oversight

Returned Peace Corps Volunteers: Labor and Peace Corps Need Joint Approach to Monitor Access to and Quality of Health Care Benefits

Published by the Government Accountability Office on 2012-11-19.

Below is a raw (and likely hideous) rendition of the original report. (PDF)

                             United States Government Accountability Office

GAO                          Report to Congressional Committees




November 2012
                             RETURNED PEACE
                             CORPS VOLUNTEERS
                             Labor and Peace
                             Corps Need Joint
                             Approach to Monitor
                             Access to and Quality
                             of Health Care
                             Benefits


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GAO-13-27
                                             November 2012

                                             RETURNED PEACE CORPS VOLUNTEERS
                                             Labor and Peace Corps Need Joint Approach to
                                             Monitor Access to and Quality of Health Care
                                             Benefits
Highlights of GAO-13-27, a report to
congressional committees




Why GAO Did This Study                       What GAO Found
Peace Corps volunteers who suffer a          From 2009 through 2011, the Department of Labor (DOL) provided a total of
service-connected illness or injury are      about $36 million in Federal Employees’ Compensation Act (FECA) benefits—
eligible to receive certain health care      health and other benefits—for Peace Corps volunteers who have returned from
and other benefits under FECA—a              service abroad (volunteers). Specifically, DOL provided about $22 million in
workers’ compensation program                health care benefits for these volunteers in the form of reimbursements for
administered by DOL. FECA provides           medical expenses related to service-connected injuries and illnesses, and
health care benefits—reimbursements          $13.8 million in other benefits, such as reimbursement for travel expenses
for medical expenses—to federal              incurred when seeking medical care. During this period, approximately 1,400
employees and volunteers for illnesses
                                             volunteers each year received these health care benefits under the FECA
or injuries that DOL determines are
                                             program. The most common types of medical conditions for which DOL provided
service-connected.
                                             reimbursements were mental, emotional, and nervous conditions; dental;
GAO was mandated to report on the            other/nonclassified diseases; and infectious or parasitic diseases. These four
access and quality of health care            medical conditions accounted for more than a quarter of all medical
benefits for Peace Corps volunteers.         reimbursements for volunteers under FECA from 2009 through 2011.
This report (1) identifies the health care
and other benefits provided to               In general, neither DOL nor the Peace Corps use all available information in the
volunteers from 2009 through 2011            four areas GAO reviewed to monitor access and quality of FECA benefits for
under the FECA program, and (2)              volunteers. GAO found that the Peace Corps uses information in just one of the
examines the extent to which DOL and         areas—volunteers’ awareness of the FECA program; however, in general,
the Peace Corps use available agency         neither agency uses information in the remaining three areas. These areas are
information to monitor the accessibility     (1) information on volunteers’ knowledge of FECA program and application
and quality of FECA health care              requirements, such as required medical documentation; (2) information on DOL’s
benefits provided to volunteers. GAO         timeliness in reviewing FECA applications and reimbursing medical expenses,
reviewed agency documents,                   and on the level of customer satisfaction; and (3) availability of FECA-registered
interviewed agency officials, and            medical providers. By not using information available to the agencies, DOL and
analyzed DOL data. GAO developed a           the Peace Corps are missing an opportunity to determine whether, or to what
framework with four areas to define          extent, volunteers face access and quality issues in the FECA program. For
access and quality and examined              example, DOL and the Peace Corps may not be able to determine the extent to
available information in these areas
                                             which there are limitations in the availability of FECA-registered providers for
that could be used for monitoring.
                                             certain medical specialties.
What GAO Recommends                          DOL and the Peace Corps each have certain responsibilities related to the
GAO recommends that the Secretary            provision of FECA benefits for eligible volunteers, and each has information that
of Labor and the Director of the Peace       could be used for monitoring. From DOL’s perspective, volunteers do not
Corps jointly develop and implement          represent a large proportion of the overall FECA population. However, FECA is a
an approach for working together to          relatively larger issue from the Peace Corps’ perspective. The volunteers are a
use available agency information to          unique population compared to others who receive benefits under FECA, and the
monitor the access to and quality of         FECA costs associated with volunteers represent a growing portion of the Peace
FECA benefits provided to volunteers.        Corps’ annual budget. Neither agency has all the information GAO reviewed, and
Neither DOL nor the Peace Corps              the agencies generally do not work together to use available information to
indicated whether or not they agreed         monitor the accessibility and quality of FECA benefits for volunteers. As a result,
with GAO’s recommendation. Instead,          DOL and the Peace Corps are missing an opportunity to make use of the
the agencies provided additional             available information to help ensure the accessibility and quality of FECA
context related to the provision of          benefits for volunteers.
FECA benefits.
View GAO-13-27. For more information,
contact Linda T. Kohn at (202) 512-7114 or
kohnl@gao.gov.

                                                                                     United States Government Accountability Office
Contents


Letter                                                                                    1
              Background                                                                  6
              From 2009 through 2011, DOL Provided about $36 Million in Health
                Care and Other Benefits for Volunteers                                    9
              The Peace Corps Uses Information on Volunteers’ Awareness of
                FECA, but Neither DOL Nor the Peace Corps Use Other
                Available Information to Monitor Access and Quality                     12
              Conclusions                                                               18
              Recommendation for Executive Action                                       19
              Agency Comments and Our Evaluation                                        19

Appendix I    Comments from the Peace Corps                                             23



Appendix II   GAO Contact and Staff Acknowledgments                                     25



Tables
              Table 1: The Medical Conditions for Which the Department of
                       Labor (DOL) Made Reimbursements for Returned Peace
                       Corps Volunteers under the Federal Employees’
                       Compensation Act (FECA), 2009 through 2011                       10
              Table 2: Extent to Which Available Information Is Used by the
                       Department of Labor (DOL) and the Peace Corps to
                       Monitor Accessibility and Quality of Federal Employees’
                       Compensation Act (FECA) Benefits for Returned Peace
                       Corps Volunteers                                                 13




              Page i                               GAO-13-27 Returned Peace Corps Volunteers
Abbreviations

DOL               Department of Labor
FECA              Federal Employees’ Compensation Act
GPRA              Government Performance and Results Act of 1993
OMB               Office of Management and Budget
OWCP              Office of Workers’ Compensation Programs
POWER             Protecting Our Workers and Ensuring Reemployment



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Page ii                                       GAO-13-27 Returned Peace Corps Volunteers
United States Government Accountability Office
Washington, DC 20548




                                   November 19, 2012

                                   Congressional Committees

                                   Founded in 1961, the Peace Corps’ mission is to help host countries meet
                                   their needs for trained personnel while promoting mutual understanding
                                   between Americans and other peoples. Peace Corps volunteers commit
                                   to 2-year assignments in host communities in various countries, where
                                   they work on projects such as teaching English, strengthening farmer
                                   cooperatives, or building sanitation systems. As of July 2012, over
                                   200,000 Peace Corps volunteers have served in 139 countries. 1 After
                                   completing their service with the Peace Corps, volunteers typically return
                                   to the United States. 2 In this report, we generally refer to returned Peace
                                   Corps volunteers as volunteers.

