Archive for the ‘veterans’ Category

Post-9/11 vets fight suicide, mental health issues

July 25, 2014 Comments off

Post-9/11 vets fight suicide, mental health issues
Source: Iraq and Afghanistan Veterans of America

The newest generation of combat veterans is struggling with integration into civilian life, confronted by suicidal thoughts, mental-health issues, unemployment and the inability to get timely assessments of their disability claims.

Yet post-9/11 veterans who have used the Department of Veterans Affairs health-care system generally have a favorable impression of the medical services provided, according to a nationwide survey of 2,089 members of the Iraq and Afghanistan Veterans of America.

The survey puts hard statistics on a variety of pressing issues Iraq and Afghanistan veterans face on the home front, he said.

The survey was conducted during a three-week period early this year, prior to public disclosures of secret wait lists and mismanagement at the Phoenix VA hospital and at facilities across the country.

The survey is the sixth and most comprehensive that the organization has conducted, IAVA Research Director Jackie Maffucci said. The research was conducted online and was composed of about 200 questions, with respondents answering only questions relevant to their experiences.

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VA OIG — Administrative Investigation, Prohibited Personnel Practice and Preferential Treatment, National Cemetery Administration, VA Central Office

July 22, 2014 Comments off

Administrative Investigation, Prohibited Personnel Practice and Preferential Treatment, National Cemetery Administration, VA Central Office (PDF)
Source: U.S. Department of Veterans Affairs, Office of Inspector General

The former Under Secretary for Memorial Affairs engaged in a prohibited personnel practice when he created a position and preselected an employee for that position. He also engaged in preferential treatment of an NCA contractor when he developed a less-than-arm’s-length relationship with the contractor. Further, NCA improperly gave the contractor sole-source contracts to provide one-to-one services to select NCA employees.

Why Is Veteran Unemployment So High?

July 17, 2014 Comments off

Why Is Veteran Unemployment So High?
Source: RAND Corporation

According to official statistics, the unemployment rate of young military veterans ages 18-24 reached 29 percent in 2011. This report seeks to put that statistic in perspective by examining the historical time-series of veteran unemployment, comparing the veteran unemployment rate to that of non-veterans, and examining how veteran unemployment varies with time since military separation. Between 2000 and 2011, younger veterans were, on average, 3.4 percentage points more likely to be unemployed than similarly situated younger non-veterans. However, this difference between veteran and non-veteran unemployment falls rapidly with age and time since military separation. The report concludes that the best available evidence supports the hypothesis that relatively high rates of veteran unemployment reflect the fact that veterans, especially younger veterans, are more likely to have recently separated from a job — namely, military service — and, consequently, are more likely to be engaged in job search, which takes time, especially during periods of slow economic growth. The available evidence lends little support to the hypothesis that veterans are inherently disadvantaged in the civilian labor market. Limiting unemployment benefits available to recently separated veterans would likely reduce the length of unemployment spells, but the net effect of such a policy action on the long-term federal budget is unclear. There is very limited evidence on the effectiveness of other federal policies aimed at facilitating the transition of veterans into the civilian labor market.

New From the GAO

July 15, 2014 Comments off

New GAO Report and Testimonies
Source: Government Accountability Office


1. Medicaid Payment: Comparisons of Selected Services under Fee-for-Service, Managed Care, and Private Insurance. GAO-14-533, July 15.
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1. VA Disability Claims Processing: Preliminary Observations on Accuracy Rates and Quality Assurance Activities, by Daniel Bertoni, director, education, workforce and income security issues, before the House Committee on Veterans’ Affairs. GAO-14-731T, July 14.
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2. Helium Program: BLM’s Implementation of the Helium Stewardship Act of 2013, by Anne-Marie Fennell, director, natural resources and environment, before the Subcommittee on Energy and Mineral Resources, House Committee on Natural Resources. GAO-14-751T, July 15.
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3. Federal Workforce: Human Capital Management Challenges and the Path to Reform, by Robert Goldenkoff, director, strategic issues, before the Subcommittee on Federal Workforce, U.S. Postal Service and the Census, House Committee on Oversight and Government Reform. GAO-14-723T, July 15.
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VA OIG — Review of the Special Initiative To Process Rating Claims Pending Over 2 Years

