WASHINGTON – Months after pledging to improve veterans care, the Bush administration has yet to find clear answers to some of the worst problems afflicting wounded warriors, such as delays in disability payments and providing personalized care, investigators say.
A report by the Government Accountability Office, released Wednesday, offers the first preliminary assessment of improvement efforts initiated by the Pentagon and Veterans Affairs Department after revelations in February of shoddy outpatient treatment at Walter Reed Army Medical Center.
The report found that even though the Army has touted creation of more personalized medical care units so that wounded veterans don't slip through the cracks, nearly half — or 46 percent — of returning service members who were eligible did not get the service due to staffing shortages.
The report said after 10 years of review, the Pentagon and VA still remain far away from having a comprehensive system for sharing medical records as injured veterans move from facility to facility.
And despite months of review by no less than eight congressional committees, a presidential task force, a presidential commission and the Pentagon and VA itself, the government has no apparent solution for reducing severe delays of 177 days, on average, in providing disability payments.
"Many challenges remain, and critical questions remain unanswered," GAO investigators John H. Pendleton and Daniel Bertoni wrote in calling for urgent action. "Success will ultimately depend on sustained attention, systematic oversight by DoD and VA, and sufficient resources."
Army spokesman Paul Boyce said Wednesday that officials were working diligently to provide "high-quality medical and mental health care for America's soldiers and veterans." The Army has said it hopes to have full staffing of its medical care units by January 2008. The VA has said it was hiring 1,100 new processors to reduce backlogs.
Responding to delays in sharing medical records, Patrick Dunne, VA's assistant secretary for policy and planning, said the VA and Pentagon had recently completed electronic sharing of veterans data involving allergies, outpatient medications, lab results and radiology. The two departments are using a contractor to study the feasibility and scope of sharing full inpatient records electronically, he said.
Rep. John Tierney, D-Mass., chairman of the House Oversight subcommittee on national security, said he was troubled by the lingering problems. "Taking care of our wounded heroes is too important to not demand that we strive for the highest levels of care and respect," he said.
Following the disclosures of patient neglect at Walter Reed, three high-level Pentagon officials stepped down. The Army quickly pledged to improve care by hiring more mental health counselors and creating new "warrior transition units" — comprising a doctor, nurse case manager and squad leader — who could help coordinate care.
The VA, which operates separate facilities for 5.8 million veterans, also said it would boost efforts, with VA Secretary Jim Nicholson vowing to work to improve data-sharing of medical records and to reduce backlogs. Nicholson later announced in July he was resigning and will step down Oct. 1.
On separate fronts, Congress approved additional money for veterans care, while the presidential commission headed by former Sen. Bob Dole, R-Kan., and former Health and Human Services Secretary Donna Shalala recommended changes that would increase benefits for family members, create a Web site for medical records and revamp the way disability pay is awarded.
On Wednesday, the GAO praised these initial steps. But it cautioned that long-standing problems were far from being resolved as the various groups negotiated their various proposals and as the Pentagon and VA faced challenges in hiring needed staff.
As of mid-September, 17 of the 32 warrior transition units had less than 50 percent of the critical staff in place. And in many cases, the Army had filled slots by borrowing staff from other positions, thus providing only a temporary solution as thousands of veterans return from Iraq and Afghanistan.
Regarding disability benefits, the GAO said the government was currently in limbo amid competing proposals to fix the disability ratings system. The Dole-Shalala commission, for example, urged that only the VA — and not the Pentagon — provide disability payments, while other proposals gave the Pentagon a limited role.
But in all the proposals, no consideration was given as to how the additional duties would affect the VA, which is straining to reduce backlogs for disability benefits, the report said. Nicholson in recent days has acknowledged that the VA was nowhere close to reducing monthslong delays and cited that as a top challenge for his successor.
"Delayed decisions, confusing policies and the perception that DoD and VA disability ratings result in inequitable outcomes have eroded the credibility of the system," the GAO investigators said. "It is imperative that DoD and VA take prompt steps to address fundamental system weaknesses."