                                   Returned volunteers who suffer a service-connected illness or injury are
                                   eligible to receive compensation for certain medical expenses as well as
                                   other benefits under the Federal Employees’ Compensation Act (FECA). 3
                                   The FECA program is a federal workers’ compensation program
                                   administered by Department of Labor’s (DOL) Office of Workers’
                                   Compensation Programs (OWCP). The FECA program provides health
                                   care benefits—in the form of reimbursement for medical expenses—to
                                   federal employees and Peace Corps volunteers for illnesses or injuries
                                   that DOL determines were sustained while in the performance of an
                                   employee’s duty. 4 In addition to these health care benefits, the FECA
                                   program provides other benefits for federal employees, including Peace
                                   Corps volunteers, who are injured or become ill while performing their
                                   duties. These benefits include reimbursement for travel expenses related
                                   to obtaining medical treatment and wage-loss compensation—that is,
                                   disability payments—for those who are temporarily unable to perform
                                   their duties.


                                   1
                                    The Peace Corps received an appropriation of $375 million in fiscal year 2012.
                                   2
                                    According to the Peace Corps, about 4,000 volunteers per year completed their Peace
                                   Corps service from 2009 through 2011.
                                   3
                                    5 U.S.C. §§ 8101 et seq.
                                   4
                                    The Peace Corps Act provides that its volunteers shall not be deemed federal employees
                                   except as specified by statute. 22 U.S.C. § 2504(a). FECA provides that it is applicable to
                                   Peace Corps volunteers with certain exceptions. 5 U.S.C. § 8142(b).




                                   Page 1                                        GAO-13-27 Returned Peace Corps Volunteers
The Peace Corps and DOL each have certain responsibilities related to
the provision of FECA benefits for eligible volunteers who return from
service abroad. Specifically, the Peace Corps is responsible for informing
volunteers that they may be eligible for FECA benefits, assisting in the
application process, and paying DOL back annually for FECA benefits
provided to volunteers. DOL is responsible for administering the program
by reviewing and approving applications for FECA benefits and for
providing reimbursements for the costs of medical care and other
expenses for service-connected injuries or illnesses. Given their
responsibilities, it is important that DOL and the Peace Corps periodically
monitor the accessibility and quality of the program for the volunteers. 5

Peace Corps volunteer advocates have raised several questions
regarding whether volunteers have access to timely, high-quality health
care and other benefits under FECA for service-connected injuries and
illnesses. For example, these advocates have asked whether volunteers
are made aware of FECA benefits, whether they report injuries or
illnesses, 6 and whether they can locate or access medical providers. 7
Advocates also raised questions about whether volunteers face
challenges during the FECA application process, such as dealing with
multiple agencies—the Peace Corps and DOL.




5
 Federal internal control standards call for agencies to establish policies and
procedures—including conducting ongoing monitoring of agency activities and effective
information sharing throughout the organization—to provide reasonable assurance that
agency objectives are being met. See GAO, Standards for Internal Control in the Federal
Government, GAO/AIMD-00-21.3.1 (Washington, D.C.: November 1999). The Office of
Management and Budget’s (OMB) Circular No. A-123 also defines management’s
responsibility for internal control in federal agencies on the basis of GAO’s standards. See
OMB Circular No. A-123, (Revised): Management’s Responsibility for Internal Control
(Dec. 21, 2004).
6
 According to a Peace Corps volunteer advocate, some volunteers who are victims of
sexual or other assaults may not report illnesses or injuries to the Peace Corps staff in-
country or at close-of-service because the volunteer is ashamed or fearful of filing a
report. As a result, the volunteer may be unable to gather the required medical evidence
while in-country to support their FECA application and thereby establish a service
connection.
7
 Volunteers are responsible for finding medical providers who have registered for the
FECA program. According to DOL officials, to be considered a FECA-registered provider,
a provider must (a) enroll in the program, (b) be state licensed, and (c) accept DOL’s
terms of payment for the FECA program.




Page 2                                         GAO-13-27 Returned Peace Corps Volunteers
In response to the questions raised by advocates, the House Committee
on Foreign Affairs convened a hearing in May 2011. Subsequently, the
Kate Puzey Peace Corps Volunteer Protection Act of 2011 was enacted
in November 2011. 8 Among other things, the law requires that GAO
examine the accessibility and quality of the health care services provided
through DOL to volunteers who return from service abroad in the Peace
Corps. 9 In this report we

1. identify the health care and other benefits provided by DOL to
   returned Peace Corps volunteers from 2009 through 2011 under the
   FECA program, and
2. examine the extent to which DOL and the Peace Corps use available
   agency information to monitor the accessibility and quality of FECA
   health care benefits provided to returned Peace Corps volunteers.

To identify the health care and other benefits provided to volunteers by
DOL under the FECA program from 2009 through 2011, we reviewed
agency documents, such as those that describe FECA benefits provided
to volunteers. We also conducted an analysis of DOL’s claims data from
the FECA chargeback database on the reimbursements for medical
expenses that DOL, under the FECA program, made on behalf of federal
agencies from 2009 through 2011. 10 We analyzed these data to identify
(1) the number of volunteers receiving FECA benefits each year, (2) the
total amount of reimbursements DOL made for medical expenses, (3) the
types of injuries and illnesses for which volunteers received health care
benefits—reimbursements for medical expenses—and (4) the other
benefits provided under FECA. 11 We also identified the total amount of



8
 Pub. L. No. 112-57, 125 Stat. 737 (codified at 22 U.S.C. §§ 2507a et seq.). Kate Puzey
was a volunteer who was murdered in 2009 during her service in Benin.
9
22 U.S.C. § 2507i(b).
10
   The costs of reimbursement of health care and other expenses for work-related injuries,
illnesses, and deaths are assigned to employing agencies annually using the FECA
chargeback mechanism. Each year OWCP furnishes each agency with a statement
summarizing the costs for injuries and illnesses suffered by its employees.
11
  When analyzing these data, we selected all claims—or FECA applications—with an
adjudication status of compensable, which identifies the number of claims that were
approved for FECA benefits. Medical reimbursements and medical conditions are
associated with individual FECA claims submitted by volunteers that have been approved
by DOL. Some volunteers may be approved for multiple FECA claims.




