Review groups identified significant problems after the media reports concerning Walter Reed. Initial efforts to respond to these problems were primarily coordinated through the Senior Oversight Committee, and DOD and VA undertook additional efforts to respond to these problems. Following the revelations at Walter Reed, several review groups noted significant problems that may arise during servicemembers’ recovery from wounds, illnesses, and injuries. Some of these problems involve the provision of appropriate medical care, while others involve the acquisition of needed DOD and VA benefits. In 2007, one of the review groups, the President’s Commission on Care for America’s Returning Wounded Warriors—commonly referred to as the Dole-Shalala Commission—noted that recovering servicemembers depend on the effective and efficient provision of medical services and benefits across the recovery care continuum, which is separated into three phases: recovery, when wounded, ill, and injured servicemembers are stabilized and receive acute inpatient medical treatment at an MTF, VAMC, or private medical facility; rehabilitation, when recovering servicemembers with complex trauma, such as missing limbs, receive medical and rehabilitative care; and reintegration, when servicemembers either return to active duty or to the civilian community as veterans. A recovering servicemember or veteran may not experience the recovery care continuum as a linear process, and may move back and forth across the continuum over time, depending on his or her medical needs. For example, a servicemember who has transitioned to the rehabilitation phase may go back to the recovery phase if there is a need to return to an MTF to obtain acute medical care, such as a surgical procedure. DOD and VA took a number of steps to address the problems identified by the review groups that investigated the issues raised by the Walter Reed media reports. As an initial step, the departments established the Senior Oversight Committee to coordinate and oversee DOD’s and VA’s efforts to jointly resolve these problems. Through this committee, DOD and VA created programs and initiatives to assist recovering servicemembers and veterans as they navigate the recovery care continuum. Key efforts included the establishment of the integrated disability evaluation system (IDES), the Federal Recovery Coordination Program (FRCP), the Recovery Coordination Program (RCP), and the Interagency Program Office. (See fig. 1.) Senior Oversight Committee. The Senior Oversight Committee was responsible for ensuring that the recommendations—which totaled more than 600 from the various review groups—were properly reviewed, coordinated, implemented, and resourced. Supporting the Senior Oversight Committee was an Overarching Integrated Product Team, the membership of which included the Assistant Secretaries of Defense, the military departments’ Assistant Secretaries for Manpower and Reserve Affairs, and various senior officials from DOD and VA. This team coordinated, integrated, and synchronized the work of the eight “Lines of Action” (LOA) that focused on specific issues, including case management, disability evaluation systems, and data sharing between DOD and VA. (See fig. 2.) Each LOA included representation from DOD, including each military service, and VA. They performed the bulk of the work to address the issues and recommendations of the various review groups, including establishing plans, setting and tracking milestones, and identifying and enacting early and short-term solutions. More specifically, the LOAs were as follows: LOA 1—Disability Evaluation: Responsible for addressing efforts to reform the DOD and VA disability evaluation systems. LOA 2—Traumatic Brain Injury (TBI)/Post Traumatic Stress Disorder (PTSD): Responsible for addressing issues related to TBI/PTSD. LOA 3—Case Management: Responsible for addressing issues related to the care, management, and transition of recovering servicemembers from recovery to rehabilitation and reintegration. LOA 4—DOD/VA Data Sharing: Responsible for addressing issues regarding the electronic exchange of DOD and VA health records. LOA 5—Facilities: Responsible for addressing issues relating to military and VA medical facilities. LOA 6—”Clean Sheet” Review: Developed recommendations to improve care and benefits without the constraints of existing laws, regulations, organizational roles, personnel constraints, or budgets. LOA 7—Legislation and Public Affairs: Responsible for addressing legal and other issues for policy development. LOA 8—Personnel, Pay, and Financial Support: Responsible for addressing compensation and benefit issues. Some of the key efforts initiated out of the LOAs included the establishment of an integrated disability evaluation system, care coordination programs, and steps towards the electronic exchange of DOD and VA health records—a responsibility that was later assumed by the Interagency Program Office. DOD/VA Integrated Disability Evaluation System. Through LOA 1, DOD and VA jointly began to develop and pilot IDES to improve the disability evaluation process by eliminating duplication in DOD’s and VA’s separate evaluation systems and expediting the receipt of