Objective:
We determined whether the DoD had implemented recommendations in DoD OIG Report No. DODIG-2014-097, “Audit of the Transfer of DoD Service Treatment Records to the Department of Veterans Affairs,” July 31, 2014.
Background:
A Service Treatment Record (STR) is a chronological record of all essential medical, dental, and mental health care received by service members during their military careers. The Department of Veteran Affairs (VA) uses STRs as the official record to support continuity of clinical care and eligibility for compensation benefits for active duty and Reserve service members and those who have separated or retired. Report No. DODIG-2014-097, issued in July 2014, found that the DoD did not consistently transfer STRs in a complete and timely manner to the VA.
In response to the findings and recommendations in the 2014 report, the Under Secretary of Defense for Personnel and Readiness (USD[P&R]), in coordination with the Director, Defense Health Agency (DHA), agreed to:
- revise DoD Instruction 6040.45 to clarify requirements for submitting complete STRs in a timely manner; and
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establish a program management office in charge of monitoring compliance with DoD medical record guidance and ensuring the Military Departments conduct annual reviews of STRs with service members.
In addition, the Commander, U.S. Army Medical Command (MEDCOM), and Commander, U.S. Navy Bureau of Medicine and Surgery (BUMED), agreed to review their STR-transfer process to identify and resolve inefficiencies that delayed the transfer process of STRs.
Findings:
In response to the 2014 audit, the USD(P&R) revised DoD Instruction 6040.45 to clarify procedures to ensure complete STRs are transferred to the VA in a timely manner. MEDCOM and BUMED also reviewed their processes to transfer STRs to the VA to identify and resolve inefficiencies that delayed STR processing. As a result of their reviews, the Army and Navy improved their timeliness in transferring STRs to the VA.
For benefit claims made in FY 2016, our review of a statistically selected sample of STRs transferred to the VA revealed the following results.
- Army: Of 70,069 STRs transferred to the VA, 59,948 (86 percent) were transferred in a timely manner, and 64,619 (92 percent) were complete; compared to 17 percent and 67 percent, respectively in 2014.
- Navy: Of 18,683 STRs transferred to the VA, 12,445 (67 percent) were transferred in a timely manner and 16,815 (90 percent) were complete; compared to 22 percent and 56 percent, respectively in 2014.
- Marine Corps: Of 19,181 STRs transferred to the VA, 15,558 (81 percent) were transferred in a timely manner and 17,476 (91 percent) were complete.1
Additionally, the USD(P&R) and the Director, DHA, relied on the Periodic Health Assessment (PHA) and Individual Medical Readiness (IMR) programs, which are used to determine a service member’s medical condition and deployability status, to conduct annual STR reviews and ensure their completeness. As part of the PHA, the USD(P&R) issued DoD Instruction 6200.06 requiring the use of DD Form 3024; this new form includes questions to ensure that all care, including care received outside the military health system, is reported in the service member’s STR.2
The Assistant Secretary of Defense for Health Affairs (ASD[HA]) gave the Military Departments until September 30, 2017 to fully implement DoD Instruction 6200.06, but extended the deadline to December 31, 2017, because the Military Departments informed ASD(HA) that not all Service Components would meet the deadline.
While the Army and Navy improved their processes for transferring timely and complete STRs to the VA, we remain concerned by the significant number of STRs that were not transferred to the VA in a timely manner, which could delay the VA in approving benefit claims for service members.
Additionally, the Army, Navy, and Marine Corps continue to implement the use of DD Form 3024, “Annual Periodic Health Assessment.” Until this form is implemented, the USD(P&R) and DHA will not be able to ensure STRs include all medical care, including care received from facilities outside the military health system. STRs missing information on care received from facilities outside the military health system may also delay the VA in approving service member benefit claims.
Recommendations:
We recommend that the USD(P&R), in coordination with the Director, DHA:
- develop a plan and timeline to ensure the Military Departments implement the DD Form 3024 if it has not been implemented by December 31, 2017;
- determine, once the DD Form 3024 is implemented, whether the PHA and IMR programs are adequate to satisfy the service members’ STR annual review requirement; and
- conduct periodic checks of STRs transferred by all services to the VA in order to ensure compliance with the timeliness and completeness requirements in DoD Instruction 6040.45. The periodic checks should include STRs of separated personnel from every Military Department.
Management Comments and Our Response:
The Under Secretary of Defense (Personnel and Readiness) and the Defense Health Agency agreed with our recommendations but did not propose actions to address our recommendations. Therefore, the recommendations are unresolved. We request that the Under Secretary of Defense (Personnel and Readiness), in coordination with the Defense Health Agency, provide the detailed corrective actions that will be taken to implement the recommendations.
1 During the 2014 audit, the Navy was also responsible for transferring Marine Corps STRs to the VA. As a result, the percentages for timeliness and
completeness reported in the prior audit applied to both the Navy and Marine Corps STRs. As of November 2015, the Marine Corps started transferring
its own STRs.
2 DoD Instruction 6200.06 requires the PHA to be documented using the DD Form 3024 “Annual Periodic Health Assessment.”
This report is a result of Project No. D2016-D000XD-0201.000.