July 15, 2014 Comments off

Review of the Special Initiative To Process Rating Claims Pending Over 2 Years (PDF)
Source: U.S. Department of Veterans Affairs, Office of Inspector General

On April 19, 2013, the Veterans Benefits Administration (VBA) began a Special Initiative to process all claims pending over 2 years. VA Regional Office (VARO) staff were to issue provisional ratings for cases awaiting required evidence and complete these older claims within 60 days. Our review focused on whether (1) provisional ratings resulted in veterans receiving benefits more quickly and helped eliminate the backlog, and (2) older claims were accurately. The Special Initiative rating process was less effective than VBA’s existing rating process in providing benefits to veterans quickly. Further, VBA removed all provisional claims from its pending inventory, despite more work being needed to complete them. This process misrepresented VBA’s actual workload of pending claims and its progress toward eliminating the overall claims backlog. At the end of June 2013 following completion of the Special Initiative, VBA reported 516,922 rating claims pending in its backlog, but only 1,258 rating claims pending over 2 years. We estimated 7,823 provisionally rated claims had been removed from the inventory though they still awaited final decisions. These claims represented less than 2 percent of VBA’s reported backlog, but about 12 percent of claims completed under the Initiative. VAROs did not prioritize finalization of the provisionally rated claims once they were issued. We estimated 6,860 provisional ratings were still waiting for final decisions as of January 2014, 6 months after the Initiative had ended. Because VBA did not ensure existing controls were functioning as needed to effectively identify and manage provisionally rated claims, some veterans may never have received final rating decisions if not for our review. Additionally, VBA did not accurately process 77 (32 percent) of 240 rating decisions we reviewed under this Initiative. Generally, these errors occurred because VAROs felt pressured to complete these claims within VBA’s 60 day deadline. We estimated VARO staff inaccurately processed 17,600 of 56,500 claims, resulting in $40.4 million in improper payments during the Initiative period. We recommended the Under Secretary for Benefits establish controls for all provisionally-rated claims, reflect these claims in VBA’s pending workload statistics, expedite finalization of provisional ratings, and review for accuracy all claims that received provisional ratings under the Special Initiative. The Under Secretary for Benefits concurred with our recommendations. Management’s planned actions are responsive and we will follow up as required on all actions.

No Time to Waste: Evidence-Based Treatment for Drug Dependence at the United States Veterans Administration Department of Veterans Affairs

July 13, 2014 Comments off

No Time to Waste: Evidence-Based Treatment for Drug Dependence at the United States Veterans Administration Department of Veterans Affairs
Source: Human Rights Watch

The 39-page report states that more than one million US veterans take prescription opioids for pain, and nearly half of them use the drugs “chronically,” or beyond 90 days. Alcohol and drug dependence is strongly associated with homelessness and mental health conditions including post-traumatic stress syndrome and depression, psychological conditions that affect 40 percent of Iraq and Afghanistan veterans in VA care. Drugs or alcohol are involved in 1 of 3 Army suicides, and the VA estimates that 22 veterans commit suicide each day.

In U.S., Veterans Report Less Stress, Worry Than Civilians

July 4, 2014 Comments off

In U.S., Veterans Report Less Stress, Worry Than Civilians
Source: Gallup

Americans may understandably believe that the nation’s veterans are suffering emotionally given news reports of high levels of post-traumatic stress disorder and other mood or anxiety disorders among those who have served in the military. However, Gallup finds that among employed Americans, active-duty and veteran populations are more emotionally resilient than their civilian counterparts.

Beyond the Waiting Lists, New Senate Report Reveals a Culture of Crime, Cover-Up and Coercion within the VA

June 24, 2014 Comments off

Beyond the Waiting Lists, New Senate Report Reveals a Culture of Crime, Cover-Up and Coercion within the VA
Source: U.S. Senator Tom Coburn (R-OK)

U.S. Senator and doctor Tom Coburn, M.D. (R-OK), today released his new oversight report “Friendly Fire: Death, Delay, and Dismay at the VA.” The report is based on a year-long investigation of VA hospitals around the nation that chronicled the inappropriate conduct and incompetence within the VA that led to well-documented deaths and delays. The report also exposes the inept congressional and agency oversight that allowed rampant misconduct to grow unchecked.

