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entitled 'Defense Health Care: Comprehensive Oversight Framework Needed 
to Help Ensure Effective Implementation of a Deployment Health Quality 
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Report to the Ranking Member, Subcommittee on National Security and 
Foreign Affairs, Committee on Oversight and Government Reform, House of 
Representatives: 

United States Government Accountability Office: 

GAO: 

June 2007: 

Defense Health Care: 

Comprehensive Oversight Framework Needed to Help Ensure Effective 
Implementation of a Deployment Health Quality Assurance Program: 

GAO-07-831: 

GAO Highlights: 

Highlights of GAO-07-831, a report to the Ranking Member, Subcommittee 
on National Security and Foreign Affairs, Committee on Oversight and 
Government Reform, House of Representatives 

Why GAO Did This Study: 

Overseas deployments expose servicemembers to a number of potential 
risks to their health and well-being. However, since the mid-1990s, GAO 
has highlighted shortcomings with respect to the Department of 
Defense’s (DOD) ability to assess the medical condition of 
servicemembers both before and after their deployments. Following GAO’s 
May 1997 report, Congress enacted legislation (10 U.S.C. § 1074f) that 
required the Secretary of Defense to establish a medical tracking 
system for assessing the medical condition of servicemembers before and 
after deployments. GAO was asked to determine (1) whether DOD has 
established a medical tracking system to comply with requirements of 10 
U.S.C. § 1074f pertaining to pre- and postdeployment medical 
examinations, and (2) the extent to which DOD has effectively 
implemented a deployment health quality assurance program as part of 
its medical tracking system. In conducting this review, GAO analyzed 
pertinent documents and interviewed DOD officials. 

What GAO Found: 

DOD has established a system to comply with the requirements of 10 
U.S.C. § 1074f to perform predeployment and postdeployment medical 
examinations through a variety of deployment health activities. For 
example, DOD’s system includes the use of pre- and postdeployment 
health assessment questionnaires along with reviews of servicemembers’ 
medical records. The pre- and postdeployment health assessment 
questionnaires ask servicemembers to respond to a series of questions 
about their current medical and mental health conditions and any 
medical concerns they might have. Prior to deploying, the predeployment 
questionnaire and servicemembers’ medical records are to be reviewed by 
a health care provider to confirm whether servicemembers have met 
applicable deployment health requirements. Also, prior to or after 
redeploying, the postdeployment questionnaires are to be reviewed by a 
health care provider, along with servicemembers’ medical records, to 
determine whether additional clinical evaluation or treatment is 
needed. 

DOD has established a deployment health quality assurance program as 
part of its medical tracking system, but does not have a comprehensive 
oversight framework to help ensure effective implementation of the 
program. Thus, DOD does not have the information it needs to evaluate 
the effectiveness and efficiency of its deployment health quality 
assurance program. DOD policy specifies four elements of the program: 
(1) monthly reports on active and reserve component servicemembers’ 
deployment health data from the Army Medical Surveillance Activity 
(AMSA), (2) quarterly reports on service-specific quality assurance 
programs, (3) DOD site visits to military installations, and (4) an 
annual report on the program. DOD guidance requires each of the 
services to create their own quality assurance programs based on these 
elements. However, GAO found weaknesses in each of these elements. For 
example, DOD’s policy does not contain specific reporting requirements 
or performance measures that require AMSA to provide critical 
information needed to assess departmentwide compliance with deployment 
health requirements, such as tracking the total number of 
servicemembers who deploy overseas or return home during a specific 
time period. Also, DOD does not have quality controls in place to 
ensure the accuracy or completeness of the information it collects 
during site visits to military installations. Without a comprehensive 
oversight framework, DOD is not well-positioned to determine or assure 
Congress that active and reserve component servicemembers are medically 
and mentally fit to deploy and to determine their medical and mental 
condition upon return. Having an effective deployment health quality 
assurance program is critically important given DOD’s long-standing 
problems with assessing the medical condition of servicemembers before 
and after their deployments. Such a program has become even more 
important in the current environment, where active and reserve 
component servicemembers continue to deploy overseas in significant 
numbers in support of ongoing military operations in Afghanistan and 
Iraq. 

What GAO Recommends: 

GAO is recommending that DOD develop a comprehensive oversight 
framework with reporting requirements and results-oriented performance 
measures to improve the implementation of its deployment health quality 
assurance program. In reviewing a draft of this report, DOD concurred 
with GAO’s recommendations. 

[Hyperlink, http://www.gao.gov/cgi-bin/getrpt?GAO-07-831]. 

To view the full product, including the scope and methodology, click on 
the link above. For more information, contact Brenda S. Farrell at 
(202) 512-3604 or farrellb@gao.gov. 

[End of section] 

Contents: 

Letter: 

Results in Brief: 

Background: 

DOD Has a System in Place to Comply with Requirements for Deployment 
Medical Examinations: 

DOD Has Established a Deployment Health Quality Assurance Program, but 
the Lack of a Comprehensive Oversight Framework Hampers Effective 
Implementation: 

Conclusions: 

Recommendations for Executive Action: 

Agency Comments and Our Evaluation: 

Appendix I: Scope and Methodology: 

Appendix II: Pre-and Postdeployment Health Assessment Questionnaires: 

Appendix III: Individual Medical Readiness: 

Appendix IV: Comments from the Department of Defense: 

Appendix V: GAO Contact and Staff Acknowledgments: 

Related GAO Products: 

Abbreviations: 

AMSA: Army Medical Surveillance Activity: 
DHSD: Deployment Health Support Directorate: 
DMSS: Defense Medical Surveillance System: 
DNA: Deoxyribonucleic Acid: 
DOD: Department of Defense: 
GPRA: Government Performance and Results Act of 1993: 
HIV: Human Immunodeficiency Virus: 
IPV: Inactivated Poliovirus: 
MMR: Measles, Mumps, and Rubella: 

United States Government Accountability Office: 
Washington, DC 20548: 

June 22, 2007: 

The Honorable Christopher Shays: 
Ranking Member: 
Subcommittee on National Security and Foreign Affairs: 
Committee on Oversight and Government Reform: 
House of Representatives: 

Dear Mr. Shays: 

Overseas deployments expose servicemembers to a number of potential 
risks to their health and well-being. However, since the mid-1990s we 
have been reporting on DOD's shortcomings with respect to assessing the 
medical condition of servicemembers both before and after their 
deployments. Following our May 1997 report,[Footnote 1] Congress 
enacted legislation[Footnote 2] that required the Secretary of Defense 
to establish a medical tracking system to assess the medical condition 
of servicemembers before and after deployments to locations outside the 
United States. The elements of the system, as required by the law, 
included, among other things, the use of pre-and postdeployment medical 
examinations. As part of the system, the law also required DOD to 
establish a quality assurance program to evaluate the success of the 
system in ensuring that servicemembers receive pre-and postdeployment 
medical examinations and that record-keeping requirements with respect 
to the system are met. However, our September 2003 report highlighted 
many instances of noncompliance with DOD's deployment health 
requirements and reiterated the need for DOD to establish a quality 
assurance program to ensure that these requirements are met.[Footnote 
3] In September 2004, we reported similar findings for reserve 
forces.[Footnote 4] Further, our November 2004 report raised concerns 
that overall compliance with DOD's force health protection and 
surveillance policies for servicemembers who deployed in support of 
Operation Iraqi Freedom varied by service, by installation, and by 
policy requirement.[Footnote 5] More recently, in October 2005 we 
reported that evidence suggested that some reserve component members 
have deployed into theater with preexisting medical conditions that 
could not be adequately addressed in-theater.[Footnote 6] 

In light of these long-standing problems, you asked us to examine DOD's 
compliance with the legislative requirement to perform pre-and 
postdeployment medical examinations on servicemembers and DOD's 
deployment health quality assurance program. This report addresses (1) 
whether DOD has established a medical tracking system to comply with 
requirements of 10 U.S.C. § 1074f pertaining to pre-and postdeployment 
medical examinations, and (2) the extent to which DOD has effectively 
implemented a deployment health quality assurance program as part of 
its medical tracking system. 

To address our objectives, we obtained and reviewed pertinent 
documents, reports, and information related to DOD's deployment health 
requirements and deployment health quality assurance program from 
officials at the Assistant Secretary of Defense for Health Affairs, 
Deployment Health Support Directorate (DHSD); the Offices of the 
Surgeons General for the Army, Air Force, and Navy; the Army Medical 
Surveillance Activity (AMSA); and the Combined Fleet Forces Command and 
Naval Environmental Health Center. To determine whether DOD has 
established a medical tracking system to comply with requirements of 10 
U.S.C. § 1074f pertaining to pre-and postdeployment medical 
examinations, we reviewed 10 U.S.C. § 1074f to identify system 
requirements and DOD policies and other guidance to identify the 
measures DOD uses to establish the medical condition of servicemembers 
as part of this system. In addition, we obtained a legal opinion from 
DOD's Office of General Counsel regarding DOD's compliance with the 
requirement of 10 U.S.C. § 1074f to perform pre-and postdeployment 
medical examinations. To determine the extent to which DOD has 
effectively implemented a deployment health quality assurance program 
as part of its medical tracking system, we obtained and analyzed 
relevant DOD policies to identify requirements of the program. We also 
interviewed key officials with DHSD and the services' Offices of the 
Surgeon General to obtain a comprehensive understanding of the 
processes, procedures, and controls used for monitoring and overseeing 
the deployment health quality assurance program. We obtained and 
analyzed the results of site visits conducted by DHSD in calendar years 
2005 and 2006. To determine the reliability of DOD's quality assurance 
program reports, we obtained and analyzed data collection instruments 
and other documentation used to record, summarize, and report the 
services' compliance with deployment health requirements. We also 
discussed with responsible DOD officials, including representatives 
from the military services, their methodology for ensuring that 
information collected and reported is as accurate and reliable as 
possible. Where possible, we tested data by comparing information from 
the data collection instruments or summary documents with available 
source documents. We identified issues of inconsistency and 
incompleteness in DOD's data and, therefore, determined the data to be 
insufficiently reliable for the purpose of assessing compliance with 
deployment health requirements and we are making a recommendation to 
address this issue accordingly. In conducting our review, we limited 
our focus to the procedures that DOD has in place to medically assess 
servicemembers before and after their deployments. Other issues, such 
as recent controversies associated with alleged deployments of 
medically unfit servicemembers to Iraq, did not fall within the scope 
of this review. These issues will be addressed as part of a separate 
review. We performed our work from September 2006 through May 2007 in 
accordance with generally accepted government auditing standards. For 
more detailed information on our scope and methodology, see appendix I. 

