DOD Civilian Personnel
Greater Oversight and Quality Assurance Needed to Ensure Force Health Protection and Surveillance for Those Deployed Gao ID: GAO-06-1085 September 29, 2006As the Department of Defense (DOD) has expanded its involvement in overseas military operations, it has grown increasingly reliant on its federal civilian workforce to support contingency operations. The Senate Armed Services Committee required GAO to examine DOD's policies concerning the health care for DOD civilians who deploy in support of contingency operations in Afghanistan and Iraq. GAO analyzed over 3,400 deployment-related records for deployed federal civilians and interviewed department officials to determine the extent to which DOD has established and the military services and defense agencies (hereafter referred to as DOD components) have implemented (1) force health protection and surveillance policies and (2) medical treatment policies and procedures for its deployed federal civilians. GAO also examined the differences in special pays and benefits provided to DOD's deployed federal civilians and military personnel.
DOD has established force health protection and surveillance policies to assess and reduce or prevent health risks for its deployed federal civilian personnel, but it lacks procedures to ensure implementation. Our review of over 3,400 deployment records at eight component locations found that components lacked documentation that some federal civilian personnel who deployed to Afghanistan and Iraq had received, among other things, required pre- and post-deployment health assessments and immunizations. These deficiencies were most prevalent at Air Force and Navy locations, and one Army location. As a larger issue, DOD lacked complete and centralized data to readily identify its deployed federal civilians and their movement in theater, further hindering its efforts to assess the overall effectiveness of its force health protection and surveillance capabilities. In August 2006, DOD issued a revised policy which outlined procedures that are intended to address these shortcomings. However, these procedures are not comprehensive enough to ensure that DOD will know the extent to which its components are complying with existing health protection requirements. In particular, the procedures do not establish an oversight and quality assurance mechanism for assessing the implementation of its force health protection and surveillance requirements. Until DOD establishes a mechanism to strengthen its force health protection and surveillance oversight, it will not be effectively positioned to ensure compliance with its policies, or the health care and protection of deployed federal civilians. DOD has also established medical treatment policies for its deployed federal civilians which provide those who require treatment for injuries or diseases sustained during overseas hostilities with care that is equivalent in scope to that provided to active duty military personnel under the DOD military health system. GAO reviewed a sample of seven workers' compensation claims (out of a universe of 83) filed under the Federal Employees' Compensation Act by DOD federal civilians who deployed to Iraq. GAO found in three cases where care was initiated in theater, that the affected civilians had received treatment in accordance with DOD's policies. In all seven cases, DOD federal civilians who requested care after returning to the United States had, in accordance with DOD's policies, received medical examinations and/or treatment for their deployment-related injuries or diseases through either military or civilian treatment facilities. DOD provides certain special pays and benefits to its deployed federal civilians, which generally differ in type and/or amount from those provided to deployed military personnel. For example, both civilian and military personnel are eligible to receive disability benefits for deployment-related injuries; however, the type and amount of these benefits vary, and some are unique to each group. Further, while the survivors of deceased federal civilian and military personnel generally receive similar types of cash survivor benefits, the comparative amounts of these benefits differ.
RecommendationsOur recommendations from this work are listed below with a Contact for more information. Status will change from "In process" to "Open," "Closed - implemented," or "Closed - not implemented" based on our follow up work.
Director: Team: Phone:GAO-06-1085, DOD Civilian Personnel: Greater Oversight and Quality Assurance Needed to Ensure Force Health Protection and Surveillance for Those Deployed
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Report to Congressional Committees:
United States Government Accountability Office:
GAO:
September 2006:
DOD Civilian Personnel:
Greater Oversight and Quality Assurance Needed to Ensure Force Health
Protection and Surveillance for Those Deployed:
DOD Civilian Personnel:
GAO-06-1085:
GAO Highlights:
Highlights of GAO-06-1085, a report to congressional committees
Why GAO Did This Study:
As the Department of Defense (DOD) has expanded its involvement in
overseas military operations, it has grown increasingly reliant on its
federal civilian workforce to support contingency operations. The
Senate Armed Services Committee required GAO to examine DOD‘s policies
concerning the health care for DOD civilians who deploy in support of
contingency operations in Afghanistan and Iraq. GAO analyzed over 3,400
deployment-related records for deployed federal civilians and
interviewed department officials to determine the extent to which DOD
has established and the military services and defense agencies
(hereafter referred to as DOD components) have implemented (1) force
health protection and surveillance policies and (2) medical treatment
policies and procedures for its deployed federal civilians. GAO also
examined the differences in special pays and benefits provided to DOD‘s
deployed federal civilians and military personnel.
What GAO Found:
DOD has established force health protection and surveillance policies
to assess and reduce or prevent health risks for its deployed federal
civilian personnel, but it lacks procedures to ensure implementation.
Our review of over 3,400 deployment records at eight component
locations found that components lacked documentation that some federal
civilian personnel who deployed to Afghanistan and Iraq had received,
among other things, required pre- and post-deployment health
assessments and immunizations. These deficiencies were most prevalent
at Air Force and Navy locations, and one Army location. As a larger
issue, DOD lacked complete and centralized data to readily identify its
deployed federal civilians and their movement in theater, further
hindering its efforts to assess the overall effectiveness of its force
health protection and surveillance capabilities. In August 2006, DOD
issued a revised policy which outlined procedures that are intended to
address these shortcomings. However, these procedures are not
comprehensive enough to ensure that DOD will know the extent to which
its components are complying with existing health protection
requirements. In particular, the procedures do not establish an
oversight and quality assurance mechanism for assessing the
implementation of its force health protection and surveillance
requirements. Until DOD establishes a mechanism to strengthen its force
health protection and surveillance oversight, it will not be
effectively positioned to ensure compliance with its policies, or the
health care and protection of deployed federal civilians.
DOD has also established medical treatment policies for its deployed
federal civilians which provide those who require treatment for
injuries or diseases sustained during overseas hostilities with care
that is equivalent in scope to that provided to active duty military
personnel under the DOD military health system. GAO reviewed a sample
of seven workers‘ compensation claims (out of a universe of 83) filed
under the Federal Employees‘ Compensation Act by DOD federal civilians
who deployed to Iraq. GAO found in three cases where care was initiated
in theater, that the affected civilians had received treatment in
accordance with DOD‘s policies. In all seven cases, DOD federal
civilians who requested care after returning to the United States had,
in accordance with DOD‘s policies, received medical examinations and/or
treatment for their deployment-related injuries or diseases through
either military or civilian treatment facilities.
DOD provides certain special pays and benefits to its deployed federal
civilians, which generally differ in type and/or amount from those
provided to deployed military personnel. For example, both civilian and
military personnel are eligible to receive disability benefits for
deployment-related injuries; however, the type and amount of these
benefits vary, and some are unique to each group. Further, while the
survivors of deceased federal civilian and military personnel generally
receive similar types of cash survivor benefits, the comparative
amounts of these benefits differ.
What GAO Recommends:
To strengthen DOD‘s force health protection and surveillance for its
deployed federal civilians, GAO recommends that the Secretary of
Defense establish an oversight and quality assurance mechanism to
ensure that all components fully comply with its requirements. In
commenting on a draft of this report, DOD partially concurred with
GAO‘s recommendation.
[Hyperlink, http://www.gao.gov/cgi-bin/getrpt?GAO-06-1085].
To view the full product, including the scope and methodology, click on
the link above. For more information, contact Valerie Melvin at (202)
512-6304 or melvinv@gao.gov.
[End of Section]
Contents:
Letter:
Results in Brief:
Background:
DOD Has Established Force Health Protection and Surveillance Policies
for Deployed Federal Civilians, but Should Do More to Ensure That
Components Comply with Its Requirements:
DOD Has Established and Implemented Medical Treatment Policies Which
Provide for the Care of Its Deployed Federal Civilians:
Special Pays and Benefits Provided to Deployed DOD Federal Civilian and
Military Personnel Generally Vary in Type and Amount:
Conclusions:
Recommendation for Executive Action:
Agency Comments and Our Evaluation:
Appendix I: Scope and Methodology:
Appendix II: Temporary and Permanent Partial Disability Benefits
Provided to DOD Federal Civilian and Military Personnel:
Appendix III: Comments from the Department of Defense:
Appendix IV: GAO Contact and Staff Acknowledgments:
Tables:
Table 1: DOD Federal Civilian Deployment Records Lacking Documentation
of Pre-deployment Health Assessments:
Table 2: DOD Federal Civilian Deployment Records Lacking Documentation
of Required Immunizations:
Table 3: DOD Federal Civilian Deployment Records Lacking Documentation
of Current Tuberculosis or HIV Screenings:
Table 4: DOD Federal Civilian Deployment Records Lacking Documentation
of Post-deployment Health Assessments:
Table 5: Overview of Selected Types of Special Pays for Deployed DOD
Federal Civilian and Military Personnel:
Table 6: Scenario 1: Comparisons of Compensation Provided to DOD
Federal Civilian and Military Personnel Deployed to Afghanistan or Iraq
for One Year:
Table 7: Scenario 2: Comparisons of Compensation Provided to DOD
Federal Civilian and Military Personnel Deployed to Afghanistan or Iraq
for Six Months:
Table 8: Overview of the Type and Amount of Lump Sum Benefits Provided
to Survivors of DOD Federal Civilian and Military Personnel:
Table 9: Overview of the Type and Amount of Recurring Benefits Provided
to Survivors of DOD Federal Civilian and Military Personnel:
Table 10: Summary of Noncash Benefits Provided to Survivors of DOD
Federal Civilian and Military Personnel:
Table 11: DOD Component Locations and Number of DOD Federal Civilian
Deployment Records Included in Our Review:
Table 12: Sample Disposition for Fort Benning Federal Civilian
Deployment Records:
Table 13: Temporary Disability Compensation Payments, Payment Formula,
and 2006 Payment Caps for DOD Federal Civilian and Military Personnel:
Table 14: Permanent Partial Disability Compensation Payment Formulas
and Time Limits on Benefits for DOD Federal Civilian and Military
Personnel:
Figures:
Figure 1: Overview of the Levels of DOD Medical Care Provided While
Deployed:
Figure 2: Medical Treatment and Claims Processes for DOD Federal
Civilians Who Require Treatment for Deployment-Related Injuries or
Diseases After They Return to the United States:
Abbreviations:
AMSA: Army Medical Surveillance Activity:
CITA: Comprehensive Immunization Tracking Application:
CONUS: Continental United States:
CSRS: Civil Service Retirement System:
DCMA: Defense Contract Management Agency:
DEERS: Defense Enrollment Eligibility Reporting System:
DMDC: Defense Manpower Data Center:
DMSS: Defense Medical Surveillance System:
DOD: Department of Defense:
FECA: Federal Employees' Compensation Act:
FERS: Federal Employees' Retirement System:
HIV: Human Immunodeficiency Virus:
MEDPROS: Medical Protection System:
OWCP: Office of Workers' Compensation Programs:
PIMR: Preventive Health Assessment and Individual Medical Readiness:
SSDI: Social Security Disability Insurance:
TPC: Transatlantic Programs Center:
TSP: Thrift Savings Plan:
VA: Veterans Affairs:
United States Government Accountability Office:
Washington, DC 20548:
September 29, 2006:
Congressional Committees:
As the Department of Defense (DOD) has expanded its involvement in
overseas military operations, it has grown increasingly reliant on its
federal civilian workforce to provide support in times of war or
national emergency.[Footnote 1] In recent years, DOD has undertaken
efforts to expand the use of its civilian workforce to perform combat
support functions traditionally performed by military personnel. Since
fiscal year 2004, it has been in the process of converting thousands of
military positions to civilian positions, with additional conversions
planned in the future. DOD's 2006 Quadrennial Defense Review Report has
acknowledged the department's growing dependence on its civilian
personnel to support contingency operations beyond Afghanistan and
Iraq.