“This report shows the problems at the VA are worse than anyone imagined. The scope of the VA’s incompetence – and Congress’ indifferent oversight – is breathtaking and disturbing. This investigation found the problems at the VA are far deeper than just scheduling. Over the past decade, more than 1,000 veterans may have died as a result of the VA’s misconduct and the VA has paid out nearly $1 billion to veterans and their families for its medical malpractice. As is typical with any bureaucracy, the excuse for not being able to meet goals is a lack of resources. But this is not the case at the VA where spending has increased rapidly in recent years,” Dr. Coburn said.

Treatment for Posttraumatic Stress Disorder in Military and Veteran Populations: Final Assessment

June 23, 2014 Comments off

Treatment for Posttraumatic Stress Disorder in Military and Veteran Populations: Final Assessment
Source: Institute of Medicine

Posttraumatic stress disorder (PTSD) is one of the signature injuries of the U.S. conflicts in Afghanistan and Iraq. An estimated 8 percent of current and former service members deployed to these areas have a PTSD diagnosis. For these men and women, readjustment from combat zone deployments and reintegration into families and communities may be significantly hampered by chronic distress and disability in physical, psychological, social, and occupational functioning.

In response to the growing PTSD burden among service members and veterans, a provision of the National Defense Authorization Act for 2010 required the Secretary of the Department of Defense (DoD), in consultation with the Secretary of the Department of Veterans Affairs (VA), to commission an IOM study to assess PTSD treatment programs and services in DoD and VA.

The IOM finds that both departments have made a sustained commitment to PTSD management and invested substantial financial and programmatic resources to provide care to service members and veterans. However, a lack of standards, reporting, and evaluation significantly compromises these efforts. The report offers recommendations and guidance for improving processes and infrastructure to allow DoD and VA to respond more strategically and effectively to the increasing prevalence of PTSD among U.S. service members and veterans.

Transgender Military Service in the United States

June 23, 2014 Comments off

Transgender Military Service in the United States
Source: Williams Institute

An estimated 150,000 transgender individuals have served in the U.S. armed forces, or are currently on active duty. In addition, an estimated 134,000 transgender individuals are veterans or are retired from Guard or Reserve service, 8,800 transgender adults are currently on active duty in the U.S. armed forces, and an estimated 6,700 transgender individuals are serving in the Guard or Reserve forces. Transgender individuals assigned female at birth are nearly three times more likely than all adult women, and those assigned male at birth are 1.6 times more likely than all adult men, to serve.

New From the GAO

June 13, 2014 Comments off

New GAO Reports
Source: Government Accountability Office

1. Partnerships and S Corporations: IRS Needs to Improve Information to Address Tax Noncompliance. GAO-14-453, May 14.
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2. Defense Health Care: TRICARE Dental Services Contracts’ Requirements and Structure. GAO-14-497, June 13.
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Combined Assessment Program Summary Report – Evaluation of the Controlled Substances Inspection Program at Veterans Health Administration Facilities

June 13, 2014 Comments off

Combined Assessment Program Summary Report – Evaluation of the Controlled Substances Inspection Program at Veterans Health Administration Facilities (PDF)
Source: U.S. Department of Veterans Affairs, Office of Inspector General

The purpose of the review was to determine whether Veterans Health Administration (VHA) facilities complied with requirements related to controlled substances (CS) security and inspections and to follow up on the OIG report Healthcare Inspection – Review of Selected Pharmacy Operations in Veterans Health Administration Facilities (Report No. 07-03524-40, December 3, 2009). OIG performed this review in conjunction with 58 Combined Assessment Program reviews of VHA medical facilities conducted from October 1, 2012, through September 30, 2013. OIG identified opportunities for improvement in: conducting annual physical security surveys and correcting identified deficiencies; completing quarterly trend reports and providing them to facility Directors; conducting monthly CS inspections of non-pharmacy areas; completing non-pharmacy inspection activities; performing emergency drug cache quarterly physical counts and monthly verification of seals; validating completion of required drug destruction activities, accountability of prescription pads stored in the pharmacy, and outpatient pharmacy written prescriptions for schedule II drugs; providing annual CS inspector training. VHA can strengthen policy by defining acceptable reasons for missed CS area inspections and providing guidance on CS Coordinator performance of monthly inspections. OIG made 10 recommendations.

