After volunteers separate from the Peace Corps they typically return to the United States, and may transition into new employment. As they make this employment transition, the Peace Corps offers various health care services and benefits to returned volunteers. First, each volunteer receives a close-of-service medical evaluation that assesses their health status as they complete their service. The Peace Corps also has a contract with an insurance company to make a health insurance policy— AfterCorps—available for volunteers to purchase. This policy covers non-service-connected illnesses or injuries. The Peace Corps also pays for certain health examinations for 6 months after a volunteer’s service is completed. Finally, volunteers may also be eligible for reimbursements under the FECA program for medical expenses associated with service- connected illnesses or injuries, such as those identified during the physical conducted at the close-of-service medical evaluation. The FECA program provides health benefits—reimbursement for medical expenses related to illnesses or injuries that DOL determines are service connected—as well as other benefits, such as wage-loss (death and disability) compensation. To receive benefits through FECA, a volunteer must establish that, among other things, he or she was in the performance of duty at the time the illness or injury occurred. Under the FECA program, volunteers are considered to be in the performance of duty 24 hours a day while abroad during the period of their Peace Corps service. DOL requires that if an illness or injury is first discovered after a volunteer has returned from service, then the medical evidence must show that the injury or illness was sustained while overseas or in the performance of duty. In order to be eligible for FECA health care benefits for preexisting illnesses or injuries—a condition that existed prior to service—the volunteer’s medical evidence must demonstrate that the volunteer’s service was the proximate cause of or aggravated, accelerated, or precipitated the illness or injury. Further, volunteers must apply for FECA benefits within 3 years of the date of injury or illness, or within 3 years after they recognize that a health condition is service- connected. In 2010, the FECA program provided about $2.8 billion in health and other benefits to about 251,000 federal and postal employees—including volunteers—who suffered a service related illness or injury. Volunteers who apply for FECA benefits typically go through the following steps: 1. Each volunteer is informed of the availability of FECA benefits at the close-of-service medical evaluation. a. Each volunteer is expected to receive a close-of-service medical evaluation that assesses his or her health status prior to leaving service to document any service-connected illnesses or injuries. Should a volunteer terminate service early—before completing his or her assignment—the volunteer will also undergo a complete medical and dental exam to identify any unmet health care needs and potential medical issues. 2. Volunteers complete a FECA application and submit it to DOL through the Peace Corps’ Post-Service Unit.a. The Peace Corps—through its Post-Service Unit—assists volunteers applying for benefits by helping them to complete the appropriate forms and providing the appropriate medical evidence from volunteers’ Peace Corps medical records. b. The Peace Corps’ Post-Service Unit sends all FECA applications—which includes information on the injury or illness reported by the volunteer—to DOL for review and eligibility determination. 3. FECA applications submitted for volunteers are reviewed by DOL, and the agency then makes an eligibility determination. a. For those applications that do not include sufficient information and require further development, volunteers are given approximately 30 days to submit additional information to support their request for FECA benefits. If the additional information submitted is sufficient, the application is approved. If the additional information is not sufficient, the FECA application is denied and medical treatment is not authorized. b. For those applications that are approved, DOL assigns a medical diagnosis on the basis of medical evidence submitted in the FECA application. This assigned medical diagnosis defines the medical treatment and services for which the volunteer is eligible for FECA reimbursement. 4. Typically, after benefits are approved by DOL, a volunteer obtains health care services through a medical provider. After receiving these services, the volunteer or the volunteer’s medical provider submits a bill to DOL for reimbursement. DOL provides reimbursement for medical expenses. 