities  directed toward a specific purpose or goal that an agency undertakes  and are being administered in fiscal year 2014. These activities may  include assistance for health, housing, employment, and family  support, as well as various program types (e.g., direct federal  programs, direct federal benefits programs, and grants). In addition,  our definition included tax expenditures (credits, deductions, deferrals,  or preferential tax rates) that are managed or administered by DOD or  VA (and related offices and departments as defined above); however,  we did not identify any such programs.

Active-duty servicemembers: Those who are currently serving on  active duty in the United States armed forces. This includes activated  members of the National Guard and Reserve under Title 10 (full-time  duty in the armed forces) or Title 32 (duty performed for which  National Guard receives pay from federal government).

Veterans: A person who served in the active military, naval, or air  service and who was discharged or released under conditions other  than dishonorable. This also includes Title 10 or Title 32 active Guard  and Reserve components that have deployed but are still serving in  the Reserve Component.

Public: The broader civilian community in the United States, including  citizens, public and private employers, police, and court systems.

Specific Definition of Terms for Objective 1  I. Definition: DOD or military services’ programs or activities that address  the effects of combat—including physical, mental, or social heath—on  post-9/11 active-duty servicemembers or their spouses or dependents.

Specific definitions for this objective:  IA. Effects of combat - One or more of the following that results from  combat, warfare, or armed conflict:  1.  Physical health - care for extremity, hearing, vision, burns, or other  physical injuries and pain, as well as clinical case management and  coordination support.  2.  Mental / emotional health - care for psychological and brain injuries— such as posttraumatic stress disorder (PTSD) psychotherapies and  traumatic brain injury (TBI) treatments—substance abuse, suicide  prevention, as well as clinical case management and coordination  support.  3.  Social domains - support for family and caregivers, legal support, non- medical case management, support for reserve components, post- deployment reintegration support for servicemembers and their  families, and spiritual support, and other related effects.  4.  While servicemembers and their spouses or dependents must benefit  from a program or activity that addresses the effects of combat, a  program or activity does not have to only benefit servicemembers that  directly experience combat. For example, the Joint Family Support  Assistance Program supports military families who are geographically  dispersed from a military installation. This program could support  military families in which one or more servicemembers are serving in  a combat zone or deployed to Germany (or other noncombat zone)  while the family is living stateside.

IB. Criteria for excluding programs  1.  Exclude programs that exclusively provide services to post-9/11  active-duty servicemembers who are transitioning to VA or civilian  employment or civilian life (these programs are included in objective  2).

Specific Definition of Terms for Objective 2  II. Definition: DOD, military services, or VA programs or activities whose  primary focus is to help post-9/11 servicemembers transition or veterans  or deactivated members of the reserve components readjust to civilian  life, including their spouses or dependents.

Specific definitions for this objective:  IIA. Primary focus: Key reasons for which the program or activity was  designed or created (or one of its main missions or objectives) as stated  in the agency’s description of the program or activity.

IIB. Help: Assist transition or readjustment through services and efforts,  such as: providing physical and mental health services; counseling and outreach;  training, job placement and support, employment benefits, and career  guidance, education benefits;  campaigns designed to raise awareness of DOD or VA resources  available to post-9/11 servicemembers or veterans or their spouses or  dependents; providing technology like assistive technology, equipment; case management, legal support; housing benefits/support; and, support for family or caregivers, benefits counseling, or other related  efforts.

IIC. Civilian Life: Time after separating from the military, including VA  care, services, or benefits; nonmilitary employment; or higher education.

IID. Criteria for excluding programs  1.  Exclude programs that provide services to post-9/11 servicemembers  who remain in the military or transition back to active-duty. (These  types of programs are covered in objective 1.)  2.  Exclude programs to enhance overall coordination between DOD and  VA (e.g., Joint Executive Council).

Specific Definition of Terms for Objective 3  III. Definition: DOD, military services, or VA programs whose primary  focus is to raise civilian public awareness of the combat experiences of  post-9/11 active-duty servicemembers and the readjustment experiences  of veterans.

Specific definitions for this objective:  IIIA. Primary focus: Key reasons for which the program or activity was  designed or created (or one of its main missions or objectives) as stated  in the agency’s description of the program or activity.