Page 3                                        GAO-13-27 Returned Peace Corps Volunteers
wage-loss compensation and reimbursements DOL made to volunteers
for travel expenses from 2009 through 2011. We compared the types of
injuries and illnesses for which volunteers received health care benefits
and the demographic and other characteristics of volunteers to other
recipients of FECA benefits. In addition, we interviewed DOL and Peace
Corps agency officials about the benefits provided to volunteers under
FECA and the types of injuries or illnesses reported by volunteers.

To assess the reliability of DOL’s FECA data, we reviewed prior GAO
work using DOL’s FECA chargeback database—which is used to track
FECA costs for employing agencies, such as the Peace Corps—and
obtained information from agency officials knowledgeable about the
database. We performed data quality checks to assess the reliability of
the FECA chargeback database received from DOL. These data quality
checks involved an assessment to identify missing or incorrect entries or
outliers. On the basis of the information we obtained and analyses we
conducted, we determined that the data we used were sufficiently reliable
for the purposes of this report.

To identify the extent to which DOL and the Peace Corps use available
agency information to monitor the accessibility and quality of FECA health
care benefits provided to volunteers, we developed a framework with four
key areas to define accessibility and quality and that could be used to
monitor the accessibility and quality of FECA benefits. Because the FECA
program is a workers’ compensation program and not a health care
delivery program, DOL does not deliver or actively manage the health
care services received by returned volunteers. Therefore, we did not
assess the quality of health care services delivered by medical providers
to volunteers. Rather, we examined volunteers’ access to FECA benefits
and the quality of the FECA workers’ compensation program using the
following four areas: (1) volunteers’ awareness of the FECA program,
including their general awareness of the FECA program and knowledge
of the specific health care benefits available under FECA; (2) volunteers’
knowledge of FECA program and application requirements, including
knowledge of the FECA eligibility requirements and the documentation
that is typically required by DOL to make a FECA application decision; (3)
DOL’s timeliness in reviewing FECA applications and providing
reimbursement for health and other benefits, including average time to
review and approve or deny a FECA application, average time to provide
reimbursement for submitted medical claims, and the level of customer




Page 4                                GAO-13-27 Returned Peace Corps Volunteers
satisfaction with the FECA program; 12 and (4) availability of FECA-
registered medical providers, including the ability of volunteers to access
these providers. 13

We interviewed officials and reviewed documentation about the
information available to DOL and the Peace Corps for monitoring access
and quality of the FECA program, including information related to our four
key areas. For example, we examined: (1) the Peace Corps’ policies on
informing volunteers of their rights to FECA benefits to determine what
information is available on volunteers’ awareness of the FECA program,
and (2) letters sent by DOL to volunteers whose FECA applications were
denied. 14 We synthesized the information provided by agency officials to
determine the extent to which the two agencies use information in the four
areas to monitor the accessibility and quality of FECA benefits for
volunteers. Because the Peace Corps and DOL both have certain
responsibilities related to the provision of FECA benefits for eligible
volunteers who return from service abroad, we also looked at the extent
to which the Peace Corps and DOL work together by sharing this
information. 15




12
  To calculate DOL’s timeliness in reviewing FECA applications, we selected only the
initial, or first, adjudication of a FECA application. We calculated the time it took DOL to
process the receipt of the initial FECA application and then approve or deny the claim.
13
   As part of our review of FECA-registered providers, we examined an online provider
search tool published by DOL. When doing so, we followed the instructions provided on
the tool, which state that users are recommended to enter either the state, the city and
state, or the zip code to define the search area. Users are also recommended to leave the
field “provider specialty” blank.
14
  We reviewed about 30 percent of the denial letters sent to volunteers from 2009 to 2011.
These letters were randomly selected and provided to us by the Peace Corps. These
letters include a summary of the volunteer’s reported injury as well as the reason(s) for
denying the FECA application.
15
  In prior work, GAO identified eight key practices that can help enhance and sustain
collaboration—broadly defined as any joint activity that is intended to produce more public
value than could be produced when the organizations act alone—among federal agencies.
For example, agencies should agree on roles and responsibilities and identify and address
needs by leveraging resources. See GAO, Results-Oriented Government: Practices That
Can Help Enhance and Sustain Collaboration among Federal Agencies, GAO-06-15
(Washington, D.C.: Oct. 21, 2005).




Page 5                                           GAO-13-27 Returned Peace Corps Volunteers
                   We conducted this performance audit from March 2012 to November
                   2012, in accordance with generally accepted government auditing
                   standards. Those standards require that we plan and perform the audit to
                   obtain sufficient, appropriate evidence to provide a reasonable basis for
                   our findings and conclusions based on our audit objectives. We believe
                   that the evidence obtained provides a reasonable basis for our findings
                   and conclusions based on our audit objectives.


                   After volunteers separate from the Peace Corps they typically return to
Background         the United States, and may transition into new employment. As they
                   make this employment transition, the Peace Corps offers various health
                   care services and benefits to returned volunteers. First, each volunteer
                   receives a close-of-service medical evaluation that assesses their health
                   status as they complete their service. The Peace Corps also has a
                   contract with an insurance company to make a health insurance policy—
                   AfterCorps 16—available for volunteers to purchase. This policy covers
                   non-service-connected illnesses or injuries. The Peace Corps also pays
                   for certain health examinations for 6 months after a volunteer’s service is
                   completed. Finally, volunteers may also be eligible for reimbursements
                   under the FECA program for medical expenses associated with service-
                   connected illnesses or injuries, such as those identified during the
                   physical conducted at the close-of-service medical evaluation.


FECA Eligibility   The FECA program provides health benefits—reimbursement for medical
                   expenses related to illnesses or injuries that DOL determines are service
                   connected—as well as other benefits, such as wage-loss (death and
                   disability) compensation. To receive benefits through FECA, a volunteer
                   must establish that, among other things, he or she was in the




                   16
                     AfterCorps is a private health insurance policy that covers non-service-connected
                   medical problems. The Peace Corps enrolls all volunteers after their close-of-service and
                   pays for the first month of coverage. Volunteers are eligible to extend their coverage for up
                   to 18 months. This is a medical policy and does not include routine dental coverage.