However, DOD's use of its civilian personnel to support military
operations has long raised questions about its policies relating to the
deployment of civilians in support of contingency operations. In 1994,
we reported on the adequacy of DOD's planning for the future use of
civilian personnel to support military operations in combat areas and
noted a number of problems in deploying civilians to the Gulf War and
caring for them in theater.[Footnote 2] For example, we noted that many
civilians had not been screened to ensure that they were medically fit
to serve in desert conditions. Thus, some had arrived in the desert
with medical and physical limitations, such as severe heart problems
and kidney disorders that precluded them from effectively performing
their duties. Other problems, while not as grave, indicated a lack of
preparation for civilians in theater. For example, clear procedures did
not exist to ensure that civilians received medical care comparable to
that received by military personnel. In addition, procedures were not
in place to provide for overtime or danger pay that the deployed
civilians were eligible to receive. Questions had also existed
concerning whether civilian life insurance policies contained war
exclusion clauses that would preclude survivors of deceased civilian
personnel from receiving accidental death benefits if civilians were
killed while deployed in support of the Gulf War.
The Senate Armed Services Committee required us to examine DOD's
policies concerning its federal civilians who deploy in support of
contingency operations in Afghanistan and Iraq.[Footnote 3] In
accordance with that requirement and agreements with your offices, we
examined the extent to which DOD has established and the military
services and one defense agency (hereafter referred to as DOD
components)[Footnote 4] have implemented (1) force health protection
and surveillance policies for the department's deployed federal
civilians and (2) medical treatment policies and procedures for the
department's deployed federal civilians who require treatment for
injuries and diseases. In addition, per your request, we examined the
special pays and benefits provided to DOD's deployed federal civilian
personnel, including the extent to which these special pays and
benefits differ from those provided to deployed active duty military
personnel. We provided briefings on the preliminary results of our work
to congressional committees in March 2006. This report updates our
preliminary observations and provides further information regarding DOD
federal civilian deployments to Afghanistan and Iraq.
To determine the extent to which DOD has established force health
protection and surveillance policies for its deployed federal
civilians, we reviewed DOD deployment health requirements for
contingency operations in Afghanistan and Iraq and discussed these
policies with the appropriate DOD officials. Our review focused on DOD
federal civilians who (1) deployed to Afghanistan or Iraq for 30
continuous days or more between June 1, 2003, and September 30, 2005,
and (2) returned to the United States by February 28, 2006.[Footnote 5]
Because DOD had difficulty identifying the total number of federal
civilians who had deployed to Afghanistan or Iraq, we assessed the
implementation of DOD's deployment health requirements at eight
component locations that were selected using a number of approaches.
Given that DOD components have flexibility in where they conduct
deployment processing, we selected the locations for our review
accordingly. Specifically, the Army uses a centralized approach,
deploying its federal civilians at three primary locations; therefore,
we selected all three locations for review. By contrast, the Navy and
Air Force use a decentralized approach, deploying their federal
civilians at their home stations. For these components, we selected
five locations based on data which indicated that these locations had
deployed the largest numbers of federal civilian personnel to
Afghanistan and Iraq. Through an informal agreement between DCMA and
Army, the Army processes DCMA's federal civilians for deployment
through two of the Army's three deployment locations. Therefore, DCMA
deployment data in this report are included in the Army results to the
extent that DCMA federal civilian deployments were documented at the
two relevant Army locations. At all eight component locations, we
reviewed either all available hard copy or electronic deployment
records, or in one instance, a sample of the deployment records for
deployed federal civilian personnel who met our criteria above. In
total, we reviewed hard copies of records for 454 (out of the reported
822) federal civilian deployments at seven component locations and
electronic records for 2,977 (out of the reported 2,977) federal
civilian deployments at the other location where all deployment records
were being maintained electronically. Deployed federal civilians
included in our review may have deployed more than once during our
selected deployment time frame; consequently, there may be fewer unique
civilians than deployments reviewed. The results of these deployment
record reviews, however, could not be projected beyond the reviewed
records to all federal civilians who had deployed during this time
frame. To facilitate our review of federal civilian deployment records
at the selected component locations, we developed a data collection
instrument to review and collect deployment health information from
each individual civilian's deployment record. After our review of hard
copy deployment records, we requested each component's medical
personnel to reexamine those hard copy deployment records that were
missing required health documentation, and we adjusted our results
where documentation was subsequently provided. We also obtained and
analyzed other documentation from information systems used by the
components to capture deployment and related health information, making
adjustments to our results where documentation was subsequently found
in the systems. We took steps to assess the reliability of the civilian
deployment and related health data for the purposes of this review,
including consideration of issues such as the completeness of the data
from the respective information systems' program managers and
administrators. We also examined whether the data were subjected to
quality control measures, such as periodic testing of the data against
deployment records to ensure the accuracy and completeness of the data.
In addition, we reviewed existing documentation related to the data
sources and interviewed knowledgeable agency officials about the data.
Although we found these deployment and health data not sufficiently
reliable for (1) identifying the universe of deployed DOD federal
civilians or (2) use as the sole source for reviewing the health and
immunization information for DOD federal civilian deployments, we found
the data in the information systems sufficiently reliable when used as
one of several sources in our review of deployment records. In those
instances where we did not find evidence of a deployment health
assessment or immunization in either the deployment records or in the
electronic data systems, we concluded that the health assessment or
immunization was not documented.
To determine the extent to which DOD and the selected components had
established medical treatment policies for deployed federal civilian
personnel who required treatment for injuries, illnesses, and diseases,
we analyzed DOD policies and guidance related to defense health care
and discussed these with senior DOD and service surgeon general
officials. To assess the implementation of the policies, we requested
all of the workers' compensation claims that had been filed under the
Federal Employees' Compensation Act[Footnote 6] by DOD federal
civilians who had deployed to Afghanistan and Iraq. However, our actual
review of claims filed by DOD federal civilian personnel was limited to
those who had deployed to Iraq because the responsible DOD officials
were unable to identify the specific claims that had been filed by
those federal civilians who had deployed to Afghanistan. We selected
and reviewed a non-probability sample of workers' compensation claims
to reflect a range of casualties, including injuries, physical and
mental illnesses, and diseases. The scope of our review did not extend
to the Department of Labor's claims review process, which covers the
workers' compensation claims process.
To determine the types of and differences in special pays and benefits
provided to DOD federal civilian and military personnel who deploy in
support of contingency operations in Afghanistan and Iraq, we examined
the major provisions for special pays and disability and death benefits
for civilian and military personnel, relying primarily on statutes,
Department of State regulations, and DOD guidance. To illustrate how
special pays affected overall compensation provided to DOD federal
civilian and military personnel, we modeled scenarios for both groups
based on similar circumstances, such as pay grades, length of
deployment, and special pays. With regard to disability benefits, we
compared benefits provided to DOD federal civilians for line-of-duty
injuries with benefits provided to military personnel for service-
connected injuries, focusing on three main categories of disability:
(1) temporary disability, (2) permanent partial disability, and (3)
permanent total disability. With regard to death benefits, we primarily
reviewed statutes governing both cash and noncash government-provided
benefits. In this report, we do not take a position regarding the
adequacy or appropriateness of the special pays and benefits provided
to DOD federal civilian and military personnel.
We performed our review from March 2006 through August 2006 in
accordance with generally accepted government auditing standards. For
more detailed information on our scope and methodology, see appendix I.
Results in Brief:
DOD has established force health protection and surveillance policies
aimed at assessing and reducing or preventing health risks for its
deployed federal civilian personnel, but it lacks procedures to ensure
the components' full implementation of these policies. Our review of
deployment records at eight locations found that the components lacked
documentation to show that some federal civilian personnel who deployed
to Afghanistan and Iraq had received, among other things, required pre-
and post-deployment health assessments and immunizations. These
deficiencies were most prevalent at Air Force and Navy locations, and
at one Army location. As a larger issue, DOD lacked complete and
centralized data to ensure that it could identify its deployed
civilians and track their movement in theater, further hindering its
efforts to assess the overall effectiveness of its force health
protection and surveillance capabilities. As a positive step, in August
2006, DOD issued a revised policy (to be effective in December 2006)
that outlines procedures for addressing these shortcomings. However,
the procedures are not comprehensive enough to ensure that DOD will be
sufficiently informed of the extent to which its components are
complying with the department's health protection requirements for
deployed federal civilians. In particular, the procedures do not
establish an oversight and quality assurance mechanism to enable DOD to
effectively assess and ensure the full implementation of its force
health protection requirements. Until DOD establishes an oversight and
quality control mechanism to strengthen its force health protection and
surveillance oversight, it will not be effectively positioned to ensure
the components' compliance with its policies, or ensure the health care
and protection of its deployed federal civilian personnel.
DOD has also established medical treatment policies that cover its
federal civilians while they are deployed in support of contingency
operations in Afghanistan and Iraq, and selected workers' compensation
claims that we reviewed confirmed that those deployed federal civilians
received care that was consistent with the policies. These policies
state that DOD civilians who require treatment for injuries, illnesses,
or diseases sustained during overseas hostilities may be provided care
equivalent in scope to that provided to active duty military personnel
under the DOD military health system. In this regard, DOD's military
health system provides four levels of medical care to military service
personnel, as well as DOD federal civilians, while they are deployed in
support of contingency operations in Afghanistan or Iraq--ranging from
level one, which consists of basic first aid and emergency care in
theater, to level four, involving medical treatment at DOD's Regional
Medical Center in Landstuhl, Germany. Our review of a sample of seven
workers' compensation claims (out of a universe of 83) filed under the
Federal Employees' Compensation Act by DOD federal civilians who
deployed to Iraq, found that in three cases where care was initiated in
theater, the affected civilians had received treatment in accordance
with DOD's policies. Further, DOD's policies state that civilian
personnel who require treatment for deployment-related injuries or
illnesses after they return to the United States may select either a
qualified local physician or hospital of their choice, or a military
medical treatment facility to provide the necessary treatment. We found
that in the seven cases reviewed, DOD federal civilians who requested
care after returning to the United States, had, in accordance with
DOD's policies, received medical examinations and/or treatment for
their deployment-related injuries or illnesses and diseases through
either military or civilian treatment facilities.
DOD provides certain special pays and benefits to its deployed federal
civilians which generally differ in type and/or amount from those
provided to deployed military personnel. For example, in cases where
injuries are sustained while deployed, both DOD federal civilian and
military personnel are eligible to receive two broad categories of
disability benefits--disability compensation[Footnote 7] and disability
retirement;[Footnote 8] however, the type and amount of the benefits
vary, and some are unique to each group. In addition, while survivors
of deceased DOD federal civilian and military personnel generally
receive similar types of cash survivor benefits for Social Security,
burial expenses, and death gratuity, the comparative amounts of these
benefits differ. However, survivors of DOD federal civilian personnel
almost always receive lower noncash benefits than military personnel.
In written comments on a draft of this report, DOD partially concurred
with our recommendation to establish an oversight and quality assurance
mechanism to ensure that the components comply with its force health
protection and surveillance requirements. The department outlined
several steps it is taking to determine appropriate implementation of
our recommendation but took issue with some of our specific findings.
DOD's comments and our evaluation of them are discussed in the agency
comments section of this report.
Background:
The structure of the armed forces is based on the Total Force concept,
which recognizes that all elements of the structure--active duty
military personnel, reservists, defense contractors, host nation
military and civilian personnel, and DOD federal civilian employees--
contribute to national defense. In recent years, federal civilian
personnel have deployed along with military personnel to participate in
Operations Joint Endeavor, conducted in the countries of Bosnia-
Herzegovina, Croatia, and Hungary; Joint Guardian, in Kosovo; and
Desert Storm, in Southwest Asia. Further, since the beginning of the
Global War on Terrorism, the role of DOD's federal civilian personnel
has expanded to include participation in combat support functions in
Operations Enduring Freedom and Iraqi Freedom.[Footnote 9]
DOD relies on the federal civilian personnel it deploys to support a
range of essential missions, including intelligence collection,
criminal investigations, and weapon systems acquisition and
maintenance. To ensure that its federal civilian employees will deploy
to combat zones and perform critical combat support functions in
theater, DOD established the emergency-essential program in 1985. Under
this program, DOD designates as "emergency-essential" those civilian
employees whose positions are required to ensure the success of combat
operations or the availability of combat-essential systems. DOD can
deploy federal civilian employees either on a voluntary or involuntary
basis to accomplish the DOD mission.
