Defense Health Care:
Oversight of Military Services' Post-Deployment Health Reassessment Completion Rates Is Limited
GAO-08-1025R: Published: Sep 4, 2008. Publicly Released: Sep 4, 2008.
Military servicemembers engaged in combat tours in Afghanistan and Iraq are at risk of developing combat-related mental health conditions, including post-traumatic stress disorder (PTSD). In many cases, signs of potential mental health conditions do not surface until months after servicemembers return from deployment. In 2004, Army researchers published a series of articles that indicated a significant increase in the number of servicemembers reporting mental health concerns 90 to 120 days after returning from deployment, compared with mental health concerns reported before or soon after deployment. These findings led the Department of Defense (DOD) in March 2005 to develop requirements and policies for the post-deployment health reassessment (PDHRA) as part of its continuum of deployment health assessments for servicemembers. PDHRA is a screening tool for military servicemembers; it is designed to identify and address their health concerns--including mental health concerns--90 to 180 days after return from deployment. Servicemembers answer a set of questions about their physical and mental health conditions and concerns, and health care providers review the answers and refer servicemembers for further evaluation and treatment if necessary. A November 2007 study showed that a larger number of servicemembers indicated mental health concerns on their PDHRAs than on assessments earlier in their deployment cycles. Although DOD established PDHRA requirements and policies, it gave the military services discretion to implement them to meet their unique needs as long as the services adhere to the requirements and policies. DOD oversees the military services' compliance with PDHRA requirements through its deployment health assessment quality assurance program and is required to report on the quality assurance program annually to the Armed Services Committees of the House of Representatives and Senate. In June 2007, we reported that DOD's oversight of its deployment health assessments does not provide DOD or Congress with the information needed to evaluate DOD and the military services' compliance with deployment health assessment requirements. That report is part of a body of work in which we identified weaknesses in DOD's quality assurance program. The Senate Committee on Armed Services directed us to review DOD's oversight of PDHRA, and the House Committee on Armed Services and 11 senators also expressed interest in this work. In this report, we focus on how DOD ensures that servicemembers complete the PDHRA. Specifically, we discuss how well DOD's quality assurance program oversees the military services' compliance with the requirement that they ensure that servicemembers complete the PDHRA.
DOD's quality assurance program has limitations and does not allow the department to accurately assess whether the military services ensure that servicemembers complete the PDHRA. DOD's quality assurance program relies on quarterly reports from each military service, monthly reports from AFHSC, and site visits to military installations to oversee the military services' compliance with deployment health assessment requirements, including completion of PDHRA. Each of these sources of information has limitations. The military services' quarterly reports and the monthly reports from AFHSC do not provide the information DOD needs to accurately assess the military services' PDHRA completion rates, which would allow DOD to determine if the military services have ensured that servicemembers completed the PDHRA. These reports do not allow DOD to calculate a completion rate because they do not provide essential information, such as the total number of servicemembers who returned from deployment and should have completed the PDHRA in that quarter or month. Furthermore, DOD cannot use information collected from site visits to validate the services' quarterly reports because the small number of site visits constitutes an insufficient sample for validation purposes. In our 2007 report, we recommended that DOD make enhancements to its quality assurance program, which would allow the department to better evaluate compliance with deployment health requirements. Although DOD concurred with the recommendation included in the 2007 report, as of June 2008, the department had not implemented the recommendation. As a result, DOD's quality assurance program cannot provide decision makers with reasonable assurance that servicemembers complete PDHRA. Overall, DOD concurred with our report's findings and conclusions; however, DOD identified several items in the report that it addressed in written comments. DOD suggested that the function of oversight is beyond the scope of the quality assurance program. Additionally, DOD commented that the department is taking steps that it believes will resolve some of the issues we note in this report. However, DOD did not provide us with relevant details or evidence pertaining to these efforts. We believe that oversight is an essential function of the quality assurance program and that the program currently does not receive the information necessary to perform this function.