Recommendation: The Secretary of Defense should ensure that the Under Secretary of Defense for Personnel and Readiness, in coordination with the Director, CAPE, the Joint Staff Surgeon, and the secretaries of the military departments, establish joint planning assumptions for developing operational medical and dental personnel requirements, including a definition of what forces should and should not be identified as "operational." (Recommendation 1)

Agency: Department of Defense
Status: Open

Comments: The Department of Defense concurred with this recommendation and said it would take steps to implement it. According to department officials, as of November 2019, they are drafting a report that will address this recommendation. We will continue to monitor DOD's efforts.

Recommendation: The Secretary of Defense should ensure that the Under Secretary of Defense for Personnel and Readiness, in coordination with the Director of Cost Assessment and Program Evaluation, the Joint Staff Surgeon, and the secretaries of the military departments, establish a method to assess options for achieving joint efficiencies in medical and dental personnel requirements and any associated risks. (Recommendation 2)

Agency: Department of Defense
Status: Open

Comments: The Department of Defense concurred with this recommendation and said it would take steps to implement it. According to department officials, as of November 2019, they are drafting a report that will address this recommendation. We will continue to monitor the department's efforts. .

Recommendation: The Secretary of Defense should ensure that the Under Secretary of Defense for Personnel and Readiness, in coordination with the Director of Cost Assessment and Program Evaluation, the Joint Staff Surgeon, and the secretaries of the military departments, apply joint planning assumptions and a method for assessing efficiencies and risk, use these to determine operational medical and dental requirements, and report to Congress. (Recommendation 3)

Agency: Department of Defense
Status: Open

Comments: The Department of Defense concurred with this recommendation and said it would take steps to implement it. According to department officials, as of November 2019, they are drafting a report that will address this recommendation. We will continue to monitor DOD's efforts..

Recommendation: The Secretary of Defense should ensure that the Assistant Secretary of Defense for Health Affairs, in coordination with the Surgeons General of the military departments, identify and mitigate limitations in the clinical readiness metric, such as data reliability, a lack of complete information on reserve component providers and patient care workload performed outside of medical treatment facilities (MTFs), and the lack of linkage between the metric and patient care and retention outcomes. (Recommendation 4)

Agency: Department of Defense
Status: Open

Comments: The Department of Defense concurred with this recommendation and said it would take steps to implement it. As of November 2019, DOD has not taken any actions to implement this recommendation.

Recommendation: The Secretary of Defense should ensure that the Assistant Secretary of Defense for Health Affairs, in coordination with the Surgeons General of the military departments and the Director of the Defense Health Agency, determines which critical wartime specialties perform high-risk, high-acuity procedures and rely upon perishable skill sets and use this information to prioritize specialties to which the clinical readiness metric could be expanded (Recommendation 5).

Agency: Department of Defense
Status: Open

Comments: The Department of Defense concurred with this recommendation and said it would take steps to implement it. As of November 2019, DOD has not implemented this recommendation.

Recommendation: The Secretary of Defense should ensure that the Assistant Secretary of Defense for Health Affairs, in coordination with each of the Surgeons General of the military departments and the Director of the Defense Health Agency, estimates the cost and benefits, by specialty, of implementing a clinical readiness metric and use that information to determine whether DODs approach should be revised. Costs to be considered should include those needed to provide additional training for medical personnel to achieve clinical readiness thresholds and to hire additional civilian personnel in MTFs to backfill military providers who leave to attend training. (Recommendation 6)

Agency: Department of Defense
Status: Open

Comments: The Department of Defense concurred with this recommendation and said it would take steps to implement it. As of November 2019, DOD has not implemented this recommendation.

Recommendation: The Under Secretary of Defense for Personnel and Readiness should collect quality information and conduct an analysis of the potential effects of unreimbursed travel expenses incurred by reservists to perform military service on DOD's ability to retain reservists in the force, and respond to these risks by considering the costs and benefits of any possible actions to address the identified issues.

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

Comments: DOD concurred with our recommendation. As of September 2020, DOD has taken some steps to address this recommendation. Specifically, the National Guard Bureau and the Deputy Assistant Secretary of Defense (Reserve Integration) commissioned the Institute for Defense Analyses to conduct a study to address our recommendation. According to DOD officials, the study was completed in September 2019 but has not yet been published, and an implementation plan is currently being developed. We will continue to monitor the status of this recommendation.

Recommendation: To facilitate oversight of the size of DOD's reserve-component headquarters and ensure that they have the minimum personnel needed to complete their assigned missions, and to minimize the potential for gaps or overlaps at the National Guard's state Joint Force headquarters, the Secretary of Defense should direct the Chief of the National Guard Bureau to assess and validate all personnel requirements at the state Joint Force headquarters to include the Army staff element and Air staff element.

