In fiscal year 2009, VA compensated 1.2  million claims for veterans with either tinnitus or hearing loss injuries,  representing an annual federal expenditure exceeding $1.1 billion for  disability compensation payments. Services Are Employing Strategies to Identify and Mitigate Hazardous Noise, but Inconsistent Practices and Limited Training Weaken Their Efforts

		Services Use a Risk-Based Approach to Monitor Sites for Hazardous Noise Levels, but Lack Reliable Notification for Interim Changes

According to services’ policies, the services monitor noise levels at various  sites on a periodic basis according to the level of risk these sites pose to  servicemembers, but they do not provide guidance for a reliable  notification system for changes to site conditions that may occur in the  interim. For example, at sites we visited, high-risk areas, such as firing ranges  and flight decks, thought to pose the greatest chance of exposure to  hazardous noise are surveyed annually. For example, Navy officials told us they  conduct noise surveys every 4 years for their administrative offices,  whereas Army officials conduct them every 5 years. These strategies include engineering noise  to safer levels, setting time limits on noise exposure, and requiring the use  of protective equipment; however they are not consistently practiced. DOD’s Approach to Evaluating Hearing Conservation Has Key Weaknesses, While Some Services Have Taken Steps to Review and Improve Their Own Programs

		DOD Lacks Adequate Performance Indicators

DOD delegates most program evaluation to the services, but lacks  adequate performance indicators to proactively assess how well services  are reducing hearing loss among servicemembers. At the time of our  review, DOD policy required that services evaluate their hearing  conservation programs on an annual basis based on two annual  performance indicators both targeted for servicemembers enrolled in a  hearing conservation program—(1) the percentage of servicemembers that  take a required annual hearing test and (2) the rate of significant hearing  loss. Limitations in Information System Processes Hinder Program Evaluation Efforts

Program evaluation is also hindered by limitations in the processes used to  capture, track, and use hearing-related performance data. Services Have Made Efforts to Review and Improve Their Own Hearing Programs

Each service has taken some steps to review their own hearing  conservation programs and identify opportunities for improvement. These  include scheduled reviews of hearing loss data and hearing test audits,  among other efforts. Plans Are Almost Complete for Both the Hearing Center of Excellence and a System to Facilitate DOD and VA Data Sharing

		A Plan for the Center Has Been Submitted for Final Department Approval

DOD has developed, but not yet finalized, its planning for the DOD Hearing  Center of Excellence that Congress mandated in October 2008 to be  established. Neither Congress nor DOD set a date for when planning should be  formally approved to implement the center, but a key DOD official  estimated that the concept of operations may get final DOD approval in  the near future. Furthermore, the interim director told us that the focus of the center will  be to  research and support field testing of the best available protection and  communication devices currently available, as well as developing  improved hearing protection, along with better education and training on  its use;   create best practice guidelines for improving hearing outcomes after injury  and explore new lines of therapy to protect or restore hearing loss or  injury;   determine how many hazardous noise exposures are too many for a  servicemember and the level of hearing needed for selected jobs to  facilitate appropriate job assignments;   develop and implement better restorative and rehabilitative devices;    promote standards for implementing hearing awareness and treatment  into medical air evacuations for injured troops; and   collaborate with academic centers and industry in all these pursuits to  mitigate or restore hearing loss. Recommendations for Executive Action

