PDHRA
How does the DoD administer the post-deployment health reassessment
to National Guard and Reserve servicemembers and what information
it obtains, and how Veterans Affairs interacts with DoD in the process.
By Marjorie Kanof
Almost all National Guard and Reserve servicemembers serve in the military on a part-time basis while maintaining a civilian career. When not deployed, they usually meet one weekend a month for a drill weekend and two weeks a year for annual training. Commanding officers are responsible for ensuring that servicemembers in their military units are medically ready to be deployed. As part of that effort, they are responsible for having servicemembers in their unit complete deployment health assessments.
DoD’s deployment-related continuum of health care includes three health assessments, which are used to determine whether further evaluation is needed for servicemembers deployed overseas greater than 30 days to locations without a permanent military treatment facility. They do not diagnose medical conditions.
The pre-deployment health assessment is administered within 60 days before deployment. It is a mandatory health assessment for most servicemembers deploying overseas. The post-deployment health assessment must be completed between 30 days prior to leaving a deployment location and within 30 days after returning from deployment. It is a mandatory health assessment for servicemembers returning from deployment.
The post-deployment health reassessment (PDHRA) is administered 90 to 180 days after returning from deployment. While it is mandatory that DoD offer servicemembers the opportunity to participate in the PDHRA, servicemembers are only required to answer limited demographic questions; they are not required to answer any of the health questions. Further, those who have left the military have the option to complete the PDHRA but are not required to do so.
Background
While the pre- and post-deployment health assessments were established in response to legislation, the PDHRA was created independently by DoD. In 2004, researchers published articles that indicated servicemembers reported a significant increase in mental health concerns 90 to 120 days after returning from deployment compared with mental health concerns reported before or just after deployment. In response, DoD developed the PDHRA process to provide identification of health concerns during this post-deployment time frame and to assess whether servicemembers need referrals for further evaluation. DoD and international health experts worked jointly with VA mental health experts to develop the PDHRA form.
Veterans who have served in combat in certain conflicts, including those from the National Guard and Reserves, are presumed to be eligible for VA health care services for any condition for two years from the date of separation from military service, even if there is insufficient medical evidence to conclude that the condition is attributable to military service. This two-year presumptive eligibility includes those National Guard and Reserve members who have left active duty and returned to their units. If veterans do not enroll until after the two-year presumptive period, they will be subject to the same eligibility and enrollment rules as other veterans, who generally have to prove that a medical problem is connected to their military service or that they have incomes below certain thresholds.
PDHRA
Processing
DoD generally administers the PDHRA to National Guard and Reserve servicemembers using a health care contractor either in person or by telephone through a call center, depending on the number of individuals being assessed. DoD officials said their contract officials generally administer the PDHRA in person when they can achieve economies of scale, that is, when a sufficient number of servicemembers—at least 60—are scheduled for an assessment at a drill location. At in-person administrations, contractor personnel—including administrative staff and health care providers—go to the drill location. Contractor officials stated that most PDHRAs are administered to Army National Guard servicemembers in person because they generally deploy in large enough groups.
According to DoD officials, when fewer than 60 servicemembers are being assessed, PDHRAs are administered by telephone through a call center operated by DoD’s health care contractor. Contractor officials indicated that the Air National Guard and the Army, Navy, and Marine Corps Reserves typically use the call center because they tend to deploy servicemembers in small groups. DoD officials told us that for administrations using the call center, commanding officers decide whether servicemembers complete PDHRAs by phone during a drill weekend or during their personal time.
Whether administered in person or through the call center, the PDHRA form consists of two sets of questions—one set answered by servicemembers and the other by health care providers. Servicemembers answer the first set of questions online. These questions ask about servicemembers’ demographics—such as the servicemember’s date of birth, gender, and marital status—and health concerns. The second set of questions is completed by a health care provider—typically a physician, physician’s assistant, or nurse practitioner. The provider discusses with the servicemember answers from the first set of questions and uses that information to answer the second set of questions, which ask the provider to assess servicemember’s health concerns and make referrals if needed.
