Defense Health Care

Following the 1991 Persian Gulf War, research and investigations into the causes of servicemembers' unexplained illnesses were hampered by a lack of servicemember health and deployment data, including 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. This testimony is based on GAO's report, entitled Defense Health Care: Improvements Needed in Occupational and Environmental Health Surveillance during Deployment to Address Immediate and Long-term Heath Issues (GAO-05-632). The testimony presents findings about how the deployed military services have implemented DOD's policies for collecting and reporting OEHS data for Operation Iraqi Freedom (OIF) and 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. 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. Moreover, DOD officials could not identify the reports they had not received to determine the extent of noncompliance. 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. OEHS reports have been used consistently during OIF as part of operational risk management activities intended to identify and address immediate health risks and to make servicemembers aware of the risks of potential exposures. While these efforts may help in reducing health risks, DOD has not systematically evaluated their implementation during OIF. 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. To address problems with linking OEHS reports to individual servicemembers, the deployed military services have tried 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. Additionally, according to DOD and Veterans Affairs (VA) officials, no federal research plan has been developed to evaluate the long-term health of servicemembers deployed in support of OIF, including the effects of potential exposures to occupational or environmental hazards. GAO's report made several recommendations, including that the Secretary of Defense improve deployment OEHS data collection and reporting and evaluate OEHS risk management activities and that the Secretaries of Defense and Veterans Affairs jointly develop a federal research plan to address long-term health effects of OIF deployment. DOD plans to take steps to meet the intent of our first recommendation and partially concurred with the other recommendations. VA concurred with our recommendation for a joint federal research plan.