Servicemembers wounded in recent conflicts are surviving injuries that would have been fatal in past conflicts, in part because of advanced protective equipment and medical treatment. However, the severity of their injuries can result in a lengthy transition from patient status back to active duty or to veteran status. Most severely wounded servicemembers from the conflicts in Iraq and Afghanistan initially are evacuated to Landstuhl Regional Medical Center in Germany for treatment. From there, they are usually transported to military treatment facilities in the United States, with most of the severely wounded admitted to Walter Reed Army Medical Center, the National Naval Medical Center, or Brooke Army Medical Center. Acute medical treatment and stabilization is the first of three phases in the “continuum of care” experienced by severely wounded servicemembers. The second phase of the continuum is rehabilitation at a DOD, VA, or civilian facility. (The recovery needs of some servicemembers receiving rehabilitation may require their return to a medical center for acute medical care, such as surgical procedures.) The third phase of the continuum is reintegration—either return to active duty or to the civilian community as a veteran, where they may receive health care from DOD, VA, or civilian providers. From January 2008—when FRCP enrollment began—through September 2010, the FRCP provided services to a total of 1,268 servicemembers and veterans. As of September 2010, the program had 607 active enrollees, ranging in age from 19 to 61 years, with a median age of 27 years. About half of the enrollees were or had been married. Fifty-eight percent had designated another person as his or her primary caregiver, and 38 percent had delegated legal authority to another person. (See table 1 for additional demographic information about current FRCP enrollees.) FRCs are senior-level registered nurses and licensed social workers whose principal role is to coordinate services with case managers rather than provide services directly to enrollees. FRCs are expected to serve as the single point of contact for the enrollees and their families and to assist the enrollees in a number of ways. FRCP care coordination guidelines identify FRC activities, which are outlined in table 2. According to FRCP policy, the FRC’s primary responsibility is to develop and monitor progress of each enrollee as detailed in that person’s Federal Individual Recovery Plan, which is created and implemented by the FRC with input from the enrollee and his or her family and clinical team. This plan is to be a comprehensive, client-centered plan that sets individualized goals for recovery and is intended to guide and support the enrollee through the continuum of care. FRCs update Federal Individual Recovery Plans to reflect changing conditions or enrollee goals. Based on their diagnoses and other factors, enrollees are likely to require a complex array of clinical and nonclinical services from multiple providers and facilities. (See table 3.) In providing care coordination services, the FRC may engage with an enrollee’s health care providers, other care coordinators, and case managers, such as those with the military services’ wounded warrior programs. As care coordinators, FRCs are generally not expected to directly provide the services needed by enrollees. However, FRCs may provide services directly to enrollees in certain situations, such as when they cannot determine whether a case manager has taken care of an issue for an FRCP enrollee, when asked to resolve complex problems, or when making complicated arrangements, for example, identifying and arranging admission to a substance abuse treatment program for a veteran who was beginning to develop violent behaviors and had refused to complete a VA drug rehabilitation treatment program. It is unclear whether all of the eligible “severely wounded, ill, and injured” servicemembers and veterans who could benefit from the FRCP are being enrolled in the program. The FRCP cannot readily identify these individuals because the “severely wounded, ill, and injured” classification is not captured in existing data sources. Additionally, the program’s broad eligibility criteria cannot be used systematically to identify potentially eligible servicemembers and veterans. Instead, the FRCP must rely on referrals from others to identify these individuals, although the program has also taken steps to identify potential enrollees through the FRCs’ efforts at medical facilities and through a “look back” initiative to identify eligible veterans who were wounded prior to program implementation. In addition, the FRCs must exercise judgment in applying the program’s criteria for enrollment determinations, and FRCP leadership does not systematically review these decisions to ensure that these criteria are applied appropriately so that referred individuals who could benefit from the program are enrolled, and that individuals who could be served by less intensive services are referred to other programs. FRCP officials have experienced difficulties in identifying the potentially eligible population of “severely wounded, ill, or injured” servicemembers and veterans, and as a result, it is unclear whether all of these individuals who could benefit from care coordination services are enrolled in the program. The Senior