Department of Veterans Affairs Access Audit– System-Wide Review of Access: Results of Access Audit Conducted May 12, 2014, through June 3, 2014

June 9, 2014 Comments off

Department of Veterans Affairs Access Audit– System-Wide Review of Access: Results of Access Audit Conducted May 12, 2014, through June 3, 2014 (PDF)
Source: U.S. Department of Veterans Affairs

1. Efforts to meet needs of Veterans (and clinicians) led to an overly complicated scheduling process that resulted in high potential to create confusion among scheduling clerks and front-line supervisors.

2. Meeting a 14-day wait-time performance target for new appointments was simply not attainable given the ongoing challenge of finding sufficient provider slots to accommodate a growing demand for services. Imposing this expectation on the field before ascertaining the resources required and its ensuing broad promulgation represent an organizational leadership failure.

3. The concept of “desired date” is a scheduling practice unique to VA, and difficult to reconcile against more accepted practices such as negotiating a specific appointment date based on provider availability, or using a “return to clinic” interval requested by providers.

4. Overall, 13 percent of scheduling staff interviewed indicated they received instruction (from supervisors or others) to enter in the “desired date” field a date different from the date the Veteran had requested. At least one instance of such practices was identified in 76 percent of VA facilities. In certain instances this may be appropriate (e.g., a provider-directed date can, under VA policy, override a date specified by a patient), but the survey did not distinguish this, nor did it determine whether this was done through lack of understanding or malintent unless it was clearly apparent.

5. Eight percent of scheduling staff indicated they used alternatives to the Electronic Wait List (EWL) or Veterans Health Information Systems and Technology Architecture (VistA) package. At least one of such instance was identified in 70 percent of facilities. As with desired date practices, we did not probe the extent to which some of these alternatives might have been justified under VA policy. The questionnaire employed did not isolate appropriate uses of external lists.

6. Findings indicate that in some cases, pressures were placed on schedulers to utilize inappropriate practices in order to make waiting times (based on desired date, and the waiting lists), appear more favorable. Such practices are sufficiently pervasive to require VA re-examine its entire performance management system and, in particular, whether current measures and targets for access are realistic or sufficient.

7. Staffing challenges were identified in small CBOCs, especially where there were small counts of providers or administrative support.

See also: VA Access Audit (all reports)

CRS — The Number of Veterans That Use VA Health Care Services: A Fact Sheet

June 5, 2014 Comments off

The Number of Veterans That Use VA Health Care Services: A Fact Sheet (PDF)
Source: Congressional Research Service (via Federation of American Scientists)

It’s a simple question—how many veterans use services at the Veterans Health Administration (VHA)? It’s a question being asked a lot these days, and it is important, baseline information to know when changes are being contemplated1 to the way in which VA delivers health care to veterans.

In the course of an investigation into allegations that veterans seeking health care services from the VHA experienced long delays in treatment, the Department of Veterans Affairs (VA) Office of Inspector General (OIG) released an interim report3 that substantiated the delays. Final determinations by the OIG of the full scope and impact of the problems, including whether delays in treatment resulted in harm to or the death of any veterans, will not be available until the OIG completes its investigation and issues a final report.

The issue of wait times for VA health care is not new (see CRS Insight IN10063, Wait Times for Veterans Health Not New). Approaches to providing timely access to care for veterans enrolled in VA health care have included the use of non-VA care reimbursed by the VA (see CRS Insight IN10074, Getting Health Care Outside the VA). The need to rely on non-VA care in some cases has raised questions about the VA’s capacity to provide services to the veteran population now and in the future. Knowing how many veterans there are is essential to answering those questions.