Results in Brief: 

DOD has established a medical tracking system to comply with the 
requirements of 10 U.S.C. § 1074f to perform predeployment and 
postdeployment medical examinations through a variety of deployment 
health activities. This section of the law requires the Secretary of 
Defense to establish a system to assess the medical condition of 
servicemembers deployed outside the United States. According to the 
law, the system is to include the use of medical examinations, 
including an assessment of mental health and the drawing of blood 
samples, both before and after deployment. DOD has established a 
medical tracking system to assess the medical condition of 
servicemembers intended to ensure that only medically and mentally fit 
servicemembers deploy outside of the United States. For example, DOD's 
system includes the use of pre-and postdeployment health assessment 
questionnaires and reviews of servicemembers' medical records (e.g., 
physical examinations, immunizations, dental history). The 
predeployment health assessment questionnaires, which are to be 
completed no earlier than 60 days prior to deployment, are a series of 
questions about servicemembers' current medical (including dental) and 
mental health conditions, including prescriptions, vision issues, and 
any medical concerns servicemembers might have. These questionnaires 
and servicemembers' medical records are to be reviewed by a health care 
provider to confirm whether servicemembers have received standard and 
theater-specific immunizations and recent medical (physical) 
examinations that identify diseases and medical conditions that may 
prevent them from deploying. Based on the responses to the 
predeployment questionnaires and the review of the medical records, 
servicemembers may be referred for further testing and evaluation prior 
to deployment. Also, within 30 days prior to or after 
redeploying,[Footnote 7] servicemembers are to complete the 
postdeployment health assessment questionnaire. The postdeployment 
questionnaires are to be reviewed by a health care provider, along with 
servicemembers' medical records, to evaluate current health status, 
deployment experiences, environmental exposures, and health concerns 
related to their deployments. Based on these reviews, the health care 
provider may recommend additional clinical evaluation or treatment as 
needed. In response to an inquiry from our office, DOD's Office of 
General Counsel explained that the health assessments the department 
performs meet the requirement of 10 U.S.C. § 1074f for pre-and 
postdeployment medical examinations. We conclude that DOD's 
interpretation is reasonable. 

DOD has also established a deployment health quality assurance program 
as part of its medical tracking system, but lacks a comprehensive 
oversight framework to help ensure effective implementation of the 
program. Thus, DOD does not have the information it needs to evaluate 
the effectiveness and efficiency of its quality assurance program. The 
Government Performance and Results Act of 1993[Footnote 8] (GPRA) 
provides federal agencies with a framework for developing oversight, 
which includes establishing reporting requirements and performance 
measures. DOD's deployment health quality assurance program policy 
specifies four elements of DOD's program: (1) monthly reports on active 
and reserve component servicemembers' deployment health assessment data 
from centralized databases maintained by AMSA, (2) quarterly reports on 
service-specific deployment health quality assurance programs, (3) 
periodic visits to military installations to complement and validate 
the services' deployment health programs, and (4) an annual report to 
the Assistant Secretary of Defense for Health Affairs on the 
department's quality assurance program. DOD guidance requires each of 
the services to create their own quality assurance programs based on 
these elements. While DOD has established a program that includes these 
four elements, DOD cannot determine whether the program has been 
effectively implemented because DOD does not have a comprehensive 
oversight framework with all the specific reporting requirements and 
necessary performance measures to evaluate the services' compliance 
with deployment health requirements or to help ensure that the services 
are implementing the program consistently. 

* Monthly AMSA reports: Although DOD requires monthly reports from AMSA 
on servicemembers' deployment health data, it does not provide AMSA 
with results-oriented performance measures and specific reporting 
requirements that would enable DOD to determine the departmentwide 
compliance with deployment health requirements. For example, DOD's 
policy does not require that AMSA provide critical information needed 
to assess compliance with deployment health requirements, such as the 
total number of servicemembers that deployed/redeployed during the 
reporting period. Without knowing the total number of servicemembers 
deployed/redeployed, DOD cannot determine the extent to which 
servicemembers completed the required pre-and postdeployment health 
assessment questionnaires. 

* Quarterly reports on the services' programs: While DOD's policy 
requires that the services report on service-specific compliance with 
deployment health requirements in their quarterly reports, DOD has not 
enforced this requirement. Consequently, each service is choosing to 
selectively report on requirements, which prevents the department from 
having a complete picture/assessment of compliance with deployment 
health requirements across the services. For example, while the Army 
reports on only a sample of servicemembers who deploy or redeploy 
during the reporting period, the Air Force reports on the total number 
of servicemembers who deploy or redeploy during the reporting period. 
However, the Army's report includes all overseas locations of 
deployment whereas the Air Force only reports on deployments in support 
of Operations Iraqi Freedom or Enduring Freedom. 

* Site visits: While DHSD conducts four visits per year to military 
installations to assess the services' deployment health quality 
assurance programs, it does not have quality controls in place to 
ensure the accuracy or completeness of the information it collects. 
DHSD representatives use data collection instruments to facilitate 
their program reviews, but DHSD officials told us that none of these 
instruments are reviewed by an independent or second reviewer. 
Independent reviews are a key aspect of quality controls that reduce 
the risk of errors in a quality assurance program. In our review of 
calendar years 2005 and 2006 DHSD site visit reports and supporting 
documentation, we found instances of incomplete data including missing 
dates for when pre-and postdeployment health assessment questionnaires 
were administered. Moreover, we found that DHSD did not always adhere 
to DOD's deployment health requirements when assessing the programs. 
For example, while not all servicemembers received blood draws upon 
redeployment within the required time frame, DHSD made determinations 
in their site visit reports that the services had adhered to the 
requirements. 

Because of these weaknesses, DOD's annual report does not provide DOD 
and congressional decision makers with complete, comprehensive, and 
accurate information to determine if the department is complying with 
its own deployment health requirements. Moreover, DOD and congressional 
decision makers are unable to determine whether DOD has effectively 
implemented a quality assurance program to determine or assure Congress 
that servicemembers are medically and mentally fit to deploy and to 
determine their medical and mental condition upon return. Having an 
effective deployment health quality assurance program is critically 
important given DOD's long-standing problems with assessing the medical 
condition of active and reserve component servicemembers both before 
and after their deployments, and has become even more important in the 
current environment, where these servicemembers continue to deploy 
overseas in significant numbers in support of ongoing military 
operations. 

We are recommending that DOD develop a comprehensive oversight 
framework with reporting requirements and results-oriented performance 
measures to improve the implementation of its deployment health quality 
assurance program. In written comments on a draft of this report, DOD 
concurred with our recommendations. DOD's comments are reprinted in 
appendix IV. 

Background: 

In November 1997, Congress included a provision in the National Defense 
Authorization Act for Fiscal Year 1998[Footnote 9] that required the 
Secretary of Defense to establish a medical tracking system for 
servicemembers deployed overseas. Specifically, the legislation 
required the following: 

"(a) System Required--The Secretary of Defense shall establish a system 
to assess the medical condition of members of the armed forces 
(including members of the reserve components) who are deployed outside 
the United States or its territories or possessions as part of a 
contingency operation (including a humanitarian operation, peacekeeping 
operation, or similar operation) or combat operation. 

"(b) Elements Of System--The system described in subsection (a) shall 
include the use of predeployment medical examinations and 
postdeployment medical examinations (including an assessment of mental 
health and the drawing of blood samples) to accurately record the 
medical condition of members before their deployment and any changes in 
their medical condition during the course of their deployment. The 
postdeployment examination shall be conducted when the member is 
redeployed or otherwise leaves an area in which the system is in 
operation (or as soon as possible thereafter). 

"(c) Recordkeeping--The results of all medical examinations conducted 
under the system, records of all health care services (including 
immunizations) received by members described in subsection (a) in 
anticipation of their deployment or during the course of their 
deployment, and records of events occurring in the deployment area that 
may affect the health of such members shall be retained and maintained 
in a centralized location to improve future access to the records. 

"(d) Quality Assurance--The Secretary of Defense shall establish a 
quality assurance program to evaluate the success of the system in 
ensuring that members described in subsection (a) receive predeployment 
medical examinations and postdeployment medical examinations and that 
the recordkeeping requirements with respect to the system are met." 

The Assistant Secretary of Defense for Health Affairs has the 
responsibility for establishing the overall policy and guidance 
necessary for DOD to implement the required medical tracking system, 
including the associated quality assurance program. Within the Office 
of the Assistant Secretary of Defense for Health Affairs, the Deputy 
Assistant Secretary of Defense for Force Health Protection and 
Readiness has responsibility for the day-to-day operations and 
management of both the medical tracking system and the quality 
assurance program. It is then the responsibility of the Offices of the 
Surgeons General of the Army, Navy, and Air Force to implement and 
manage the day-to-day operations of the medical tracking system and the 
quality assurance program within the respective services. 

