Centralized database. The Army and Air Force Did Not Comply with Deployment Health Surveillance Policies for Many Servicemembers

The Army and Air Force did not comply with DOD’s force health  protection and surveillance requirements for many of the servicemembers  in our samples at the selected installations we visited. Many Servicemembers Lacked Pre-deployment and Post-deployment Health Assessments

We found that servicemembers missing one or both of their pre- and  post-deployment assessments ranged from 38 to 98 percent in our  samples. Based on our review of servicemember medical records for the  deployments at the four installations we visited, we found that between  14 and 46 percent of the servicemembers were missing at least one of their  required immunizations prior to deployment (see fig. According to DOD health officials, the lack of complete and accurate  medical records complicated the diagnosis and treatment of  servicemembers who experienced post-deployment health problems that  they attributed to their military service in the Persian Gulf in 1990-91. As set forth  above, Public Law 105-85, enacted November 1997, requires the Secretary  of Defense to retain and maintain health-related records in a centralized  location. Health-related documentation missing from the centralized  database ranged from 0 to 63 percent for pre-deployment health  assessments, 11 to 75 percent for post-deployment health assessments,  and 8 to 93 percent for immunizations. We believe that the lack of such a system was  a major cause of the high rate of noncompliance we found at the units we  visited. DMDC is currently reviewing the deployment  information submitted by the services to determine its accuracy and  completeness. Moreover, because  DOD and the services do not have an effective quality assurance program  in place to help ensure compliance, these problems went undetected and  uncorrected. Continued noncompliance with these policies may result  in servicemembers with existing health problems or concerns being  deployed with unaddressed health problems or without the immunization  protection they need to counter theater disease threats. Appendix I: Scope and Methodology

To meet our objectives, we interviewed responsible officials and reviewed  pertinent documents, reports, and information related to force health  protection and deployment health surveillance requirements obtained  from officials at the Office of the Assistant Secretary of Defense for Health  Affairs; the Office of the Deputy Assistant Secretary of Defense for Force  Health Protection and Readiness; the Office of the Assistant Secretary of  Defense for Reserve Affairs; the Joint Staff; the Marine Corps Force Health  Protection Office; and the Offices of the Surgeons General for the Army  and Air Force Headquarters in the Washington, D.C., area. To determine whether the military services were meeting DOD’s force  health protection and surveillance requirements for servicemembers  deploying in support of OEF and OJG, we identified DOD and each  service’s overall deployment health surveillance policies. To determine whether DOD has corrected problems related to the  accuracy and completeness of databases reflecting which servicemembers  deployed to certain locations, we interviewed officials within the  Deployment Health Support Directorate and the Defense Manpower Data  Center and reviewed documentation related to the completeness of  deployment databases and planned improvements in capabilities.
Why GAO Did This Study

Following the 1990-91 Persian Gulf War, many servicemembers experienced health problems that they attributed to their military service in the Persian Gulf. However, a lack of servicemember health and deployment data hampered subsequent investigations into the nature and causes of these illnesses. Public Law 105-85, enacted in November 1997, required the Department of Defense (DOD) to establish a system to assess the medical condition of service members before and after deployments. GAO was asked to determine whether (1) the military services met DOD's force health protection and surveillance requirements for servicemembers deploying in support of Operation Enduring Freedom (OEF) in Central Asia and Operation Joint Guardian (OJG) in Kosovo and (2) DOD has corrected problems related to the accuracy and completeness of databases reflecting which servicemembers were deployed to certain locations.

What GAO Found

The Army and Air Force--the focus of GAO's review--did not comply with DOD's force health protection and surveillance policies for many active duty servicemembers, including the policies that they be assessed before and after deploying overseas, that they receive certain immunizations, and that health-related documentation be maintained in a centralized location. GAO's review of 1,071 servicemembers' medical records from a universe of 8,742 at selected Army and Air Force installations participating in overseas operations disclosed that 38 to 98 percent of servicemembers were missing one or both of their health assessments and 14 to 46 percent were missing at least one of the required immunizations. DOD also did not maintain a complete, centralized database of servicemembers' medical assessments and immunizations. Health-related documentation missing from the centralized database ranged from 0 to 63 percent for pre-deployment assessments, 11 to 75 percent for post-deployment assessments, and 8 to 93 percent for immunizations. There is no effective quality assurance program at the Office of the Assistant Secretary of Defense for Health Affairs or at the Army or Air Force that helps ensure compliance with policies. GAO believes that the lack of such a program was a major cause of the high rate of noncompliance. Continued noncompliance with these policies may result in servicemembers deploying with health problems or delays in obtaining care when they return. Finally, DOD's centralized deployment database is still missing the information needed to track servicemembers' movements in the theater of operations. By July 2003, the department's data center had begun receiving location-specific deployment information from the services and is currently reviewing its accuracy and completeness.