VA’s VR&E program is designed to ensure that veterans with disabilities find meaningful work and achieve maximum independence in daily living. In 2004, VA estimates that it spent more than $670 million on its VR&E program to serve about 73,000 participants. This represents about 2 percent of VA’s $37 billion budget for nonmedical benefits, most of which involves cash compensation for veterans with disabilities. VR&E services include vocational counseling, evaluation, and training that can include payment for tuition and other expenses for education, as well as job placement assistance. Interested veterans generally apply for VR&E services after they have applied and qualified for disability compensation based on a rating of their service-connected disability. This disability rating—ranging from 0 to 100 percent in 10 percent increments—entitles veterans to monthly cash payments based on their average loss in earning capacity resulting from a service-connected injury or combination of injuries. To be entitled to VR&E services, veterans with disabilities generally must have at least a 20 percent disability rating and an employment handicap as determined by a vocational rehabilitation counselor. Although cash compensation is not available to servicemembers until after they separate from the military, they can receive VR&E services prior to separation under certain circumstances. To make these services available prior to discharge, VA expedites the determination of eligibility for VR&E by granting a preliminary rating, known as a memorandum rating. VA’s outreach to servicemembers who plan to apply for veterans’ disability compensation has been part of its transition assistance program, which was established in 1990. Either in group sessions or in one-on-one encounters, VA provides servicemembers with information about disability benefits and services, which includes the VR&E program, and offers assistance in applying for them. In addition, VA administers a pre- discharge program that expedites the disability compensation claims processing for servicemembers who are pending discharge. This program also helps VR&E staff identify those who could benefit from vocational rehabilitation and employment services. VA has recently included activated National Guard and Reserve members in its outreach efforts. Servicemembers injured in Iraq and Afghanistan are surviving injuries that would have been fatal in past conflicts, due, in part, to advanced protective equipment and medical treatment. However, the severity of their injuries can result in a lengthy transition from injured servicemember to veteran. Initially, most seriously injured servicemembers, including activated National Guard and Reserve members, are brought to Landstuhl Regional Medical Center in Germany for treatment. From there, they are transported to the appropriate U.S. medical facilities, which are usually major military treatment facilities (MTFs) but may also be VA medical centers. According to DOD officials, once stabilized and discharged from the hospital, servicemembers usually relocate to be closer to their homes or military bases and are treated as outpatients by the closest VA or military hospital. (See fig. 1.) At this point, the military generally begins to assess whether the servicemember will be able to remain in the military, a process that could take months to complete. The process can take even longer if the servicemember appeals the military’s initial disability decision. In response to recommendations made by the VA Vocational Rehabilitation and Employment Task Force, VA is beginning to change its approach to VR&E to better reflect contemporary views of disability. The Secretary of Veterans Affairs established this external task force in 2003 to conduct a comprehensive review of VA’s VR&E program. In addition, faced with the immediate need to provide benefits and services to a new generation of veterans with disabilities, VA in August 2003 formed an internal task force to develop and implement policies to improve the transition of injured servicemembers back to civilian life. Known as the Seamless Transition Task Force, it included ad hoc participation from DOD. Although this task force’s initial priority was to ensure the continuity of medical care for injured servicemembers as they transition from military to VA health care, it has also coordinated efforts to ensure access to all other VA benefits, including VR&E services. We have previously reported on the importance of early intervention to maximize the work potential of individuals with disabilities. We have also reported, however, that current federal disability programs offer little opportunity for early intervention with individuals who apply for compensation. These programs require lengthy assessments in which applicants must focus on demonstrating their work limitations rather than their abilities and potential to work. Consequently, vocational rehabilitation is typically introduced late in the process. Furthermore, we have designated federal disability programs, including VA’s, as high-risk programs because they lack emphasis on the potential for vocational rehabilitation to return people to work and also rely on outmoded assumptions about the relationship between impairment and work. VA has instructed its regional offices to make seriously injured servicemembers a high priority for all VA assistance and asked DOD to provide data that would ensure VA’s ability to identify and