Our prior work has highlighted weaknesses in DOD's assessment of 
servicemembers' health before and after deployment. In September 2003, 
we reported that the Army and Air Force did not comply with DOD's force 
health protection and surveillance requirements for many servicemembers 
deploying in support of Operation Enduring Freedom in Central Asia and 
Operation Joint Guardian in Kosovo.[Footnote 10] Specifically, our 
review disclosed problems with the Army's and Air Force's 
implementation of DOD's force health protection and surveillance 
requirements in the following areas: (1) deployment health assessments, 
(2) immunizations and other predeployment requirements, and (3) the 
completeness of medical records and centralized data collection. Our 
September 2003 report also raised concerns over a lack of DOD oversight 
of departmentwide efforts to comply with health surveillance 
requirements. Specifically, we reported that an effective quality 
assurance program had not been established at the Office of the 
Assistant Secretary of Defense for Health Affairs or at the Offices of 
the Surgeons General of the Army or Air Force to help ensure compliance 
with force health protection and surveillance policies. We believed 
that the lack of such a system was a major cause of the high rate of 
noncompliance and thus recommended that the department establish an 
effective quality assurance program to ensure that the military 
services comply with the force health protection and surveillance 
requirements for all servicemembers. The department concurred with our 
recommendation, and in January 2004 began implementation of its 
deployment health quality assurance program. 

In September 2004, we reported similar issues related to DOD's ability 
to effectively manage the health status of its reserve forces.[Footnote 
11] Specifically we noted that DOD's centralized database had missing 
and incomplete predeployment health assessment questionnaires because 
not all of the required health information collected from reserve 
component members had reached DOD's central data collection point. We 
recommended that the Secretary of Defense take steps to ensure that 
predeployment health assessment questionnaires are submitted to the 
centralized data collection point as required. DOD concurred with our 
recommendation and noted that revised guidance was currently in 
coordination to clarify the requirement for submitting predeployment 
health assessments to the centralized database. 

In November 2004, we reported that overall compliance with DOD's force 
health protection and surveillance policies for servicemembers who 
deployed in support of Operation Iraqi Freedom varied by service, by 
installation, and by policy requirement.[Footnote 12] At that time, we 
did not evaluate the effectiveness of DOD's deployment health quality 
assurance program because of the relatively short time of its 
implementation. 

Finally, in October 2005 we reported that evidence suggested that 
reserve component members have deployed into theater with preexisting 
medical conditions that could not be adequately addressed in- 
theater.[Footnote 13] We also reported that DOD had limited visibility 
over the health status of reserve component members after they are 
called to duty and is unable to determine the extent of care provided 
to those members deployed with preexisting medical conditions despite 
the existence of various sources of medical information. We recommended 
that the Secretary of Defense determine what preexisting medical 
conditions should not be allowed into specific theaters of operations 
and to take steps to ensure that each service component consistently 
utilizes these as criteria for determining the medical deployability of 
its reserve component members. We also recommended that the Secretary 
of Defense explore using existing tracking systems to track those who 
have treatable preexisting medical conditions in theater. DOD partially 
concurred with our recommendation concerning the identification of 
preexisting medical conditions that would preclude deployment and noted 
that the services had made advances in identifying some preexisting 
conditions that would preclude deployment, but also stated that due to 
the ever-changing nature of theater of operations this list could never 
be fully comprehensive or fully enforceable. DOD also concurred with 
our recommendation pertaining to the use of existing tracking systems 
to track treatable preexisting medical conditions. Specifically, DOD 
indicated that ongoing refinements to these systems based on lessons 
learned would improve the documentation of medical conditions 
throughout the military services including information concerning 
reserve members with preexisting conditions. 

DOD Has a System in Place to Comply with Requirements for Deployment 
Medical Examinations: 

DOD has established a medical tracking system to comply with the 
requirement of 10 U.S.C. § 1074f to perform predeployment and 
postdeployment medical examinations through a variety of deployment 
health activities, including the use of pre-and postdeployment health 
assessment questionnaires along with reviews of servicemembers' medical 
records. This section of the law requires the Secretary of Defense to 
establish a medical tracking system to assess the medical condition of 
servicemembers deployed outside the United States. According to section 
1074f(b)(1), the system is to include the use of medical examinations, 
including an assessment of mental health and the drawing of blood 
samples, both before and after deployment. 

In DOD's May 1998 report to Congress, the department outlined its 
approach to establish a medical tracking system for servicemembers 
deployed overseas.[Footnote 14] As part of this approach, DOD performed 
medical examinations using predeployment and postdeployment health 
assessment questionnaires, including an assessment of mental health and 
drawing of blood samples, both before and after deployment. The 
predeployment assessment consisted of a series of questions about the 
servicemembers' current medical (including dental) and mental health 
conditions, including prescriptions, vision issues, and any medical 
concerns servicemembers might have. In 2002, DOD established the 
requirement that the predeployment assessment was to be completed 
within 30 days prior to deployment. The postdeployment assessment 
consisted of a series of questions about the servicemembers medical and 
mental health condition resulting from having been deployed. It was to 
be completed prior to leaving the theater of operation or within 30 
days of final departure from theater. Examples of the pre-and 
postdeployment questionnaires can be found in appendix II. 

In August 2006, DOD replaced and expanded its approach with a 
comprehensive deployment health program.[Footnote 15] Within the 
programs, DOD required the military services to perform a number of 
activities designed to monitor servicemembers' health before and after 
deployments, including the following: 

* Predeployment Activities. First, servicemembers are required to 
complete a predeployment health assessment questionnaire no earlier 
than 60 days prior to deployment. Second, the questionnaires are 
required to be reviewed by a health care provider[Footnote 16] to 
determine whether the servicemember is fit to deploy. To make this 
determination, the health care provider should review both the 
servicemembers' medical records and responses to the questions. The 
medical records are reviewed and evaluated against the following six 
individual medical readiness elements: whether the servicemember has 
(1) received an annual assessment for changes in health status; (2) any 
deployment-limiting conditions such as pregnancy, asthma, severe 
traumatic injuries with incomplete rehabilitation, etc; (3) oral 
conditions that if not treated could result in dental emergencies; (4) 
received all required immunizations; (5) received medical readiness 
laboratory tests such as HIV testing and has current DNA samples on 
file, (6) all required individual medical equipment. For more detailed 
information about individual medical readiness requirements see 
appendix III. Prior to deployment, DOD requires that any condition that 
causes a servicemember to receive a failing mark in any of these six 
elements be corrected. Corrective actions could include providing the 
servicemember with required immunizations, screening for tuberculosis, 
or drawing serum specimens. Based on the health care provider review 
and the responses to specific questions on the assessment, 
servicemembers may be referred, prior to deploying, to the appropriate 
health care provider(s) for further testing and evaluation, if needed, 
for medical conditions or concerns (e.g., cardiac, mental health). DOD 
requires that the completed questionnaire be placed in the 
servicemember's medical record and a copy be sent to AMSA for record 
keeping. 

* Postdeployment Activities. DOD requires that a postdeployment health 
assessment questionnaire be completed during the period from 30 days 
prior to and 30 days after redeployment. The completed form is to be 
placed in the servicemember's medical record and a copy sent to AMSA. 
In addition, a review of the servicemembers' medical records and a face-
to-face meeting with a trained health care provider[Footnote 17] are to 
be completed within 30 days of redeployment to discuss the individual's 
responses on the postdeployment health assessment, mental health or 
psychosocial issues commonly associated with deployments, prescription 
medications taken during deployment, and concerns about possible 
environmental or occupational exposures. Additional requirements 
include documentation of medical referrals or concerns resulting from 
deployment, documentation of the results of any follow- up 
examinations, tuberculosis screening for high-risk servicemembers, and 
blood serum sample collection within 30 days of redeployment. In 2005, 
DOD issued a new policy requiring a postdeployment health reassessment 
questionnaire as well.[Footnote 18] The purpose of the reassessment is 
to identify health concerns that emerge over time after deployment and 
is to be conducted between 90 and 180 days after servicemembers return 
to their home station. 

We requested the views of DOD's Office of General Counsel on DOD's 
compliance with the medical examination requirement of section 
1074f.[Footnote 19] DOD's Office of General Counsel noted that DOD's 
May 1998 report to Congress provided the department's understanding 
that the medical examination requirement was satisfied by the plan to 
carry out health assessments. DOD's Office of General Counsel pointed 
out that subsequent to this report to Congress, Congress did not, until 
October of 2006,[Footnote 20] amend section 1074f or otherwise 
establish a requirement different than that described in the 
department's 1998 report. DOD's Office of General Counsel further 
pointed out that subsequent to DOD's 1998 report, Congress did enact 
other laws that refer to health assessments required by section 
1074f.[Footnote 21] DOD's Office of General Counsel concluded that 
"although the term 'medical examination' was not defined in the 
original 1997 statute, from 1998 until the present, both DOD and the 
Congress have used the terms 'medical examination' and 'health 
assessment' synonymously to describe the Military Health System pre-and 
postdeployment action required by section 1074f." 

The term "medical examinations" in the statute could be interpreted to 
mean medical activities beyond those included in DOD's current 
deployment health program as described above. However, DOD's use of a 
variety of deployment health activities, including the use of pre-and 
postdeployment health assessment questionnaires along with reviews of 
servicemembers' medical records is a reasonable interpretation of 
section 1074f. 

DOD Has Established a Deployment Health Quality Assurance Program, but 
the Lack of a Comprehensive Oversight Framework Hampers Effective 
Implementation: 

DOD has established a deployment health quality assurance program as 
part of its medical tracking system, but lacks a comprehensive 
oversight framework to help ensure effective implementation of the 
program. DOD's deployment health quality assurance program policy 
outlines four specific elements--such as monthly reports on 
servicemembers' deployment health data from a centralized database 
maintained by AMSA--and it requires each of the services to create 
their own quality assurance programs based on these elements. While DOD 
has established a program that includes these four elements, it cannot 
determine whether the program has been effectively implemented because 
DOD does not have a comprehensive oversight framework with all the 
specific reporting requirements and necessary performance measures to 
evaluate the services' compliance with deployment health requirements 
or to ensure that the services are implementing the program 
consistently. 