IIIB. Raise public awareness and understanding  1.  Welcome home and reintegration events in communities and college  campuses as well as parades and appreciation events aimed at  informing the nonservicemember population.  2.  Awareness and appreciation campaigns and events as well as public  service announcements aimed at civilians, and efforts to educate  business leaders about the skills veterans can provide employers, and  other related efforts.

IIIC. Criteria for excluding programs  1.  Excludes programs and public awareness campaigns aimed  specifically at providing assistance, service, or awareness to  servicemembers, veterans or their families. (These types of  programs are covered in objective 2.)  2.  Excludes DOD and VA efforts to provide stakeholder assistance to  nonfederal entities, such as nonprofits, that provide support or  assistance to servicemembers, veterans, and their families.  2.  We identified publicly available sources that contain lists of relevant  federal programs. We identified these sources based on discussions  with DOD and VA officials and internal GAO experts on research  methods and federal programs for servicemembers and veterans, as  well as through online searches. Table 5 provides the name and  description of each source we used by objective.  3.  We used the definitions and sources from steps 1 and 2 to identify  the relevant programs for our lists. For the programs included on  our lists, we used the sources identified in step 2 to collect  information about the (1) program/activity’s name, (2)  purpose/objectives, (3) the agency and/or office responsible for its  administration, and (4) the population served. For a subset of the  programs identified in the searches, we conducted tests to  determine the degree to which analysts agreed on the same  programs for inclusion. Once we compiled preliminary lists of  programs, we provided the lists to internal GAO experts on  research methods and federal programs for servicemembers and  veterans for review and comment. We modified the lists  accordingly.

Next, a GAO analyst reviewed all of the sources and documented  a judgment about whether the programs identified conformed to  the definitions we developed in step 1. A second GAO analyst  then reviewed separately the assessment and documented an  agreement or disagreement with the initial decision. If any  differences emerged, the two analysts discussed the differences  and made changes based on a verbal resolution of those  differences. For any instances in which the two analysts did not  resolve differences, a third GAO analyst adjudicated and a final  decision was reached.  4.  We sent our preliminary list of programs to officials at DOD and  VA for comment and verification. Agencies either confirmed that  programs on our preliminary lists should be included, identified  those that should not be on our lists, or added programs that were  not included on our preliminary lists. We modified the lists  accordingly.

This four-step process identified 170 separate programs, although some  of them are relevant to more than one objective. Specifically, 26 programs  are included in more than one objective, such as the Air Force Wounded  Warrior Program (AFW2) that addresses the effects of combat and helps  wounded and injured servicemembers and veterans transition to civilian  life. In addition, some programs share a common name but are  independently implemented by each military service branch. For example,  the Yellow Ribbon Reintegration Program provides similar services but is  independently administered by each service branch. With such programs,  we separately counted each military service’s program. In carrying out  this four step process, we did not conduct an independent legal analysis  of the statutory or regulatory basis or requirements for any of the  programs we identified. We used the various documentary and data  sources to corroborate one another and determined that the documentary  and data sources used together were sufficiently reliable for our  descriptive purposes.

To help convey our findings, we developed categories to group the types  of service provided by the programs. The categories include (1) caregiver  support, (2) case management/care coordination, (3) counseling, (4)  disability, (5) education assistance, (6) employment assistance, (7)  information and referral, (8) mental health and substance abuse, (9)  physical health, (10) spiritual health, and (11) other. Because some  programs offer more than one type of service, programs can fall into more  than one category or service type. Although a service may be included in  many programs or activities, the service may not or may be commonly  used by servicemembers or veterans. For example, the Transition  Assistance Program (TAP) is one program, but the services provided  through the program are widespread because all eligible, transitioning  servicemembers are generally required to participate in this program.

Finally, our scope for the first three objectives was limited to identifying  DOD and VA programs based on the types of service provided; we did  not analyze these programs to identify instances of fragmentation,  overlap, duplication, or gaps in benefits or services. In addition, the  programs included in our review were accurate and up-to-date when we  issued the report. However, some may change over time.

section_title: Comparing Lists of Programs
paragraphs: To address the fourth objective, we compared the lists of programs that  we generated under objectives 1-3 with DOD and VA’s 2013 program  inventories—part of OMB’s federal program inventory compiled in  response to a GPRAMA requirement—to identify similarities and  differences between the agencies’ inventories and our lists. To help make  this comparison, we drew upon prior GAO work on agencies’ GPRAMA  program inventories. Although this objective was not included in the  mandate, we added it because of the parallels between the mandate and  the GPRAMA requirement for developing program inventories.

