	DOD Has Established Force Health Protection and Surveillance Policies for Deployed Federal Civilians, but Should Do More to Ensure That Components Comply with Its Requirements

We reported in 2006 that DOD had established force health protection and  surveillance policies aimed at assessing and reducing or preventing health  risks for its deployed federal civilian personnel; however, at the time of  our review, the department lacked a quality assurance mechanism to  ensure the components’ full implementation of its policies. Our  review of deployment records and other documentation at the selected  component locations found that these components lacked documentation  to show that some federal civilian personnel who deployed to Afghanistan  and Iraq had received the required pre-deployment health assessments. Lack of Centralized Deployment Information Hinders the Overall Effectiveness of Force Health Protection and Surveillance for Deployed Federal Civilian Personnel

Beyond the aforementioned weaknesses found in the selected  components’ implementation of force health protection and surveillance  requirements for deploying federal civilians, as a larger issue, we noted in  our 2006 report that DOD lacked comprehensive, centralized data that  would enable it to readily identify its deployed civilians, track their  movements in theater, or monitor their health status, further hindering  efforts to assess the overall effectiveness of its force health protection and  surveillance capabilities. DOD Has Established and Implemented Medical Treatment Policies Which Provide for the Care of Its Deployed Federal Civilians

In our 2006 report, we found that DOD had established medical treatment  policies that cover its federal civilians while they are deployed to support  contingency operations in Afghanistan and Iraq, and available workers’  compensation claims we reviewed confirmed that those deployed federal  civilians received care consistent with the policies. These policies state  that DOD federal civilians who require treatment for injuries or diseases  sustained during overseas hostilities may be provided care under the DOD  military health system. Specifically, in  reviewing a sample of seven workers’ compensation claims (out of a  universe of 83) filed under the Federal Employees’ Compensation Act by  DOD federal civilians who deployed to Iraq, we found that in three cases  where care was initiated in theater the affected federal civilians had  received treatment in accordance with DOD’s policies. Further, in all seven claims that we reviewed, DOD federal  civilians who requested medical care after returning to the United States,  had, in accordance with DOD’s policy, received initial medical  examinations and/or treatment for their deployment-related injuries or  illnesses and diseases through either military or civilian treatment  facilities. DOD Provides Special Pays and Benefits to Deployed DOD Federal Civilian and Military Personnel, but the Types and Amounts Differ

Our 2006 report found that DOD provides a number of special pays and  benefits to its federal civilian personnel who deploy in support of  contingency operations, which are generally different in type and in  amount from those provided to deployed military personnel. In 2003, we designated federal  disability programs as a high-risk area because of continuing challenges  with modernizing those programs. Survivors of DOD federal civilian  personnel, however, almost always receive lower noncash benefits than  military personnel. Other special pays were unique to each group. DOD Federal Civilian and Military Personnel Receive Different Types and Amounts of Disability Benefits, Depending on Specific Program Provisions and Individual Circumstances

In the event of sustaining an injury while deployed, DOD federal civilian  and military personnel are eligible to receive two broad categories of  government-provided disability benefits—disability compensation and  disability retirement. Survivors of DOD Federal Civilian and Military Personnel Received Comparable Types of Benefits, but Benefit Amounts Differ

Survivors of deceased DOD federal civilian and military personnel  generally receive similar types of cash survivor benefits—either as a lump  sum, a recurring payment, or both—through comparable sources.
Why GAO Did This Study

As the Department of Defense (DOD) has expanded its involvement in overseas military operations, it has grown increasingly reliant on its federal civilian workforce to support contingency operations. GAO was asked to discuss DOD's (1) force health protection and surveillance policies, (2) medical treatment policies that cover federal civilians while they are deployed to support contingency operations in Afghanistan and Iraq, and (3) differences in special pays and benefits provided to DOD's deployed federal civilian and military personnel. For this statement, GAO primarily drew on its September 2006 report that addressed these objectives. For its report, GAO analyzed over 3,400 deployment-related records at eight component locations for deployed federal civilians and policies related to defense health care, reviewed claims filed under the Federal Employees' Compensation Act (FECA); and examined major provisions of special pays and disability and death benefits provided to DOD's deployed federal civilians and military personnel.

What GAO Found

In 2006, GAO reported that DOD had established force health protection and surveillance policies to assess and reduce or prevent health risks for its deployed federal civilians, but it lacked procedures to ensure implementation. GAO's review of over 3,400 deployment records found that components lacked documentation that some federal civilians who deployed to Afghanistan and Iraq had received, among other things, required pre- and post-deployment health assessments and immunizations. Also, DOD lacked centralized data to readily identify its deployed civilians and their movement in theater, thus hindering its efforts to assess the overall effectiveness of its force health protection and surveillance capabilities. GAO noted that until DOD establishes a mechanism to strengthen its oversight of this area, it would not be effectively positioned to ensure compliance with its policies, or the health care of deployed federal civilians. GAO also reported that DOD had established medical treatment policies for its deployed federal civilians, which provide those who require treatment for injuries or diseases sustained during overseas hostilities with care under the DOD military health system. GAO reviewed a sample of seven workers' compensation claims (out of a universe of 83) filed under FECA by DOD federal civilians who deployed to Iraq. GAO found in three cases where care was initiated in theater that the affected civilians had received treatment in accordance with DOD's policies. In all seven cases, DOD civilians who requested care after returning to the United States had, in accordance with DOD's policies, received medical examinations and/or treatment for their deployment-related injuries or diseases. GAO reported that DOD provides certain special pays and benefits to its deployed federal civilians, which generally differ in type and/or amount from those provided to deployed military personnel. For example, in cases where injuries are sustained while deployed, both DOD federal civilian and military personnel are eligible to receive government-provided disability benefits; however, the type and amount of the benefits vary, and some are unique to each group. Importantly, continuing challenges with modernizing federal disability programs have been the basis for GAO's designation of this as a high-risk area since 2003. In addition, while the survivors of deceased DOD federal civilian and military personnel generally receive similar types of cash survivor benefits for Social Security, burial expenses, and death gratuity, the comparative amounts of these benefits differ. However, survivors of DOD federal civilians almost always receive lower noncash benefits than military personnel. GAO does not take a position on the adequacy or appropriateness of the special pays and benefits provided to DOD federal civilian and military personnel. Any deliberations on this topic should include an examination of how such changes would affect ensuring adequate and appropriate benefits for those who serve their country, as well as the long-term fiscal well-being of the nation.