DOD Has Established a Deployment Health Quality Assurance Program: 

In response to congressional mandates and a GAO recommendation, in 
January 2004 DOD established a deployment health quality assurance 
program, as part of its medical tracking system, designed to assess 
compliance with deployment health requirements. DOD's policy and 
implementing guidance for the program is contained in a memorandum from 
the Assistant Secretary of Defense for Health Affairs.[Footnote 22] 
DOD's policy delegates the responsibility for executing the program to 
the Deputy Assistant Secretary of Defense for Force Health Protection 
and Readiness, DHSD, and to the military services. According to the 
policy, DOD's program consists of the following four elements: 

* Periodic reporting on pre-and postdeployment health assessments. AMSA 
is required to provide (at a minimum) monthly reports to DHSD on active 
and reserve component servicemembers' deployment health assessment 
data. 

* Periodic reporting on service-specific deployment health quality 
assurance programs. The services are required to provide (at a minimum) 
quarterly reports to DHSD on the status and findings, including 
compliance with deployment health requirements, of their respective 
required quality assurance programs. 

* Periodic visits to military installations to assess deployment health 
programs. The program requires joint visits by representatives from 
DHSD and from service medical departments to military installations for 
the purpose of complementing and validating the services' deployment 
health quality assurance reporting. 

* An annual report on the DOD deployment health quality assurance 
program. The program requires that DHSD prepare and coordinate with the 
services an annual report on the status of the requirements of the 
program to the Assistant Secretary of Defense for Health 
Affairs.[Footnote 23] 

DOD Does Not Have a Comprehensive Oversight Framework to Determine 
Whether Its Deployment Health Quality Assurance Program Has Been 
Effectively Implemented: 

DOD has not established a comprehensive oversight framework for its 
deployment health quality assurance program, which is necessary to 
ensure the program's effective implementation. GPRA provides federal 
agencies with a model framework for developing program 
oversight.[Footnote 24] Specifically, GPRA establishes a results- 
oriented framework that identifies, among other things, performance 
measures and reporting requirements. However, DOD does not have a 
comprehensive oversight framework with all the specific reporting 
requirements and necessary performance measures to evaluate the 
services' compliance with deployment health requirements or to help 
ensure that the services are implementing the program consistently. 
Because DOD's deployment health quality assurance program lacks a 
comprehensive oversight framework, the program, as currently 
implemented, does not provide decision makers with the information they 
need to evaluate the effectiveness and efficiency of either DOD's or 
the services' respective quality assurance programs. In reviewing DOD's 
program, we found problems with its implementation of the monthly AMSA 
reports, the quarterly service-specific reports, and the DHSD site 
visits. Because DOD's annual report is based on information from these 
three elements, the department's annual report does not provide DOD or 
congressional decision makers with the complete, comprehensive, and 
accurate information necessary to determine whether the department is 
complying with its own deployment health requirements. Moreover, DOD 
and congressional decision makers are unable to determine whether DOD 
has effectively implemented a quality assurance program that reasonably 
assures that servicemembers are medically fit to deploy. 

DOD Has Not Identified All Results-Oriented Performance Measures and 
Has Not Provided AMSA with Specific Reporting Requirements: 

DOD's deployment health quality assurance program requires that AMSA 
submit to DHSD monthly reports on active and reserve component 
servicemembers' deployment health assessment data. The deployment 
health assessment data that AMSA reports are collected individually by 
the services and maintained centrally in the Defense Medical 
Surveillance System (DMSS) at AMSA.[Footnote 25] However, in reviewing 
AMSA's reports we found that while the reports provide some data on 
servicemembers' deployment health, they do not provide all the 
essential information necessary to assess the services' compliance or 
determine departmentwide compliance with all deployment health 
requirements. This problem results largely because DOD has not 
identified all the necessary results-oriented performance measures and 
provided AMSA with specific reporting requirements for all deployment 
health requirements. DOD's policy identifies some performance measures 
that could be used to assess whether the services are complying with 
selected deployment health requirements, such as measures for the 
identification of deployed/redeployed personnel and whether pre-and 
postdeployment health assessment questionnaires are on file at AMSA. 
However, DOD's policy does not identify performance measures for 
additional deployment health requirements such as whether 
servicemembers received all required immunizations. In addition, DOD's 
policy does not identify reporting requirements related to all 
deployment health data needed to effectively assess compliance with its 
own deployment health requirements. For example, DOD's policy does not 
require that AMSA provide critical information needed to assess 
compliance with deployment health requirements, such as the total 
number of servicemembers that deployed/redeployed during the reporting 
period. Without knowing the total number of servicemembers deployed/ 
redeployed, DOD cannot determine the extent to which servicemembers 
completed the required pre-and postdeployment health assessment 
questionnaires. Similarly, DOD's policy does not require that the AMSA 
reports specify whether servicemembers completed pre-and postdeployment 
questionnaires within required time frames (no earlier than 60 days 
prior to deployment, and during the period from 30 days prior to and 30 
days after redeployment), which is necessary to determine whether 
servicemembers are completing the required questionnaires in a timely 
manner. In addition, DOD's policy only specifies that AMSA's reports 
include information related to selected postdeployment health 
requirements, such as the accomplishment of blood samples, the number 
of referrals, and the number of referrals accomplished. As a result, 
DOD does not have all of the essential information necessary to assess 
the services' compliance or determine departmentwide compliance with 
all deployment health requirements. 

DOD Has Not Enforced Its Policy Requiring the Services to Report on 
Compliance with Deployment Health Requirements: 

DOD's deployment health quality assurance program requires that the 
services submit to DHSD quarterly reports regarding their compliance 
with deployment health requirements; however, DOD has not enforced its 
reporting requirements. DOD's policy specifies that the services' 
quarterly reports address three key elements: (1) the identification of 
deployed/redeployed personnel, (2) completion of applicable pre-and 
postdeployment health assessment questionnaires and related 
requirements (e.g., immunizations, blood samples, referrals), and (3) 
inclusion of deployment-related health documentation in permanent 
medical records. However, DOD's policy does not specify uniform 
standards that should be used in collecting and reporting the required 
information. Instead, DOD's policy directs the services to determine 
the scope and methodology of their respective programs, including 
associated performance measures. The services' differing 
interpretations of DOD's policy have resulted in the services utilizing 
different approaches for the collection and reporting of the required 
information in their quarterly reports. 

Our review of the services' quarterly reports for calendar years 2004, 
2005, and 2006 found that DHSD has not enforced the reporting 
requirements outlined in its policy. Specifically, we identified 
differences in the extent to which the services report compliance with 
applicable pre-and postdeployment health assessment questionnaires and 
related requirements such as drawing blood serum samples. For example, 
the Navy's reports only include its compliance with postdeployment 
requirements and do not include information regarding predeployment 
requirements. As another example, the Marine Corps' reports do not 
always include information regarding its compliance with pre-and 
postdeployment requirements for drawing blood serum samples. 
Furthermore, with regard to the inclusion of deployment-related health 
documentation in permanent medical records, only the Army and the Air 
Force provide DHSD with information in their quarterly reports 
regarding whether deployment-related health documentation is included 
in servicemembers' permanent medical records. 

In addition, we found that the services report information to DHSD 
using different criteria. For example, while the Army reports on only a 
sample of servicemembers who deploy or redeploy during the reporting 
period, the Air Force reports on the total number of servicemembers who 
deploy or redeploy during the reporting period. Moreover, the Army's 
report includes all locations of deployment whereas, according to Air 
Force officials, the Air Force only reports on deployments in support 
of Operations Iraqi Freedom or Enduring Freedom. Further, the Marine 
Corps' reports include the total number of Marines that deployed and 
redeployed during the reporting period in addition to those Marines who 
deployed in earlier reporting periods but who are still deployed. 

The lack of guidance or standards for providing the required 
information in the services' quarterly reports has created a number of 
problems for DOD. For example, the lack of standards hampers DOD's 
ability to compare compliance across the military services and 
therefore report overall departmentwide compliance because the services 
do not always provide DHSD with complete and consistent information 
regarding the status and findings of their respective programs. 

DOD Site Visits to Assess the Services' Deployment Health Quality 
Assurance Programs Do Not Have Quality Controls in Place: 

DOD's deployment health quality assurance program requires that DHSD 
conduct at least four visits per year to military installations for the 
purpose of assessing the services' deployment health quality assurance 
programs. While DHSD has conducted the minimum number of site visits 
required each year since 2004, it does not have the quality controls in 
place to ensure that the deployment health data collected and reported 
are complete and accurate. Federal internal control standards require 
that data control activities, such as edit checks, verification, and 
reconciliation, be conducted and documented to help provide reasonable 
assurance that program objectives are being met.[Footnote 26] While not 
a formal audit, DOD's deployment health quality assurance program is 
designed to identify strengths and weaknesses with the program and, 
when appropriate, make changes to ensure that deployment health 
requirements are being met. 