We conducted our work from March 2014 to November 2014 in  accordance with generally accepted government auditing standards.  Those standards require that we plan and perform the audit to obtain  sufficient, appropriate evidence to provide a reasonable basis for our  findings and conclusions based on our audit objectives. We believe that  the evidence obtained provides a reasonable basis for our findings based  on our audit objectives.

section_title: Appendix II: Programs Addressing the Effects of Combat (Objective 1)
paragraphs: Appendix II: Programs Addressing the Effects of Combat (Objective 1)
subsections: section_title: Program Name
paragraphs: Mental health  and  substance  abuse  description  of “Other”

Appendix II: Programs Addressing the Effects of Combat (Objective 1)

Appendix II: Programs Addressing the    Effects of Combat (Objective 1)

section_title: Program Name
paragraphs: Mental health  and  substance  abuse  description  of “Other”

section_title: Appendix II: Programs Addressing the Effects of Combat (Objective 1)
paragraphs: Appendix II: Programs Addressing the   Effects of combat (Objective 1)

section_title: Program Name
paragraphs: Mental health  and  substance  abuse  description  of “Other”

Appendix II: Programs Addressing the Effects of Combat (Objective 1)

Appendix II: Programs Addressing the   Effects of combat (Objective 1)

section_title: Program Name
paragraphs: Mental health  and  substance  abuse  description  of “Other”

Appendix II: Programs Addressing the Effects of Combat (Objective 1)

Appendix II: Programs Addressing the   Appendix II: Programs Addressing the   Effects of combat (Objective 1)  Effects of combat (Objective 1)

section_title: Program Name
paragraphs: Mental health  and  substance  abuse  description  of “Other”

Appendix II: Programs Addressing the Effects of Combat (Objective 1)

Appendix II: Programs Addressing the   Effects of combat (Objective 1)

section_title: Program Name
paragraphs: Mental health  and  substance  abuse  description  of “Other”

section_title: Appendix II: Programs Addressing the Effects of Combat (Objective 1)
paragraphs: Appendix II: Programs Addressing the   Effects of combat (Objective 1)

section_title: Program Name
paragraphs: Mental health  and  substance  abuse  description  of “Other”

Appendix II: Programs Addressing the Effects of Combat (Objective 1)

Appendix II: Programs Addressing the   Effects of combat (Objective 1)

section_title: Program Name
paragraphs: Mental health  and  substance  abuse  description  of “Other”

Appendix II: Programs Addressing the Effects of Combat (Objective 1)

Appendix II: Programs Addressing the   Effects of combat (Objective 1)

section_title: Program Name
paragraphs: Mental health  and  substance  abuse  description  of “Other”

Service- member,  Veteran, and  Family  Marine  Forces  Reserve                                                                                                                                             (MARFORR ES)  Psycholog- ical Health  Outreach  Program (P- HOP)

Appendix II: Programs Addressing the Effects of Combat (Objective 1)

Appendix II: Programs Addressing the   Effects of combat (Objective 1)

section_title: Program Name
paragraphs: Mental health  and  substance  abuse  description  of “Other”

Appendix II: Programs Addressing the Effects of Combat (Objective 1)

Appendix II: Programs Addressing the   Effects of combat (Objective 1)

section_title: Program Name
paragraphs: Mental health  and  substance  abuse  description  of “Other”

Appendix II: Programs Addressing the Effects of Combat (Objective 1)

Appendix II: Programs Addressing the   Effects of combat (Objective 1)

section_title: Program Name
paragraphs: Mental health  and  substance  abuse  description  of “Other”

Appendix II: Programs Addressing the Effects of Combat (Objective 1)

