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.

Recommendations for Executive Action

  1. Status: Closed - Implemented

    Comments: DOD has taken several actions to improve the type and timing of education and training provided to servicemembers on hearing protection. For example, according to DOD, all services now provide hearing protection training at enlisted and officer accession points. In addition, each of the services and the Hearing Center of Excellence now make online training available to all service members. In 2012, the Marines began to mandate annual hearing protection training and the Army has plans to follow suit in 2015. However, more work remains to improve the tracking of hearing loss training. Each of the services report plans to evaluate the use of current systems to improve the tracking of training completion, but many of these system changes are still in progress.

    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

  2. Status: Closed - Implemented

    Comments: In December 2010, DOD updated the DoD instruction 6055.12, "Hearing Conservation Program" to include improved performance indicators. These include measures designed to be more proactive in hazard evaluation and prevention prior to measurable hearing loss, such as the percentage of noise hazardous workplace characterizations completed and an index of unacceptable noise exposures.

    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

  3. Status: Closed - Implemented

    Comments: DOD reports some efforts to improve their ability capture, track, and use performance data through the DOEHRS-HC system, including deployed software upgrades in June, August, and December 2012 to correct some of the limitations in tracking individual hearing testing data and follow-up testing requirements. DOD has also made efforts to improve accuracy in data processing, and ad hoc reporting capability. However, more work remains to improve the system used to track hazardous noise exposure. While DOD has not reported any improvements to the DOEHRS-IH system, the agency has plans to continue to pursue funding to achieve needed system performance improvements, including integration with other relevant databases.

    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

  4. Status: Closed - Implemented

    Comments: To regularly examine appropriateness and feasibility of expanding promising initiatives, the DOD now uses its annual Safety & Occupational Health In-Progress Review (IPR) and the DoD Hearing Conservation Work Group as mechanisms for direct cross-flow and application of individual Military Service improvement initiatives. The working group meets quarterly, provides technical evaluations, and makes recommendations to improve the DOD hearing conservation programs. As result of the working group's efforts, DOD reports the following improvements to its Hearing Conservation Program: an overall decrease in significant threshold shift rates (a measure of hearing loss) over the past 5 years; Military Services emphasizing hearing loss as a readiness issue; working group advice to ODUSD (I&E) and Military Service leadership to improve Hearing Conservation Program policy and guidance documents; developing and sharing improved hearing conservation training products; developing and sharing improved measures of program effectiveness, including use of enterprise management systems to increase senior leadership visibility; identifying and prioritizing system change requests required to improve DOEHRS-HC and DOEHRS-DR functionality; and collaboration and awareness of Military Service research laboratory activities to evaluate new hearing protection devices and equipment noise reduction engineering.

    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

 

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