DHSD relies on the use of data collection instruments to facilitate the 
collection of information, but does not provide for an independent 
verification of the completeness and accuracy of data obtained from the 
medical records. DHSD officials told us that none of the data 
collection instruments from their site visits are reviewed by an 
independent or second reviewer to ensure that the information recorded 
is accurate or complete. Independent verification is an important 
internal control activity under segregation of duties designed to 
reduce the risk of errors. We identified numerous instances where the 
information captured by DHSD's hard-copy and electronic data collection 
instruments was incomplete. Specifically, for our review of hard-copy 
data collection instruments from DHSD site visits in 2005, we found 
that 99 of 140 data collection instruments (71 percent) from a site 
visit to a Marine Corps' installation contained one or more incomplete 
data fields, while for a site visit to an Air Force installation, 53 of 
126 data collection instruments (42 percent) had one or more incomplete 
data fields. In addition, we found some instances where either the 
deployment date or the redeployment date data fields were not complete. 
In addition, our review of electronic data collection instruments for 
2006 found at least one incomplete data field in 53 of 299 data 
collection instruments (18 percent) that we reviewed. Without 
independent verification of the data recorded by the reviewer, DHSD 
does not have any assurance that the compliance information recorded 
accurately reflects the compliance status for the records reviewed. 

In addition, our review of available DHSD site visit data for calendar 
year 2005 found that DHSD did not always adhere to DOD's deployment 
health requirements when assessing the services' programs. 
Specifically, we identified numerous instances where the reviewing DHSD 
officials did not consistently apply DOD's standards for completing pre-
and postdeployment health assessment questionnaires, drawing pre- and 
postdeployment blood samples, and receiving required immunizations 
within specified time frames. For example, our review of data from 
DHSD's site visits identified a total of 99 out of 567 medical records 
(17 percent) where one or more deployment health requirement had not 
been completed within established time requirements, yet the site visit 
summary indicated the requirement for those immunizations had been met. 
In addition, our review of DHSD's site visit data verifying the 
existence of data within DMSS and at the serum repository at AMSA found 
that for 100 out of 295 records (34 percent), timeliness standards had 
not been properly applied for at least one deployment health 
requirement such as the completion of pre-and postdeployment health 
assessment questionnaires or drawing pre-and postdeployment blood 
samples. Because DHSD officials were not properly applying DOD's 
timeliness standards, reported compliance for DHSD's site visit reports 
for 2005 may be overstated. 

Conclusions: 

As servicemembers continue to deploy overseas in significant numbers in 
support of ongoing military operations, it is increasingly important 
that DOD be able to accurately assess the medical condition of those 
servicemembers both before and after their deployments. Although DOD 
has established a deployment health quality assurance program, it has 
not developed a comprehensive oversight framework with all the specific 
reporting requirements and performance measures needed to provide 
oversight of, and ensure effective implementation of the program. 
Having an effective deployment health quality assurance program is 
critically important given DOD's long-standing problems with assessing 
the medical condition of active and reserve forces both before and 
after their deployments. Without such a framework, the ability of 
decision makers--both within DOD and Congress--to make informed, fact- 
based decisions regarding whether the department is complying with its 
own deployment health requirements is limited. Moreover, until DOD 
implements a more effective deployment health quality assurance 
program, it will not be well positioned to determine or assure Congress 
that servicemembers are medically and mentally fit to deploy and to 
determine their medical and mental condition upon return. 

Recommendations for Executive Action: 

To improve DOD's ability to effectively implement its deployment health 
quality assurance program, we recommend that the Secretary of Defense 
direct the Assistant Secretary of Defense for Health Affairs to develop 
a comprehensive oversight framework to evaluate the services' 
compliance with deployment health requirements and to ensure that the 
services are implementing the program consistently. Such a framework 
should do the following: 

* Provide AMSA with specific reporting requirements and results- 
oriented performance measures to evaluate the services' adherence to 
deployment health requirements, including identifying the total number 
of servicemembers deployed/redeployed and administering pre-and 
postdeployment health assessment questionnaires within required time 
frames, which would enable AMSA to develop information regarding 
departmentwide compliance. 

* Enforce the requirement for the services to report on all deployment 
health requirements on a quarterly basis. 

* Establish quality controls, including independent reviews of data, to 
ensure the accuracy or completeness of the information DHSD collects in 
its site visits to military installations. 

Agency Comments and Our Evaluation: 

DOD provided written comments on a draft of this report and agreed with 
our recommendations. 

In commenting on our recommendations, the Assistant Secretary of 
Defense for Health Affairs commented that the department recognizes the 
need for a more comprehensive oversight framework to better ensure 
effective implementation of the deployment health quality assurance 
program. To that end, the Office of the Deputy Assistant Secretary of 
Defense for Force Health Protection and Readiness recently published a 
new instruction[Footnote 27] on force health protection quality 
assurance. The Assistant Secretary further commented that the 
department is now developing reporting requirements along with results- 
oriented performance measures--as our report recommends--that will 
serve to better evaluate compliance and facilitate consistent 
implementation across the military services. Specifically, the 
Assistant Secretary commented that the department will (1) work with 
AMSA and the military services to specify reporting requirements, 
jointly refine performance measures for critical deployment health 
activities, and strive to achieve better alignment of deployment- 
related information among AMSA, the services, and the Defense Manpower 
Data Center to get a more accurate picture of compliance; and (2) 
continue to perform joint site visits to military installations as a 
critical complement to centralized monitoring through AMSA and DMSS, 
while including independent verification as an internal quality control 
mechanism during on-site medical records review. Our review of the 
department's new instruction and its planned actions indicate that DOD 
is taking steps in the right direction. If the department follows 
through with its efforts, we believe that it will be responsive to our 
recommendations. DOD's comments are reprinted in appendix IV. 

As we agreed with your office, unless you publicly announce the 
contents of this report earlier, we plan no further distribution of it 
until 30 days from the date of this letter. We will then send copies of 
the report to the Secretary of Defense, the Assistant Secretary of 
Defense for Health Affairs, the Deputy Assistant Secretary of Defense 
for Force Health Protection and Readiness, the Secretaries of the Army, 
Navy, and Air Force. We will also send copies to others who are 
interested and make copies available to others who request them. This 
report will also be available at no charge on GAO's Web site at 
http://www.gao.gov. 

If you have any questions regarding this report, please contact me at 
(202) 512-3604 or farrellb@gao.gov. Contact points for our Offices of 
Congressional Relations and Public Affairs may be found on the last 
page of this report. GAO staff who made major contributions to the 
report are listed in appendix V. 

Sincerely yours, 

Signed by: 

Brenda S. Farrell: 
Director, Defense Capabilities and Management: 

[End of section] 

Appendix I: Scope and Methodology: 

To address our objectives, we obtained and reviewed pertinent 
documents, reports, and information related to the Department of 
Defense's (DOD) deployment health requirements and deployment health 
quality assurance program. We also interviewed responsible officials at 
the Assistant Secretary of Defense for Health Affairs, Deployment 
Health Support Directorate (DHSD); the Offices of the Surgeons General 
for the Army, Air Force, and Navy; the Army Medical Surveillance 
Activity (AMSA); and the Combined Fleet Forces Command and Naval 
Environmental Health Center in the Washington, D.C., and Norfolk, 
Virginia, areas. 

To determine whether DOD has established a medical tracking system to 
comply with requirements of 10 U.S.C. § 1074f pertaining to pre-and 
postdeployment medical examinations, we compared statutory requirements 
to DOD policies and requirements. Specifically, we reviewed relevant 
sections of 10 U.S.C. § 1074f to identify system requirements and 
system elements. We also reviewed DOD policies, directives, and 
instructions to identify the measures that DOD uses to establish the 
medical condition of servicemembers and compared these measures to the 
system requirements and system elements. In addition, we obtained a 
legal opinion from DOD's Office of General Counsel regarding DOD's 
compliance with the requirement of 10 U.S.C. § 1074f to perform pre-and 
postdeployment medical examinations. 

To determine the extent to which DOD has effectively implemented a 
deployment health quality assurance program as part of its medical 
tracking system, we obtained and analyzed various documents, including 
DOD's and the services' deployment health quality assurance program 
policies establishing requirements for the program; the Government 
Performance and Results Act of 1993;[Footnote 28] and federal internal 
control standards.[Footnote 29] We also interviewed key officials with 
DHSD and the services' Offices of the Surgeons General to obtain a 
comprehensive understanding of the processes, procedures, and controls 
used for monitoring and overseeing the deployment health quality 
assurance program. We obtained and analyzed the results of the 
program's periodic reporting for calendar years 2004, 2005, and 2006, 
including monthly AMSA reports, the quarterly service-specific reports, 
and DOD's annual report, to determine the content of the reports, 
compliance rates with deployment health requirements, and any trends in 
compliance rates, both within and among the services. We also obtained 
and analyzed the results of site visits conducted by DHSD in calendar 
years 2005 and 2006. To determine the reliability of DOD's quality 
assurance program reports, we obtained and analyzed data collection 
instruments and other documentation used to record, summarize, and 
report the services' compliance with deployment health requirements. We 
also discussed with responsible DOD officials, including 
representatives from the military services, their methodology for 
ensuring that information collected and reported is as accurate and 
reliable as possible. Where possible, we tested data by comparing 
information from the data collection instruments or summary documents 
with available source documents. We identified issues of inconsistency 
and incompleteness in DOD's data and, therefore, determined the data to 
be insufficiently reliable for the purpose of assessing compliance with 
deployment health requirements and we are making a recommendation to 
address this issue accordingly. 

In conducting our review, we limited our focus to the procedures that 
DOD has in place to medically assess servicemembers before and after 
their deployments. Other issues, such as recent controversies 
associated with alleged deployments of medically unfit servicemembers 
to Iraq, did not fall within the scope of this review. These issues 
will be addressed as part of a separate review. 

We performed our work from September 2006 through May 2007 in 
accordance with generally accepted government auditing standards. 

[End of section] 

Appendix II: Pre-and Postdeployment Health Assessment Questionnaires: 

Pre-Deployment Health Assessment: 

Authority. 10 U.S.C. 136 Chapter 55. 1074f, 3013, 5013, 8013 and E.O. 
9397: 

Principal Purpose: To assess your state of health before possible 
deployment outside the United States in support of military operations 
and to assist military healthcare providers in identifying and 
providing present and future medical care to you. 