Appendix II: Programs Addressing the  Effects of combat (Objective 1)

section_title: Program Name
paragraphs: Mental health  and  substance  abuse  description  of “Other”

section_title: Appendix II: Programs Addressing the Effects of Combat (Objective 1)
paragraphs: Appendix II: Programs Addressing the   Effects of combat (Objective 1)

section_title: Program Name

section_title: Appendix II: Programs Addressing the Effects of Combat (Objective 1)
paragraphs: Appendix II: Programs Addressing the   Effects of combat (Objective 1)

section_title: Program Name
paragraphs: Mental health  and  substance  abuse  description  of “Other”

section_title: Appendix II: Programs Addressing the Effects of Combat (Objective 1)
paragraphs: Appendix II: Programs Addressing the   Effects of combat (Objective 1)

section_title: Program Name
paragraphs: Mental health  and  substance  abuse  description  of “Other”

section_title: Appendix II: Programs Addressing the Effects of Combat (Objective 1)
paragraphs: Appendix II: Programs Addressing the   Effects of combat (Objective 1)

section_title: Program Name
paragraphs: Mental health  and  substance  abuse  description  of “Other”

Appendix II: Programs Addressing the Effects of Combat (Objective 1)

Appendix II: Programs Addressing the   Effects of combat (Objective 1)

section_title: Program Name
paragraphs: Mental health  and  substance  abuse  description  of “Other”

Appendix III: Programs for Transitioning and Readjusting to Civilian Life (Objective 2)

Appendix III: Programs for Transitioning and Readjusting to  Civilian Life (Objective 2)

Mental  health and  substance  abuse  “Other”

Appendix III: Programs for Transitioning and Readjusting to Civilian Life (Objective 2)

Appendix III: Programs for Transitioning and  Readjusting to Civilian Life (Objective 2)

section_title: Program Name
paragraphs: Mental  health and  substance  abuse  “Other”

Appendix III: Programs for Transitioning and Readjusting to Civilian Life (Objective 2)

Appendix III: Programs for Transitioning and  Readjusting to Civilian Life (Objective 2)

section_title: Program Name
paragraphs: Mental  health and  substance  abuse  “Other”

section_title: Appendix III: Programs for Transitioning and Readjusting to Civilian Life (Objective 2)
paragraphs: Appendix III: Programs for Transitioning and  Readjusting to Civilian Life (Objective 2)

section_title: Program Name
paragraphs: Mental  health and  substance  abuse  “Other”

Appendix III: Programs for Transitioning and Readjusting to Civilian Life (Objective 2)

Appendix III: Programs for Transitioning and  Readjusting to Civilian Life (Objective 2)

section_title: Program Name
paragraphs: Mental  health and  substance  abuse  “Other”

X  Appendix III: Programs for Transitioning and Readjusting to Civilian Life (Objective 2)

Appendix III: Programs for Transitioning and  Appendix III: Programs for Transitioning and  Readjusting to Civilian Life (Objective 2)  Readjusting to Civilian Life (Objective 2)

section_title: Program Name
paragraphs: Mental  health and  substance  abuse  “Other”

X  Appendix III: Programs for Transitioning and Readjusting to Civilian Life (Objective 2)

Appendix III: Programs for Transitioning and  Readjusting to Civilian Life (Objective 2)

section_title: Program Name
paragraphs: Mental  health and  substance  abuse  “Other”

Appendix III: Programs for Transitioning and Readjusting to Civilian Life (Objective 2)

Mental  health and  substance  abuse  “Other”

Appendix III: Programs for Transitioning and Readjusting to Civilian Life (Objective 2)

Appendix III: Programs for Transitioning and  Readjusting to Civilian Life (Objective 2)

section_title: Program Name
paragraphs: Mental  health and  substance  abuse  “Other”

section_title: Appendix III: Programs for Transitioning and Readjusting to Civilian Life (Objective 2)
paragraphs: Appendix III: Programs for Transitioning and  Readjusting to Civilian Life (Objective 2)

section_title: Program Name
paragraphs: Mental  health and  substance  abuse  “Other”

section_title: Appendix III: Programs for Transitioning and Readjusting to Civilian Life (Objective 2)
paragraphs: Appendix III: Programs for Transitioning and  Readjusting to Civilian Life (Objective 2)

section_title: Program Name
paragraphs: Mental  health and  substance  abuse  description   of “Other”

section_title: Appendix III: Programs for Transitioning and Readjusting to Civilian Life (Objective 2)
paragraphs: Appendix III: Programs for Transitioning and  Readjusting to Civilian Life (Objective 2)

