Services’ Compliance with Force Health Protection and Surveillance Requirements for OIF Was Mixed, but Appears Better Than for OEF/OJG

The overall record of the military services in meeting force health  protection and surveillance system requirements for OIF was mixed and  varied by service, by installation visited, and by specific policy  requirement; however, our data shows much better compliance with these  requirements in the Army and Air Force installations we reviewed  compared to the installations in our earlier review of OEF/OJG. Of the  installations reviewed for this report, the Marine Corps generally had  lower levels of compliance than the other services. Also, the services did not  fully comply with requirements that servicemembers’ permanent medical  records include required health-related information, and that DOD’s  centralized database includes documentation of servicemember  health-related information. Noncompliance with the requirements for pre-deployment health  assessments may result in servicemembers with existing health problems  or concerns being deployed with unaddressed health problems. Also,  failure to complete post-deployment health assessments may risk a delay  in obtaining appropriate medical follow-up attention for a health problem  or concern that may have arisen during or following the deployment. Higher percentages of Army and Air Force servicemembers received  required pre-deployment immunizations for OIF. Lower percentages of deployment health-related documentation were  missing in the servicemembers’ permanent medical records and at DOD’s  centralized database for OIF. Implementation of DOD’s Deployment Health Quality Assurance Program Is Ongoing

In response to congressional mandates and a GAO recommendation, DOD  established a deployment health quality assurance program in January  2004 to ensure compliance with force health protection and surveillance  requirements and implementation of the program is ongoing. DOD officials  believe that their quality assurance program has improved the services’  compliance with requirements. DOD’s quality assurance program requires:    Periodic reporting on pre- and post-deployment health assessments. The program requires joint visits by representatives from the  Directorate and from service medical departments to military installations  for the purpose of validating the service’s deployment health quality  assurance reporting. The services are at different stages of developing their deployment quality  assurance programs. At the installations we visited, we observed that the Army and Air Force  had centralized quality assurance processes in place that extensively  involved installation medical personnel examining whether DOD’s force  health protection and surveillance requirements were met for deploying/  redeploying servicemembers. In contrast, we observed that the Marine  Corps installations did not have well-defined quality assurance processes  for ensuring that the requirements were met for servicemembers. To determine the extent to which the military services were meeting the  Department of Defense’s (DOD) force health protection and surveillance  requirements for servicemembers deploying in support of Operation Iraqi  Freedom (OIF), we identified DOD’s and each service’s overall  deployment health surveillance policies. In comparing compliance rates for OIF with those for Operation Enduring  Freedom (OEF) and Operation Joint Guardian (OJG), we reviewed active  duty servicemembers’ medical records for Army servicemembers and Air  Force servicemembers at selected installations. At each sampled location, we examined servicemember medical records  for evidence of the following force health protection and deployment  health-related documentation required by DOD’s force health protection  and deployment health surveillance policies:    Pre- and post-deployment health assessments, as applicable;    Tuberculosis screening test (within 1 year of deployment);    Pre-deployment immunizations:    hepatitis A;   influenza (within 1 year of deployment);    measles, mumps, and rubella;    polio;  tetanus-diphtheria (within 10 years of deployment); and  typhoid (within 5 years of deployment); and  Immunizations required prior to deployment or in theater:    anthrax (at least one immunization); and    smallpox  To provide assurances that our review of the selected medical records was  accurate, we requested the installations’ medical personnel to reexamine  those medical records that were missing required health assessments or  immunizations and adjusted our results where documentation was  subsequently identified.
Why GAO Did This Study

A lack of servicemember health and deployment data hampered investigations into the nature and causes of illnesses reported by many servicemembers following the 1990-91 Persian Gulf War. Public Law 105-85, enacted in November 1997, required the Department of Defense (DOD) to establish a system to assess the medical condition of servicemembers before and after deployments. Following its September 2003 report examining Army and Air Force compliance with DOD's force health protection and surveillance policies for Operation Enduring Freedom (OEF) and Operation Joint Guardian (OJG), GAO was asked in November 2003 to also determine (1) the extent to which the services met DOD's policies for Operation Iraqi Freedom (OIF) and, where applicable, compare results with OEF/OJG; and (2) what steps DOD has taken to establish a quality assurance program to ensure that the military services comply with force health protection and surveillance policies.

What GAO Found

Overall compliance with DOD's force health protection and surveillance policies for servicemembers that deployed in support of OIF varied by service, installation, and policy requirement. Such policies require that servicemembers be assessed before and after deploying overseas and receive certain immunizations, and that health-related documentation be maintained in a centralized location. GAO reviewed 1,862 active duty and selected reserve component servicemembers' medical records from a universe of 4,316 at selected military service installations participating in OIF. Overall, Army and Air Force compliance for sampled servicemembers for OIF appears much better compared to OEF and OJG. For example, (1) lower percentages of Army and Air Force servicemembers were missing pre- and post-deployment health assessments for OIF; (2) higher percentages of Army and Air Force servicemembers received required pre-deployment immunizations for OIF; and (3) lower percentages of deployment health-related documentation were missing in servicemembers' permanent medical records and at DOD's centralized database for OIF. The Marine Corps installations examined generally had lower levels of compliance than the other services; however, GAO did not review medical records from the Marines or Navy for OEF and OJG. Noncompliance with the requirements for health assessments may result in deployment of servicemembers with existing health problems or concerns that are unaddressed. It may also delay appropriate medical follow-up for a health problem or concern that may have arisen during or after deployment. In January 2004, DOD established an overall deployment quality assurance program for ensuring that the services comply with force health protection and surveillance policies, and implementation of the program is ongoing. DOD's quality assurance program requires (1) reporting from DOD's centralized database on each service's submission of required pre-deployment and post-deployment health assessments for deployed servicemembers, (2) reporting from each service regarding the results of the individual service's deployment quality assurance program, and (3) joint DOD and service representative reviews at selected military installations to validate the service's deployment health quality assurance reporting. DOD officials believe that their quality assurance program has improved the services' compliance with requirements. However, the services are at different stages of implementing their own quality assurance programs as mandated by DOD. At the installations visited, GAO analysts observed that the Army and Air Force had centralized quality assurance processes in place that extensively involved medical personnel examining whether DOD's force health protection and surveillance requirements were met for deploying/re-deploying servicemembers. In contrast, GAO analysts observed that the Marine Corps installations did not have well-defined quality assurance processes for ensuring that requirements were met for servicemembers.