Routine Use: To other Federal and State agencies and civilian 
healthcare providers, as necessary, in order to provide necessary 
medical care and treatment. 

Disclosure: (Military personnel and DoD civilian Employees Only) 
Voluntary. If not provided, healthcare WILL BE furnished, but 
comprehensive care may not be possible. 

INSTRUCTIONS: Please read each question completely and carefully before 
marking your selections. Provide a response for each question. If you 
do not understand a question, ask the administrator. 

Demographics: 

Last Name: 
MI: 
First Name: 
Today's Date (d/mm/yyyy): 
Social Security Number:  
Deploying Unit: 
DOB (dd/mm/yyyy): 

Gender: 
Male or Female? 
Service Branch: 
Air Force, Army, Coast Guard, Marine Corps, Navy, or Other? 
Component: 
Active duty, National Guard, Reserves, or Civilian Government Employee? 
Pay Grade: 
E1, E2, E3, E4, E5, E6, E7, E8, E9, O1, O2, O3, O4, O5, O6, O7, O8, O9, 
O10, W1, W2, W3, W4, W5, or Other?  

Location of Operation: 
Europe, Australia, SW Asia, Africa, SE Asia, Central America, Asia 
(Other), Unknown, or South America? 

Deployment Location (If Known) (City, Town, or Base): 
List Country (If Known): 
Name of Operation: 

Administrator Use Only. 

Indicate the status of each of the following:  

Yes, No, or N/A for the following: 
Medical threat briefing completed? 
Medical information sheet distributed? 
Serum for HIV drawn within 12 months? 
Immunizations current? 
PPD screening within 24 months? 

Health Assessment: 

1. Would you say your health in general is: 
Excellent, Very Good, Good, Fair, or Poor? 

2. Do you have any medical or dental problems? 
Yes or No: 

3. Are you currently on a profile, or light duty, or are you undergoing 
a medical board? 
Yes or No: 

4. Are you pregnant? (Females Only) 
Don't Know, Yes, or No: 

5. Do you have a 90-day supply of your prescription medication or birth 
control pills? 
NIA, Yes, or No: 

6. Do you have two pairs of prescription glasses (if worn) and any 
other personal medical equipment? 
NIA, Yes, or No: 

7. During the past year, have you sought counseling or care for your 
mental health? 
Yes or No. 

8. Do you currently have any questions or concerns about your health? 
Yes or No: 

Please list your concerns: 

I certify that responses on this form are true. 

Service Member signature: 

Pre-Deployment Health Provider Review (For Health Provider Use Only): 

After interview/exam of patient, the following problems were noted and 
categorized by Review of Systems. More than one may be noted for 
patients with multiple problems. Further documentation of problem to be 
placed in medical records. 

Referral Indicated: 

None: 
GI: 
Cardiac: 
Combat 1 Operational Stress Reaction: 
Dental: 
Dermatologic: 
GU: 
GYN: 
Mental Health: 
Neurologic: 
Orthopedic: 
Pregnancy: 
Pulmonary: 
Other: 
ENT: 
Eye: 
Family Problems: 
Fatigue, Malaise, Multisystem complaint: 

FINAL MEDICAL DISPOSITION: 
Deployable or Not Deployable: 

Comments (If not deployable, explain): 

I certify that this review process has been completed. Provider's 
signature and stamp: 

Date (dd/mm/yyyy): 

Post-Deployment Health Assessment: 

Authority: 10 U.S.C. 136 Chapter 55. 1074f, 3013, 5013, 8013 and E.O. 
9397: 

Principal Purpose: To assess your state of health after deployment 
outside the United States in support of military operations and to 
assist military healthcare providers in identifying and providing 
present and future medical care to you. 

Routine Use: To other Federal and State agencies and civilian 
healthcare providers, as necessary, in order to provide necessary 
medical care and treatment. 

Disclosure: (Military personnel and DoD civilian Employees Only) 
Voluntary. If not provided, healthcare WILL BE furnished, but 
comprehensive care may not be possible. 

Instructions: Please read each question completely and carefully before 
marking your selections. Provide a response for each question. If you 
do not understand a question, ask the administrator.  

Demographics: 

Today's Date (dd/mm/yyyy): 
Last Name: 
MI: 
First Name: 
Social Security Number: 
Name of Your Unit or Ship during this Deployment: 
DOB (dd/mm/yyyy): 
Date of arrival in theater (dd/mm/yyyy): 
Date of departure from theater (dd/mm/yyyy): 

Gender: 
Male or Female? 
Service Branch: 
Air Force, Army, Coast Guard, Marine Corps, Navy, or Other? 
Component: 
Active Duty, National Guard, Reserves, or Civilian Government Employee? 
Pay Grade: 
E1, E2, E3, E4, E5, E6, E7, E8, E9, 001, 002, 003, 004, 005, 006, 007, 
008, 009, 010, W1, W2, W3, w4, W5, or other? 

Location of Operation: 
Europe, Australia, South America, SW Asia, Africa, North America, SE 
Asia, Central America, Other, Asia (Other), or Unknown: 

To what areas were you mainly deployed: (mark all that apply - list 
where/date arrived): 

Kuwait: 
Iraq: 
Qatar: 
Turkey: 
Afghanistan: 
Uzbekistan: 
Bosnia: 
Kosovo: 
On a ship: 
CONUS: 
Other: 

Name of Operation: 
Occupational specialty during this deployment (MOS, NEC or AFSC): 
Combat specialty: 

Administrator Use Only: 

Indicate the status of each,of the following: 
Answer the following questions with either Yes, No, or NIA: 

Medical threat debriefing completed? 
Medical information sheet distributed? 
Post Deployment serum specimen collected? 

Please answer all questions in relation to This deployment: 

1. Did your health change during this deployment? 

Health stayed about the same or got better or Health got worse: 

2. How many times were you seen in sick call during this deployment? 

No. of times: 

3. Did you have to spend one or more nights in a hospital as a patient 
during this deployment? 

No: 

Yes, reason/dates: 

4. Did you receive any vaccinations just before or during this 
deployment? 

Smallpox (leaves a scar on the arm): 

Anthrax: 

Botulism: 

Typhoid: 

Meningococcal: 

Other, list: 

Don't know: 

None: 

5. Did you take any of the following medications during this 
deployment? 

(mark all that apply): 

PB (pyridostigmine bromide) nerve agent pill: 

Mark-1 antidote kit: 

Anti-malaria pills: 

Pills to stay awake, such as dexedrine: 

Other, please list: 

Don't know: 

6. Do you have any of these symptoms now or did you develop them 
anytime during this deployment? 

Check one for each of the following: 

No; 
Yes During; 
Yes Now; 

Chronic cough. 
Runny nose. 
Fever. 
Weakness. 
Headaches. 
Swollen, stiff or painful joints. 
Back pain. 
Muscle aches. 
Numbness or tingling in hands or feet. 
Skin diseases or rashes. 
Redness of eyes with tearing. 
Dimming of vision, like the lights were going out. 
Chest pain or pressure. 
Dizziness, fainting, light headedness. 
Difficulty breathing. 
Still feeling tired after sleeping. 
Difficulty remembering. 
Diarrhea. 
Frequent indigestion. 
Vomiting. 
Ringing of the ears. 

7. Did you see anyone wounded, killed, or dead during this deployment? 
(mark all that apply

No. 
Yes - coalition. 
Yes-enemy. 
Yes-civilian. 
No. 
Yes. 

8. Were you engaged in direct combat where you discharged  your weapon? 
No. 
Yes. 
(land, sea, or air)

9. During this deployment, did you ever feel that you were in great 
danger of being killed? 
No. 
Yes. O No O Yes: O. 

10. Are you currently interested in receiving help for a stress, 
emotional, alcohol or family problem? 

No. 
Yes. 

11. Over the last 2 weeks, how often have you been bothered by any of 
the following problems? Please respond with None, some, or a lot. 

Little interest or pleasure in doing things? 
Feeling down, depressed, or hopeless? 
Thoughts that you would be better off dead or hurting yourself in some 
way? 

12. Have you ever had any experience that was so frightening, horrible, 
or upsetting that, In The Past Month, you... 

Please respond with yes or no. 

Have had any nightmares about it or thought about it when you did not 
want to? 
Tried hard not to think about it or went out of your way to avoid 
situations that remind you of it? 
Were constantly on guard, watchful, or easily startled? 
Felt numb or detached from others, activities, or your surroundings? 

13. Are you having thoughts or concerns that... 

Please respond yes, no, or unsure. 

You may have serious conflicts with your spouse, family members, or 
close friends? 
You might hurt or lose control with someone? 

14. While you were deployed, were you exposed to: (mark all that 
apply): 

Please respond No, Sometimes, or Often. 

DEET insect repellent applied to skin. 
Pesticide-treated uniforms. 
Environmental pesticides (like area fogging). 
Flea or tick collars. 
Pesticide strips. 
Smoke from oil fire. 
Smoke from burning trash or feces. 
Vehicle or truck exhaust fumes. 
Tent heater smoke. 
JP8 or other fuels. 
Fog oils (smoke screen). 
Solvents. 
Paints. 
Ionizing radiation. 
Raderimicrowaves. 
Lasers. 
Loud noises. 
Excessive vibration. 
Industrial pollution. 
Sand/dust. 
Depleted Uranium ((f yes, explain). 
Other exposures. 