                   Page 6                                         GAO-13-27 Returned Peace Corps Volunteers
performance of duty at the time the illness or injury occurred. 17 Under the
FECA program, volunteers are considered to be in the performance of
duty 24 hours a day while abroad during the period of their Peace Corps
service. DOL requires that if an illness or injury is first discovered after a
volunteer has returned from service, then the medical evidence must
show that the injury or illness was sustained while overseas or in the
performance of duty. 18 In order to be eligible for FECA health care
benefits for preexisting illnesses or injuries—a condition that existed prior
to service—the volunteer’s medical evidence must demonstrate that the
volunteer’s service was the proximate cause of or aggravated,
accelerated, or precipitated the illness or injury. 19 Further, volunteers
must apply for FECA benefits within 3 years of the date of injury or illness,
or within 3 years after they recognize that a health condition is service-
connected. 20 In 2010, the FECA program provided about $2.8 billion in
health and other benefits to about 251,000 federal and postal
employees—including volunteers—who suffered a service related illness
or injury. 21




17
  DOL requires claimants to meet the following five criteria when establishing eligibility for
FECA benefits: (1) claim is filed within a 3-year statutory time period, (2) the injured or
deceased was a federal employee, (3) an injury, disease, or death occurred, (4) the injury,
disease, or death occurred in the performance of duty, and (5) the resulting medical
condition was caused by the injury, disease, or death. See 20 C.F.R. § 10.115 (2012).
Though not generally deemed federal employees, Peace Corps volunteers are eligible for
FECA benefits. 5 U.S.C. § 8142(b).
18
  The FECA program requires that claimants submit a medical report from the attending
physician. 20 C.F.R. § 10.115 (2012). The FECA physician definition includes surgeons,
podiatrists, dentists, clinical psychologists, optometrists, chiropractors, and osteopathic
practitioners and does not include nurse practitioners or physicians’ assistants. 5 U.S.C.
§ 8101(2). Further, DOL requires that the medical report include, among other things, a
formal diagnosis, which is used to guide DOL in assigning a medical diagnosis that is
used as the basis for reimbursement.
19
  20 C.F.R. § 10.730(c) (2012).
20
  5 U.S.C. § 8122.
21
 GAO, Federal Employees’ Compensation Act: Benefits for Retirement-Age
Beneficiaries, GAO-12-309R (Washington, D.C.: Feb. 6, 2012).




Page 7                                          GAO-13-27 Returned Peace Corps Volunteers
Application Process for   Volunteers who apply for FECA benefits typically go through the following
FECA Program Benefits     steps:
for Volunteers
Preapplication            1. Each volunteer is informed of the availability of FECA benefits at the
                             close-of-service medical evaluation.
                               a. Each volunteer is expected to receive a close-of-service medical
                                  evaluation that assesses his or her health status prior to leaving
                                  service to document any service-connected illnesses or injuries.
                                  Should a volunteer terminate service early—before completing his
                                  or her assignment—the volunteer will also undergo a complete
                                  medical and dental exam to identify any unmet health care needs
                                  and potential medical issues.

                          2. Volunteers complete a FECA application and submit it to DOL through
                             the Peace Corps’ Post-Service Unit. 22
                               a. The Peace Corps—through its Post-Service Unit—assists
                                  volunteers applying for benefits by helping them to complete the
                                  appropriate forms and providing the appropriate medical evidence
                                  from volunteers’ Peace Corps medical records. 23

                               b. The Peace Corps’ Post-Service Unit sends all FECA
                                  applications—which includes information on the injury or illness
                                  reported by the volunteer—to DOL for review and eligibility
                                  determination.

Application Review        3. FECA applications submitted for volunteers are reviewed by DOL, and
                             the agency then makes an eligibility determination.
                               a. For those applications that do not include sufficient information
                                  and require further development, volunteers are given
                                  approximately 30 days to submit additional information to support
                                  their request for FECA benefits. If the additional information
                                  submitted is sufficient, the application is approved. If the additional



                          22
                           Volunteers seeking FECA benefits are required to complete form CA-1 or form CA-2.
                          23
                            The Peace Corps maintains medical records for any injury or illness reported during a
                          volunteer’s service. In addition, any injury or illness noted at the close-of-service medical
                          evaluation is documented in the volunteer’s medical record, which is included in the FECA
                          application should a volunteer apply for FECA benefits.




                          Page 8                                         GAO-13-27 Returned Peace Corps Volunteers
                                     information is not sufficient, the FECA application is denied and
                                     medical treatment is not authorized.

                                 b. For those applications that are approved, DOL assigns a medical
                                    diagnosis on the basis of medical evidence submitted in the FECA
                                    application. This assigned medical diagnosis defines the medical
                                    treatment and services for which the volunteer is eligible for FECA
                                    reimbursement.

Reimbursement for Medical   4. Typically, after benefits are approved by DOL, a volunteer obtains
Expenses                       health care services through a medical provider. After receiving these
                               services, the volunteer or the volunteer’s medical provider submits a
                               bill to DOL for reimbursement. 24 DOL provides reimbursement for
                               medical expenses.
                            5. On an annual basis, DOL requires the Peace Corps to pay DOL back
                               for these reimbursements.

                            From 2009 through 2011, DOL provided a total of about $36 million in
From 2009 through           FECA benefits for volunteers, providing about $22 million in health care
2011, DOL Provided          benefits—reimbursements for medical expenses to treat service-
                            connected injuries and illnesses for Peace Corps volunteers—and
about $36 Million in        $13.8 million in other benefits. During this period, almost 1,400 volunteers
Health Care and Other       each year received health care benefits. 25 The average reimbursement
Benefits for                for medical expenses per volunteer was about $5,000 in 2009, and about
                            $5,600 in 2011. 26 The most-common medical conditions for which DOL
Volunteers                  provided health care benefits—reimbursements for medical services—
                            were mental, emotional, and nervous conditions; dental;


                            24
                              Peace Corps officials told us that volunteers may choose not to wait for DOL’s approval
                            of their FECA application before receiving medical care; however, any related medical
                            expenses are not reimbursable by DOL if the FECA application is ultimately denied.
                            25
                              Medical reimbursements and medical conditions are associated with individual FECA
                            claims—or applications—submitted by volunteers that have been approved by DOL.
                            Some volunteers may be approved for multiple FECA claims. This happens infrequently—
                            for up to about 5 percent of the approved application from 2009 through 2011. For the
                            purpose of our reporting, we refer to the number of approved FECA claims as the number
                            of volunteers.

