International Affairs:

Questions for the Record Related to the Benefits and Medical Care for Federal Civilian Employees Deployed to Afghanistan and Iraq

GAO-08-155R: Published: Oct 16, 2007. Publicly Released: Oct 16, 2007.

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GAO appeared before the House Subcommittee on Oversight and Investigations, Committee on Armed Services on September 18, 2007, to discuss the benefits and medical care for federal civilian and U.S. government contract employees deployed to Iraq and Afghanistan. This report responds to Congress' request that GAO provide answers to questions for the record from the hearing. The questions are (1) What are the congressional requirements for medical tracking of deployed military servicemembers and civilians? and (2) What work has GAO conducted on this topic?

Following GAO's May 1997 report, Congress enacted legislation3 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 of the United States. This legislation was amended by a provision in the John Warner National Defense Authorization Act for Fiscal Year 2007. The current legislation amends elements of the system and the quality assurance program as well as adds criteria for referral for further evaluations and minimum mental health standards for deployment. Since the 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 that required the Secretary of Defense to establish a medical tracking system for assessing the medical condition of servicemembers before and after deployments. 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. Our report also raised concerns over a lack of DOD oversight of departmentwide efforts to comply with health surveillance requirements. In September 2004, we reported similar issues related to DOD's ability to effectively manage the health status of its reserve forces. 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. 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, and 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. In February 2007, the Office of the Deputy Assistant Secretary of Defense for Force Health Protection and Readiness published a new instruction on force health protection quality assurance. This policy applies to military servicemembers, as well as applicable DOD and contractor personnel. The new policy requires the military services to implement procedures to monitor key force health protection elements such as pre- and post-deployment health assessments. In our June 2007 report on DOD's compliance with the legislative requirement to perform pre- and post-deployment medical examinations on servicemembers, DOD lacked a comprehensive oversight framework to help ensure effective implementation of its deployment health quality assurance program, which included specific reporting requirements and results-oriented performance measures to evaluate the services' adherence to deployment health requirements.

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