15. On how many days did you wear your MOPP over garments? 

No. of days: 

16. How many times did you put on your gas mask because of alerts and 
NOT because of exercises? 

No. of times: 

17. Were you in or did you enter or closely inspect any destroyed 
military vehicles? 

No. 
Yes: 

18. Do you think you were exposed to any chemical, biological, or 
radiological warfare agents during this deployment? 

No. 
Don't know: 
Yes, explain with date and location: 

[End of table] 

Health Care Provider Only: 

Post-Deployment Health Care Provider Review, Interview, and Assessment: 

Interview: 

1. Would you say your health in general is: 
Excellent, Very good, Good, Fair, or Poor. 
2. Do you have any medical or dental problems that developed during 
this deployment? 
3. Are you currently on a profile or light duty? 
4. During this deployment have you sought, or do you now intend to 
seek, counseling. or care for your mental health? 

5. Do you have concerns about possible exposures or events during this 
deployment that you feel may affect your health? 
Please list concerns: 

6. Do you currently have any questions or concerns about your health? 
Please list concerns: 

Health Assessment: 

After my interview/exam of the service member and review of this form, 
there is a need for further evaluation as indicated below. (More than 
one may be noted for patients with multiple problems. Further 
documentation of the problem evaluation to be placed in the service 
member's medical record.) 

Referral Indicated For: 

None; 
GI;  
Cardiac; 
GU; 
Combat/Operational Stress Reaction; 
GYN;
Dental; 
Mental Health;
Dermatologic; 
Neurologic; 
ENT; 
Orthopedic; 
Eye; 
Pregnancy; 
Family Problems; 
Pulmonary; 
Fatigue, Malaise, Multisystem complaint; 
Other. 

Exposure Concerns (During deployment):

Environmental; 
Occupational; 
Combat or mission related; 
None;  

Comments: 

I certify that this review process has been completed. Provider's 
signature and stamp: 

End of Health Review: 

[End of section] 

Appendix III: Individual Medical Readiness: 

In January 2006, DOD published an instruction,[Footnote 30] requiring 
that the services report individual medical readiness. Individual 
medical readiness is intended to provide operational commanders, 
military department leaders, and primary care managers the ability to 
monitor the medical readiness status of their personnel, ensuring a 
healthy and fit fighting force that is medically ready to deploy. DOD 
Instruction 6025.19 requires quarterly individual medical readiness 
reports submitted by the Surgeons General of the services to the Force 
Health Protection Council summarizing the individual medical readiness 
status of active and selected reserve members (both officers and 
enlisted) who are available to deploy. Assessing individual medical 
readiness status is a continuous process and contains six key elements 
for which servicemembers are rated as either pass or fail. These 
elements include the following: 

* Periodic Health Assessment: An annual assessment for changes in 
health status, especially changes that could affect a member's ability 
to perform military duties.[Footnote 31] Each service is responsible 
for determining how it will meet DOD's requirement for the completion 
of the Periodic Health Assessment. 

- Pass: current Periodic Health Assessment: 

- Fail: overdue Periodic Health Assessment (not accomplished within 3 
months after the month in which it is due): 

* Deployment-limiting Conditions: Defined by military department- 
specific policies. Examples include pregnancy, asthma, and severe 
traumatic injury with incomplete rehabilitation. 

- Pass: no deployment limiting conditions: 

- Fail: deployment limiting conditions exist: 

* Dental Readiness: All services use the same classification system to 
assess and monitor dental readiness. 

- Pass: class 1 (no dental treatment or reevaluation required within 
the next 12 months) or 2 (patients have the potential for dental 
emergencies with the next 12 months but it is not likely if certain 
treatments are obtained): 

- Fail: class 3 (patients with oral conditions that if not treated are 
expected to result in dental emergencies within the next 12 months) or 
4 (patients requiring a dental examination and whose dental 
classification is unknown): 

* Immunization Status: Required immunizations include hepatitis A, 
tetanus-diphtheria, MMR (measles, mumps, and rubella), inactivated 
poliovirus (IPV), hepatitis B, and influenza (once per season). 

- Pass: all immunizations current: 

- Fail: overdue for one or more immunizations: 

* Medical Readiness Laboratory Tests: Includes human immunodeficiency 
virus (HIV) testing and deoxyribonucleic acid (DNA) sample on file. 

- Pass: HIV testing, with one result on file within the past 24 months 
and a DNA sample on file: 

- Fail: Missing or past-due HIV test or DNA sample not on file: 

* Individual Medical Equipment: Core requirement is one pair of gas 
mask inserts for all deployable personnel needing visual correction. 

- Pass: one pair of gas mask inserts for all deployable personnel 
needing visual correction: 

- Fail: no gas mask inserts for all deployable personnel needing visual 
correction: 

Servicemembers are then placed into one of the following four readiness 
categories based on the pass/fail grades in the six elements: 

* Fully medically ready: current in all categories including dental 
class 1 or 2: 

* Partially medically ready: lacking one or more immunizations, 
readiness laboratory studies, or medical equipment: 

* Not medically ready: existence of a chronic or prolonged deployment- 
limiting condition (per service-specific physical standards 
guidelines), including servicemembers who are hospitalized or 
convalescing from serious illness or injury, or individuals in dental 
class 3: 

* Medical readiness indeterminate: inability to determine the 
servicemember's current health status because of missing health 
information such as a lost medical record, an overdue Periodic Health 
Assessment or being in dental class 4: 

The minimum goal for overall medical readiness is to have more than 75 
percent of servicemembers fully medically ready for deployment. 

[End of section] 

Appendix IV: Comments from the Department of Defense: 

The Assistant Secretary Of Defense: 
1200 Defense Pentagon: 
Washington, DC 20301-1200: 
Health Affairs: 

Jun 8 2007: 

Ms. Brenda S. Farrell: 
Director, Defense Capabilities and Management: 
U. S. Government Accountability Office: 
441 G Street, N.W. 
Washington, DC 20548: 

Dear Ms. Farrell: 

Thank you for the opportunity to review the GAO draft report, GAO-07- 
831, "Defense Health Care: Comprehensive Oversight Framework Needed to 
Help Ensure Effective Implementation of Deployment Health Quality 
Assurance Program," dated May 21, 2007 (GAO Code 350897). 

The Department concurs with the findings and recommendation contained 
in this report. We are pleased your review found that our systematic 
approach to performing pre-and post-deployment health assessments 
through a variety of deployment health activities complies with enacted 
legislation requiring a medical tracking system for assessing the 
conditions of Service members before and after deployments. We 
recognize the need for a more comprehensive oversight framework to 
better ensure effective implementation of our deployment health quality 
assurance program. To that end, the Office of the Deputy Assistant 
Secretary of Defense for Force Health Protection and Readiness recently 
published a new DoD Instruction on force health protection quality 
assurance. We are now developing reporting requirements along with 
results-oriented performance measures-as your report recommends-that 
will serve to better evaluate compliance and facilitate consistent 
implementation across the military Services. Our detailed comments are 
enclosed. 

My points of contact are Dr. Michael Kilpatrick at 703-578-8510 
(functional) and Mr. Gunther Zimmerman (audit liaison) at 703-681-3492. 

Sincerely, 

Signed by: 
S. Ward Casscells, MD: 

Enclosure: 
As stated: 

GAO Draft Report - Dated May 21, 2007 GAO Code 350897/GAO-07-831: 

"Defense Health Care: Comprehensive Oversight Framework Needed to Help 
Ensure Effective Implementation of Deployment Health Quality Assurance 
Program" 

Department Of Defense Comments To The Recommendation: 

Recommendation: The GAO recommends that the Secretary of Defense direct 
the Assistant Secretary of Defense for Health Affairs to develop a 
comprehensive oversight framework to evaluate the Services' compliance 
with deployment health requirements and to ensure that the Services are 
implementing the program consistently. Such a framework should do the 
following: 

* Provide the Army Medical Surveillance Activity (AMSA) with specific 
reporting requirements and results-oriented performance measures to 
evaluate the Services' adherence to deployment health requirements, 
including identifying the total number of Service members deployed/ 
redeployed and administering pre-and post-deployment health assessment 
questionnaires within required timeframes, which would enable AMSA to 
develop information regarding Department-wide compliance; 

* Enforce the requirement for the Services to report on all deployment 
health requirements on a quarterly basis; and: 

* Establish quality controls, including independent reviews of data, to 
ensure the accuracy or completeness of the information the Deployment 
Health Support Directorate (DHSD) collects in its site visits to 
military installations. 

DOD Response: The Department concurs and offers the following comments. 

The Department recognizes that the DoD deployment health quality 
assurance program established in 2004 needs to evolve into a more 
structured and results-oriented framework for assessing compliance, and 
we appreciate that GAO's efforts during this review will guide us in 
directions that ultimately should improve the health of Service members 
who deploy in harm's way. To enhance our deployment health quality 
assurance components per your recommendation, and as part of our more 
comprehensive force health protection quality assurance program 
initiative, we will: 

* Work with and through the Army Medical Surveillance Activity (AMSA) 
and the military Services to specify reporting requirements and jointly 
refine performance measures for critical deployment health activities. 
We see this as an essential step to increasing consistency among the 
Services' programs. At the same time, we recognize that each Service 
benefits from some degree of flexibility in tailoring its deployment 
health quality assurance activities to accommodate differences in 
operational environment, size and complexity, managerial judgment, and 
the reliability, availability, and performance of their respective 
information systems. Further, we will strive to achieve better 
alignment of deployment-related information among AMSA, the Services, 
and the Defense Manpower Data Center, to get a more accurate picture of 
the deployer "denominator" upon which to measure compliance. 

* Continue to perform joint site visits to military installations as a 
critical complement to centralized monitoring through AMSA and the 
Defense Medical Surveillance System (DMSS). Independent verification 
will be included as an internal quality control mechanism during our on-
site medical records reviews to ensure the information gathered on 
these visits is both accurate and complete. We strongly believe these 
jointly-conducted visits offer significant opportunities for first- 
hand looks at deployment health processes and are for many locations- 
the only way to review medical records pending full implementation of 
automated recordkeeping in garrison and in theater. One of the key 
goals in this regard is to better balance the efficiency of centralized 
monitoring through AMSA with the effectiveness of on-site visits. 

