VA and DOD Health Care

There have been numerous reports of the Department of Veterans Affairs’ (VA) medical facilities failing to provide timely and accessible care. In some cases, such delays in care or failure to provide care reportedly resulted in harm to veterans. Similarly, there have also been concerns about the Department of Defense’s (DOD) ability to provide care to service members and their dependents. 

There are a number of ways that VA and DOD could improve their health care programs. 

For instance:  

• Veterans Community Care. The Veterans Community Care Program was implemented in June 2019 to allow eligible veterans to receive care from non-VA providers. However, VA hasn't established a timeliness metric for veterans to receive care from a community provider. Additionally, while VA facilities set up dedicated teams to review appointment requests and determine if a veteran can see a community provider, VA needs to ensure better oversight and accountability of these teams.

• Modernizing VA infrastructure. VA’s health care system offers services to more than 9.5 million people. However, VA’s facilities are aging and in need of upgrades to meet veterans’ needs. While VA developed more than 1500 recommendations for modernizing and realigning its health care infrastructure, there were gaps in the data VA used to inform its recommendations. VA could also improve its planning and communication with stakeholders.

• DOD health care delivery. Millions of beneficiaries are eligible for DOD health care. In November 2022, DOD completed its multiyear transition of medical treatment facilities from the military departments to the Defense Health Agency. DOD set up 22 offices to manage facilities, but has faced staffing challenges and has not studied and validated the number of personnel the Agency needs for these offices.

• Provider quality. The Defense Health Agency is responsible for ensuring the quality and safety of health care delivered by providers at its military medical treatment facilities and in the community through TRICARE. However, the Defense Health Agency and its TRICARE contractors did not always adhere to DHA’s quality management procedures. For example, TRICARE contractors did not always fully verify providers’ medical licenses.

• Mental health. Thousands of service members transition from military to civilian life each year and can face challenges like post-traumatic stress disorder or other mental health symptoms. DOD and VA jointly screen for certain mental health conditions at separation, but some of the screening questions haven’t been tested or determined to be reliable. In addition, the DOD and VA Joint Executive Committee oversees military transition activities, but has not assessed the effectiveness of efforts to facilitate access to mental health services during the transition period. Preventing suicide is VA’s top stated priority, however, it also faces challenges with its Veterans Crisis Line—including staff burnout.

• Wartime medical skills. DOD's more than 73,000 enlisted medical personnel serve in roles ranging from paramedics to imaging technicians and must be ready to use their wartime medical skills to care for injured and ill service members. However, DOD could do more to define, track, and assess wartime medical skills. For example, the Army does not consistently track skills training in its official system, and none of the military services have developed targets for training completion.

• Supply chain management. The VA faced unexpected supply chain challenges during the COVID-19 pandemic. In response, it took steps like establishing central storage facilities for critical medical supplies. The VA has several linked initiatives to update its supply chain but needs to ensure that it has a comprehensive strategy for supply chain management.

• Coordination with community providers. Both VA and DOD can refer eligible veterans and beneficiaries to community providers for needed care. For example, VA can refer veterans to community providers to treat conditions like depression. However, VA does not monitor whether health records are sent back to the referring VA facility or whether the community provider has taken training on treating veterans. Additionally, DOD makes referrals to civilian providers to meet demand but hasn’t monitored how long it takes to get appointments after an urgent referral.

• Electronic health records. The VA relies on electronic health records for patient care, risk management for its patient population, and health research. VA started transferring records to a new system, which went live in October 2020. However, the new system has presented issues for some users. For example, most users in a VA 2021 and 2022 survey were not satisfied with the system’s performance or training. VA halted future deployments of its new electronic health record system in 2023 to focus on making improvements. In December 2024, VA announced plans to restart deployment to additional medical facilities in 2026.