To position DOD and the services to better protect servicemembers from  hearing loss, we recommend that the Under Secretary for Personnel and  Readiness work with the Assistant Secretary for Health Affairs and take  the following four actions to ensure that:    DOD and the services improve upon the type, timing, and tracking of  training and education provided to servicemembers on hearing protection,  by providing information that is more comprehensive and training that is  more frequent and possibly earlier in servicemembers’ careers. DOD and the services address limitations in the processes used to capture,  track, and use performance data. VA did not provide formal written comments, but both DOD and VA  submitted technical changes to the draft of the report, which we  incorporated into the report as appropriate. To review how well the services identify and mitigate hazardous noise and  evaluate their hearing conservation programs, we visited nine military  installations across the country—with at least two locations for each of  the armed services, to review hearing conservation activities and  interviewed officials both responsible for and participating in each base’s  hearing conservation program. To determine the status of the DOD Hearing Center of Excellence and its  registry and efforts to share information to improve hearing protection, we  interviewed officials from DOD, including the center’s interim director and  the representatives of the armed services and VA involved in these efforts.
Why GAO Did This Study

Exposure to hazardous noise can have negative implications for both servicemember health and readiness. Moreover, in fiscal year 2009, some of the most common impairments for veterans receiving Veterans Affairs (VA) disability benefits were hearing related, as annual payments for such conditions exceeded $1.1 billion. To examine Department of Defense (DOD) efforts to prevent hearing loss, GAO is reporting on (1) how well the DOD and armed services identify and mitigate hazardous noise; (2) how well the military evaluates hearing conservation program performance; and (3) the status of DOD's Hearing Center of Excellence and the extent that DOD and VA are sharing information to inform this and other efforts. GAO reviewed DOD and services' policies and guidance, reviewed DOD performance data, interviewed officials and servicemembers, and conducted site visits to nine military bases.

What GAO Found

Each of the armed services is taking steps to monitor hazardous noise, but inconsistencies in some hearing protection strategies and limited training weaken mitigation efforts. Services monitor noise periodically, depending on the level of risk servicemembers have in being exposed to hazardous noise (for example, annually for firing ranges and flight decks, and every 5 years for administrative offices). However, they lack a reliable system for detecting changes in noise levels that may occur outside the scheduled review cycle. Although DOD requires that noise be controlled by setting exposure limits and requiring the use of hearing protection, these strategies are not consistently used. For example, servicemembers told us that they do not always wear hearing protection, citing concerns with comfort and communication. Annual hearing-related training is required for at-risk servicemembers, but services are not able to fully determine who has completed annual training, and many servicemembers told GAO that training is not necessarily well timed. DOD's evaluation of services' hearing conservation programs has key weaknesses, but some services have taken steps to review and improve their own programs. First, DOD performance indicators are not sufficiently comprehensive. One key indicator--the rate of hearing loss among servicemembers in the hearing conservation programs--only measures program performance after hearing loss has occurred. Second, evaluation is limited by weaknesses in the processes used to capture, track, and use performance data. For example, the data may not accurately capture the number of servicemembers enrolled in the respective programs--a number required to calculate compliance rate. Third, audiologists, and other key stakeholders do not, on some bases GAO visited, routinely coordinate to share and evaluate hearing loss data to identify and mitigate noise hazards. Individual services have, at times, conducted reviews of their own programs and made some improvements. For example, once the Army decided that soldiers would not be deployed if the individual had not completed a required hearing test, the number of hearing tests rose significantly. DOD has developed, though not yet finalized, a plan for a Hearing Center of Excellence to improve hearing loss prevention and treatment as well as a plan for its registry to track and share information with VA on injured military personnel and veterans. Neither Congress nor the DOD set a date for when planning should be formally approved to implement the center, but a key DOD official estimated that plans may receive final DOD approval in the near future. In the meantime, an interim director for the center has begun to lay the groundwork for implementation of both the center and the registry. While data sharing between DOD and VA has been very limited to date, military and VA officials said the registry should ultimately facilitate sharing and development of best practices.

What GAO Recommends

GAO recommends that to improve hearing conservation programs, DOD should address issues with the type, timing, and tracking of training and education; develop an appropriate set of performance indicators; improve processes to collect and use performance data; and examine services' reviews to identify opportunities for program improvement. In reviewing a draft of this report, DOD concurred with GAO's recommendations. DOD and VA provided technical comments, which GAO incorporated as appropriate.