DOD Has Established Force Health Protection and Surveillance Policies
for Deployed Federal Civilians, but Should Do More to Ensure That
Components Comply with Its Requirements:
DOD has established force health protection and surveillance policies
aimed at assessing and reducing or preventing health risks for its
deployed federal civilian personnel; however, the department lacks
procedures to ensure the components' full implementation of its
policies. In reviewing DOD federal civilian deployment records and
other electronic documentation[Footnote 10] at selected component
locations, we found that these components lacked documentation to show
that they had fully complied with DOD's force health protection and
surveillance policy requirements for some federal civilian personnel
who deployed to Afghanistan and Iraq. As a larger issue, DOD's policies
did not require the centralized collection of data on the identity of
its deployed civilians, their movements in theater, or their health
status, further hindering its efforts to assess the overall
effectiveness of its force health protection and surveillance
capabilities. In August 2006, DOD issued a revised policy (to be
effective in December 2006) that outlines procedures to address its
lack of centralized deployment and health-related data. However, the
procedures are not comprehensive enough to ensure that DOD will be
sufficiently informed of the extent to which its components fully
comply with its requirements to monitor the health of deployed federal
civilians.
DOD Components Did Not Always Implement All Force Health Protection and
Surveillance Requirements:
The DOD components included in our review lacked documentation to show
that they always implemented force health protection and surveillance
requirements for deployed federal civilians. These requirements include
completing (1) pre-deployment health assessments to ensure that only
medically fit personnel deploy outside of the United States as part of
a contingency or combat operation; (2) pre-deployment immunizations to
address possible health threats in deployment locations; (3) pre-
deployment medical screenings for tuberculosis and human
immunodeficiency virus (HIV); and (4) post-deployment health
assessments to document current health status, experiences,
environmental exposures, and health concerns related to their work
while deployed.
Pre-deployment health assessments:
DOD's force health protection and surveillance policies require the
components to assess the medical condition of federal civilians to
ensure that only medically fit personnel deploy outside of the United
States as part of a contingency or combat operation.[Footnote 11] The
policies stipulate that all deploying civilian personnel are to
complete pre-deployment health assessment forms within 30 days of their
deployments, and health care providers are to review the assessments to
confirm the civilians' health readiness status and identify any needs
for additional clinical evaluations prior to their deployments.
While the components that we included in our review had procedures in
place that would enable them to implement DOD's pre-deployment health
assessment policies, it was not clear to what extent they had done so.
Our review of deployment records and other documentation at the
selected component locations found that these components lacked
documentation to show that some federal civilian personnel who deployed
to Afghanistan and Iraq had received the required pre-deployment health
assessments. For those deployed federal civilians in our review, we
found that, overall, a small number of deployment records (52 out of
3,771) were missing documentation to show that they had received their
pre-deployment health assessments, as reflected in table 1.
Table 1: DOD Federal Civilian Deployment Records Lacking Documentation
of Pre-deployment Health Assessments:
Location: Army: Fort Benning CONUS Replacement Center[A];
Number of federal civilian deployment records reviewed: 578;
Number (and percent) with no documentation in either records or data
files: 2 (0.3).
Location: Army: Fort Bliss CONUS Replacement Center[A];
Number of federal civilian deployment records reviewed: 2,977[B];
Number (and percent) with no documentation in either records or data
files: 0 (0.0)[B].
Location: Army: U.S. Army Corps of Engineers Transatlantic Programs
Center;
Number of federal civilian deployment records reviewed: 127;
Number (and percent) with no documentation in either records or data
files: 2 (1.6).
Location: Army: Total;
Number of federal civilian deployment records reviewed: 3,682;
Number (and percent) with no documentation in either records or data
files: 4.
Location: Navy: Naval Air Depot Cherry Point;
Number of federal civilian deployment records reviewed: 52;
Number (and percent) with no documentation in either records or data
files: 19 (36.5).
Location: Navy: Total;
Number of federal civilian deployment records reviewed: 52;
Number (and percent) with no documentation in either records or data
files: 19.
Location: Air Force: Andrews Air Force Base;
Number of federal civilian deployment records reviewed: 10;
Number (and percent) with no documentation in either records or data
files: 9 (90.0).
Location: Air Force: Hill Air Force Base;
Number of federal civilian deployment records reviewed: 8;
Number (and percent) with no documentation in either records or data
files: 5 (62.5).
Location: Air Force: Hurlburt Field;
Number of federal civilian deployment records reviewed: 12;
Number (and percent) with no documentation in either records or data
files: 11 (91.7).
Location: Air Force: Wright-Patterson Air Force Base;
Number of federal civilian deployment records reviewed: 7;
Number (and percent) with no documentation in either records or data
files: 4 (57.1).
Location: Air Force: Total;
Number of federal civilian deployment records reviewed: 37;
Number (and percent) with no documentation in either records or data
files: 29.
Location: Grand Total;
Number of federal civilian deployment records reviewed: 3,771[C];
Number (and percent) with no documentation in either records or data
files: 52.
Source: GAO analysis of documentation from DOD federal civilian
deployment records and component medical databases.
² Note: CONUS refers to the continental United States.
[A] DCMA federal civilians deployed through Forts Benning and Bliss
CONUS Replacement Centers. At Fort Benning, we selected a probability
sample of 238 out of 606 deployment records for deployed federal
civilians;
consequently, the numbers and percentages shown are weighted estimates
to provide 95 percent confidence with a margin of error of 5 percentage
points.
[B] Although the Army deploys its federal civilian personnel at three
primary sites, Fort Bliss deployed the largest number of federal
civilians during our time frame. We reviewed the entire universe of
deployment records for federal civilian personnel deployed from this
location because the records were being maintained electronically,
which facilitated the review of all records. According to the program
manager and database administrator, the quality of these data, in terms
of their completeness and accuracy, is questionable because there are
no assurances that all DOD federal civilian personnel who deployed are
included in the database.
[C] Deployed federal civilians included in our review may have deployed
more than once during our deployment time frame; consequently, there
may be fewer than 3,771 unique federal civilians.
[End of table]
As shown in table 1, the federal civilian deployment records we
included in our review showed wide variation by location regarding
documentation of pre-deployment health assessments, ranging from less
than 1 percent to more than 90 percent. On an aggregate component-level
basis, at the Navy location in our review, we found that documentation
was missing for 19 of the 52 records in our review. At the Air Force
locations, documentation was missing for 29 of the 37 records in our
review. In contrast, all three Army locations had hard copy or
electronic records which indicated that almost all of their federal
deployed civilians had received pre-deployment health assessments.
Pre-deployment Immunizations:
In addition to completing pre-deployment health assessment forms, DOD's
force health protection and surveillance policies stipulate that all
DOD deploying federal civilians receive theater-specific immunizations
to address possible health threats in deployment locations.[Footnote
12] Immunizations required for all civilian personnel who deploy to
Afghanistan and Iraq include: hepatitis A (two-shot series); tetanus-
diphtheria (within 10 years of deployment); smallpox (within 5 years of
deployment); typhoid; and influenza (within the last 12 months of
deployment).
As reflected in table 2, based on the deployment records maintained by
the components at locations included in our review, the overall number
of federal civilian deployment records lacking documentation of only
one of the required immunizations for deployment to Afghanistan and
Iraq was 285 out of 3,771. However, 3,313 of the records we reviewed
were missing documentation of two or more immunizations.
Table 2: DOD Federal Civilian Deployment Records Lacking Documentation
of Required Immunizations:
Location: Army: Fort Benning CONUS Replacement Center[A];
Number of federal civilian deployment records reviewed: 578;
Number (and percent) missing only one immunization: 246 (42.6);
Number (and percent) missing two or more immunizations: 195 (33.7).
Location: Army: Fort Bliss CONUS Replacement Center[A];
Number of federal civilian deployment records reviewed: 2,977[B];
Number (and percent) missing only one immunization: 0 (0.0);
Number (and percent) missing two or more immunizations: 2,977 (100.0).
Location: Army: U.S. Army Corps of Engineers Transatlantic Programs
Center;
Number of federal civilian deployment records reviewed: 127;
Number (and percent) missing only one immunization: 25 (19.7);
Number (and percent) missing two or more immunizations: 85 (66.9).
Location: Army: Total;
Number of federal civilian deployment records reviewed: 3,682;
Number (and percent) missing only one immunization: 271;
Number (and percent) missing two or more immunizations: 3,257.
Location: Navy: Naval Air Depot Cherry Point;
Number of federal civilian deployment records reviewed: 52;
Number (and percent) missing only one immunization: 8 (15.4);
Number (and percent) missing two or more immunizations: 39 (75.0).
Location: Navy: Total;
Number of federal civilian deployment records reviewed: 52;
Number (and percent) missing only one immunization: 8;
Number (and percent) missing two or more immunizations: 39.
Location: Air Force: Andrews Air Force Base;
Number of federal civilian deployment records reviewed: 10;
Number (and percent) missing only one immunization: 2 (20.0);
Number (and percent) missing two or more immunizations: 7 (70.0).
Location: Air Force: Hill Air Force Base;
Number of federal civilian deployment records reviewed: 8;
Number (and percent) missing only one immunization: 0 (0.0);
Number (and percent) missing two or more immunizations: 3 (37.5).
Location: Air Force: Hurlburt Field;
Number of federal civilian deployment records reviewed: 12;
Number (and percent) missing only one immunization: 3 (25.0);
Number (and percent) missing two or more immunizations: 3 (25.0).
Location: Air Force: Wright-Patterson Air Force Base;
Number of federal civilian deployment records reviewed: 7;
Number (and percent) missing only one immunization: 1 (14.3);
Number (and percent) missing two or more immunizations: 4 (57.1).
Location: Air Force: Total;
Number of federal civilian deployment records reviewed: 37;
Number (and percent) missing only one immunization: 6;
Number (and percent) missing two or more immunizations: 17.
Location: Grand Total;
Number of federal civilian deployment records reviewed: 3,771[C];
Number (and percent) missing only one immunization: 285;
Number (and percent) missing two or more immunizations: 3,313.
Source: GAO analysis of documentation from DOD federal civilian
deployment records and component medical databases.
Note: CONUS refers to the continental United States.
[A] DCMA federal civilians deployed through Forts Benning and Bliss
CONUS Replacement Centers. At Fort Benning, we selected a probability
sample of 238 out of 606 deployment records for deployed federal
civilians;
consequently, the numbers and percentages shown are weighted estimates
to provide 95 percent confidence with a margin of error of 5 percentage
points.
[B] Although the Army deploys its federal civilian personnel at three
primary sites, Fort Bliss deployed the largest number of federal
civilians during our time frame. We reviewed the entire universe of
deployment records for federal civilian personnel deployed from this
location because the records were being maintained electronically,
which facilitated the review of all records. According to the program
manager and database administrator, the quality of these data, in terms
of their completeness and accuracy, is questionable because there are
no assurances that all DOD federal civilian personnel who deployed are
included in the database.
[C] Deployed federal civilians included in our review may have deployed
more than once during our deployment time frame; consequently, there
may be fewer than 3,771 unique federal civilians.
[End of table]
At the Army's Fort Bliss, our review of its electronic deployment data
determined that none of its deployed federal civilians had
documentation to show that they had received immunizations. Officials
at this location stated that they believed some immunizations had been
given; however, they could not provide documentation as evidence of
this.
Pre-deployment Medical Screenings:
DOD policies require deploying federal civilians to receive certain
screenings, such as for tuberculosis and HIV.[Footnote 13] Table 3
indicates that 55 of the 3,771 federal civilian deployment records
included in our review were lacking documentation of the required
tuberculosis screening; and approximately 35 were lacking documentation
of HIV screenings prior to deployment.
Table 3: DOD Federal Civilian Deployment Records Lacking Documentation
of Current Tuberculosis or HIV Screenings:
Location: Army: Fort Benning CONUS Replacement Center[A];
Number of federal civilian deployment records reviewed: 578;
Number (and percent) missing tuberculosis screening: 2 (0.3);
Number (and percent) missing HIV screening: 12 (2.1).
Location: Army: Fort Bliss CONUS Replacement Center[A];
Number of federal civilian deployment records reviewed: 2,977[B];
Number (and percent) missing tuberculosis screening: 3 (0.1);
Number (and percent) missing HIV screening: 2 (0.1).