monitor this population. Because many seriously injured servicemembers are initially treated at major military treatment facilities, VA has deployed staff to these sites to provide information on all veterans’ benefits, including VR&E services. To ensure the identification and monitoring of all seriously injured servicemembers, VA initiated a memorandum of agreement proposing that DOD share a range of information, including the names of those with serious injuries, their medical condition, and their military status. As of December 2004, a formal agreement with DOD had not been reached. In the meantime, VA has instructed its regional offices to develop local liaison with DOD in order to identify and assist seriously injured servicemembers. The 12 regional offices we reviewed have developed information of varying completeness and reliability. However, once regional offices have identified and contacted seriously injured servicemembers, VA has no policy for VR&E staff to maintain contact with those individuals who do not apply for VR&E services while in the hospital or after they return home. Nevertheless, some regional offices reported maintaining contact with these servicemembers while others did not. In a September 2003 letter, VA instructed its regional offices to provide priority consideration and assistance to seriously injured servicemembers returning from Afghanistan and Iraq. VA specifically instructed regional offices to focus on servicemembers whose disabilities are definitely or likely to result in military separation. Minimally, this includes servicemembers with injuries DOD has classified as “very serious,” “serious,” or in a “special category.” In this letter, VA instructed its regional offices to assign a case manager to each seriously injured servicemember who applies for disability compensation. In addition, VA noted the particular importance of early intervention for those who are seriously injured and emphasized that seriously injured servicemembers applying for VR&E should receive the fastest possible service. Moreover, VA reminded VR&E staff that they can initiate evaluation and counseling and, in some cases, authorize training before a servicemember is discharged. Since most seriously injured servicemembers are initially treated at major MTFs, VA has detailed staff to these facilities. These staff have included VA social workers and disability compensation benefits counselors. In addition to these staff, at Walter Reed, where the largest number of seriously injured servicemembers has been treated, VA’s Washington D.C. regional office has since 2001 provided a vocational rehabilitation counselor to work with hospitalized patients. To identify and monitor those whose injuries may result in a need for VA services, including vocational rehabilitation, VA has asked DOD to share data about injured servicemembers. VA has been working to develop a formal agreement with DOD on what specific information to share. In the spring of 2004, VA submitted a draft memorandum of agreement to DOD’s Office of the Assistant Secretary of Defense for Health Affairs proposing that DOD provide lists of all injured servicemembers admitted to MTFs. In addition, VA requested personal identifying information, medical information, and DOD’s injury classification for each listed servicemember. VA also requested monthly lists of servicemembers being evaluated for medical separation from military service. Several VA officials and regional office staff we interviewed said that systematic information from DOD would provide them with a way to more reliably identify and monitor seriously injured servicemembers. As of December 2004, a formal agreement with DOD was still pending. In the absence of a formal arrangement to ensure that DOD provides data on seriously injured servicemembers, VA has relied on its regional offices to obtain information about them. In its September 2003 letter, the agency asked the regional offices to coordinate with staff at MTFs and VA medical centers in their areas to ascertain the identities, medical conditions, and military status of the seriously injured. While VA officials reported to us that they had provided veterans’ benefits information to injured servicemembers, they did not have complete and reliable data as to how many of these were seriously injured. In response to guidance by VA’s central office, every regional office has designated a coordinator to serve as a point of contact with MTFs and VA medical centers, as well as other VA regional offices, in order to monitor injured servicemembers as they relocate across the country. When servicemembers are discharged from an MTF, VA officials told us that the affiliated VA regional office coordinator notifies the coordinator in the region to which the person relocates. The new coordinator contacts the seriously injured servicemember to discuss any claims that have been filed and to provide those who have not already done so an opportunity to apply for other benefits, including VR&E services. Regional officials we interviewed reported that they have followed VA’s instructions to keep updated logs of all contacts they have with seriously injured servicemembers. Regional offices are required to send these logs to VA’s central office, which uses them to monitor outreach. In our review of 12 regional offices, we found that they have developed different information sources resulting in varying levels of information on seriously injured servicemembers.