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Open Recommendations

Electronic Health Records: DOD Has Deployed New System but Challenges Remain
GAO-24-106187
Apr 18, 2024
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4 Open Recommendations
Agency Affected Recommendation Status
Department of Defense The Secretary of Defense should direct the Federal EHR Modernization Office to identify and address specific barriers to maximizing integration at the FHCC, consistent with the FHCC executive agreement. (Recommendation 1)
Open
When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
Department of Defense The Secretary of Defense should direct the Defense Health Agency Health Informatics organization in conjunction with the Program Executive Officer of Defense Healthcare Management Systems to establish MHS GENESIS user satisfaction targets (i.e., goals) and ensure that the system demonstrates improvement toward meeting those targets. (Recommendation 2)
Open
When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
Department of Defense The Secretary of Defense should direct the Program Executive Officer of Defense Healthcare Management Systems to develop and implement a plan to provide an alternative to the MHS GENESIS dental module. (Recommendation 3)
Open
When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
Department of Veterans Affairs The Secretary of Veterans Affairs should direct the Federal EHR Modernization Office to identify and address specific barriers to maximizing integration at the FHCC, consistent with the FHCC executive agreement. (Recommendation 4)
Open
When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

Veterans Health: VA Should Improve Its Monitoring of Severe Maternal Complications and Mental Health Screenings
GAO-24-106209
Jan 16, 2024
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2 Open Recommendations
Agency Affected Recommendation Status
Department of Veterans Affairs The Secretary of Veterans Affairs should ensure that as OWH begins monitoring SMM on an ongoing basis, it disaggregates and reviews data on trends in SMM by veteran characteristics, such as race and ethnicity, age, or whether veterans lived in a rural area. (Recommendation 1)
Open
When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
Department of Veterans Affairs The Secretary of Veterans Affairs should ensure that OWH finalizes the development of and implements a systematic process to compile and review data on MCC screening of veterans for mental health conditions on an ongoing basis. This process should include data on MCCs' completion of required mental health screenings, as well as screening results. (Recommendation 2)
Open
When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

VA Disability Benefits: Board of Veterans' Appeals Should Address Gaps in Its Quality Assurance Process
GAO-24-106156
Nov 28, 2023
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4 Open Recommendations
Agency Affected Recommendation Status
Board of Veterans Appeals The Chairman of the Board of Veterans' Appeals should develop written policies and procedures related to its accuracy rate measure, to require that OAI (1) involves more than one official in the calculation process; (2) documents its calculation of monthly and fiscal year accuracy rates; and (3) manages related error data. (Recommendation 1)
Open
The Board agreed in principle with this recommendation. Board officials stated the recommendation should clarify the Board's need for a policy and procedure to manage data: the loss of data was specific to fiscal years 2019 and 2020. However, we note that the data loss stemmed from not having policies and procedures and without them, these types of data management issues could occur again. We continue to believe that having policies and procedures are an important part of internal control. Without written policies and procedures, the Board could face further challenges such as additional data loss, improperly storing data, or using inconsistent methodologies.
Board of Veterans Appeals The Chairman of the Board of Veterans' Appeals should monitor how veteran law judges choose to incorporate the feedback they receive from the case review process—including whether errors are corrected—and use this data to inform decision making related to the case review process. (Recommendation 2)
Open
The Board agreed with this recommendation. We will monitor the agency's progress to implement it.
Board of Veterans Appeals The Chairman of the Board of Veterans' Appeals should develop and implement an evidence-based decision-making process that includes a plan outlining how it will build evidence to assess the underlying causes for the most common errors identified by the case review process and the most common reasons for CAVC remands. The Board should use this evidence to better target its interventions and assess their results. One option is to fold the development of this process into the Board's planned evaluation. (Recommendation 3)
Open
The Board agreed in principle with this recommendation. We will monitor the agency's efforts to implement it.
Board of Veterans Appeals The Chairman of the Board of Veterans' Appeals should study how to evaluate VLJ adjudicative decisional consistency. One option is to fold the development of this study into the Board's planned evaluation. (Recommendation 4)
Open
The Board disagreed with this recommendation. Board officials stated that it would be inappropriate to force consistency in VLJ decisions in a way that is inconsistent with codes of judicial conduct and other standards applicable to VLJs. They stated that there will and should be variance in how legal authority is applied to the individual facts and circumstances of each case appealed to the Board. Board officials further stated that VLJs should be independent and not subject to pressure and influence. They also stated that, as part of evaluating individual VLJs' adherence to performance standards, the Board evaluates the total number of decisions each VLJ has adjudicated and the manner in which they have adjudicated them, among other things. In addition, Board officials noted that the number of decisions remanded does not demonstrate whether such remands were warranted, and that the number of CAVC remands or reversals does not necessarily correlate with productivity, legal acumen, or even with performance. Finally, they said that the concept of "consistency" of decision-making among individual judges evaluating sets of facts and circumstances of each individual case is a difficult one to address at all levels of adjudication, not only at the Board, but also at CAVC. We acknowledge the importance of judicial independence, that some degree of variance is expected given that independence, and that variation is not necessarily an indicator of poor quality decision-making. In addition, the Board acknowledges that consistency among VLJs in the use of appropriate legal authority is appropriate. However, without studying consistency, the Board will remain unaware of whether systemic inconsistencies in VLJ decision-making exist, and the Board will be unable to target interventions, as appropriate. We continue to believe that the results of systematic study of VLJ adjudicative decisions for consistency could provide a basis for targeting interventions, such as training, to assist VLJs. As such, this recommendation is not intended to "force" consistency in any VLJ decisions, but rather is meant to help the Board assist VLJs. Our recommendation is worded to allow the Board the necessary latitude to implement it in a way that allows for the retention of judicial independence while meeting other goals it deems appropriate.