Location: Army: U.S. Army Corps of Engineers Transatlantic Programs
Center;
Number of federal civilian deployment records reviewed: 127;
Number (and percent) missing tuberculosis screening: 28 (22.0);
Number (and percent) missing HIV screening: 2 (1.6).
Location: Army: Total;
Number of federal civilian deployment records reviewed: 3,682;
Number (and percent) missing tuberculosis screening: 33;
Number (and percent) missing HIV screening: 16.
Location: Navy: Naval Air Depot Cherry Point;
Number of federal civilian deployment records reviewed: 52;
Number (and percent) missing tuberculosis screening: 10 (19.2);
Number (and percent) missing HIV screening: 10 (19.2).
Location: Navy: Total;
Number of federal civilian deployment records reviewed: 52;
Number (and percent) missing tuberculosis screening: 10;
Number (and percent) missing HIV screening: 10.
Location: Air Force: Andrews Air Force Base;
Number of federal civilian deployment records reviewed: 10;
Number (and percent) missing tuberculosis screening: 6 (60.0);
Number (and percent) missing HIV screening: 0 (0.0).
Location: Air Force: Hill Air Force Base;
Number of federal civilian deployment records reviewed: 8;
Number (and percent) missing tuberculosis screening: 5 (62.5);
Number (and percent) missing HIV screening: 0 (0.0).
Location: Air Force: Hurlburt Field;
Number of federal civilian deployment records reviewed: 12;
Number (and percent) missing tuberculosis screening: 1 (8.3);
Number (and percent) missing HIV screening: 8 (66.7).
Location: Air Force: USAF Wright-Patterson;
Number of federal civilian deployment records reviewed: 7;
Number (and percent) missing tuberculosis screening: 0 (0.0);
Number (and percent) missing HIV screening: 1 (14.3).
Location: Air Force: Total;
Number of federal civilian deployment records reviewed: 37;
Number (and percent) missing tuberculosis screening: 12;
Number (and percent) missing HIV screening: 9.
Location: Grand Total;
Number of federal civilian deployment records reviewed: 3,771[C];
Number (and percent) missing tuberculosis screening: 55;
Number (and percent) missing HIV screening: 35.
Source: GAO analysis of documentation from DOD federal civilian
deployment records and component medical databases.
Note: CONUS refers to the continental United States.
[A] DCMA federal civilians deployed through Forts Benning and Bliss
CONUS Replacement Centers. At Fort Benning, we selected a probability
sample of 238 out of 606 deployment records for deployed federal
civilians;
consequently, the numbers and percentages shown are weighted estimates
to provide 95 percent confidence with a margin of error of 5 percentage
points.
[B] Although the Army deploys its federal civilian personnel at three
primary sites, Fort Bliss deployed the largest number of federal
civilians during our time frame. We reviewed the entire universe of
deployment records for federal civilian personnel deployed from this
location because the records were being maintained electronically,
which facilitated the review of all records. According to the program
manager and database administrator, the quality of these data, in terms
of their completeness and accuracy, is questionable because there are
no assurances that all civilian personnel who deployed are included in
the database.
[C] Deployed federal civilians included in our review may have deployed
more than once during our deployment time frame; consequently, there
may be fewer than 3,771 unique federal civilians.
[End of Table]
Post-deployment Health Assessments:
DOD's force health protection and surveillance policies also require
returning DOD federal civilian personnel to undergo post-deployment
health assessments to document current health status, experiences,
environmental exposures, and health concerns related to their work
while deployed.[Footnote 14] The post-deployment process begins within
5 days of civilians' redeployment from the theater to their home or
demobilization processing stations. DOD's policies require civilian
personnel to complete a post-deployment assessment that includes
questions on health and exposure concerns. A health care provider is to
review each assessment and recommend additional clinical evaluation or
treatment as needed.
As reflected in table 4, our review of deployment records at the
selected component locations found that these components lacked
documentation to show that most deployed federal civilians (3,525 out
of 3,771) who deployed to Afghanistan and Iraq had received the
required post-deployment health assessments upon their return to the
United States. Federal civilian deployment records lacking evidence of
post-deployment health assessments ranged from 3 at the U.S. Army Corps
of Engineers Transatlantic Programs Center and Wright-Patterson Air
Force Base, respectively, to 2,977 at Fort Bliss.
Table 4: DOD Federal Civilian Deployment Records Lacking Documentation
of Post-deployment Health Assessments:
Location: Army: Fort Benning CONUS Replacement Center[A];
Number of federal civilian deployment records reviewed: 578;
Number (and percent) with no documentation in records or data files:
502 (86.9).
Location: Army: Fort Bliss CONUS Replacement Center[A];
Number of federal civilian deployment records reviewed: 2,977[B];
Number (and percent) with no documentation in records or data files:
2,977 (100.0).
Location: Army: U.S. Army Corps of Engineers Transatlantic Programs
Center;
Number of federal civilian deployment records reviewed: 127;
Number (and percent) with no documentation in records or data files: 3
(2.4).
Location: Army: Total;
Number of federal civilian deployment records reviewed: 3,682;
Number (and percent) with no documentation in records or data files:
3,482.
Location: Navy: Naval Air Depot Cherry Point;
Number of federal civilian deployment records reviewed: 52;
Number (and percent) with no documentation in records or data files: 15
(28.8).
Location: Navy: Total;
Number of federal civilian deployment records reviewed: 52;
Number (and percent) with no documentation in records or data files:
15.
Location: Air Force: Andrews Air Force Base;
Number of federal civilian deployment records reviewed: 10;
Number (and percent) with no documentation in records or data files: 9
(90.0).
Location: Air Force: Hill Air Force Base;
Number of federal civilian deployment records reviewed: 8;
Number (and percent) with no documentation in records or data files: 6
(75.0).
Location: Air Force: Hurlburt Field;
Number of federal civilian deployment records reviewed: 12;
Number (and percent) with no documentation in records or data files: 10
(83.3).
Location: Air Force: Wright-Patterson Air Force Base;
Number of federal civilian deployment records reviewed: 7;
Number (and percent) with no documentation in records or data files: 3
(42.9).
Location: Air Force: Total;
Number of federal civilian deployment records reviewed: 37;
Number (and percent) with no documentation in records or data files:
28.
Location: Grand Total;
Number of federal civilian deployment records reviewed: 3,771[C];
Number (and percent) with no documentation in records or data files:
3,525.
Source: GAO analysis of documentation from DOD federal civilian
deployment records and component medical databases.
Note: CONUS refers to the continental United States.
[A] DCMA federal civilians deployed through Forts Benning and Bliss
CONUS Replacement Centers. At Fort Benning, we selected a probability
sample of 238 out of 606 deployment records for deployed federal
civilians;
consequently, the numbers and percentages shown are weighted estimates
to provide 95 percent confidence with a margin of error of 5 percentage
points.
[B] Although the Army deploys its federal civilian personnel at three
primary sites, Fort Bliss deployed the largest number of federal
civilians during our time frame. We reviewed the entire universe of
deployment records for federal civilian personnel deployed from this
location because the records were being maintained electronically,
which facilitated the review of all records. According to the program
manager and database administrator, the quality of these data, in terms
of their completeness and accuracy, is questionable because there are
no assurances that all civilian personnel who deployed are included in
the database.
[C] Deployed federal civilians included in our review may have deployed
more than once during our deployment time frame; consequently, there
may be fewer than 3,771 unique federal civilians.
[End of table]
Lack of Centralized Deployment Information Hinders the Overall
Effectiveness of Force Health Protection and Surveillance for Deployed
Federal Civilian Personnel:
Beyond the aforementioned weaknesses found in the selected components'
implementation of force health protection and surveillance requirements
for deploying federal civilians, as a larger issue, DOD lacks
comprehensive, centralized data that would enable it to readily
identify its deployed civilians, track their movements in theater, or
monitor their health status, further hindering efforts to assess the
overall effectiveness of its force health protection and surveillance
capabilities. The Defense Manpower Data Center (DMDC) is responsible
for maintaining the department's centralized system that currently
collects location-specific deployment information for military
servicemembers, such as grid coordinates, latitude/longitude
coordinates, or geographic location codes.[Footnote 15] However, DOD
has not taken steps to similarly maintain centralized data on its
deployed federal civilians. In addition, DOD had not provided guidance
that would require its components to track and report data on the
locations and movements of DOD federal civilian personnel in theaters
of operations. In the absence of such a requirement, each DOD component
collected and reported aggregated data that identified the total number
of DOD federal civilian personnel in a theater of operations, but each
lacked the ability to gather, analyze, and report information that
could be used to specifically identify individuals at risk for
occupational and environmental exposures during deployments.
In previously reporting on the military services' implementation of
DOD's force health protection and surveillance policies in 2003, we
highlighted the importance of knowing the identity of servicemembers
who deployed during a given operation and of tracking their movements
within the theater of operations as major elements of a military
medical surveillance system.[Footnote 16] We further noted the
Institute of Medicine's finding that documentation on the location of
units and individuals during a given deployment is important for
epidemiological studies and appropriate medical care during and after
deployments. For example, this information allows epidemiologists to
study the incidences of disease patterns across populations of deployed
servicemembers who may have been exposed to diseases and hazards within
the theater, and health care professionals to treat their medical
problems appropriately. Without location-specific information for all
of its deployed federal civilians and centralized data in its
department-level system, DOD limits its ability to ensure that
sufficient and appropriate consideration will also be given to
addressing the health care concerns of these individuals.
DOD also had not provided guidance to the components that would require
them to forward completed deployment health assessments for all federal
civilians to the Army Medical Surveillance Activity (AMSA), where these
assessments are suppose to be archived in the Defense Medical
Surveillance System (DMSS), integrated with other historical and
current data on personnel and deployments, and used to monitor the
health of personnel who participate in deployments. The overall success
of deployment force protection and surveillance efforts, in large
measure, depends on the completeness of health assessment data. The
lack of such data may hamper DOD's ability to intervene in a timely
manner to address health care problems that may arise from DOD federal
civilian deployments to overseas locations in support of contingency
operations.
DOD Has Taken Steps to Address Policy Shortcomings, but Lacks Mechanism
to Oversee Components' Compliance:
With increases in the department's use of federal civilian personnel to
support military operations, DOD officials have recognized the need for
more complete and centralized location-specific deployment information
and deployment-related health information on its deployed federal
civilians. In this regard, in August 2006, the Office of the Under
Secretary of Defense for Personnel and Readiness issued revised policy
and program guidance that generally addressed the shortcomings in DOD's
force health protection and surveillance capabilities.[Footnote 17] The
revised policy and guidance, scheduled to become effective in December
2006, require the components within 3 years, to electronically report
(at least weekly) to DMDC, location-specific data for all deployed
personnel, including federal civilians. In addition, the policy and
guidance require the components to submit all completed health
assessment forms to the AMSA for inclusion in DMSS.
Nonetheless, DOD's new policy is not comprehensive enough to ensure
that the department will be sufficiently informed of the extent to
which its components are complying with existing health protection
requirements for its deployed federal civilians. Although the policy
requires DOD components to report certain location-specific and health
data for all of their deployed personnel, including federal civilians,
it does not establish an oversight and quality assurance mechanism for
assessing and ensuring the full implementation of the force health
protection and surveillance requirements by all DOD components that our
prior work has identified as essential in providing care to military
personnel.
In a September 2003 report[Footnote 18] on the Army's and the Air
Force's compliance with force health protection policy for
servicemembers, we noted that neither of the military services had
fully complied with DOD's force health protection and surveillance
policies for many active duty servicemembers, including the policies
requiring that servicemembers be assessed before and after deploying
overseas and receive certain immunizations. We further noted that DOD,
at that time, did not have an effective quality assurance program to
provide oversight of, and ensure compliance with, the department's
force health protection and surveillance requirements, and that the
lack of such a system was a major cause of the high rate of
noncompliance that we identified at the units we visited. In response
to a legislative mandate[Footnote 19] and our recommendation, DOD
established an oversight mechanism to evaluate the success of its force
health protection and surveillance policies in ensuring that
servicemembers received pre-and post-deployment medical examinations
and that record-keeping requirements were met. This oversight mechanism
included (1) periodic site visits jointly conducted with staff from the
Office of the Assistant Secretary for Health Affairs and staff from the
military services to assess compliance with the deployment health
requirements, (2) periodic reports from the services on their quality
assurance programs, and (3) periodic reports from AMSA on health
assessment data maintained in the centralized database. Until the
department provides a similar oversight and quality assurance mechanism
for its deployed federal civilians, it will not be effectively
positioned to ensure compliance with its policies, or ensure the health
care and protection of these individuals as they continue to support
contingency operations.