VA benefits. Specifically, IDES merges DOD’s and VA’s separate medical exams for servicemembers into a single exam process; consolidates DOD’s and VA’s separate disability rating decisions into a single VA rating decision; and provides staff to perform outreach and nonclinical case management and explain VA results and processes to servicemembers. By October 2011, DOD and VA had fully deployed IDES at 139 MTFs in the United States and several other countries. Care Coordination Programs. LOA 3 took the lead role in addressing problems with uncoordinated case management for recovering servicemembers and veterans through the establishment of two care coordination programs—the FRCP and the RCP. The FRCP was based on a recommendation from the Dole-Shalala Commission that a single individual—a recovery coordinator—would work with existing DOD and VA case managers to ensure that servicemembers had the resources needed for their care. LOA 3 designed the FRCP to assist “severely” wounded, ill, and injured OEF and OIF servicemembers, veterans, and their families with access to care, services, and benefits. This population includes servicemembers and veterans who suffer from traumatic brain injuries, amputations, burns, spinal cord injuries, visual impairment, and PTSD. The program uses federal recovery coordinators to monitor and coordinate clinical services, including facilitating and coordinating medical appointments, and nonclinical services, such as providing assistance with obtaining financial benefits or special accommodations, needed by program enrollees and their families. Federal recovery coordinators, who are senior-level registered nurses and licensed clinical social workers, were intended to serve as the single point of contact among all of the case managers of DOD, VA, and other governmental and nongovernmental programs that provide services directly to servicemembers and veterans. Although the FRCP was designed as a joint program, it is administered by VA, and the federal recovery coordinators are VA employees. LOA 3 subsequently developed the RCP in response to a requirement in the NDAA 2008. The RCP is a DOD-specific program that uses recovery care coordinators to coordinate nonclinical services and resources for “seriously” wounded, ill, and injured servicemembers who may return to active duty, unlike those categorized as “severely” wounded, ill, and injured, who are not likely to return to duty and would be served by the FRCP. The military services were responsible for separately implementing the RCP through each of their existing wounded warrior programs as a means of providing care coordination services to program enrollees. Electronic Sharing of Health Records. LOA 4 was focused on addressing issues related to the electronic exchange of DOD and VA health records. However, this effort was superseded by the NDAA 2008, which required the establishment of the Interagency Program Office to serve as a single point of accountability for both departments in the development and implementation of interoperable electronic health records.DOD and VA retained the responsibility for the development and Although management of the information technology systems, the Interagency Program Office was responsible for ensuring the implementation of an electronic health records system or capabilities that allowed for the complete sharing of health care information for the provision of clinical care. In October 2011, the Interagency Program Office also became accountable for DOD’s and VA’s work on developing an integrated electronic health records system that both departments would use for their beneficiaries. In addition to the Senior Oversight Committee’s efforts, DOD, its military services, and VA developed or modified a number of programs and initiatives to assist recovering servicemembers and veterans in navigating the recovery care continuum. Military Services’ Wounded Warrior Programs. The military services’ wounded warrior programs were established to assist recovering servicemembers during their recovery, rehabilitation, and initial reintegration back to active duty or to civilian life. Most of these programs provide nonclinical case management services to the recovering servicemembers; that is, they help to resolve issues related to finances, benefits and compensation, administrative and personnel paperwork, housing, and transportation. In addition, the wounded warrior programs serve as the central point of access to other types of services or resources that support recovering servicemembers, such as clinical case management, care coordination, and career, education, and readiness services. (See table 1.) If a wounded warrior program does not directly provide a service or resource, it can facilitate servicemembers’ access to that service or resource. Although the wounded warrior programs were intended mainly to provide services to recovering servicemembers, all but one of the programs continue to assist individuals after they have transitioned to veteran status. VA Transition Programs. VA’s Liaison for Healthcare Program and its OEF/OIF/OND Care Management Program assist recovering servicemembers with transitioning from DOD’s to VA’s health care system.