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

Letter

Background

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.

Federal Assistance to Servicemembers, Veterans, and Their Families

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.

GPRA Modernization Act and Agency Coordination

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.

We Identified 99 DOD Programs That Address the Effects of Combat

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.

We Identified 87 DOD and VA Programs That Help Servicemembers Transition and Veterans Readjust to Civilian Life

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.

We Identified 12 DOD and VA Programs That Raise Awareness and Understanding of Servicemembers’ and Veterans’ Experiences

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.

Variation in Definitions Limits the Ability to Compare Our Lists with DOD and VA Inventories

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.

Agency Comments and Our Evaluation

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.

Appendix I: Scope and Methodology

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).

Identifying DOD and VA Programs

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.

Comparing Lists of Programs

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.

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

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

Program Name

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)

Program Name

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)

Program Name

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)

Program Name

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)

Program Name

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)

Program Name

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)

Program Name

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)

Program Name

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)

Program Name

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)

Program Name

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)

Program Name

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)

Program Name

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)

Program Name

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)

Program Name

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

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

Program Name

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)

Program Name

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)

Program Name

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)

Program Name

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)

Program Name

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)

Program Name

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)

Program Name

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)

Program Name

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)

Program Name

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)

Program Name

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)

Program Name

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)

Program Name

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)

Program Name

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)

Program Name

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)

Program Name

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)

Program Name

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)

Program Name

Mental health and substance abuse description of “Other”

Appendix IV: Comments from the Department of Defense

Appendix V: Comments from the Department of Veterans Affairs

Appendix VI: GAO Contact and Staff Acknowledgments

GAO Contact

Staff Acknowledgments

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.