DOD Has Established and Implemented Medical Treatment Policies Which
Provide for the Care of Its Deployed Federal Civilians:
DOD has established medical treatment policies that cover its federal
civilians while they are deployed to support contingency operations in
Afghanistan and Iraq, and available workers' compensation claims we
reviewed confirmed that those deployed federal civilians received care
consistent with the policies. These policies state that DOD federal
civilians who require treatment for injuries or diseases sustained
during overseas hostilities may be provided care under the DOD military
health system.[Footnote 20] Thus, DOD's deployed federal civilians may
receive care through the military's treatment facilities. As shown in
figure 1, DOD's military health system provides four levels of medical
care to personnel who are injured or become ill while deployed.
Figure 1: Overview of the Levels of DOD Medical Care Provided While
Deployed:
[See PDF for image]
Source: Assistant Secretary of Defense for Health Affairs.
[End of figure]
Specifically, medical treatment during a military contingency begins
with level one care, which consists of basic first aid and emergency
care at a unit in the theater of operation. The treatment then moves to
a second level of care, where, at an Aid station, injured or ill
personnel are examined and evaluated to determine their priority for
continued movement outside of the theater of operation and to the next
(third) level of care. At the third level, injured or ill personnel are
treated in a medical installation staffed and equipped for
resuscitation, surgery, and postoperative care. Finally, at the fourth
level of care, which occurs far from the theater of operation, injured
or ill personnel are treated in a hospital staffed and equipped for
definitive care. Injured or ill DOD federal civilians deployed in
support of contingency operations in Afghanistan and Iraq who require
level four medical care are transported to DOD's Regional Medical
Center in Landstuhl, Germany.
Injured or ill DOD federal civilians who cannot be returned to duty in
theater are evacuated to the United States for continuation of medical
care. In these cases (or where previously deployed federal civilians
later identify injuries or diseases and subsequently request medical
treatment), DOD's policy provides for its federal civilians who require
treatment for deployment-related injuries or occupational illnesses to
receive medical care through either the military's medical treatment
facilities or civilian facilities. The policy stipulates that federal
civilians who are injured or become ill as a result of their deployment
must file a Federal Employees' Compensation Act (FECA) claim[Footnote
21] with DOD, which then files a claim with the Department of Labor's
Office of Workers' Compensation Programs (OWCP).
The Department of Labor's OWCP is responsible for making a decision to
award or deny medical benefits. OWCP must establish--based on evidence
provided by the DOD civilian--that the employee is eligible for
workers' compensation benefits due to the injury or disease for which
the benefits are claimed. To obtain benefits under FECA, DOD federal
civilians must show that (1) they were employed by the U.S. government,
(2) they were injured (exposed) in the workplace, (3) they have filed a
claim in a timely manner, (4) they have a disabling medical condition,
and (5) there is a causal link between their medical condition and the
injury or exposure. Three avenues of appeal are provided for DOD
federal civilians in the event that the initial claim is denied: (1)
reconsideration by an OWCP claims examiner, (2) a hearing or review of
the written record by OWCP's Branch of Hearings and Review, and (3) a
review by the Employees' Compensation Appeals Board. DOD's medical
treatment process and the OWCP's claims process are shown in figure 2.
Figure 2: Medical Treatment and Claims Processes for DOD Federal
Civilians Who Require Treatment for Deployment-Related Injuries or
Diseases After They Return to the United States:
[See PDF for image]
Source: GAO analysis.
Note: OWCP refers to the Office of Workers' Compensation Programs.
[End of figure]
Overall, the claims we reviewed showed that the DOD federal civilians
who sustained injuries or diseases while deployed had received care
that was consistent with DOD's medical treatment policies.
Specifically, in reviewing a sample of seven workers' compensation
claims (out of a universe of 83) filed under the Federal Employees'
Compensation Act by DOD federal civilians who deployed to Iraq, we
found that in three cases where care was initiated in theater the
affected federal civilians had received treatment in accordance with
DOD's policies. For example, in one case, a deployed federal civilian
was treated for traumatic injuries at a hospital outside of the theater
of operation and could not return to duty in theater because of the
severity of the injuries sustained. The civilian was evacuated to the
United States and received medical care through several of the
military's medical treatment facilities as well as through a civilian
facility. Further, in all seven claims that we reviewed, DOD federal
civilians who requested medical care after returning to the United
States, had, in accordance with DOD's policy, received initial medical
examinations and/or treatment for their deployment-related injuries or
illnesses and diseases through either military or civilian treatment
facilities. While OWCP has primary responsibility for processing and
approving all FECA claims for medical benefits, as noted earlier, the
scope of our review did not include assessing actions taken by the
Department of Labor's OWCP in further processing workers' compensation
claims for injured or ill civilians and authorizing continuation of
medical care once their claims were submitted for review.
Special Pays and Benefits Provided to Deployed DOD Federal Civilian and
Military Personnel Generally Vary in Type and Amount:
DOD provides a number of special pays and benefits to its federal
civilian personnel who deploy in support of contingency operations,
which are generally different in type and in amount from those provided
to deployed military personnel. Both groups receive special pays, but
the types and amounts differ. In our modeled scenarios, the overall
amounts of compensation, which include special pays, were higher for
DOD federal civilian personnel than for military personnel. DOD federal
civilian personnel also receive different types and amounts of
disability benefits, depending on specific program provisions and
individual circumstances. Further, survivors of deceased DOD federal
civilian and military personnel generally receive comparable types of
cash survivor benefits--lump sum, recurring, or both--but benefit
amounts differ for the two groups. Survivors of DOD federal civilian
personnel, however, almost always receive lower noncash benefits than
military personnel.
Deployed DOD Federal Civilian and Military Personnel Generally Receive
Various Special Pays to Compensate Them for Conditions of Deployment,
but the Types and Amounts Differ:
DOD federal civilian and military personnel are both eligible to
receive special pays to compensate them for the conditions of
deployment. As shown in table 5, some of the types of special pays are
similar for both DOD federal civilian and military personnel, although
the amounts paid to each group differ. Other special pays were unique
to each group.
Table 5: Overview of Selected Types of Special Pays for Deployed DOD
Federal Civilian and Military Personnel:
Type of special pay: Premium pay;
Civilian personnel: Overtime, night differential, Sunday/holiday work,
compensatory time off;
Military personnel: No equivalent.
Type of special pay: Post differential (Civilian);
Hardship duty pay (Military);
Civilian personnel: 35 percent of basic pay;
Military personnel: $100 per month.
Type of special pay: Danger pay (Civilian);
Hostile fire pay/imminent danger pay (Military);
Civilian personnel: 35 percent of basic pay;
Military personnel: $225 per month.
Type of special pay: Family separation allowance;
Civilian personnel: No equivalent;
Military personnel: $250 per month.
Type of special pay: Combat zone tax exclusion;
Civilian personnel: No equivalent;
Military personnel: For enlisted personnel, all compensation is tax-
free;
officers are capped at $6,724.50 per month.
Type of special pay: Savings deposit program;
Civilian personnel: No equivalent;
Military personnel: 10 percent interest on savings deposits up to
$10,000.
Source: GAO analysis of military and federal data.
[End of table]
DOD federal civilian and military personnel deployed to posts with
unusually difficult or unhealthful conditions or severe physical
hardships are authorized a similar type of post (hardship)
differential. In addition, danger pay is granted to both groups serving
at a post where civil insurrection, civil war, or war-like conditions
exist. In this context, DOD federal civilian personnel who are deployed
to Afghanistan and Iraq are eligible to receive post (hardship)
differential and danger pay, each equivalent to 35 percent of their
base salaries. In contrast, military personnel receive monthly pays of
$100 for hardship duty and $225 for imminent danger.
However, some special pays are unique to each group. For example, to
partially reimburse those who are involuntarily separated from their
dependents, military personnel are eligible to receive a family
separation allowance that is not available to deployed DOD federal
civilian personnel. Additionally, unlike DOD federal civilian
personnel, military personnel also receive a combat zone tax exclusion
while deployed to Afghanistan and Iraq that excludes certain income
from federal taxes. DOD federal civilian personnel, by contrast, are
eligible for a variety of premium pays, such as overtime and night
differential, that are not available to military personnel.
Although DOD federal civilian and military personnel generally receive
various special pays to compensate them for conditions of deployment,
in certain scenarios that we modeled, the overall amounts of
compensation payments were higher for DOD federal civilian personnel
than for military personnel, as illustrated in tables 6 and 7.
Table 6: Scenario 1: Comparisons of Compensation Provided to DOD
Federal Civilian and Military Personnel Deployed to Afghanistan or Iraq
for One Year:
Types of Compensation: Base pay;
Comparison 1: Civilian (GS-11): $61,510;
Comparison 1: Military (O-3): $54,036;
Comparison 2: Civilian (GS-13): $87,664;
Comparison 2: Military (O-5): $79,567;
Comparison 3: Civilian (GS-15): $121,856;
Comparison 3: Military (O-6): $98,575.
Types of Compensation: Basic allowance for subsistence (BAS)[A];
Comparison 1: Civilian (GS-11): 0;
Comparison 1: Military (O-3): 2,250;
Comparison 2: Civilian (GS-13): 0;
Comparison 2: Military (O- 5): 2,250;
Comparison 3: Civilian (GS-15): 0;
Comparison 3: Military (O-6): 2,250.
Types of Compensation: Basic allowance for housing (BAH)[A];
Comparison 1: Civilian (GS-11): 0;
Comparison 1: Military (O-3): 26,784;
Comparison 2: Civilian (GS-13): 0;
Comparison 2: Military (O-5): 31,644;
Comparison 3: Civilian (GS-15): 0;
Comparison 3: Military (O-6): 31,908.
Types of Compensation: 30 hours overtime (per week);
Comparison 1: Civilian (GS-11): 55,396;
Comparison 1: Military (O-3): 0;
Comparison 2: Civilian (GS-13): 65,520;
Comparison 2: Military (O-5): 0;
Comparison 3: Civilian (GS-15): 91,088;
Comparison 3: Military (O-6): 0.
Types of Compensation: Post differential/hardship duty pay[B];
Comparison 1: Civilian (GS-11): 21,529;
Comparison 1: Military (O-3): 1,200;
Comparison 2: Civilian (GS-13): 30,682;
Comparison 2: Military (O-5): 1,200;
Comparison 3: Civilian (GS-15): 42,650;
Comparison 3: Military (O-6): 1,200.
Types of Compensation: Danger pay/ hostile fire/imminent danger pay[
B];
Comparison 1: Civilian (GS-11): 21,529;
Comparison 1: Military (O- 3): 2,700;
Comparison 2: Civilian (GS-13): 30,682;
Comparison 2: Military (O-5): 2,700;
Comparison 3: Civilian (GS-15): 42,650;
Comparison 3: Military (O-6): 2,700.
Types of Compensation: Family separation allowance[A];
Comparison 1: Civilian (GS-11): 0;
Comparison 1: Military (O-3): 3,000;
Comparison 2: Civilian (GS-13): 0;
Comparison 2: Military (O-5): 3,000;
Comparison 3: Civilian (GS-15): 0;
Comparison 3: Military (O- 6): 3,000.
Types of Compensation: Gross Pay;
Comparison 1: Civilian (GS-11): 159,963;
Comparison 1: Military (O-3): 89,970;
Comparison 2: Civilian (GS-13): 183,500[C];
Comparison 2: Military (O-5): 120,361;
Comparison 3: Civilian (GS-15): 183,500[C];
Comparison 3: Military (O-6): 139,633.
Types of Compensation: TSP contribution[D];
Comparison 1: Civilian (GS- 11): 15,000;
Comparison 1: Military (O-3): 4,498;
Comparison 2: Civilian (GS-13): 15,000;
Comparison 2: Military (O-5): 6,018;
Comparison 3: Civilian (GS-15): 15,000;
Comparison 3: Military (O-6): 6,982.