section_title: Program Name
paragraphs: Mental  health and  substance  abuse  description   of “Other”

section_title: Appendix III: Programs for Transitioning and Readjusting to Civilian Life (Objective 2)
paragraphs: Appendix III: Programs for Transitioning and  Readjusting to Civilian Life (Objective 2)

section_title: Program Name
paragraphs: Mental  health and  substance  abuse  description of  “Other”

section_title: Appendix III: Programs for Transitioning and Readjusting to Civilian Life (Objective 2)
paragraphs: Appendix III: Programs for Transitioning and  Readjusting to Civilian Life (Objective 2)

section_title: Program Name
paragraphs: Mental  health and  substance  abuse  description   of “Other”

section_title: Appendix III: Programs for Transitioning and Readjusting to Civilian Life (Objective 2)
paragraphs: Appendix III: Programs for Transitioning and  Readjusting to Civilian Life (Objective 2)

section_title: Program Name
paragraphs: Mental  health and  substance  abuse  description   of “Other”

section_title: Appendix IV: Comments from the Department of Defense

section_title: Appendix V: Comments from the Department of Veterans Affairs

section_title: Appendix VI: GAO Contact and Staff Acknowledgments
subsections: section_title: GAO Contact

section_title: Staff Acknowledgments
paragraphs: In addition to the contact named above, individuals making key  contributions to this report were Brett Fallavollita, Assistant  Director; James Whitcomb, Analyst-in-Charge, Deitra Lee, and  Joel Marus. In addition, key support was provided by Bonnie  Anderson, James Bennett, David Chrisinger, Debra Draper, Alex  Galuten, Kathy Leslie, Ben Licht, Sheila McCoy, Paul Schearf,  Stacy-Ann Spence, Walter Vance, and Amber Yancey-Carroll.


Question-summary annotations: questions: question: What is the purpose of the 99 programs GAO identified?
answer: GAO identified 99 programs provided by the Department of Defense (DOD) to help address the effects of combat on post-9/11 servicemembers, their families, or both.
child_questions: question: What do the programs offer?
answer: These programs often offer multiple types of services.
child_questions: question: What types of service do the programs offer?
answer: The services most common are mental health and substance abuse (50), information and referral (37), and case management or care coordination (15).

questions: question: What is the problem with the list of programs GAO developed?
answer: The lists of programs that GAO developed using its definition are not comparable with those in DOD's 2013 program inventory and have only limited comparability with VA's 2013 program inventory.
child_questions: question: Why do the list of programs have limited comparability?
answer: This limited comparability is primarily due to differing contexts in which the lists were compiled. While GAO's lists address specific mandated questions, DOD's and VA's lists were developed following Office of Management and Budget guidance, which generally provides flexibility in how agencies define their programs.

question: How did DOD identify programs at a broad level?
answer: For example, DOD's inventory is partially organized by its strategic goals. One goal is “preserving and enhancing the all-volunteer force,” for which wounded warrior care is cited as a high priority. Under this goal, DOD lists “hospitals” and “regional defense facilities” as programs.
child_questions: question: How does GAO contrast with DOD when identifying programs?
answer: In contrast, GAO identified individual programs, such as the Army Wounded Warrior Program and Warrior Transition Units, which were not listed in DOD's inventory.

questions: question: What are the purposes of the programs GAO identified in the report?
answer: In this report GAO identified the number of programs, including the types of services offered that: 1) address the effects of combat on post-9/11 active-duty servicemembers and their families, 2) help post-9/11 servicemembers and veterans transition to civilian life, and 3) help raise public awareness and understanding of servicemembers' and veterans' combat and transition experiences.
child_questions: question: What else did GAO examine in the report?
answer: Also, GAO examined how the lists of programs identified compare with program inventories prepared by DOD and VA pursuant to law.

question: How did GAO address its objectives?
answer: To address these objectives, GAO established and applied its definition of “program.” GAO also searched publicly available sources that contain lists of programs; sent preliminary lists of programs to DOD and VA for verification; and reviewed relevant reports and 2013 program inventories for DOD and VA.
child_questions: question: How did GAO define programs?
answer: In general, GAO defined programs as federally funded, organized sets of activities agencies undertake that are directed toward specific purposes or goals and are being administered in fiscal year 2014.