Departments Don't Communicate and Veterans Pay Price

“Why are we still discussing the 'seamless transition'”? asked Sen. Daniel Akaka (D-Hawaii) at a hearing of the Senate Veterans Affairs Committee.

The phrase refers to the process by which members of the armed services move from health care coverage under the military TRICARE system to the Department of Veterans Affairs (VA) health system after discharge. Service members, legislators, and veterans groups have been urging the two systems to streamline this handoff for years, thus far with only modest results.

While the VA is lauded for its advanced, computerized medical record-keeping, the armed forces still use a mix of paper and electronic records. Furthermore, there is no common medical-records system within the Department of Defense (DoD), said Ellen Embrey, deputy assistant secretary of defense for health affairs/force health protection and readiness.

“Each service branch has its own,” Embrey told the senators.“ DoD does have the ability to transmit selected records to the VA.”

“Then why does someone's mother have to carry paper records around?” asked Sen. Richard Burr (R-N.C.).

Only certain laboratory tests and X-rays can be sent electronically to the VA, explained Michael Kussman, M.D., chief executive in charge of the Veterans Health Administration. The main patient record remains on paper.

Michael O'Rourke, assistant director for veterans health policy at the Veterans of Foreign Wars (VFW), noted that “seamless transition” is a nice phrase, but questioned whether it's actually working as intended.“ We don't think so,” he told Psychiatric News.

Paul Rieckhoff, executive director of the Iraq and Afghanistan Veterans of America was more blunt, telling Psychiatric News, “It's anything but seamless.”

“At the very least, the VA and the DoD should be able to electronically share data so that the wounded service members' medical records can simply be transmitted electronically once they enter the VA health care system,” testified L. Tammy Duckworth, M.A., director of the Illinois Department of Veterans Affairs, at the hearing in March. That isn't happening yet. “The DoD and the VA are still negotiating a memorandum of agreement for this process,” she said.

Veterans also need universal and uniform screening for posttraumatic stress disorder (PTSD), traumatic brain injury, and hearing and vision loss, said Duckworth, a major in the Illinois National Guard who lost both legs when her helicopter was shot down in Iraq. Screening for vision loss is critical.“ Vision loss, an acute injury on its own terms, can also negatively affect how patients perform on tests for traumatic brain injury, which are heavily reliant on vision,” she told the senators.

The failure of the two bureaucracies to connect smoothly places a burden on individual veterans and their families, said Rieckhoff, a first lieutenant and platoon leader in Iraq in 2003-04. “It's up to the vet to self diagnose, then seek out help at the VA, be his own advocate and shepherd himself through the process,” he said. Often an entirely new set of records begins when the veteran signs up with the VA.

The lack of an aggregate data registry will become an even greater problem as the more than 1.4 million troops who have served in the two theaters of war move through the system and need care, said Rieckhoff.

The VFW now offers guidance to troops at seven U.S. military bases, explaining regulations and implications of decisions veterans make as they leave the service, said O'Rourke. Often they need help with medical terminology. A soldier may complain of headaches, tremors, depression, and seizures but never make the connection with an explosion in Iraq that cause a closed-head brain injury.

“They could use a federal health care manager to walk them through the process from the service to the VA to state veterans' offices,” said O'Rourke.

One-way information sharing is not enough, said veterans' advocates. Many members of the National Guard rely on the VA for health care following active duty, but then may be called back to active service and deployed, thus falling back under the TRICARE umbrella. Their records should be able to follow them in both directions, said Rieckhoff.

Back on Capitol Hill, the senators also heard tales of wounded troops and their struggles with the military health system.

“I hope the bureaucracy doesn't say these are merely individual cases and don't represent a bigger problem,” said Sen. Jon Tester (D-Mont.), speaking of both the VA and the DoD. ▪