The Department determined in 2004 that a collaborative, multi-faceted 
approach with the Services and AMSA was the appropriate means for 
bringing the deployment health quality assurance program on-line. Joint 
site visits (at that time quite unprecedented, now generally accepted) 
combined with periodic reports served initially as a balanced means for 
tracking Service compliance-looking for reasonable assurances rather 
than absolute assurances that deployment health requirements were being 
met. 

[End of section] 

Appendix V: GAO Contact and Staff Acknowledgments: 

GAO Contact: 

Brenda S. Farrell, (202) 512-3604 or farrellb@gao.gov: 

Acknowledgments: 

In addition to the contact named above, Sandra B. Burrell, Assistant 
Director; Alissa H. Czyz; Steve J. Fox; Wesley A. Johnson; Susan J. 
Mason; Julie C. Matta; Terry L. Richardson; Kate Robertson; Norris W. 
Smith; and John C. Wren made key contributions to this report. 

[End of section] 

Related GAO Products: 

DOD Civilian Personnel: Greater Oversight and Quality Assurance Needed 
to Ensure Force Health Protection and Surveillance for Those Deployed. 
GAO-06-1085. Washington, D.C.: September 29, 2006. 

Military Personnel: DOD and the Services Need to Take Additional Steps 
to Improve Mobilization Data for the Reserve Components. GAO-06-1068. 
Washington, D.C.: September 20, 2006. 

Military Personnel: Top Management Attention Is Needed to Address Long- 
standing Problems with Determining Medical and Physical Fitness of the 
Reserve Force. GAO-06-105. Washington. D.C.: October 27, 2005. 

Defense Health Care: Improvements Needed in Occupational and 
Environmental Health Surveillance during Deployments to Address 
Immediate and Long-term Health Issues. GAO-05-632. Washington, D.C.: 
July 14, 2005. 

Defense Health Care: Force Health Protection and Surveillance Policy 
Compliance Was Mixed, but Appears Better for Recent Deployments. GAO- 
05-120. Washington, D.C.: November 12, 2004. 

Military Personnel: DOD Needs to Address Long-term Reserve Force 
Availability and Related Mobilization and Demobilization Issues. GAO- 
04-1031. Washington, D.C.: September 15, 2004. 

Defense Health Care: DOD Needs to Improve Force Health Protection and 
Surveillance Processes. GAO-04-158T. Washington, D.C.: October 16, 
2003. 

Defense Health Care: Quality Assurance Process Needed to Improve Force 
Health Protection and Surveillance. GAO-03-1041. Washington, D.C.: 
September 19, 2003. 

Military Personnel: DOD Needs More Data to Address Financial and Health 
Care Issues Affecting Reservists. GAO-03-1004. Washington, D.C.: 
September 10, 2003. 

Defense Health Care: Army Has Not Consistently Assessed the Health 
Status of Early-deploying Reservists. GAO-03-997T. Washington, D.C.: 
July 9, 2003. 

Defense Health Care: Army Needs to Assess the Health Status of All 
Early-Deploying Reservists. GAO-03-437. Washington, D.C.: April 15, 
2003. 

VA And Defense Health Care: Military Medical Surveillance Policies in 
Place, but Implementation Challenges Remain. GAO-02-478T. Washington, 
D.C.: February 27, 2002. 

Gulf War Illnesses: Research, Clinical Monitoring, and Medical 
Surveillance. GAO/T-NSIAD-98-88. Washington, D.C.: February 5, 1998. 

Gulf War Illnesses: Improved Monitoring of Clinical Progress and 
Reexamination of Research Emphasis Are Needed. GAO/NSIAD-97-163. 
Washington, D.C.: June 23, 1997. 

Defense Health Care: Medical Surveillance Improved Since Gulf War, but 
Mixed Results in Bosnia. GAO/NSIAD-97-136. Washington, D.C.: May 13, 
1997. 

Reserve Forces: DOD Policies Do Not Ensure That Personnel Meet Medical 
and Physical Fitness Standards. GAO/NSIAD-94-36. Washington, D.C.: 
March 23, 1994. 

Operation Desert Storm: War Highlights Need to Address Problem of 
Nondeployable Personnel. GAO/NSIAD-92-208. Washington, D.C.: August 31, 
1992. 

FOOTNOTES 

[1] GAO, Defense Health Care: Medical Surveillance Improved Since Gulf 
War, but Mixed Results in Bosnia, GAO/NSIAD-97-136 (Washington, D.C.: 
May 13, 1997). 

[2] National Defense Authorization Act for Fiscal Year 1998, Pub. L. 
No. 105-85, § 765 (1997) (codified at 10 U.S.C. § 1074f). 

[3] GAO, Defense Health Care: Quality Assurance Process Needed to 
Improve Force Health Protection and Surveillance, GAO-03-1041 
(Washington, D.C.: Sept. 19, 2003). 

[4] GAO, Military Personnel: DOD Needs to Address Long-term Reserve 
Force Availability and Related Mobilization and Demobilization Issues, 
GAO-04-1031 (Washington, D.C.: Sept. 15, 2004). 

[5] GAO, Defense Health Care: Force Health Protection and Surveillance 
Policy Compliance Was Mixed, but Appears Better for Recent Deployments, 
GAO-05-120 (Washington, D.C.: Nov. 12, 2004). 

[6] GAO, Military Personnel: Top Management Attention Is Needed to 
Address Long-standing Problems with Determining Medical and Physical 
Fitness of the Reserve Force, GAO-06-105 (Washington, D.C.: Oct. 27, 
2005). 

[7] For the purposes of this report, we use the terms "redeploying" and 
"redeployed" to mean returning from deployment. 

[8] Pub. L. No. 103-62 (1993). 

[9] Pub. L. No. 105-85, § 765 (1997). 

[10] See GAO-03-1041. 

[11] See GAO-04-1031. 

[12] See GAO-05-120. 

[13] See GAO-06-105. 

[14] Department of Defense Report to Congress: Medical Tracking System 
for Members Deployed Overseas (May 1998). 

[15] Department of Defense Instruction 6490.03, Deployment Health (Aug. 
11, 2006). 

[16] DOD defines "health care provider" as a nurse, medical technician, 
medic, or corpsman. 

[17] DOD defines a "trained health care provider" as a physician, 
physician assistant, nurse practitioner, advanced practice nurse, 
independent duty corpsman, independent duty medical technician, or 
Special Forces medical sergeant. 

[18] Assistant Secretary of Defense for Health Affairs Memorandum, 
"Postdeployment Health Reassessment" (Mar. 10, 2005). 

[19] Letter from Mr. John Casciotti, Associate Deputy General Counsel 
(Health Affairs), DOD Office of General Counsel to Mr. John Van Schaik, 
Assistant General Counsel, GAO Office of General Counsel, November 6, 
2006. 

[20] Section 1074f was amended by section 738 of the John Warner 
National Defense Authorization Act for Fiscal Year 2007, Pub. L. No. 
109-364, to provide that the pre-and post-deployment medical 
examination should include an "assessment" of mental health and 
traumatic brain injury as well as further details on the elements of 
the quality assurance program required under section 1074f(d)(1), 
including information on the types of health care providers conducting 
"postdeployment health assessments." 

[21] Ronald W. Reagan National Defense Authorization Act for Fiscal 
Year 2005, Pub. L. No. 108-375, §§ 732(b) and 739 (2004). 

[22] Assistant Secretary of Defense for Health Affairs Memorandum, 
"Policy for Department of Defense Deployment Health Quality Assurance 
Program" (Jan. 9, 2004). 

[23] Subsequent legislation required that information on DOD's 
deployment health quality assurance program be provided to Congress. 
Specifically, section 739 of Pub. L. No. 108-375 (Oct. 28. 2004) 
amended title 10 of the United States Code by adding section 1073b. 
Section 1073b requires that DOD submit annually to the Armed Services 
Committees of the Senate and the House of Representatives reports on 
health protection quality, including the recording of health assessment 
data in military health records. 

[24] GAO, Results-Oriented Government: GPRA Has Established a Solid 
Foundation for Achieving Greater Results, GAO-04-38 (Washington, D.C.: 
Mar. 10, 2004). 

[25] According to AMSA, the DMSS database contains up-to-date and 
historical data on diseases and medical events (e.g., hospitalizations, 
ambulatory visits, reportable diseases, and health risk appraisals) for 
military personnel and deployments. 

[26] See GAO, Standards for Internal Control in the Federal Government, 
GAO/AIMD-00-21.3.1 (Washington, D.C.: November 1999) and Internal 
Control Management and Evaluation Tool, GAO-01-1008G (Washington, D.C.: 
August 2001). 

[27] Department of Defense Instruction 6200.05, Force Health Protection 
(FHP) Quality Assurance (QA) Program (Feb. 16, 2007). 

[28] Pub. L. No. 103-62 (1993). 

[29] See GAO, Standards for Internal Control in the Federal Government, 
GAO/AIMD-00-21.3.1 (Washington, D.C.: November 1999) and Internal 
Control Management and Evaluation Tool, GAO-01-1008G (Washington, D.C.: 
August 2001). 

[30] Department of Defense Instruction 6025.19, Individual Medical 
Readiness (Jan. 3, 2006). 

[31] The assessment records general information such as blood pressure, 
weight, height; screenings for hearing, vision, and depression; as well 
as counseling on leading health indicators. In addition the assessment 
includes testing and evaluations based on risk factors such as age, 
sex, occupation, and personal habits such as smoking. 

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