Types of Compensation: Combat zone tax exclusion[E];
Comparison 1: Civilian (GS-11): 0;
Comparison 1: Military (O-3): 56,736;
Comparison 2: Civilian (GS-13): 0;
Comparison 2: Military (O-5): 80,694;
Comparison 3: Civilian (GS-15): 0;
Comparison 3: Military (O-6): 80,694.
Types of Compensation: Military tax exclusion[F];
Comparison 1: Civilian (GS-11): 0;
Comparison 1: Military (O-3): 32,034;
Comparison 2: Civilian (GS-13): 0;
Comparison 2: Military (O-5): 36,894;
Comparison 3: Civilian (GS-15): 0;
Comparison 3: Military (O-6): 37,158.
Types of Compensation: Adjusted gross income[G];
Comparison 1: Civilian (GS-11): 144,963;
Comparison 1: Military (O-3): 0;
Comparison 2: Civilian (GS-13): 168,500;
Comparison 2: Military (O-5): 0;
Comparison 3: Civilian (GS-15): 168,500;
Comparison 3: Military (O-6): 14,799.
Types of Compensation: Federal taxes due[H];
Comparison 1: Civilian (GS-11): 23,687;
Comparison 1: Military (O-3): 0;
Comparison 2: Civilian (GS-13): 30,528;
Comparison 2: Military (O-5): 0;
Comparison 3: Civilian (GS-15): 30,528;
Comparison 3: Military (O-6): - 4,970.
Types of Compensation: Income After Taxes;
Comparison 1: Civilian (GS- 11): $136,276;
Comparison 1: Military (O-3): $89,970;
Comparison 2: Civilian (GS-13): $152,972;
Comparison 2: Military (O-5): $120,361;
Comparison 3: Civilian (GS-15): $152,972;
Comparison 3: Military (O-6): $144,603.
Source: GAO's analysis.
Notes: Scenario assumes comparable pay grades, Washington, D.C.,
location, and married with two children. Numbers may not add due to
rounding.
[A] Not taxable for military personnel.
[B] Post differential and danger pays are 35 percent of base pay for
deployed DOD federal civilians. Hardship duty and hostile fire/imminent
danger pays are $100 and $225 per month, respectively, for deployed
military personnel.
[C] Although total compensation for the calendar year is capped at
$200,000, Title 5 § 5307 provides that an employee may be paid premium
pay only to the extent that the premium pay does not cause the
aggregate of total compensation for the calendar year to exceed the
annual rate of basic pay for Level I of the Executive Schedule
(currently $183,500 for 2006). Section 1105 of Pub. L. No. 109-163
authorized the Secretary of Defense to increase the annual premium pay
limitation for 2006 to $200,000 for employees serving overseas in the
U.S. Central Command area of responsibility. Premium pay in excess of
$183,500, up to $200,000, will be paid to employees during the first
pay period of 2007.
[D] Assumes $15,000 was paid into the Thrift Savings Plan (TSP) by DOD
federal civilians, and 5 percent of gross pay for military personnel.
TSP is a retirement savings plan for civilians who are employed by the
United States government and members of the uniformed services.
[E] The combat zone tax exclusion is authorized by 26 U.S.C. § 112.
Military personnel serving in direct support of operations in the
combat zone are eligible for the combat zone tax exclusion. All
enlisted income is eligible for this exclusion. Officers are capped at
the highest enlisted basic pay plus any imminent danger pay received,
which currently is $6,724.50 per month.
[F] Includes nontaxable family separation allowance, BAS, and BAH.
[G] Adjusted Gross income minus TSP, combat zone tax exclusion, and
other military tax exclusions.
[H] Computed using commercial tax preparation software.
[End of table]
Table 7: Scenario 2: Comparisons of Compensation Provided to DOD
Federal Civilian and Military Personnel Deployed to Afghanistan or Iraq
for Six Months:
Types of Compensation: Base pay;
Comparison 1: Civilian (GS-11): $61,510;
Comparison 1: Military (O-3): $54,036;
Comparison 2: Civilian (GS-13): $87,664;
Comparison 2: Military (O-5): $79,567;
Comparison 3: Civilian (GS-15): $121,856;
Comparison 3: Military (O-6): $98,575.
Types of Compensation: Basic allowance for subsistence (BAS)[A];
Comparison 1: Civilian (GS-11): 0;
Comparison 1: Military (O-3): 2,250;
Comparison 2: Civilian (GS-13): 0;
Comparison 2: Military (O- 5): 2,250;
Comparison 3: Civilian (GS-15): 0;
Comparison 3: Military (O-6): 2,250.
Types of Compensation: Basic allowance for housing (BAH)[A];
Comparison 1: Civilian (GS-11): 0;
Comparison 1: Military (O-3): 26,784;
Comparison 2: Civilian (GS-13): 0;
Comparison 2: Military (O-5): 31,644;
Comparison 3: Civilian (GS-15): 0;
Comparison 3: Military (O-6): 31,908.
Types of Compensation: 30 hours overtime (per week);
Comparison 1: Civilian (GS-11): 27,698;
Comparison 1: Military (O-3): 0;
Comparison 2: Civilian (GS-13): 32,760;
Comparison 2: Military (O-5): 0;
Comparison 3: Civilian (GS-15): 45,544;
Comparison 3: Military (O-6): 0.
Types of Compensation: Post differential/hardship duty pay[B];
Comparison 1: Civilian (GS-11): 10,764;
Comparison 1: Military (O-3): 600;
Comparison 2: Civilian (GS-13): 15,341;
Comparison 2: Military (O-5): 600;
Comparison 3: Civilian (GS-15): 21,325;
Comparison 3: Military (O-6): 600.
Types of Compensation: Danger pay/ hostile fire/imminent danger pay[
B];
Comparison 1: Civilian (GS-11): 10,764;
Comparison 1: Military (O- 3): 1,350;
Comparison 2: Civilian (GS-13): 15,341;
Comparison 2: Military (O-5): 1,350;
Comparison 3: Civilian (GS-15): 21,325;
Comparison 3: Military (O-6): 1,350.
Types of Compensation: Family separation allowance[A];
Comparison 1: Civilian (GS-11): 0;
Comparison 1: Military (O-3): 1,500;
Comparison 2: Civilian (GS-13): 0;
Comparison 2: Military (O-5): 1,500;
Comparison 3: Civilian (GS-15): 0;
Comparison 3: Military (O- 6): 1,500.
Types of Compensation: Gross Pay;
Comparison 1: Civilian (GS-11): 110,736;
Comparison 1: Military (O-3): 86,520;
Comparison 2: Civilian (GS-13): 151,106;
Comparison 2: Military (O-5): 116,911;
Comparison 3: Civilian (GS-15): 183,500[C];
Comparison 3: Military (O-6): 136,183.
Types of Compensation: TSP contribution[D];
Comparison 1: Civilian (GS- 11): 15,000;
Comparison 1: Military (O-3): 4,326;
Comparison 2: Civilian (GS-13): 15,000;
Comparison 2: Military (O-5): 5,846;
Comparison 3: Civilian (GS-15): 15,000;
Comparison 3: Military (O-6): 6,809.
Types of Compensation: Combat zone tax exclusion[E];
Comparison 1: Civilian (GS-11): 0;
Comparison 1: Military (O-3): 28,368;
Comparison 2: Civilian (GS-13): 0;
Comparison 2: Military (O-5): 40,347;
Comparison 3: Civilian (GS-15): 0;
Comparison 3: Military (O-6): 40,347.
Types of Compensation: Military tax exclusion[F];
Comparison 1: Civilian (GS-11): 0;
Comparison 1: Military (O-3): 30,534;
Comparison 2: Civilian (GS-13): 0;
Comparison 2: Military (O-5): 35,394;
Comparison 3: Civilian (GS-15): 0;
Comparison 3: Military (O-6): 35,658.
Types of Compensation: Adjusted gross income[G];
Comparison 1: Civilian (GS-11): 95,736;
Comparison 1: Military (O-3): 23,292;
Comparison 2: Civilian (GS-13): 136,106;
Comparison 2: Military (O-5): 35,324;
Comparison 3: Civilian (GS-15): 168,500;
Comparison 3: Military (O-6): 53,369.
Types of Compensation: Federal taxes due[H];
Comparison 1: Civilian (GS-11): 9,561;
Comparison 1: Military (O-3): -4,790;
Comparison 2: Civilian (GS-13): 21,007;
Comparison 2: Military (O-5): - 1,155;
Comparison 3: Civilian (GS-15): 30,528;
Comparison 3: Military (O-6): 1,856.
Types of Compensation: Income After Taxes;
Comparison 1: Civilian (GS- 11): $101,175;
Comparison 1: Military (O-3): $91,310;
Comparison 2: Civilian (GS-13): $130,099;
Comparison 2: Military (O-5): $118,066;
Comparison 3: Civilian (GS-15): $152,972;
Comparison 3: Military (O-6): $134,327.
Source: GAO's analysis.
Notes: Scenario assumes comparable grades, Washington, D.C. location,
and married with two children. Numbers may not add due to rounding.
[A] Not taxable for military personnel.
[B] Post differential and danger pays are 35% of base pay for deployed
DOD federal civilians. Hardship duty and hostile fire/imminent danger
pays are $100 and $225 per month, respectively, for deployed military
personnel.
[C] Although total compensation for the calendar year is capped at
$200,000, Title 5 § 5307 provides that an employee may be paid premium
pay only to the extent that the premium pay does not cause the
aggregate of total compensation for the calendar year to exceed the
annual rate of basic pay for Level I of the Executive Schedule
(currently $183,500 for 2006). Section 1105 of Pub. L. No. 109-163
authorized the Secretary of Defense to increase the annual premium pay
limitation for 2006 to $200,000 for employees serving overseas in the
U.S. Central Command area of responsibility. Premium pay in excess of
$183,500, up to $200,000, will be paid to employees during the first
pay period of 2007.
[D] Assumes $15,000 was paid into Thrift Savings Plan (TSP) by DOD
federal civilians, and 5% of gross pay for military personnel. TSP is a
retirement savings plan for civilians who are employed by the United
States government and members of the uniformed services.
[E] The combat zone tax exclusion is authorized by 26 U.S.C. § 112.
Military personnel serving in direct support of operations in the
combat zone are eligible for the combat zone tax exclusion. All
enlisted income is eligible for this exclusion. Officers are capped at
the highest enlisted basic pay plus any imminent danger pay received,
which currently is $6,724.50 per month.
[F] Includes nontaxable family separation allowance, BAS, and BAH.
[G] Adjusted Gross income minus TSP, combat zone tax exclusion, and
other military tax exclusions.
[H] Computed using commercial tax preparation software.
[End of table]
DOD Federal Civilian and Military Personnel Receive Different Types and
Amounts of Disability Benefits, Depending on Specific Program
Provisions and Individual Circumstances:
In the event of sustaining an injury while deployed, DOD federal
civilian and military personnel are eligible to receive two broad
categories of disability benefits--disability compensation[Footnote 22]
and disability retirement.[Footnote 23] However, the benefits
applicable to each group vary by type and amount, depending on specific
program provisions and individual circumstances. Within these broad
categories, there are three main types of disability: (1) temporary
disability, (2) permanent partial disability, and (3) permanent total
disability.
Temporary Disability Benefits:
Both DOD federal civilian and military personnel who are injured in the
line of duty are eligible to receive continuation of their pay during
the initial period of treatment and may be eligible to receive
recurring payments for lost wages. However, the payments to DOD federal
civilian personnel are based on their salaries and whether the employee
has any dependents, regardless of the number, which can vary
significantly, whereas disability compensation payments made by the
Department of Veterans Affairs (VA) to injured military personnel are
based on the severity of the injury and their number of dependents. DOD
federal civilian personnel are eligible to receive continuation of pay
(salary) for up to 45 days, followed by a recurring payment for wage
loss which is based on a percentage of salary and whether they have any
dependents, up to a cap.[Footnote 24] In contrast, military personnel
receive continuation of pay of their salary for generally no longer
than a year, followed by a recurring VA disability compensation payment
for wage loss that is based on the degree of disability and their
number of dependents, and temporary DOD disability retirement for up to
5 years. Appendix II provides additional information on temporary
disability compensation payments for federal civilian and military
personnel.