                            In 2009, volunteers received medical reimbursements of $6.5 million, volunteers received
                            $7.7 million in 2010, and volunteers received $7.6 million in 2011.
                            26
                             In this report we do not adjust the reimbursements for medical expenses for inflation.




                            Page 9                                        GAO-13-27 Returned Peace Corps Volunteers
                                                 other/nonclassified diseases; and infectious or parasitic diseases. 27
                                                 These four medical conditions represented about 40 percent of all
                                                 medical conditions and accounted for about $5.9 million—or more than a
                                                 quarter—of all medical reimbursements for volunteers under FECA
                                                 between 2009 and 2011. See table 1 for the medical conditions for which
                                                 DOL provided reimbursements for volunteers under FECA.

Table 1: The Medical Conditions for Which the Department of Labor (DOL) Made Reimbursements for Returned Peace Corps
Volunteers under the Federal Employees’ Compensation Act (FECA), 2009 through 2011

                                                                                              Amount reimbursed                  Percentage of total
                                                                                         a                        b
Medical condition                                                           Frequency         (dollars in millions )        reimbursement (percent)
Mental, emotional, or nervous conditions                                              466                         $3.3                               15.2%
Dental                                                                                417                           0.4                                     1.8
                               c
Other/nonclassified diseases                                                          388                           1.3                                     6.1
Infectious or parasitic diseases                                                      336                           0.8                                     3.8
Pain, swelling, stiffness, or redness in joint                                        278                           1.0                                     4.8
Sprain or strain of ligament, muscle, tendon (not back)                               247                           1.6                                     7.5
Fracture                                                                              199                           1.2                                     5.6
Pregnancy                                                                             136                           0.5                                     2.1
Musculoskeletal Condition                                                             119                           1.0                                     4.6
Skin Condition                                                                        110                         0.07                                      0.3
        d
Other                                                                                1,371                        10.5                                 48.2
Total                                                                                4,067                       $21.9                               100%
                                                 Source: GAO analysis of DOL data.
                                                 a
                                                  The frequency represents the number of times a medical condition or nature of injury is recorded as
                                                 the basis for FECA reimbursement. We used the recorded nature of injury as a proxy for medical
                                                 condition because it provided the best link to reimbursements made on behalf of volunteers.
                                                 Volunteers can receive reimbursement for more than one condition, thus the number of conditions
                                                 may exceed the number of volunteers who received FECA benefits.
                                                 b
                                                     Dollar amounts may not add to the total due to rounding.
                                                 c
                                                  Other/nonclassified diseases are illness or injuries that generally do not fit neatly into the existing
                                                 illness and injury categories used by DOL.
                                                 d
                                                     These represent all other medical conditions for which volunteers received reimbursements.


                                                 In addition to health care benefits, volunteers also received other
                                                 benefits—such as wage-loss compensation and reimbursement for travel
                                                 to receive medical treatment. Specifically, from 2009 through 2011, these


                                                 27
                                                   Other/nonclassified diseases are illness or injuries that generally do not fit neatly into the
                                                 existing illness and injury categories used by DOL.




                                                 Page 10                                                GAO-13-27 Returned Peace Corps Volunteers
other benefits received by volunteers totaled about $13.8 million. 28 In
2011, the total reimbursements for both health care and other benefits
were about $12 million, which represents about 3.3 percent of the Peace
Corps’ 2012 appropriation of $375 million. According to Peace Corps
officials, these health care and other expenses represent a growing
portion of its annual budget. These officials explained that from 2009
through 2011 these expenses have increased a total of approximately
7.2 percent. 29

Volunteers who received FECA benefits from 2009 through 2011 are
unique in several ways when compared to other recipients of these
benefits. 30 Specifically, our analysis of DOL’s FECA program claims data
found that the volunteers were generally younger and more likely to be
female when compared to others who received benefits under the FECA
program. Volunteers were, on average, 12 years younger than others
who received FECA benefits. About two-thirds of volunteers receiving
FECA benefits were female, whereas less than half of others receiving
FECA benefits were female. These differences in age and gender are
consistent with the overall demographics of these two populations—the
volunteers and federal workers.

In addition, the medical conditions for which volunteers received FECA
benefits were different than those for others who received FECA benefits.
For example, volunteers were more likely than others to receive FECA
benefits for mental, emotional, or nervous conditions; dental conditions;
other/nonclassified diseases; and infectious or parasitic diseases. While
these four medical conditions represented 40 percent of the conditions for
volunteers, they represented less than 2 percent for the others receiving
FECA benefits.




28
  Volunteers received other benefits totaling about $4.6 million in 2009, $4.7 million in
2010, and $4.4 million in 2011.
29
  In contrast, DOL officials stated that costs for the overall FECA population increased an
average of 5 percent each year over the last several years.
30
  For purposes of analyzing medical conditions, other recipients of benefits under FECA
do not include the State Department. However, when comparing volunteers to State
Department employees who received FECA benefits we saw similar results to those we
found when comparing volunteers to other recipients of benefits under FECA.




Page 11                                         GAO-13-27 Returned Peace Corps Volunteers
                       The Peace Corps uses information it has to monitor volunteers’
The Peace Corps Uses   awareness of the FECA program; however, in general, neither DOL nor
Information on         the Peace Corps use information in the remaining three areas in our
                       review to monitor the accessibility and quality of FECA benefits for
Volunteers’            volunteers. These areas are (1) information on volunteers’ knowledge of
Awareness of FECA,     FECA program and application requirements, such as medical
but Neither DOL Nor    documentation that is required to be submitted with an application;
                       (2) information on DOL’s timeliness in reviewing FECA applications and
the Peace Corps Use    reimbursing medical expenses, and on the level of customer satisfaction
Other Available        with the FECA program; and (3) information on the availability of FECA-
                       registered medical providers. 31 Table 2 summarizes the extent to which
Information to         DOL and the Peace Corps use information available in the four key areas
Monitor Access and     to monitor the accessibility and quality of FECA benefits for volunteers.

Quality




                       31
                         The information in the four areas we identified does not represent a comprehensive list
                       of all types of information that could be used to monitor the accessibility and quality of the
                       FECA program for volunteers.




