Naval Forces Central Command. Inconsistent and Ambiguous Policies Have Impeded Central Storage and Quality Assurance of OEHS Data Inconsistent DOD and Military Service-Specific Policies Have Resulted in Fragmentation and Duplication in the Storage of OEHS Data

Inconsistencies between DOD and military service-specific policies  regarding OEHS data storage has led to fragmentation and duplication of  OEHS data between the department’s two systems—MESL and  DOEHRS. Our prior work has  found that inefficiencies can occur when there is fragmentation and  duplication, such as when more than one system offers the same  services.store unclassified OEHS data, officials’ efforts to store these data are  inefficient and have resulted in both fragmentation and duplication. This  has occurred because, in some cases, similar types of unclassified OEHS   Without consistent policies on which system should be used to  data have been submitted to both MESL and DOEHRS, and in other  cases, identical OEHS data has been submitted to both systems. However, neither system serves as a central repository for these data. As  a result, it is difficult to identify complete and comprehensive data sets for  specific types of OEHS data, which may lead to problems when officials  attempt to use these data in the future. Officials may perform  these quality assurance checks while at a deployment site. As a result, some of the  military services developed their own guidance, which has resulted in  inconsistent approaches and levels of effort. This runs  counter to federal standards for internal control, which state that  management should continually monitor information captured and  maintained for several factors, including its reliability. Site Assessments Are Used to Identify Potential Health Risks, but the Extent to Which These Risks Are Mitigated for Deployed Servicemembers Is Unclear

		Site Assessments Are Used to Identify Potential Health Risks for Servicemembers Deployed to Iraq and Afghanistan

The military services use site assessments to identify and address  potential occupational and environmental health risks at deployment  locations. In 2007, DOD established the Occupational and Environmental  Health Site Assessment (OEHSA) as the standardized process for  assessing and reporting occupational and environmental health site  conditions at deployment sites. In contrast, DOD’s policy for its safety and occupational health  program requires that the department’s components, including the  combatant commands, establish procedures to ensure that decisions  related to risk management are documented, archived, and reevaluated  on a recurring basis. Furthermore, clear and appropriate documentation  is a key component of internal controls, according to the federal  standards for internal control. DOD’s and VA’s Use of OEHS Data to Address Post- Deployment Health Conditions Has Been Limited

Despite the ongoing collection of OEHS data, both DOD and VA have  used OEHS data to a limited extent to address post-deployment health  conditions. Force Health Protection & Readiness officials told us that the  primary limitation with OEHS data collected during deployments  continues to be the inability to capture individual servicemembers’  exposures—an issue that we reported on in 2012. However, problems with the  storage and quality assurance for OEHS data compromise the  departments’ ability to use them in determining service-connections for  specific health conditions, or in conducting other important research. Of additional concern, DOD does not know the extent to which  recommended countermeasures for mitigating exposures to occupational  and environmental health hazards are being implemented at deployment  sites because CENTCOM does not require the documentation of these  decisions. While the health and well-being of our servicemembers and  veterans is paramount, DOD’s and VA’s ability to prevent, diagnose, and  study post-deployment health conditions is compromised without  accessible and reliable information about risk mitigation activities and  OEHS data. Recommendations for Executive Action

To eliminate the fragmentation and duplication in the storage of  unclassified OEHS data we recommend that the Secretary of Defense  determine which IT system—DOEHRS or MESL—should be used to  store specific types of unclassified OEHS data, clarify the department’s  policy accordingly, and require all other departmental and military-service- specific policies to be likewise amended and implemented to ensure  consistency. To ensure that potential occupational and environmental health risks are  mitigated for servicemembers deployed to Iraq and Afghanistan, we  recommend that the Secretary of Defense require CENTCOM to revise its  policy to ensure that base commanders’ decisions on whether to  implement risk mitigation recommendations identified in OEHSAs are  adequately documented and consistently monitored by the appropriate  command. In commenting on this draft, DOD concurred with all of our  recommendations, and VA generally agreed with our conclusions. Further, CENTCOM officials told us that they are not monitoring the  implementation of these recommendations.
Why GAO Did This Study

OEHS is the regular collection and reporting of occupational and environmental health hazard data that can be used to help prevent, treat, or control disease or injury. In 2005, GAO reported that DOD needed to make improvements with OEHS during deployments to address immediate and long-term health issues.
GAO was asked to assess DOD's current OEHS efforts. This report examines (1) the extent to which the military services centrally store OEHS data and verify its reliability; (2) how, if at all, DOD identifies potential occupational and environmental health risks for sites in Iraq and Afghanistan, and to what extent these risks are mitigated; and (3) the extent to which DOD and VA use OEHS data to address post-deployment health conditions. GAO reviewed and analyzed DOD and military service policies on OEHS data storage and quality assurance, as well as policies related to conducting and monitoring assessments for deployment sites. GAO also interviewed DOD, military service, and VA officials, as well as groups representing servicemembers and veterans.

What GAO Found

Inconsistencies between Department of Defense (DOD) and military service-specific policies regarding occupational and environmental health surveillance (OEHS) data storage have contributed to fragmentation and duplication of OEHS data between two information technology systems—the Military Exposure Surveillance Library (MESL) and the Defense Occupational and Environmental Health Readiness System (DOEHRS). Not having consistent policies for which system should be used to store OEHS data is contrary to federal standards for internal control. As a result, officials' efforts to store these data have resulted in both fragmentation and duplication, which GAO's prior work has shown may result in inefficiencies. Correspondingly, in some cases, similar types of unclassified OEHS data are being submitted to both MESL and DOEHRS, and in other cases, identical OEHS data are being submitted to both systems. However, neither system serves as a central repository for these data, and as a result, it is difficult to identify complete and comprehensive OEHS data sets, which may lead to problems when officials attempt to use these data in the future. Additionally, DOD's policy for OEHS data does not specifically address quality assurance. Consequently, some of the military services have developed their own guidance, resulting in inconsistent approaches and levels of effort, which has reduced DOD's ability to be confident that the data are sufficiently reliable. Federal standards for internal control state that management should continually monitor information captured and maintained for several factors, including reliability.
The military services use site assessments to identify and address potential occupational and environmental health risks at a deployment site. These assessments may include recommended countermeasures, such as the use of personal protective equipment. However, the extent to which these recommendations are being implemented is unclear because U.S. Central Command (CENTCOM)—the combatant command responsible for military operations in the geographic area that includes Iraq and Afghanistan—does not require base commanders to document their decisions on implementing them. Officials also said they are not monitoring these recommendations, and instead rely on others to elevate concerns, as necessary. In contrast, DOD's policy for its safety and occupational health program requires the department's components, including the combatant commands, to ensure that risk management decisions are documented and reevaluated. Federal standards for internal control also note that appropriate documentation is a key internal control activity and that agencies should monitor their activities for managing identified risks.
Both DOD and the Department of Veterans Affairs (VA) have used OEHS data to a limited extent to address post-deployment health conditions. For example, DOD officials said that the primary limitation with OEHS data collected during deployments continues to be the inability to capture exposure data at the individual servicemember level, although a method to do so is currently being explored. Additionally, DOD and VA use OEHS data to conduct research that may help determine service connections for post-deployment health conditions, but it has been difficult for researchers to establish a causal link between exposures and specific health conditions.

What GAO Recommends

GAO recommends that DOD clarify its policies for the storage and quality assurance of OEHS data, and require other related policies to be amended accordingly. GAO also recommends that CENTCOM revise its policy to require adequate documentation and consistent monitoring of deployment risk mitigation activities. In commenting on the report, DOD concurred with GAO's recommendations, and VA generally agreed with the conclusions.