Military Health Care: DOD and VA Could Benefit from More Information on Staff Use of Military Toxic Exposure Records

Fast Facts

Military service members and veterans may have health issues from their exposure to toxic substances during military service—such as smoke and harmful emissions from open-air burn pits.

In 2019, DOD and the VA launched a web-based tool to compile data on individuals' service-related toxic exposures. Staff can use information from the tool to provide health care, process disability claims, and conduct research.

But without tracking staff use of the tool, DOD and VA can't ensure that all types of staff—e.g., clinicians, administrators, researchers—are using it to its fullest extent.

Our recommendations address this and other issues we found.

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Highlights

What GAO Found

The Individual Longitudinal Exposure Record (ILER) web application links service members' and veterans' military toxic exposure and health information from Department of Defense (DOD) and Department of Veterans Affairs (VA) databases. DOD manages data on ILER. It shows most ILER account holders are Veterans Benefits Administration (VBA) staff processing veterans' disability claims. As of November 2023, VBA staff held about 83 percent of the 17,321 ILER accounts opened across DOD and VA. The largest increases in VBA staff with ILER accounts occurred after the Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics Act of 2022 was enacted in August 2022. In response to the act, VBA requires claims benefits staff to use ILER in processing veterans' disability claims.

Individual Longitudinal Exposure Record Accounts Opened, by Agency, August 2022 through November 2023

Selected ILER users GAO interviewed—such as DOD and VA health care clinicians and VBA staff—described efficiencies and challenges with using ILER. For example, users appreciate that ILER presents exposure and deployment information in one place, eliminating the need to review records from multiple sources. Users also identified some challenges, including difficulties in finding relevant information. DOD and VA have taken steps to address challenges GAO identified, such as implementing ways to streamline and filter ILER records.

GAO found that DOD and VA have tracked the use of ILER to varying degrees. For example, through the joint Deployment Health Work Group, the agencies previously tracked use as part of a goal to increase overall ILER use. However, as of fiscal year 2024, the work group is not monitoring ILER use across DOD and VA by staff type or purpose. By monitoring such information through goals and performance measures, DOD and VA would know how ILER is being used for clinical care, processing claims, and research. This, in turn, would better position the agencies to determine if actions—such as additional outreach to staff—are needed to increase awareness about ILER and ensure it is fully used for all of its intended purposes.

Why GAO Did This Study

Military service members and veterans may experience adverse health outcomes associated with toxic exposures experienced during military service. For example, service members have reported health concerns from smoke and harmful emissions produced by open-air burn pits. In 2019, DOD and VA launched ILER as a tool to compile information on individuals' service-related toxic exposures. Staff can use ILER to provide health care, process disability claims, and conduct research.

Congress included a provision in statute for GAO to review ILER. This report, among other issues, (1) describes what available DOD data show about ILER's use among DOD and VA staff, (2) describes benefits and challenges selected DOD and VA staff have encountered while using ILER, and (3) examines DOD and VA efforts to monitor the extent of ILER use among staff.

GAO analyzed data on ILER use among staff as of November 2023; interviewed officials overseeing ILER; reviewed related documents; and interviewed DOD and VA officials at 12 facilities selected for variation in geographic location and number of ILER accounts.

Recommendations

GAO is making two recommendations each to DOD and VA, to 1) develop goals with performance measures on ILER use by staff type and purpose and, (2) use such data to inform staff outreach and other efforts supporting ILER's use. DOD and VA concurred with the recommendations, and VA identified steps the two agencies will take to implement them.

Recommendations for Executive Action

Agency Affected	Recommendation	Status
Department of Defense	The Assistant Secretary of Defense for Health Affairs should ensure that the Deployment Health Work Group establishes goals with performance measures on the extent of ILER use by types of staff and purpose within DOD and VA (Recommendation 1).	Open When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
Department of Defense	The Assistant Secretary of Defense for Health Affairs should ensure that the Deployment Health Work Group or other relevant entities, such as the ILER Steering Group, use the data collected for the goals' performance measures to inform management decisions, including outreach, training, or other efforts that support the appropriate use of ILER (Recommendation 2).	Open When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
Department of Veterans Affairs	The VA Under Secretary for Health should ensure that the Deployment Health Work Group establishes goals with performance measures on the extent of ILER use by types of staff and purpose within DOD and VA (Recommendation 3).	Open When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
Department of Veterans Affairs	The VA Under Secretary for Health should ensure that the Deployment Health Work Group or other relevant entities, such as the ILER Steering Group, use the data collected for the goals' performance measures to inform management decisions, including outreach, training, or other efforts that support the appropriate use of ILER (Recommendation 4).	Open When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.