Hearing Loss Prevention:

Improvements to DOD Hearing Conservation Programs Could Lead to Better Outcomes

GAO-11-114: Published: Jan 31, 2011. Publicly Released: Jan 31, 2011.

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Exposure to hazardous noise can have negative implications for both servicemember health and readiness. Moreover, in fiscal year 2009, some of the most common impairments for veterans receiving Veterans Affairs (VA) disability benefits were hearing related, as annual payments for such conditions exceeded $1.1 billion. To examine Department of Defense (DOD) efforts to prevent hearing loss, GAO is reporting on (1) how well the DOD and armed services identify and mitigate hazardous noise; (2) how well the military evaluates hearing conservation program performance; and (3) the status of DOD's Hearing Center of Excellence and the extent that DOD and VA are sharing information to inform this and other efforts. GAO reviewed DOD and services' policies and guidance, reviewed DOD performance data, interviewed officials and servicemembers, and conducted site visits to nine military bases.

Each of the armed services is taking steps to monitor hazardous noise, but inconsistencies in some hearing protection strategies and limited training weaken mitigation efforts. Services monitor noise periodically, depending on the level of risk servicemembers have in being exposed to hazardous noise (for example, annually for firing ranges and flight decks, and every 5 years for administrative offices). However, they lack a reliable system for detecting changes in noise levels that may occur outside the scheduled review cycle. Although DOD requires that noise be controlled by setting exposure limits and requiring the use of hearing protection, these strategies are not consistently used. For example, servicemembers told us that they do not always wear hearing protection, citing concerns with comfort and communication. Annual hearing-related training is required for at-risk servicemembers, but services are not able to fully determine who has completed annual training, and many servicemembers told GAO that training is not necessarily well timed. DOD's evaluation of services' hearing conservation programs has key weaknesses, but some services have taken steps to review and improve their own programs. First, DOD performance indicators are not sufficiently comprehensive. One key indicator--the rate of hearing loss among servicemembers in the hearing conservation programs--only measures program performance after hearing loss has occurred. Second, evaluation is limited by weaknesses in the processes used to capture, track, and use performance data. For example, the data may not accurately capture the number of servicemembers enrolled in the respective programs--a number required to calculate compliance rate. Third, audiologists, and other key stakeholders do not, on some bases GAO visited, routinely coordinate to share and evaluate hearing loss data to identify and mitigate noise hazards. Individual services have, at times, conducted reviews of their own programs and made some improvements. For example, once the Army decided that soldiers would not be deployed if the individual had not completed a required hearing test, the number of hearing tests rose significantly. DOD has developed, though not yet finalized, a plan for a Hearing Center of Excellence to improve hearing loss prevention and treatment as well as a plan for its registry to track and share information with VA on injured military personnel and veterans. Neither Congress nor the DOD set a date for when planning should be formally approved to implement the center, but a key DOD official estimated that plans may receive final DOD approval in the near future. In the meantime, an interim director for the center has begun to lay the groundwork for implementation of both the center and the registry. While data sharing between DOD and VA has been very limited to date, military and VA officials said the registry should ultimately facilitate sharing and development of best practices. GAO recommends that to improve hearing conservation programs, DOD should address issues with the type, timing, and tracking of training and education; develop an appropriate set of performance indicators; improve processes to collect and use performance data; and examine services' reviews to identify opportunities for program improvement. In reviewing a draft of this report, DOD concurred with GAO's recommendations. DOD and VA provided technical comments, which GAO incorporated as appropriate.

Status Legend:

More Info
  • Review Pending-GAO has not yet assessed implementation status.
  • Open-Actions to satisfy the intent of the recommendation have not been taken or are being planned, or actions that partially satisfy the intent of the recommendation have been taken.
  • Closed-implemented-Actions that satisfy the intent of the recommendation have been taken.
  • Closed-not implemented-While the intent of the recommendation has not been satisfied, time or circumstances have rendered the recommendation invalid.
    • Review Pending
    • Open
    • Closed - implemented
    • Closed - not implemented

    Recommendations for Executive Action

    Recommendation: To position DOD and the services to better protect servicemembers from hearing loss, the Under Secretary for Personnel and Readiness should work with the Assistant Secretary for Health Affairs and ensure that DOD and the services address limitations in the processes used to capture, track, and use performance data. This effort should address issues with data reliability, data entry, reporting capability, and integration across relevant databases.

    Agency Affected: Department of Defense: Office of the Under Secretary for Personnel and Readiness

    Status: Open

    Comments: The Office of the Secretary of Defense and Military Services has said they will address limitations related to performance data processes and problems with data reliability, data entry, reporting and database integration, but they have not explained how or when they will do it. DOD's IG did not provide an update for FY13.

    Recommendation: To position DOD and the services to better protect servicemembers from hearing loss, the Under Secretary for Personnel and Readiness should work with the Assistant Secretary for Health Affairs and ensure that DOD work with the services to develop an appropriate set of performance indicators that assess how well services are reducing hearing loss among servicemembers.

    Agency Affected: Department of Defense: Office of the Under Secretary for Personnel and Readiness

    Status: Open

    Comments: The Department of Defense issued improved performance indicators on December 3, 2010 when it updated its " Instruction 6055.12, Hearing Conservation Program." The agency will review these indicators and develop new ones as needed. DOD's IG did not provide an update for FY13.

    Recommendation: To position DOD and the services to better protect servicemembers from hearing loss, the Under Secretary for Personnel and Readiness should work with the Assistant Secretary for Health Affairs and ensure that DOD and the services improve upon the type, timing, and tracking of training and education provided to servicemembers on hearing protection, by providing information that is more comprehensive and training that is more frequent and possibly earlier in servicemembers' careers.

    Agency Affected: Department of Defense: Office of the Under Secretary for Personnel and Readiness

    Status: Open

    Comments: The Military Services are in various stages of developing and implementing improvements related to different aspects of service members' training and education. The Office of the Secretary of Defense will monitor the implementation of improvements as well as share lessons learned and standardarize those improvements across all Military Services. DOD's IG did not provide an update for FY13.

    Recommendation: To position DOD and the services to better protect servicemembers from hearing loss, the Under Secretary for Personnel and Readiness should work with the Assistant Secretary for Health Affairs and ensure that DOD work with the services to examine the appropriateness and feasibility of expanding those service-level initiatives that hold promise of improving---on a DOD-wide basis---the military hearing conservation programs. Particular attention should be focused on those efforts that already appear to have either increased compliance with program requirements or have demonstrated the potential to reduce hearing loss among servicemembers, such as establishing hearing loss as a readiness issue, improving the comfort and design of hearing protection, and including noise experts more consistently in the procurement process.

    Agency Affected: Department of Defense: Office of the Under Secretary for Personnel and Readiness

    Status: Open

    Comments: The Office of the Secretary of Defense is using and will continue to use the annual Safety and Occupational Health In-Progress Review and the Department of Defense's Hearing Conservation Work Group to review and expand those initiatives which could improve and are improving the military hearing conservation program. DOD's IG did not provide an update for FY13.

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