Defense Health Care:

Improvements Needed in Occupational and Environmental Health Surveillance During Deployments to Address Immediate and Long-Term Health Issues

GAO-05-632: Published: Jul 14, 2005. Publicly Released: Jul 19, 2005.

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Following the 1991 Persian Gulf War, research and investigations into the causes of servicemembers' unexplained illnesses were hampered by inadequate occupational and environmental exposure data. In 1997, the Department of Defense (DOD) developed a militarywide health surveillance framework that includes occupational and environmental health surveillance (OEHS)--the regular collection and reporting of occupational and environmental health hazard data by the military services. GAO is reporting on (1) how the deployed military services have implemented DOD's policies for collecting and reporting OEHS data for Operation Iraqi Freedom (OIF) and (2) the efforts under way to use OEHS reports to address both immediate and long-term health issues of servicemembers deployed in support of OIF.

Although OEHS data generally have been collected and reported for OIF, as required by DOD policy, the deployed military services have used different data collection methods and have not submitted all of the OEHS reports that have been completed. Data collection methods for air and soil surveillance have varied across the services, for example, although they have been using the same monitoring standard for water surveillance. Variations in data collection have been compounded by different levels of training and expertise among service personnel responsible for OEHS. For some OEHS activities, a cross-service working group has been developing standards and practices to increase uniformity of data collection among the services. In addition, while the deployed military services have been conducting OEHS activities, they have not submitted all of the OEHS reports that have been completed during OIF, which DOD officials attribute to various obstacles, such as limited access to communication equipment to transmit reports for archiving. Moreover, DOD officials did not have the required consolidated lists of all OEHS reports completed during each quarter in OIF and therefore could not identify the reports they had not received to determine the extent of noncompliance. To improve OEHS reporting compliance, DOD officials said they were revising an existing policy to add additional and more specific OEHS requirements. DOD has made progress in using OEHS reports to address immediate health risks during OIF, but limitations remain in employing these reports to address both immediate and long-term health issues. OIF was the first major deployment in which OEHS reports have been used consistently as part of operational risk management activities intended to identify and address immediate health risks and to make servicemembers aware of the health risks of potential exposures. While these efforts may help reduce health risks, DOD has no systematic efforts to evaluate their implementation in OIF. In addition, DOD's centralized archive of OEHS reports for OIF has several limitations for addressing potential long-term health effects related to occupational and environmental exposures. First, access to the centralized archive has been limited due to the security classification of most OEHS reports. Second, it will be difficult to link most OEHS reports to individual servicemembers' records because not all data on servicemembers' deployment locations have been submitted to DOD's centralized tracking database. For example, none of the military services submitted location data for the first several months of OIF. To address problems with linking OEHS reports to individual servicemembers, the deployed military services have made efforts to include OEHS monitoring summaries in the medical records of some servicemembers for either specific incidents of potential exposure or for specific locations within OIF. Third, according to DOD and VA officials, no federal research plan has been developed to evaluate the longterm health of servicemembers deployed in support of OIF, including the effects of potential exposures to occupational or environmental hazards.

Recommendations for Executive Action

  1. Status: Closed - Not Implemented

    Comments: The Department of Veterans Affairs has not taken steps to implement this recommendation. Currently, research to understand health effects of deployment in support of OIF is underway. VA did not provide a related update about this issue in 2008. Additionally, there was no evidence that VA has worked with DOD to develop a federal research plan.

    Recommendation: To better anticipate and understand the potential long-term health effects of deployment in support of OIF, the Secretary of Defense and the Secretary of Veterans Affairs should work together to develop a federal research plan to follow the health of these servicemembers that would include the use of archived OEHS reports.

    Agency Affected: Department of Defense

  2. Status: Closed - Not Implemented

    Comments: No action has been taken by DOD in response to this recommendation. DOD stated that it already has procedures in place to evaluate risk management decisions through a jointly established and implemented lessons learned process, including lessons pertaining to OEHS risk management. However, there is no evidence of the implementation of the lessons learned process pertaining to OEHS risk management.

    Recommendation: To improve the use of OEHS reports to address the immediate health risks of servicemembers during deployments, the Secretary of Defense should ensure that the military services jointly establish and implement procedures to evaluate the effectiveness of risk management efforts.

    Agency Affected: Department of Defense

  3. Status: Closed - Implemented

    Comments: DOD completed the revision of DoDI 6490.3 (to be re-titled, "Deployment Health Surveillance and Readiness") and it was issued on August 11, 2006. Jointly-developed, cross-Service implementation guidance for this instruction was completed on November 2, 2007. Both documents address improvements to conducting OEHS activities and to reporting the locations of servicemembers during deployment. However, in its comments to our 2005 report, DOD stated that it had already begun the process of revising this guidance and that this action was not taken in response to our work.

    Recommendation: To improve the collection and reporting of OEHS data during deployments and the linking of OEHS reports to servicemembers, the Secretary of Defense should ensure that cross-service guidance is created to implement DOD's policy, once that policy has been revised, which addresses improvements to conducting OEHS activities and to reporting the locations of servicemembers during deployment.

    Agency Affected: Department of Defense

  4. Status: Closed - Not Implemented

    Comments: No action has been taken related to this recommendation. According to DOD, progress on standardizing occupational and environmental health surveillance (OEHS) data for DOD is reflected in the Defense Occupational and Environmental Health Readiness System (DOEHRS). DOEHRS is a web-based computerized system that collects and archives industrial hygiene data on servicemembers. A modular has been added for the collection and archiving of deployed OEHS data. U.S. Central Command began using this new system in July 2006. Upgrades are being developed so the system can used by all Services in 2008. However, upgrades to the system have not been completed, and the system has not been used to develop a federal research plan.

    Recommendation: To better anticipate and understand the potential long-term health effects of deployment in support of OIF, the Secretary of Defense and the Secretary of Veterans Affairs should work together to develop a federal research plan to follow the health of these servicemembers that would include the use of archived OEHS reports.

    Agency Affected: Department of Defense

 

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