VA Disability Benefits: Actions Needed to Address Challenges Reserve Component Members Face Accessing Compensation
GAO-24-105400
Oct 30, 2023
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14 Open Recommendations
Agency Affected Recommendation Status
Department of Veterans Affairs VA's Under Secretary for Benefits should ensure that VBA develops a mechanism, such as a document that lists known reliability issues with VADIR, to better communicate to federal and non-federal users the limitations of its incomplete data, particularly the unreliable variables on military personnel records from before 1985. (Recommendation 1)
Open
VA agreed in principle with this recommendation. VA plans to work with DOD to produce documentation regarding the scope and limitations of the DOD data contained in VADIR to better communicate this information with federal and non-federal users. We will monitor the progress of these efforts.
Department of Defense The Secretary of Defense should work with the Secretary of Veterans Affairs to develop guidance, such as outreach materials, brochures, or trainings, which: (1) makes reserve component members aware of their potential eligibility for disability compensation under various duty statuses; (2) explains how reporting health conditions when they occur can affect subsequent eligibility for disability compensation; and (3) explains the importance of obtaining and maintaining sufficient documentation of duty status and medical treatment received. (Recommendation 2)
Open
DOD agreed with this recommendation. They will work with VA to develop guidance and outreach materials to ensure that service members have the resources and knowledge to safeguard their rights and benefits. Collaboration will involve the Office of the Under Secretary of Defense of Personnel and Readiness, in consultation with the Military Departments. We will monitor DOD's progress in these efforts.
Department of Veterans Affairs The Secretary of Veterans Affairs should work with the Secretary of Defense to develop guidance such as outreach materials, brochures, or trainings, which: (1) makes reserve component members aware of their potential eligibility for disability compensation under various duty statuses; (2) explains how reporting health conditions when they occur can affect subsequent eligibility for disability compensation; and (3) explains the importance of obtaining and maintaining sufficient documentation of duty status and medical treatment received. (Recommendation 3)
Open
VA agreed with this recommendation. VA will ensure documentation is available that addresses all three components of the recommendation. Once finalized, they will work with DOD to provide this guidance through the interagency structure for the Transition Assistance Program. We will monitor the progress of these efforts.
Department of Defense The Secretary of Defense should ensure that DOD's reserve components make the guidance on reporting and documenting health conditions for the purposes of disability compensation prominently available to reserve component members. (Recommendation 4)
Open
DOD agreed with this recommendation. Once DOD and VA finish collaborating to produce guidance and outreach materials, DOD plans to direct the Secretaries of the Military Departments to make the final products prominently available to their Reserve Component members. We will close this recommendation when this effort is complete.
Department of Veterans Affairs VA's Under Secretary for Benefits should make the guidance on reporting and documenting health conditions for the purposes of disability compensation prominently available to reserve component members. (Recommendation 5)
Open
VA agreed in principle with this recommendation and is committed to making this guidance available. VA stated that, while it has limited access to Reserve Component members to make guidance available to them before they transition from Reserve service, they will work with DOD to provide guidance to promote alignment and implement this recommendation (along with recommendation 3). We will monitor the progress of these efforts.
Department of Defense The Secretary of Defense should ensure the Director of ODEI clarifies policies for military service assessments of their reserve component Military Equal Opportunity programs, to reduce medical bias, which in turn could help improve reserve component members' access to disability compensation. (Recommendation 6)
Open
DOD agreed with this recommendation. ODEI plans to clarify policy in the next revision of DoD Instruction (DoDI) 1350.02 for which the Secretaries of the Military Departments are responsible for ensuring their Reserve MEOs are assessed. ODEI will coordinate with the Military Departments on the frequency of assessment for the Reserve MEO programs. The next revision is expected in Fall 2024. We will monitor DOD's progress to complete this effort.
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