To illustrate the way in which the degree of impairment and an
individual's salary can affect temporary disability compensation, in
our April 2006 review,[Footnote 25] we compared the disability benefits
available to military personnel with those available to comparable
civilian public safety officers at the federal, state, and local
levels. We found that VA compensation payments for military personnel
were based on a disability rating, regardless of salary level; in
contrast, compensation payments for civilian public safety officers
were based on salary level, regardless of disability level. Thus, for
an individual with severe injuries and relatively low wages, VA
compensation payments for military personnel were generally higher than
those of the civilian public safety officers included in the reviews.
However, if an individual had less severe injuries and high wages, VA
compensation payments for military personnel were generally lower than
those of the civilian public safety officers included in the review.
Permanent Partial Disability Benefits:
When a partial disability is determined to be permanent, DOD federal
civilian and military personnel can continue to receive recurring
compensation payments. For DOD federal civilian personnel, these
payments are provided for the remainder of life as long as the
impairment persists, and can vary significantly depending upon the
salary of the individual and the existence of dependents. Military
personnel are also eligible to receive recurring VA disability
compensation payments for the remainder of their lives, and these
payments are based on the severity of the servicemember's injury and
the number of dependents. In addition, both groups are eligible to
receive additional compensation payments beyond the recurring payments
just discussed, based on the type of impairment. DOD federal civilians
with permanent partial disabilities receive a schedule of payments
based on the specific type of impairment (sometimes referred to as a
schedule award). Some impairments may result in benefits for a few
weeks, while others may result in benefits for several years.
Similarly, military personnel receive special monthly VA compensation
payments depending on the specific type and degree of impairment.
Appendix II provides more detailed information on permanent partial
disability compensation payments for DOD federal civilian and military
personnel.
Our April 2006 review[Footnote 26] compared the compensation benefits
available to military personnel with those available to federal
civilian public safety officers, among others, using several scenarios.
Our analysis showed that when able to return to duty, military
personnel often received a greater amount of compensation benefits over
a lifetime than did civilians, even when the monthly benefit payment
was substantially lower and receipt of benefits was delayed for several
years.
Permanent partial disabilities that prevent civilian and military
personnel from returning to duty in their current jobs may entitle them
to receive disability retirement benefits based on a percentage of
salary in addition to compensation benefits; however, the eligibility
criteria and benefit amounts differ. Under the Civil Service Retirement
System (CSRS), DOD federal civilian personnel must be unfit for duty
and have 5 years of service to qualify for disability retirement
benefits. Under the Federal Employees' Retirement System (FERS),
civilian personnel must be unfit for duty and have 18 months of
service.[Footnote 27] DOD federal civilian personnel must elect either
compensation benefits or disability retirement. Military personnel who
are unfit for duty are eligible for DOD disability retirement benefits
if they have a disability rating of 30 percent or more regardless of
length of service, or if they have 20 years or more of service
regardless of disability rating. The amount of the DOD disability
retirement payment is offset dollar for dollar, however, by the amount
of the monthly VA disability compensation payment unless they have at
least 20 years of service and a disability rating of 50 percent or
more, or combat-related disabilities.
Our April 2006 review of disability benefits[Footnote 28] showed that
when military personnel and federal civilian public safety officers
were unable to return to duty due to a permanent partial disability,
such as a leg amputation, the combined compensation and retirement
benefits provided to the military personnel over a lifetime were
sometimes more, and sometimes less, than the combined benefits provided
to civilian public safety officers.
Permanent Total Disability Benefits:
When an injury is severe enough to be deemed permanent and
total,[Footnote 29] DOD federal civilian and military personnel may
receive similar types of benefits such as disability compensation and
retirement payments; however, the amounts paid to each group vary. For
civilian personnel, the monthly payment amounts for total disability
are generally similar to those for permanent partial disability
described earlier, but unlike with permanent partial disabilities, the
payments do not take into account any wage earning capacity. Both
groups are eligible to receive additional compensation payments beyond
the recurring payments that are similar to those for permanent partial
disability. DOD federal civilians with permanent disabilities receive a
schedule award based on the specific type of impairment. In addition,
DOD federal civilian personnel may be eligible for an additional
attendant allowance--up to $1,500 per month during 2006--if such care
is needed. Military personnel receive special monthly VA compensation
payments for particularly severe injuries, such as amputations,
blindness, or other loss of use of organs and extremities. The payments
are designed to account for attendant care or other special needs
deriving from the disability.
In addition to disability compensation, both DOD federal civilian and
military personnel have access to disability retirement benefits for
permanent total disabilities. The provisions for election and offset of
disability compensation and disability retirement benefits in cases of
permanent total disability are similar to provisions in cases of
permanent partial disability discussed earlier.
Another benefit available to DOD federal civilian and military
personnel with permanent total disabilities is Social Security
Disability Insurance (SSDI). SSDI benefits are available to individuals
who incur a physical or mental impairment that prevents them from
performing substantial gainful activity and that is expected to last at
least 1 year or to result in death. The benefit is based on the
employee's earnings history and lifetime contributions to Social
Security; therefore, the benefit amounts vary widely among individuals.
DOD federal civilian personnel covered by FERS and military personnel
pay into Social Security and thus may be eligible to receive SSDI
benefits. The maximum benefit to both groups in 2006 was $2,053 per
month. However, DOD federal civilian personnel must choose between
either compensation payments and SSDI benefits or have their disability
retirement payments reduced when receiving SSDI benefits.[Footnote 30]
Survivors of DOD Federal Civilian and Military Personnel Received
Comparable Types of Benefits, but Benefit Amounts Differ:
Survivors of deceased DOD federal civilian and military personnel
generally receive similar types of cash survivor benefits--either as a
lump sum, a recurring payment, or both--through comparable sources.
However, the benefit amounts generally differ for each group. Survivors
of DOD federal civilian and military personnel also receive noncash
benefits that differ in type and amounts.
As shown in table 8, survivors of deceased DOD federal civilian and
military personnel both receive lump sum benefits in the form of Social
Security, a death gratuity, burial expenses, and life insurance.
Table 8: Overview of the Type and Amount of Lump Sum Benefits Provided
to Survivors of DOD Federal Civilian and Military Personnel:
Selected types of survivor benefits: Social Security;
Civilian personnel: Lump sum: $255;
Military personnel: Lump sum: $255.
Selected types of survivor benefits: Death gratuity;
Civilian personnel: Up to $10,000;
Military personnel: $100,000.
Selected types of survivor benefits: Burial expenses;
Civilian personnel: Up to $800, plus $200 for costs associated with
terminating employee status;
Military personnel: Up to $7,700.
Selected types of survivor benefits: Life insurance;
Civilian personnel: Basic pay, rounded to the nearest thousand, plus
$2,000;
Military personnel: Servicemembers' Group Life Insurance up to
$400,000.
Selected types of survivor benefits: Retirement plan;
Civilian personnel: Basic death benefit of $24,866.19 (for fiscal year
2006) plus 50 percent of the civilian's final salary or an average of
the civilian's highest 3 years of salary;
Military personnel: No equivalent.
Source: GAO analysis of federal data.
[End of table]
Social Security provides $255 upon the death of a DOD federal civilian
employee or military member. In addition, survivors of deceased DOD
federal civilian personnel receive a death gratuity of up to $10,000,
while survivors of deceased military personnel receive $100,000. The
payment for funeral expenses provided to survivors of deceased DOD
federal civilian personnel can be as high as $800, plus $200 for costs
associated with terminating employee status, while it can be $7,700 for
deceased military personnel. Life insurance is another common source of
benefits for the survivors of many deceased civilian and military
personnel. Survivors of deceased federal civilian personnel receive a
payment equal to the civilian's rate of basic pay, rounded to the
nearest thousand, plus $2,000. Military personnel automatically are
insured as part of the Servicemembers' Group Life Insurance for up to
$400,000, unless they elect less or no coverage. DOD federal civilian
employees also receive a survivor benefit in their retirement plans.
Survivors of deceased DOD federal civilian and military personnel are
also eligible for recurring benefits, some of which are specific to
each group, as shown in table 9.
Table 9: Overview of the Type and Amount of Recurring Benefits Provided
to Survivors of DOD Federal Civilian and Military Personnel:
Type of recurring survivor benefit: Social Security;
Civilian personnel: Recurring payment based on earnings in covered
employment;
Military personnel: Recurring payment based on earnings in covered
employment.
Type of recurring survivor benefit: Survivor benefit plan;
Civilian personnel: No equivalent;
Military personnel: 55 percent of the military member's monthly
retirement pay, offset by Dependency Indemnity Compensation.
Type of recurring survivor benefit: Dependency and indemnity
compensation;
Civilian personnel: No equivalent;
Military personnel: $1,033 per month plus $257 per month for each
dependent child, plus an additional $250 for the first 2 years for
dependent children.
Type of recurring survivor benefit: Workers' compensation (only if the
death occurs while in the line of duty);
Civilian personnel: Up to 75 percent of employee's monthly salary[A];
Military personnel: No equivalent.
Type of recurring survivor benefit: Retirement plan (included if DOD
contributes to the survivor benefit);
Civilian personnel: 50 percent of monthly retirement payment if the
employee had 10 years of service[A];
Military personnel: No equivalent.
Source: GAO analysis of federal data.
[A] The survivor of a deceased DOD federal civilian can choose the
benefit through either the retirement plan or workers' compensation,
which normally pays a higher amount.
[End of table]
Survivors of both deceased DOD federal civilian and military personnel
may be eligible to receive recurring Social Security payments based on
the deceased individual's earnings in a covered period. However, other
types of recurring payments are specific to either civilian or military
personnel. For example, survivors of DOD federal civilian personnel may
receive recurring payments from a retirement plan or workers'
compensation if the death occurred while in the line of duty. Survivors
of deceased military personnel also receive payments through the
Survivor Benefit Plan, Dependency and Indemnity Compensation, or both.
In addition to lump sum and recurring benefits, survivors of deceased
DOD federal civilians and military personnel receive noncash benefits.
As shown in table 10, survivors of deceased military personnel receive
more noncash benefits than do those of deceased DOD federal civilian
personnel, with few benefits being comparable in type.
Table 10: Summary of Noncash Benefits Provided to Survivors of DOD
Federal Civilian and Military Personnel:
Noncash Benefit: Continuation of health insurance coverage;
Civilian personnel: Survivors may continue to participate in the
Federal Employees' Health Benefits Program at the same cost as a
federal employee if, prior to employee's death, these individuals were
covered as family members under the plan;
Military personnel: Surviving family members of the deceased
servicemember remain eligible for health care benefits under TRICARE[A]
at active duty dependent rates for a 3-year period, after which they
are eligible for retiree dependent rates.
Noncash Benefit: Education benefits for spouse, children, or both;
Civilian personnel: No equivalent;
Military personnel: Surviving spouse and children are eligible for up
to 45 months of education benefits.
Noncash Benefit: Military-specific;
Civilian personnel: No equivalent;
Military personnel: Surviving spouse and children are eligible for rent-
free government housing or tax-free housing allowance up to 365 days,
relocation assistance, and commissary and exchange privileges.
Source: GAO analysis of federal data.
[A] TRICARE is a regionally structured program that uses civilian
contractors to maintain health care provider networks that complement
health care provided at military treatment facilities.
[End of table]
For example, eligible survivors of military personnel who die while on
active duty obtain benefits such as rent-free government housing or tax-
free housing allowances for up to 365 days, relocation assistance, and
lifetime access to commissaries and exchanges that are not available to
civilian personnel who die in the line-of-duty. However, survivors of
both deceased DOD federal civilian and military personnel do continue
to receive health insurance that is wholly or partially subsidized.
Conclusions:
As DOD's federal civilian employees assume an expanding role in helping
the department support its contingency operations overseas, the need
for attention to the policies and benefits that affect the health and
welfare of these individuals becomes increasingly significant. DOD
currently has important policies in place that relate to the deployment
of its federal civilians. However, it lacks an adequate oversight and
quality assurance mechanism to ensure compliance and quality of
service. Thus, not all of its policies--such as those that define the
department's requirements for force health protection and surveillance-
-are being fully implemented by the DOD components. Until DOD improves
its oversight in this area, it will jeopardize its ability to be
effectively informed of the extent to which its federal civilians are
screened and deemed medically fit to deploy in support of contingency
operations; deployed civilian personnel receive needed immunizations to
counter theater disease threats; and what medical follow-up attention
federal civilians require for health problems or concerns that may
arise following their deployment.