DoD obtains information from the PDHRA process that can lead to referrals for additional evaluations. For example, the PDHRA includes questions about the occurrence of nightmares, conflicts with family and friends, and increased alcohol use. Servicemembers who answer affirmatively to these questions may need further evaluation for mental health conditions, such as post-traumatic stress disorder or alcohol abuse. Of the about 156,000 PDHRA forms completed by National Guard and Reserve servicemembers between June 2005 and January 1, 2008, about 46 percent resulted in referrals for further evaluation for physical or mental health concerns.
VA Interaction
According to Government Accountability Office (GAO) conversations with VA and DoD officials, VA officials interact with DoD in the PDHRA process in several ways. VA staff routinely attend when PDHRAs are to be administered in person. DoD’s health care contractor provides VA’s senior military liaison with information about the location and schedule as well as the number of National Guard and Reserve servicemembers expected to be assessed.
Local VA officials stated that when they are scheduled to attend a PDHRA in-person administration, they contact the unit’s commanding officer or the officer’s representative to obtain information on the unit’s combat experiences and to coordinate the number of VA staff and materials needed for the number of servicemembers scheduled to complete PDHRAs.
During GAO site visits, officials from VA medical centers and Vet Centers were observed providing servicemembers with information about VA benefits, enrolling servicemembers in the VA and helping servicemembers make appointments at VA facilities. For example during the Indianapolis site visit, local VA officials provided Army Reserve servicemembers with appointment contact information for VA facilities located not only in Indiana but also in Arizona, California, Georgia, Illinois, Kentucky, Michigan, Ohio and Texas for servicemembers who lived outside of Indiana. VA officials interviewed at headquarters, the VISN and the local office noted that PDHRA administrations provide one of the best ways for VA to give information about their benefits to National Guard and Reserve servicemembers.
VA officials stated they also interact with DoD when the PDHRA is administered through the call center. When units schedule PDHRA administrations using the call center during drill weekends, VA officials told us they generally coordinate in the same ways as they do for in-person PDHRA administrations. For example, a headquarters official said local VA officials usually go to the unit’s location to provide educational materials about VA benefits, enroll servicemembers in VA, and help them make appointments at VA facilities.
Officials at VA headquarters and a VISN indicated that VA officials also provide educational materials for servicemembers who complete PDHRAs using the call center when the assessments are not administered on a drill weekend. For example, for a unit in Jacksonville, Florida, a VISN official sent the unit’s commanding officer packets of information for distribution to the servicemembers at the unit’s next drill weekend. The information included VA enrollment forms and brochures about VA benefits.
Regardless of whether the PDHRA is administered during a drill weekend, VA and DoD interact when servicemembers are referred to VA facilities. According to VA headquarters and DoD officials, the contractor’s call center personnel will either connect servicemembers directly to a VA facility or give them information to contact the facility themselves. Following the telephone interview, call center personnel mail servicemembers a brochure about VA benefits for National Guard and Reserve servicemembers, a copy of their PDHRA form, and contact information for the VA senior military liaison to assist them if they experience problems getting an appointment at a VA facility.
Through interaction with DoD officials, VA officials obtain PDHRA information about servicemembers referred to VA and individual servicemembers’ PDHRA forms when they access VA health care. Each month, VA receives a report that provides monthly and cumulative totals of servicemembers referred, including servicemembers referred to VA facilities. For example, the January 1, 2008, report showed that of the number of servicemembers referred from June 2005 through January 1, 2008, nearly 34,000 (47 percent) were referred to VA facilities for either physical or mental health concerns. For mental health concerns, more than 11,000 servicemembers were referred to VA medical centers or clinics and over 16,000 were referred to Vet Centers. VA also receives a weekly report that lists the location of all in-person PDHRA administrations during the past week and shows the number of referrals to VA from each PDHRA administration.
Further, when servicemembers obtain health care from VA, VA officials have access to individual servicemembers’ forms. DoD also provides VA with electronic access to servicemembers’ PDHRA forms. ♦