New From the GAO

June 3, 2014 Comments off

New GAO Report
Source: Government Accountability Office

VA Real Property: Action Needed to Improve the Leasing of Outpatient Clinics. GAO-14-300, April 30.
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Healthcare Inspection – VA Patterns of Dispensing Take-Home Opioids and Monitoring Patients on Opioid Therapy

May 29, 2014 Comments off

Healthcare Inspection – VA Patterns of Dispensing Take-Home Opioids and Monitoring Patients on Opioid Therapy
Source: U.S. Department of Veterans Affairs, Office of Inspector General

As requested by the Senate Committee on Veterans’ Affairs, the VA Office of Inspector General assessed the provision of VA outpatient (take-home) opioids and monitoring of patients on opioid therapy. The population consisted of nearly half a million patients who were not receiving hospice/palliative care and who filled at least 1 oral or transdermal opioid prescription from VA for self-administration at home in FY 2012. The average and the median patient age was 59.4 and 61, respectively, and nearly 94 percent of them had been diagnosed with either pain or mental health issues and 58.4 percent with both. We determined that take-home benzodiazepines were dispensed to 7.4 percent of the study population, and 71 percent were dispensed concurrently with opioids. Take-home acetaminophens were given to 92.3 percent of the patients, and 2.0 percent of them were given an average daily dose that exceeded the maximum recommended daily dose of 4 grams. We found that 38.8 percent of the patients received medication management or pharmacy reconciliation. We determined that 6.4 percent of the new patients received both a urine drug test (UDT) prior to and a follow-up within 30 days of therapy initiation, that 37.0 percent of the existing opioid patients received both an annual UDT and a follow-up contact within 6 months of each filled opioid prescription, and that 10.5 percent of active substance use patients received both treatment for substance use and a UDT within 90 days of each filled opioid prescription. Even for the subpopulation of 19,724 active substance use patients who were on opioids for more than 90 days in FY 2012, we determined that only 18.8 percent of them received both a substance use disorder treatment in the FY and a UDT for each 90 days on opioids. We made six recommendations.

Interim Report: Review of VHA’s Patient Wait Times, Scheduling Practices, and Alleged Patient Deaths at the Phoenix Health Care System

May 28, 2014 Comments off

Interim Report: Review of VHA’s Patient Wait Times, Scheduling Practices, and Alleged Patient Deaths at the Phoenix Health Care System (PDF)
Source: U.S. Department of Veterans Affairs, Office of Inspector General

OIG provides an interim report of the ongoing review at the Phoenix Health Care System (HCS). The report identifies the allegations substantiated to date, and provides recommendations that VA should implement immediately. Allegations at the Phoenix HCS include gross mismanagement of VA resources and criminal misconduct by VA senior hospital leadership, creating systemic patient safety issues and possible wrongful deaths. While the review is still underway, OIG has substantiated that significant delays in access to care negatively impacted the quality care at this medical facility.

We initiated this review in response to allegations first reported to the OIG Hotline and expanded it at the request of the VA Secretary and the Chairman of the House Veterans’ Affairs Committee (HVAC). Due to the multitude and broad range of issues, we are conducting a comprehensive review requiring an in-depth examination of many sources of information necessitating access to records and personnel, both within and external to VA. We are using our combined expertise in audit, healthcare inspections, and criminal investigations, along with our institutional knowledge of VA programs and operations and legal authority to conduct a review of this nature and scope.

Our reviews have identified multiple types of scheduling practices that are not in compliance with VHA policy. Since the multiple lists we found were something other than the official EWL, these additional lists may be the basis for allegations of creating “secret” wait lists. We are not reporting the results of our clinical reviews in this interim report on whether any delay in scheduling a primary care appointment resulted in a delay in diagnosis or treatment, particularly for those veterans who died while on a waiting list.

Lastly, while conducting our work at the Phoenix HCS our on-site OIG staff and OIG Hotline receive numerous allegations daily of mismanagement, inappropriate hiring decisions, sexual harassment, and bullying behavior by mid- and senior-level managers at this facility. We are assessing the validity of these complaints and if true, the impact to the facility’s senior leadership’s ability to make effective improvements to patients’ access to care. We will make recommendations in our final report and ask the VA Secretary to submit target dates and implementation plans.

We recommend the VA Secretary take immediate action to review and provide appropriate health care to the 1,700 veterans we identified as not being on any existing wait list. Also, we recommend a review of all existing wait lists at the Phoenix Health Care System to identify veterans who may be at greatest risk because of a delay in the delivery of health care. We recommend initiation of a nationwide review of veterans on wait lists to ensure that veterans are seen in an appropriate time, given their clinical condition.