                       Page 12                                         GAO-13-27 Returned Peace Corps Volunteers
Table 2: Extent to Which Available Information Is Used by the Department of Labor (DOL) and the Peace Corps to Monitor
Accessibility and Quality of Federal Employees’ Compensation Act (FECA) Benefits for Returned Peace Corps Volunteers

                                                                                        Agency with information on
                                                                                               volunteers
                                                                                                                         Do the agencies use
                                                                                                                          the information to
                                                                                                                         monitor access and
Type of information                                                                       DOL         Peace Corps              quality?
Peace Corps volunteers’ awareness of the FECA program
                                                                                  a
Signed documentation from volunteer acknowledging informed of FECA                                                                Yes
Peace Corps volunteers’ knowledge of FECA program and application requirements
Statistics on the application review process, including the number of                                                             No
volunteers who were approved, needed to submit additional
                                   b
documentation, and were denied
Information on the most-common reasons for denial for volunteers, such                                                            No
as from review of those provided in denial letters
                                      c
Copies of application, medical records , and correspondence with                                                                  No
volunteers during review
DOL’s timeliness in reviewing applications and reimbursing for medical expenses, and the level of customer satisfaction
with the FECA program
                                                                                              d                                           e
Data on timeliness in reviewing FECA applications for volunteers                                                                Partially
                                                                                                f
Statistics/data on timeliness of DOL’s reimbursement of medical                                                                    No
expenses for volunteers
Data on customer satisfaction measures for volunteers                                                                              No
Availability of FECA-registered medical providers
Registration information from all FECA-registered medical providers                                                                No
                                                                                                              g
Geographic location and medical specialty of FECA-registered medical                                   Partial                     No
providers
                                             Source: GAO review of DOL and Peace Corps information.

                                             Notes: The Peace Corps and DOL each have certain responsibilities related to the provision of FECA
                                             benefits for eligible volunteers who return from service abroad. Specifically, the Peace Corps is
                                             responsible for informing volunteers that they may be eligible for FECA benefits, assisting in the
                                             application process, and paying DOL back annually for FECA benefits provided to volunteers. DOL is
                                             responsible for administering the program by reviewing and approving applications for benefits and
                                             for making reimbursements on behalf of volunteers for the costs of health and other FECA expenses.
                                             a
                                              Currently, volunteers’ are required to review material related to the FECA program during the
                                             standard close-of-service medical evaluation that assesses their health status prior to leaving service
                                             and sign a document acknowledging they were made aware of the FECA program.
                                             b
                                              Review of information on application review process—such as the number of volunteers who are
                                             approved, denied, and need to submit additional documentation—could provide information about the
                                             extent to which volunteers lack knowledge about the required medical documentation.
                                             c
                                             Any injury or illness noted at the close-of-service medical evaluation is documented in the volunteer’s
                                             medical record, which is included in the FECA application should a volunteer apply for FECA benefits.
                                             d
                                                 DOL did not have this information specific to volunteers until requested by GAO in June 2012.
                                             e
                                             As part of the review of the timeliness of FECA applications, DOL has and uses the Protecting Our
                                             Workers and Ensuring Reemployment (POWER) Initiative metrics to monitor the Peace Corps’ timely




                                             Page 13                                                  GAO-13-27 Returned Peace Corps Volunteers
submission of FECA applications. However, DOL does not use information related to DOL’s timely
review of FECA applications for the Peace Corps population.
f
    DOL did not have this information specific to volunteers until requested by GAO in June 2012.
g
 Peace Corps officials told us that they have the ability to generate lists of DOL FECA-registered
medical providers by state, zip code, and medical specialty; however, they do not use this information
to monitor availability of FECA-registered medical providers for volunteers.


As shown in table 2, the Peace Corps uses information related to
volunteers’ awareness of the FECA program. Specifically, to monitor
volunteers’ awareness, the Peace Corps currently documents that
volunteers have acknowledged that they have been informed of their
potential eligibility for FECA during their close-of-service evaluation.
Peace Corps officials told us the agency uses this information to help
ensure all volunteers are made aware of their possible eligibility for FECA
benefits.

While the Peace Corps uses information on volunteer awareness, neither
DOL nor the Peace Corps use available information related to the
remaining three areas of our review to monitor the accessibility and
quality of FECA benefits for volunteers.

Volunteers’ knowledge of FECA program and application requirements.
As table 2 shows, neither DOL nor the Peace Corps use available
information, such as data on FECA application denial rates, and
information on reasons for denials, in order to monitor the accessibility
and quality of FECA benefits for volunteers. 32 DOL officials told us that it
is not their responsibility to use this information for this type of monitoring.
However, by not using this available information to review volunteers’
level of knowledge of the FECA requirements, DOL and the Peace Corps
may be unaware, for example, of the extent to which volunteers
experience difficulties accessing FECA benefits because of limited
understanding of certain application requirements, such as in (a)
providing appropriate and sufficient medical evidence and (b) establishing
a service connection for the illness or injury for which the volunteer is
seeking FECA benefits.




32
  Our analysis of FECA claims data indicated roughly 96 percent of volunteers who
applied were approved by DOL to receive FECA benefits, while 4 percent were not
approved.




Page 14                                                GAO-13-27 Returned Peace Corps Volunteers
According to volunteer advocates, volunteers and their physicians may
lack knowledge of certain FECA documentation requirements, such as
the need to include a medical diagnosis rather than just the symptoms of
an injury or illness in the FECA application. Furthermore, our examination
of a limited number of FECA denial letters confirms that these difficulties
are often a contributing factor in the FECA applications that were not
approved from 2009 through 2011. 33 For example, our review of denial
letters showed that the most-common reasons for denial were lack of
sufficient medical documentation and inability to establish a service
connection. Further, DOL and the Peace Corps also do not work together
to use the information available to them on volunteers’ knowledge of
program and application requirements.