Oversight Committee, which created the FRCP, developed a three-level care categorization system to differentiate the population of wounded servicemembers and veterans for different programs based on the severity of their conditions. In this system, Category 1 servicemembers are those with mild wounds, illnesses, or injuries who are expected to return to duty in less than 180 days; Category 2 servicemembers are those with serious wounds, illnesses, or injuries who are unlikely to return to duty in less than 180 days and possibly may be medically separated from the military; and Category 3 servicemembers are severely wounded, ill, or injured individuals whose medical conditions are highly likely to prevent their return to duty and also likely to result in medical separation from the military. Individuals who fall under category 3 may be considered for enrollment into the FRCP, while individuals falling under categories 1 or 2 may qualify for other types of programs. However, according to the FRCP Executive Director, these are administrative categories that are not captured in existing VA or DOD medical or benefits data systems or included in medical or benefits records. As a result, the FRCP cannot use this classification to systematically identify the population of potentially eligible severely wounded servicemembers and veterans using available data sources. In addition, the FRCP Executive Director and FRCs told us that the broad eligibility criteria developed for the FRCP must be used on a case-by-case basis to identify potentially eligible individuals for the program because these criteria require some judgment. Therefore, the criteria cannot be used systematically to identify the program’s potentially eligible population. These criteria include both specific medical diagnoses and requirements that are somewhat subjective, such as whether an individual may benefit from a recovery plan. To decide whether potential enrollees may benefit from a recovery plan, FRCs reported that they evaluate the complexity of a situation by examining issues such as future medical needs, family dynamics, and any financial or legal problems— information that is not readily available in any one data source. As a result, to identify potentially eligible individuals, the FRCP relies on referrals from others, including program officials and medical facility staff. Sources of referrals include, for example, wounded warrior program staff, Recovery Care Coordinators, and clinical treatment teams. Of the program officials and medical facility staff we spoke with who discussed referrals, more than half (25 of 47) had made a referral to the program. However, more than half (15 of 27) of the program officials and medical facility staff we interviewed who responded to questions on eligibility also felt that the FRCP eligibility criteria were unclear. In addition to relying on referrals, the FRCs also take steps to identify potential enrollees. Some FRCs stated that they review their facility’s list of incoming severely wounded servicemembers and attend weekly multidisciplinary team meetings where hospital officials and medical staff discuss severely wounded patients’ cases. In an attempt to ensure that eligible veterans who were wounded prior to the program’s inception are enrolled in the program, the FRCP conducted a “look back” initiative in May 2010. Because no single data source contains sufficient information, the FRCP Executive Director told us that she combined five DOD and VA data sets and used multiple “proxy” factors to narrow the data from 40,000 veterans’ records to the final list of potentially eligible veterans. For example, the Veterans Benefits Administration’s 100 percent disability compensation list and medical diagnostic codes were used to help identify this population. Based on this analysis, the FRCP Executive Director reported that the program contacted approximately 300 potential enrollees to determine whether they could benefit from an FRC’s assistance. As a result, 35 of those severely wounded veterans will be further evaluated for potential enrollment. According to the FRCP Executive Director, this analysis was prioritized to focus on severely wounded veterans who were most likely to need FRC assistance. The Executive Director told us that, as a result, the list was not comprehensive—for example, the program did not contact veterans who were already enrolled in VA’s OEF/OIF Care Management Program under the assumption that they were already receiving adequate case management. Additionally, the FRCP Executive Director told us that identifying 35 veterans indicated that the FRCP is not reaching all potentially eligible veterans through its normal referral process or that information about the program is not reaching severely wounded veterans. The FRCP Executive Director added that once it is complete, this effort will be assessed to determine whether another “look back” is needed, but as of February 2011, leadership officials had not yet determined whether they would conduct a subsequent “look back.” Following the identification of potentially eligible servicemembers and veterans, FRCs use a more thorough application of the program’s eligibility criteria to evaluate these individuals for enrollment. The eligibility criteria are broad and require FRCs to exercise judgment with their enrollment decisions.