Finally, we recommend the VA Secretary direct the Health Eligibility Center to run a nationwide New Enrollee Appointment Request report by facility of all newly enrolled veterans and direct facility leadership to ensure all veterans have received appropriate care or are shown on the facility’s electronic waiting list.

CRS — Veterans’ Medical Care: FY2015 Appropriations

May 27, 2014 Comments off

Veterans’ Medical Care: FY2015 Appropriations (PDF)
Source: Congressional Research Service (via Federation of American Scientists)

The Department of Veterans Affairs (VA) provides benefits to veterans who meet certain eligibility criteria. Benefits to veterans range from disability compensation and pensions to hospital and medical care. The VA provides these benefits through three major operating units: the Veterans Health Administration (VHA), the Veterans Benefits Administration (VBA), and the National Cemetery Administration (NCA). This report focuses on funding for the VHA. The VHA is primarily a direct service provider of primary care, specialized care, and related medical and social support services to veterans through the nation’s largest integrated health care system. Eligibility for VA health care is based primarily on previous military service, disability, and income.

Interim Report – VBA’s Efforts to Effectively Obtain Service Treatment Records and Official Military Personnel Files

May 21, 2014 Comments off

Interim Report – VBA’s Efforts to Effectively Obtain Service Treatment Records and Official Military Personnel Files (PDF)
Source: U.S. Department of Veterans Affairs, Office of Inspector General

We are conducting this audit to determine whether the Veterans Benefits Administration (VBA) is receiving required Service Treatment Records (STR) information from DoD to timely process veterans’ disability claims, and also to assess VBA’s effectiveness in ensuring STRs and official military personnel files (OMPF) are provided timely to regional offices (RO).

During our ongoing work, we conducted a site visit and tour at the RO in St. Petersburg, FL. We identified file storage and mail processing issues requiring attention and action by the Under Secretary for Benefits. RO employees shared information during interviews that supported our observations and the issues identified.

The RO has a large file room used to store claims folders, as well as STRs and copies of OMPFs that have been combined with claims folders. We observed that the file room was overfilled with records. As a result, RO personnel have encountered difficulties locating files and in moving files in the permanent shelving units due to the volume and weight of the files.

The Intake Processing Center (IPC) within the RO receives incoming documents and files from the mailroom. We determined that mailroom personnel did not date stamp STR files and copies of OMPFs files at the time of receipt. Without this information, RO management cannot review and assess potential issues and delays with receiving and processing STR and OMPF requests.

Once documents and files are delivered to the IPC, employees sort and prepare evidence mail, which includes STRs and copies of OMPFs. Claims processors use evidence mail to further develop and make decisions on veterans’ disability claims. IPC employees reported that there was about a 3 week delay in sorting and processing evidence mail received from the mailroom.

In an effort to address these issues immediately, we are issuing an Interim Report-Management Advisory Memo, and have made three recommendations to help ensure efficient file storage and mail processing at the RO. Reporting on these issues allows VBA the opportunity to take timely corrective actions. The Under Secretary for Benefits concurred with our recommendations and provided suitable action plans. Based on actions taken, we consider two recommendations closed. We will follow up as required on the other recommendation and continue with our ongoing national audit.

Effects of Military Service on Earnings and Education Revisited; Variation by Service Duration, Occupation, and Civilian Unemployment

May 20, 2014 Comments off

Effects of Military Service on Earnings and Education Revisited; Variation by Service Duration, Occupation, and Civilian Unemployment
Source: RAND Corporation

The overriding objective of U.S. military compensation policy is to attract and retain the force necessary to meet the nation’s national security objectives. Whether and how military service affects earnings and an individual’s likelihood of completing college (one determinant of future earnings) has implications for military policies related to compensation, recruiting, and retention. Estimating the effect of military service is complicated by the fact that veterans are likely to differ from nonveterans in ways that are correlated with subsequent economic outcomes but are not observable to the researcher. This report builds on earlier work to understand how military service affects earnings, especially how these effects differ by the number of years of service and their military occupational specialties while serving. The authors also sought to understand how external factors and policies affect these impacts. To do this, they examined how economic conditions in the civilian labor market when individuals exit active duty affect postservice earnings, and they studied the effect on earnings of an Army recruiting program, Partnership for Youth Success, designed to promote enlistment but with the potential to ease the financial transition from military to civilian life.


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