DOL’s timeliness in reviewing applications and reimbursing medical
expenses, and customer satisfaction. As table 2 shows, DOL and the
Peace Corps are not using, or are only partially using, available data on
DOL’s timeliness in reviewing applications and reimbursing medical
expenses, and customer satisfaction. 34 Specifically, DOL only uses
timeliness metrics to monitor the timeliness with which the Peace Corps
submits FECA applications to DOL but does not conduct periodic
examinations of timeliness of the review of volunteers’ FECA applications
after it receives the application. Further, DOL only tracks data on
customer satisfaction measures for all FECA recipients, but not
specifically for volunteers. DOL explained that it does not use these
timeliness data to monitor access and quality specifically for volunteers.
DOL also noted the level of effort required to pull out the timeliness data
for volunteers is too extensive, and volunteers represent a small portion


33
  We reviewed about 30 percent of the denial letters sent to volunteers from 2009 to 2011.
These letters were randomly selected by the Peace Corps, and include a summary of the
volunteer’s reported injury as well as the reason(s) for denying the FECA application. DOL
noted that in cases when an application lacks required documentation, volunteers are
provided with an explanation of what additional documentation is needed, and are given
the opportunity to provide the requested documentation.
34
  DOL maintains metrics for measuring performance for the overall FECA program,
including those that are part of the Protecting Our Workers and Ensuring Reemployment
(POWER) Initiative, the Government Performance and Results Act of 1993 (GPRA), as
amended, and measures outlined in DOL’s Operational Plan. The POWER Initiative
established goals related to FECA—such as the timeliness of filing a FECA application.
Under GPRA, DOL established customer satisfaction measures for the FECA program.
Under its Operational Plan, DOL established additional timeliness and customer
satisfaction measures, such as those to monitor the timeliness of the FECA application
review process.




Page 15                                       GAO-13-27 Returned Peace Corps Volunteers
of the overall FECA population. Instead, DOL’s focus has been on using
the data in order to monitor FECA program timeliness and customer
satisfaction for all individuals who receive FECA benefits. 35 While it is
reasonable that DOL focus on the entire FECA program, DOL and the
Peace Corps also do not work together to use the timeliness and
customer satisfaction information to help the Peace Corps gauge whether
volunteers are receiving FECA benefits in a timely and satisfactory
manner. For example, Peace Corps officials told us that a survey of
former volunteers specifically about access and satisfaction issues would
be useful. According to Peace Corps officials, the results of such a survey
could help clarify whether volunteers have access to the care they need
and what the volunteers think about the quality of the care they receive.
Without this information, DOL and the Peace Corps may be unable to
determine volunteers’ level of satisfaction with the FECA program.

Our review of DOL timeliness data suggests that between 2009 and
2011, the agency met its timeliness benchmarks related to review of
FECA applications for volunteers. 36 However, because DOL does not use
these data to determine the timeliness in reviewing volunteers’ FECA
applications, DOL may not be able to determine whether or to what extent
its performance on timeliness is sustained in the future. Furthermore, a
lack of ongoing examinations of timeliness may make it difficult for DOL to
identify problems if they should arise in the future or to provide
information to alleviate the concerns of advocates and Peace Corps
officials regarding the timeliness of the review of FECA applications.

Availability of FECA-registered medical providers. DOL does not use the
information it has on FECA-registered providers to determine the
accessibility of these providers to volunteers. FECA-registered providers
are required to provide several pieces of information to DOL when
registering for the FECA program, including their geographic location and
medical specialty. DOL officials reported that they do not believe it is their
responsibility to use the information on FECA-registered providers to
examine the accessibility of FECA-registered providers in certain



35
 DOL examines timeliness and customer satisfaction for all federal employees under
FECA using metrics outlined in its Operational Plan.
36
  For example, our review of information showed that DOL reviewed about 97 percent of
all volunteers’ applications related to traumatic cases within 45 days of receiving the
application—meeting its benchmark to review 90 percent within that time frame.




Page 16                                      GAO-13-27 Returned Peace Corps Volunteers
geographic areas and for certain medical specialties. 37 By not using the
information DOL has on the geographic location and medical specialty of
FECA-registered providers, DOL and the Peace Corps cannot determine
the extent to which there are limitations in the availability of FECA-
registered providers in certain geographic areas and for certain medical
specialties.

DOL’s available information on FECA-registered providers suggests that
volunteers may face some challenges accessing registered providers.
Officials stated that although it is the responsibility of the volunteer to find
a FECA-registered provider, DOL publishes an online search tool that
contains a partial listing of the available FECA-registered providers as a
service to FECA beneficiaries, including volunteers, to help locate
providers. Officials also noted the agency does not actively manage or
update the list. 38 Although the online search tool is recognized by DOL as
incomplete, it does provide some partial information about the availability
of FECA-registered providers. We reviewed this online search tool and
found, for example, that as of June 2012 there were no FECA-registered
providers in the online search tool listed as mental health specialists in
any of the 10 states with the largest population of volunteers. 39 Peace
Corps officials and volunteer advocates also noted there are a limited
number of FECA-registered providers in some geographic locations and
medical specialties. In addition, Peace Corps officials told us that they


37
  DOL officials noted that under FECA a volunteer has the right to select his or her own
physician and reiterated that it must refrain from involvement in any activity that could be
construed as pre-selecting or creating a bias toward certain physicians.
38
  Officials explained that the search tool includes a partial list of registered providers,
including only those that are willing to have their names published. Officials stated that
they are concerned that taking a more active role in managing providers could cause
beneficiaries to incorrectly view physicians as working on behalf of DOL rather than
beneficiaries.
39
  We reviewed the provider listing using the instructions provided by DOL at the site.
These instructions ask the user to enter either (1) the state, (2) the city and state, or
(3) the zip code. Users are also recommended to leave the field “provider specialty” blank.
We reviewed the 10 states with the largest population of volunteers between 2009 and
2011—California, Colorado, Florida, Illinois, Maryland, New York, Oregon, Texas, Virginia,
and Washington. Furthermore, the online search tool did not consistently report the
medical specialty of providers. For example, not all medical providers clearly indicate their
specialty in the specialty field on the online search tool making it difficult to get a sense of
the complete number of specialists for a given area, such as mental health. DOL officials
told us that providers are not required to include medical specialty on the form when
registering for the online search tool.




Page 17                                          GAO-13-27 Returned Peace Corps Volunteers
              have assisted volunteers in finding and enrolling providers, and have had
              difficulty in doing so. Although the information on FECA-registered
              providers in the online search tool that DOL provides as a resource to
              volunteers may be incomplete, it includes information that could be used
              to help identify potential access issues and areas for monitoring the
              accessibility of FECA benefits for volunteers.


              The Peace Corps and DOL both have certain responsibilities related to
Conclusions   the provision of FECA benefits for eligible volunteers who return from
              service abroad. Specifically, DOL administers the FECA program and the
              Peace Corps pays for the expenses incurred by volunteers in the
              program. From DOL’s perspective, volunteers do not represent a large
              proportion of the overall FECA population. However, FECA is a relatively
              larger issue from the Peace Corps’ perspective. The volunteers are a
              unique population compared to others who receive benefits under
              FECA—for example, they are more likely to have mental, emotional, or
              nervous conditions that are service-connected—and, according to Peace
              Corps officials, the amount the Peace Corps pays DOL for FECA
              reimbursements represents an increasing portion of the Peace Corps’
              annual budget. Because both of the agencies have certain responsibilities
              related to the provision of FECA benefits for eligible volunteers who return
              from service abroad, it is especially important that the Peace Corps and
              DOL jointly monitor the accessibility and quality of the FECA program to
              ensure that the FECA program is achieving its intended objectives—
              including ensuring that eligible volunteers receive needed FECA health
              care benefits.