Agency: Department of Defense
Status: Open

Comments: DOD partially concurred with this recommendation. In DOD's response, the department detailed ongoing efforts to validate personnel requirements and stated that revising the scope of the National Guard Bureau's study would eliminate the ability of the Army National Guard and Air National Guard to identify their own personnel requirements. The department further stated that when shared functions are being studied, coordination should be increased between the staff elements to ensure that the correct workload is captured, requirements are not duplicated, and process efficiencies are maximized. However, we found minimal coordination on studies examining the five functions that the National Guard identified as being staffed with both Army National Guard and Air National Guard personnel. As of July 2020, the National Guard Bureau (NGB) had not assessed and validated personnel requirements at the state Joint Force headquarters.

Recommendation: To improve DOD's estimates and comparisons of the full cost of its military, civilian, and contractor workforces and to improve DOD's methodology for estimating and comparing the full cost of its various workforces, the Secretary of Defense should direct the Office of Cost Assessment and Program Evaluation to further develop guidance for cost elements that users have identified as challenging to calculate, such as general and administrative, overhead, advertising and recruiting, and training.

Agency: Department of Defense
Status: Open

Comments: According to DOD's April 2017 report on Comparing the Cost of Civilians and Contractors, DOD's Cost Assessment and Program Evaluation (CAPE) office is updating fiscal year 2017 estimates in its Full Cost of Manpower (FCoM) system to reflect separate officer and enlisted training costs. If more specific cost estimates are required, users of FCoM are directed to cost estimating tools operated by the military departments.

Recommendation: To improve DOD's estimates and comparisons of the full cost of its military, civilian, and contractor workforces and to improve DOD's methodology for estimating and comparing the full cost of its various workforces, the Secretary of Defense should direct the Office of Cost Assessment and Program Evaluation to develop business rules for estimating the full cost of National Guard and Reserve personnel.

Agency: Department of Defense
Status: Open

Comments: According to DOD's April 2017 report in Comparing the Cost of Civilians and Contractors, a cost estimating function for Reserve Component personnel far exceeds the combination of variables for developing active component and DOD civilian cost estimates. Due to the scope of the Full Cost of Manpower (FCoM) contract, OSD(CAPE) has not adopted this recommendation in terms of a web-based application. However, OSD(CAPE) intends to address general business rules for Reserve Component cost estimates in the next DoDI revision.

Recommendation: To improve DOD's estimates and comparisons of the full cost of its military, civilian, and contractor workforces and to improve DOD's methodology for estimating and comparing the full cost of its various workforces, the Secretary of Defense should direct the Office of Cost Assessment and Program Evaluation, in coordination with the department's Office of the Actuary and appropriate federal actuarial offices, to reevaluate the inclusion and quantification of pension, retiree health care costs, and other relevant costs of an actuarial nature and make revisions as appropriate.

Agency: Department of Defense
Status: Open

Comments: According to DOD's April 2017 report on Comparing the Cost of Civilians and Contractors, OSD(CAPE) has reviewed the inclusion of payments that the government makes to retirement and health benefits. All identified costs that are attributable to current retirees and past service of active civilian and military personnel, such as unfunded liabilities, are being revised in the cost estimating guidelines. OSD(CAPE) intends to incorporate these changes in the next DoDI revision and coordinate a review with the Office of the DoD Actuaty.

Recommendation: To improve DOD's estimates and comparisons of the full cost of its military, civilian, and contractor workforces and to improve DOD's ability to estimate contractor support costs, the Secretary of Defense should direct the Office of Cost Assessment and Program Evaluation, consistent with established practices for developing credible cost estimates, to research the data sources it is currently using and reassess its contractor support data sources for use when determining contractor support costs.

Agency: Department of Defense
Status: Open

Comments: According to DOD's April 2017 report on Comparing the Cost of Civilian and Contractors, the department's efforts to improve data sources are ongoing.

Recommendation: To help DOD obtain reasonable assurance that all active and Reserve component servicemembers to whom the PDHRA requirement applies are provided the opportunity to have their health concerns identified, the Assistant Secretary of Defense for Health Affairs and the military services should take steps to ensure that PDHRA questionnaires are included in DOD's central repository for each of these servicemembers.

Agency: Department of Defense
Status: Open

Comments: In its comments to this report, the Department of Defense (DOD) concurred with this recommendation. On October 2009, DOD's Force Health Protection and Response Office sent a memo to each of the military service Surgeons General emphasizing the need for the post-deployment health reassessment (PDHRA) to be offered to all service members who are eligible to complete the assessment. In 2010, DOD's noted that the services would work with the Armed Forces Health Surveillance Center (AFHSC) repository to ensure PDHRAs are submitted correctly, without transmission errors. DOD's 2011 case records showed that the Air Force and Army had developed data verification processes to ensure that AFHSC received PDHRAs. Further, the Defense Medical Data Center (DMDC) had planed to create a file consisting of the date of deployment for deployed personnel, and that the file would be available to the services in order to match DMDC with data from each of the service-specific systems, in accordance to requirements. In September 2011, although DMDC and the services had agreed to match rosters of deployed service members, there were still inconsistencies in deployment dates. In March 2012, DOD was still verifying data inconsistencies which, until resolved, leads to inaccurate reporting based on errors in the deployment dates. As of September 2019, DOD has not provided information or documentation to address this recommendation.