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

DOD has established force health protection and surveillance policies  aimed at assessing and reducing or preventing health risks for its deployed  federal civilian personnel; however, the department lacks procedures to  ensure the components’ full implementation of its policies. In  August 2006, DOD issued a revised policy (to be effective in December  2006) that outlines procedures to address its lack of centralized  deployment and health-related data. 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, DOD lacks  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. Nonetheless, DOD’s new policy is not comprehensive enough to ensure  that the department will be sufficiently informed of the extent to which its  components are complying with existing health protection requirements  for its deployed federal civilians. Until the department provides a similar oversight  and quality assurance mechanism for its deployed federal civilians, it will  not be effectively positioned to ensure compliance with its policies, or  ensure the health care and protection of these individuals as they continue  to support contingency operations. 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. Special Pays and Benefits Provided to Deployed DOD Federal Civilian and Military Personnel Generally Vary in Type and Amount

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. Further, survivors of deceased DOD federal civilian and military personnel  generally receive comparable types of cash survivor benefits—lump sum,  recurring, or both—but benefit amounts differ for the two groups. However, some special pays are unique to each group. Appendix I: Scope and Methodology

To assess the extent to which DOD has established force health protection  and surveillance policies for DOD federal civilians who deploy outside of  the United States in support of contingency operations, and how the  components (military services and the Defense Contract Management  Agency) have implemented those policies, we reviewed pertinent force  health protection and surveillance policies and discussed these policies  with the following offices or commands: U.S. Central Command; Joint  Chiefs of Staff, Manpower and Personnel; Under Secretary of Defense for  Personnel and Readiness (including the Assistant Secretary of Defense for  Health Affairs, Deployment Health Support Directorate; Civilian Personnel  Policy; and Civilian Personnel Management Services); the Surgeons  General for the Army, Navy, and Air Force; and the Defense Contract  Management Agency (DCMA). Appendix II: Temporary and Permanent Partial Disability Benefits Provided to DOD Federal Civilian and Military Personnel

Both DOD federal civilian and military personnel are eligible to receive  disability benefits when they sustain a line-of-duty injury.
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. The Senate Armed Services Committee required GAO to examine DOD's policies concerning the health care for DOD civilians who deploy in support of contingency operations in Afghanistan and Iraq. GAO analyzed over 3,400 deployment-related records for deployed federal civilians and interviewed department officials to determine the extent to which DOD has established and the military services and defense agencies (hereafter referred to as DOD components) have implemented (1) force health protection and surveillance policies and (2) medical treatment policies and procedures for its deployed federal civilians. GAO also examined the differences in special pays and benefits provided to DOD's deployed federal civilians and military personnel.

What GAO Found

DOD has established force health protection and surveillance policies to assess and reduce or prevent health risks for its deployed federal civilian personnel, but it lacks procedures to ensure implementation. Our review of over 3,400 deployment records at eight component locations found that components lacked documentation that some federal civilian personnel who deployed to Afghanistan and Iraq had received, among other things, required pre- and post-deployment health assessments and immunizations. These deficiencies were most prevalent at Air Force and Navy locations, and one Army location. As a larger issue, DOD lacked complete and centralized data to readily identify its deployed federal civilians and their movement in theater, further hindering its efforts to assess the overall effectiveness of its force health protection and surveillance capabilities. In August 2006, DOD issued a revised policy which outlined procedures that are intended to address these shortcomings. However, these procedures are not comprehensive enough to ensure that DOD will know the extent to which its components are complying with existing health protection requirements. In particular, the procedures do not establish an oversight and quality assurance mechanism for assessing the implementation of its force health protection and surveillance requirements. Until DOD establishes a mechanism to strengthen its force health protection and surveillance oversight, it will not be effectively positioned to ensure compliance with its policies, or the health care and protection of deployed federal civilians. DOD has also 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 that is equivalent in scope to that provided to active duty military personnel under the DOD military health system. GAO reviewed 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. 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 federal 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 through either military or civilian treatment facilities. 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, both civilian and military personnel are eligible to receive disability benefits for deployment-related injuries; however, the type and amount of these benefits vary, and some are unique to each group. Further, while the survivors of deceased federal civilian and military personnel generally receive similar types of cash survivor benefits, the comparative amounts of these benefits differ.