              The Peace Corps and DOL have information available to them in the four
              key areas we reviewed that could be used to monitor the accessibility and
              quality of FECA benefits for volunteers: (1) volunteers’ awareness of
              FECA; (2) volunteers’ knowledge of program and application
              requirements; (3) DOL’s timeliness in reviewing FECA applications and
              reimbursing medical expenses, and the level of customer satisfaction with
              the FECA program; and (4) availability of FECA-registered medical
              providers. However, in general, the two agencies are not using this
              information for such monitoring. For example, the agencies do not use the
              information they have to determine whether there is a gap in the number
              and geographic location of FECA-registered providers, such as the
              potential gap we identified in the number and geographic location of
              FECA-registered providers who treat mental health conditions—the most
              common medical condition for which volunteers received reimbursement.



              Page 18                                GAO-13-27 Returned Peace Corps Volunteers
                     While information is available to DOL and the Peace Corps that could be
                     used for monitoring, the agencies are generally not working together to
                     use the available information to monitor the accessibility and quality of
                     FECA benefits for volunteers. Working together is important because
                     neither agency has all the information to monitor the program on its own.
                     Finally, because the information we identified under the four areas is not
                     a comprehensive list of all the information the agencies could use to
                     monitor FECA benefits for volunteers, the Peace Corps and DOL may be
                     able to identify other information that could be used for this purpose.
                     Unless the two agencies work together on monitoring, they will miss the
                     opportunity to make use of the available information to help ensure the
                     accessibility and quality of FECA benefits for volunteers.


                     We recommend that the Secretary of Labor and the Director of the Peace
Recommendation for   Corps jointly develop and implement an approach for working together to
Executive Action     use available information to monitor the access to and quality of FECA
                     benefits provided to returned volunteers.


                     We provided a draft of this report to the Department of Labor (DOL) and
Agency Comments      the Peace Corps for review. Peace Corps provided written comments
and Our Evaluation   (reprinted in app. I), and both provided technical comments, which we
                     incorporated as appropriate. Neither DOL nor the Peace Corps indicated
                     whether or not they agreed with our recommendation. Instead, among
                     other things, DOL’s technical comments identified examples of the
                     agency’s collaboration with the Peace Corps to provide benefits under the
                     FECA program. For example, DOL noted that officials from both agencies
                     have met multiple times over the last 2 years to try to improve the
                     handling of volunteers’ claims, and that DOL officials are available to work
                     with the Peace Corps to improve the process of providing benefits to
                     volunteers. In contrast, the Peace Corps noted specific improvements
                     that it believes could assist returned volunteers, but stated that it cannot
                     make these reforms on its own and needs action from DOL. DOL’s and
                     the Peace Corps’ comments further underscore that the two agencies do
                     not have a joint approach for monitoring the quality and accessibility of
                     benefits for returned volunteers under the FECA program. As a result, we
                     are concerned that the two agencies are missing opportunities to
                     collaborate. We also remain convinced that DOL and the Peace Corps
                     should, as we recommended, work together and develop an approach for
                     using available agency information to monitor the accessibility and quality
                     of FECA benefits for returned volunteers.



                     Page 19                                GAO-13-27 Returned Peace Corps Volunteers
We are sending copies of this report to the Secretary of Labor, the
Director of the Peace Corps, and other interested parties. In addition, the
report will be available at no charge on GAO’s website at
http://www.gao.gov.

If you or your staff have any questions about this report, please contact
me at (202) 512-7114 or at kohnl@gao.gov. Contact points for our Office
of Congressional Relations and Office of Public Affairs can be found on
the last page of this report. Other major contributors to this report are
listed in appendix II.




Linda T. Kohn
Director, Health Care




Page 20                                GAO-13-27 Returned Peace Corps Volunteers
List of Committees

The Honorable John F. Kerry
Chairman
The Honorable Richard G. Lugar
Ranking Member
Committee on Foreign Relations
United States Senate

The Honorable Tom Harkin
Chairman
The Honorable Richard C. Shelby
Ranking Member
Subcommittee on Labor, Health and Human Services,
 Education, and Related Agencies
Committee on Appropriations
United States Senate

The Honorable Patrick J. Leahy
Chairman
The Honorable Lindsey Graham
Ranking Member
Subcommittee on the Department of State, Foreign Operations,
 and Related Programs
Committee on Appropriations
United States Senate

The Honorable Ileana Ros-Lehtinen
Chairman
The Honorable Howard Berman
Ranking Member
Committee on Foreign Affairs
House of Representatives

The Honorable Denny Rehberg
Chairman
The Honorable Rosa L. DeLauro
Ranking Member
Subcommittee on Labor, Health and Human Services, Education,
 and Related Agencies
Committee on Appropriations
House of Representatives



Page 21                             GAO-13-27 Returned Peace Corps Volunteers
The Honorable Kay Granger
Chairman
The Honorable Nita M. Lowey
Ranking Member
Subcommittee on State, Foreign Operations, and Related Programs
Committee on Appropriations
House of Representatives




Page 22                            GAO-13-27 Returned Peace Corps Volunteers
Appendix I: Comments from the Peace Corps
             Appendix I: Comments from the Peace Corps




             Page 23                                     GAO-13-27 Returned Peace Corps Volunteers
Appendix I: Comments from the Peace Corps




Page 24                                     GAO-13-27 Returned Peace Corps Volunteers
Appendix II: GAO Contact and Staff
                  Appendix II: GAO Contact and Staff
                  Acknowledgments



Acknowledgments

                  Linda T. Kohn, (202) 512-7114 or kohnl@gao.gov
GAO Contact
                  In addition to the contact named above, Will Simerl and Cynthia Grant,
Staff             Assistant Directors; N. Rotimi Adebonojo; Melinda Cordero;
Acknowledgments   Carolyn Fitzgerald; Krister Friday; Marina Klimenko; Amy Leone; and
                  Jennifer Whitworth made key contributions to this report.




(291016)
                  Page 25                              GAO-13-27 Returned Peace Corps Volunteers
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