5. On an annual basis, DOL requires the Peace Corps to pay DOL back for these reimbursements. From 2009 through 2011, DOL provided a total of about $36 million in FECA benefits for volunteers, providing about $22 million in health care benefits—reimbursements for medical expenses to treat service- connected injuries and illnesses for Peace Corps volunteers—and $13.8 million in other benefits. During this period, almost 1,400 volunteers each year received health care benefits. The average reimbursement for medical expenses per volunteer was about $5,000 in 2009, and about $5,600 in 2011. The most-common medical conditions for which DOL provided health care benefits—reimbursements for medical services— were mental, emotional, and nervous conditions; dental; other/nonclassified diseases; and infectious or parasitic diseases.These four medical conditions represented about 40 percent of all medical conditions and accounted for about $5.9 million—or more than a quarter—of all medical reimbursements for volunteers under FECA between 2009 and 2011. See table 1 for the medical conditions for which DOL provided reimbursements for volunteers under FECA. In addition to health care benefits, volunteers also received other benefits—such as wage-loss compensation and reimbursement for travel to receive medical treatment. Specifically, from 2009 through 2011, these other benefits received by volunteers totaled about $13.8 million. In 2011, the total reimbursements for both health care and other benefits were about $12 million, which represents about 3.3 percent of the Peace Corps’ 2012 appropriation of $375 million. According to Peace Corps officials, these health care and other expenses represent a growing portion of its annual budget. These officials explained that from 2009 through 2011 these expenses have increased a total of approximately 7.2 percent. Volunteers who received FECA benefits from 2009 through 2011 are unique in several ways when compared to other recipients of these benefits. Specifically, our analysis of DOL’s FECA program claims data found that the volunteers were generally younger and more likely to be female when compared to others who received benefits under the FECA program. Volunteers were, on average, 12 years younger than others who received FECA benefits. About two-thirds of volunteers receiving FECA benefits were female, whereas less than half of others receiving FECA benefits were female. These differences in age and gender are consistent with the overall demographics of these two populations—the volunteers and federal workers. In addition, the medical conditions for which volunteers received FECA benefits were different than those for others who received FECA benefits. For example, volunteers were more likely than others to receive FECA benefits for mental, emotional, or nervous conditions; dental conditions; other/nonclassified diseases; and infectious or parasitic diseases. While these four medical conditions represented 40 percent of the conditions for volunteers, they represented less than 2 percent for the others receiving FECA benefits. The Peace Corps uses information it has to monitor volunteers’ awareness of the FECA program; however, in general, neither DOL nor the Peace Corps use information in the remaining three areas in our review to monitor the accessibility and quality of FECA benefits for volunteers. These areas are (1) information on volunteers’ knowledge of FECA program and application requirements, such as medical documentation that is required to be submitted with an application; (2) information on DOL’s timeliness in reviewing FECA applications and reimbursing medical expenses, and on the level of customer satisfaction with the FECA program; and (3) information on the availability of FECA- Table 2 summarizes the extent to which registered medical providers.DOL and the Peace Corps use information available in the four key areas to monitor the accessibility and quality of FECA benefits for volunteers. As shown in table 2, the Peace Corps uses information related to volunteers’ awareness of the FECA program. Specifically, to monitor volunteers’ awareness, the Peace Corps currently documents that volunteers have acknowledged that they have been informed of their potential eligibility for FECA during their close-of-service evaluation. Peace Corps officials told us the agency uses this information to help ensure all volunteers are made aware of their possible eligibility for FECA benefits. While the Peace Corps uses information on volunteer awareness, neither DOL nor the Peace Corps use available information related to the remaining three areas of our review to monitor the accessibility and quality of FECA benefits for volunteers. Volunteers’ knowledge of FECA program and application requirements. As table 2 shows, neither DOL nor the Peace Corps use available information, such as data on FECA application denial rates, and information on reasons for denials, in order to monitor the accessibility and quality of FECA benefits for volunteers. DOL officials told us that it is not their responsibility to use this information for this type of monitoring. However, by not using this available information to review volunteers’ level of knowledge of the FECA requirements, DOL and the Peace Corps may be unaware, for example, of the extent to which volunteers experience difficulties accessing FECA benefits because of limited understanding of certain application requirements, such as in (a) providing appropriate and sufficient medical evidence and (b) establishing a service connection for the illness or injury for which the volunteer is seeking FECA benefits. According to volunteer advocates, volunteers and their physicians may lack knowledge of certain FECA documentation requirements, such as the need to include a medical diagnosis rather than just the symptoms of an injury or illness in the FECA application. Furthermore, our examination of a limited number of FECA denial letters confirms that these difficulties are often a contributing factor in the FECA applications that were not approved from 2009 through 2011.