Recommendation for Executive Action:
To strengthen DOD's force health protection and surveillance for its
federal civilian personnel who deploy in support of contingency
operations, we recommend that the Secretary of Defense direct the
Office of the Under Secretary of Defense for Personnel and Readiness to
establish an oversight and quality assurance mechanism to ensure that
all components fully comply with its requirements.
Agency Comments and Our Evaluation:
In written comments on a draft of this report, DOD partially concurred
with our recommendation. The department acknowledged the necessity for
all deployed civilians to receive required medical assessments and
immunizations, and that documentation must be available in every
instance. The department outlined several steps it intends to take to
determine appropriate implementation of our recommendation.
Specifically, the department stated that it has written and coordinated
a new DOD instruction, scheduled to become effective before the end of
2006, that establishes a comprehensive DOD force health protection
quality assurance program that will apply to DOD civilian personnel
accompanying deploying military forces. While DOD's response is
encouraging, we remain concerned that the department's description of
the actions it plans to take to assess the components' compliance with
its requirements lacks sufficient detail. DOD was unable to provide us
with a copy of the new instruction; thus, we could not evaluate the
comprehensiveness of its new force health protection quality assurance
program or determine whether the program identifies specific actions
the department plans to take for assessing and ensuring the full
implementation of the force health protection and surveillance
requirements by all DOD components. DOD also stated that proposed
revisions to its directives and instructions that address the planning,
preparation, and utilization of DOD civilians include, among other
things, annual assessments for compliance with pre-and post-deployment
medical assessment requirements. However, the department did not
describe what actions, if any, it plans to take to ensure that it will
be sufficiently informed of the extent to which its components are
complying with existing health protection requirements for its deployed
federal civilians. In the absence of more specific details on its
planned actions, we continue to emphasize the department's need for a
comprehensive oversight and quality assurance mechanism without which
it will not be effectively positioned to ensure compliance with its
policies, or ensure the health care and protection of its deployed
federal civilians as they continue to support contingency operations.
In addition to its comments on our recommendation, the department took
issue with some of our specific findings. DOD questioned our findings
that in many cases DOD components were unable to produce documentation
confirming that deployed federal civilians had received necessary pre-
or post-deployment medical assessments, or immunizations. The
department stated that DOD activities, particularly regarding the Army
Corps of Engineers, Transatlantic Programs Center (TPC), had determined
that documentation did exist for many records included in our review,
thus raising reservations about our findings. In particular, the
department stated that the number (and percent) of records missing two
or more immunizations that we reported for TPC was inaccurate. It
stated that based on TPC's review of the specific documentation that we
used to support our findings, we had actually identified 69 records
(54.3 percent) as missing two or more immunizations, rather than 85
(66.9 percent) noted in our draft report. We disagree. TPC overlooked
16 records included in our review that lacked documentation of any
immunizations. Moreover, as we noted in our report, to provide
assurances that the results of our review of hard copy deployment
records at the selected component locations were accurate, we requested
that each component's designated medical personnel reexamine those
deployment records that we determined were missing required health
documentation. We then adjusted our results in those instances where
documentation was subsequently provided. To provide additional
assurances regarding our determinations, we requested that each
component's designated medical personnel review and sign the data
collection instrument that we used to collect deployment health
information from each individual civilian's deployment record attesting
to our conclusions regarding the existence of health assessment or
immunization documentation.
DOD also stated that we inappropriately mixed discussion of Veterans
Affairs and DOD benefits without distinguishing between the two.
However, our report appropriately discusses two broad categories of
"government-provided" benefits: (1) those provided by DOD and (2) those
provided by VA. Nonetheless, to further clarify this section of our
report, we added "VA" and "DOD" to our discussions of disability
compensation and retirement benefits for military personnel. DOD also
stated that our discussion of military disability benefits presented
incorrect information in many cases, indicating that our statements
that compensation payments for military personnel were based on a
disability rating, regardless of salary level is only true with regard
to VA disability benefits. DOD also stated that DOD disability payments
do, in fact, take into account salary level, and that if a former
member is entitled to both, there is an offsetting mechanism. We agree.
As we state in our report, under veterans' compensation programs,
benefits typically include cash payments to replace a percentage of the
individual's loss in wages while injured and unable to work. We also
state that disability retirement benefits for military personnel are
based on a percent of salary in addition to compensation benefits, and
that the amount of retirement payment is offset dollar for dollar by
the amount of monthly compensation payment unless military personnel
have at least 20 years of service and a disability rating of 50 percent
or more, or have combat-related disabilities.
Further, DOD submitted detailed comments related to our analysis of
special pays and benefits provided to deployed DOD federal civilian and
military personnel. In particular, the department stated that our
selection and presentation of the associated data on the special pays
and benefits provided to DOD federal civilian and military personnel
could easily mislead the reader into drawing erroneous conclusions. The
department also stated that our comparisons did not take into account
the relative value of certain key benefits for which explicit dollar
amounts cannot be measured, such as retirement systems, health care
systems, and military commissary exchange privileges. To the contrary,
our report did discuss this limitation, and as is the case with any
modeled scenarios based on certain assumptions, some of the factors
with the potential to affect the overall outcomes of our comparisons
could not be included because of, as DOD pointed out, the relative
value of certain key benefits for which explicit dollar amounts cannot
be measured. It is partly for this reason that we acknowledged in the
report that we do not take a position on the adequacy or
appropriateness of the special pays and benefits provided to DOD
federal civilian and military personnel. DOD also requested that we
clearly acknowledge the fundamental differences between the military
and civilians systems. We believe that we have done so. As we noted in
our report, we did not make direct analytical comparisons between
compensation and benefits offered by DOD to deployed federal civilian
and military personnel because such comparisons must account for the
demands of the military service, such as involuntary relocation,
frequent and lengthy separations from family, and liability for combat.
DOD provided other technical comments, which we have incorporated as
appropriate. The department's comments are reprinted in their entirety
in appendix III.
We are sending copies of this report to the Chairman and Ranking
Minority Member, Senate Committee on Armed Services;
the Chairman and Ranking Minority Member, House Committee on Armed
Services; the Chairman and Ranking Minority Member, Subcommittee on
Defense, Senate Committee on Appropriations; and the Chairman and
Ranking Minority Member, Subcommittee on Defense, House Committee on
Appropriations; and other interested congressional parties. We are also
sending copies to the Secretary of Defense and the Under Secretary of
Defense for Personnel and Readiness. We will make copies available to
other interested parties upon request. Copies of this report will also
be made available at no charge on GAO's Web site at [Hyperlink,
http://www.gao.gov].
Should you or your staff have any questions about this report, please
contact me at (202) 512-6304 or by e-mail at melvinv@gao.gov. Contact
points for our Offices of Congressional Relations and Public Affairs
may be found on the last page of this report. Key contributors to this
report are listed in appendix IV.
Signed by:
Valerie C. Melvin:
Acting Director, Defense Capabilities and Management:
List of Congressional Committees:
The Honorable John Warner:
Chairman:
The Honorable Carl Levin:
Ranking Minority Member:
Committee on Armed Services:
United States Senate:
The Honorable Ted Stevens:
Chairman:
The Honorable Daniel K. Inouye:
Ranking Minority Member:
Subcommittee on Defense:
Committee on Appropriations:
United States Senate:
The Honorable Duncan L. Hunter:
Chairman:
The Honorable Ike Skelton:
Ranking Minority Member:
Committee on Armed Services:
House of Representatives:
The Honorable C.W. Bill Young:
Chairman:
The Honorable John P. Murtha:
Ranking Minority Member:
Subcommittee on Defense:
Committee on Appropriations:
House of Representatives:
[End of section]
Appendix I: Scope and Methodology:
To assess the extent to which DOD has established force health
protection and surveillance policies for DOD federal civilians who
deploy outside of the United States in support of contingency
operations, and how the components (military services and the Defense
Contract Management Agency) have implemented those policies, we
reviewed pertinent force health protection and surveillance policies
and discussed these policies with the following offices or commands:
U.S. Central Command; Joint Chiefs of Staff, Manpower and Personnel;
Under Secretary of Defense for Personnel and Readiness (including the
Assistant Secretary of Defense for Health Affairs, Deployment Health
Support Directorate; Civilian Personnel Policy; and Civilian Personnel
Management Services); the Surgeons General for the Army, Navy, and Air
Force; and the Defense Contract Management Agency (DCMA).
Our review focused on DOD federal civilians who (1) deployed to
Afghanistan or Iraq for 30 continuous days or more between June 1,
2003, and September 30, 2005, and (2) returned to the United States by
February 28, 2006.[Footnote 31] Because DOD had difficulty identifying
the total number of federal civilians who deployed to Afghanistan or
Iraq, we assessed the implementation of DOD's deployment health
requirements at eight component locations that were selected using a
number of approaches. Given that DOD components have flexibility in
where they conduct deployment processing, we selected locations for our
review accordingly. Specifically, the Army uses a centralized approach,
deploying its federal civilians at three primary locations;
therefore, we selected all three locations for review. By contrast, the
Navy and Air Force use a decentralized approach, deploying their
federal civilians from their home stations. For these components, we
selected five locations based on data that indicated that these
locations had deployed the largest numbers of federal civilian
personnel. DCMA was included in our review because it had deployed the
largest number of federal civilian personnel compared to other defense
agencies. DCMA has an informal agreement with the Army to process its
federal civilians through two of the Army's three deployment locations.
Therefore, DCMA federal civilian deployment data in this report are
included in the Army results to the extent that DCMA federal civilian
deployments were documented at the two relevant Army locations. At all
eight component locations, we reviewed either all available hard copy
or electronic deployment records, or in one instance, a sample of the
deployment records for deployed federal civilian personnel who met our
criteria above. Table 11 shows the locations included in our review and
the number of deployment records reviewed at each location.
Table 11: DOD Component Locations and Number of DOD Federal Civilian
Deployment Records Included in Our Review:
DOD component locations: Army: Fort Benning CONUS Replacement Center,
Georgia[A];
Number of DOD federal civilian deployment records reviewed: 238.
DOD component locations: Army: Fort Bliss CONUS Replacement Center,
Texas[A];
Number of DOD federal civilian deployment records reviewed: 2,977[B].
DOD component locations: Army: U.S. Army Corps of Engineers
Transatlantic Programs Center, Virginia;
Number of DOD federal civilian deployment records reviewed: 127.
DOD component locations: Navy: Naval Air Depot, Cherry Point, North
Carolina;
Number of DOD federal civilian deployment records reviewed: 52.
DOD component locations: Air Force: Andrews Air Force Base, Maryland;
Number of DOD federal civilian deployment records reviewed: 10.
DOD component locations: Air Force: Hill Air Force Base, Utah;
Number of DOD federal civilian deployment records reviewed: 8.
DOD component locations: Air Force: Hurlburt Field, Florida;
Number of DOD federal civilian deployment records reviewed: 12.
DOD component locations: Air Force: Wright-Patterson Air Force Base,
Ohio;
Number of DOD federal civilian deployment records reviewed: 7.
DOD component locations: Total;
Number of DOD federal civilian deployment records reviewed: 3,431.
Source: GAO.
Note: CONUS refers to the continental United States.
[A] DCMA federal civilians deployed through Forts Benning and Bliss
CONUS Replacement Centers. At Fort Benning, we selected a probability
sample of 238 out of 606 deployment records for deployed federal
civilians and we reviewed those 238 deployment records. When presenting
the Fort Benning review results in this report, we show numbers and
percentages that are weighted estimates to provide a 95 percent
confidence with a margin of error of 5 percentage points.
[B] Although the Army deploys its federal civilian personnel at three
primary sites, Fort Bliss deployed the largest number of federal
civilians during our time frame. We reviewed the entire universe of
deployment records for federal civilian personnel deployed from this
location because the deployment records were being maintained
electronically, which facilitated the review of all records.
[End of table]
In total, we reviewed 3,431 hard copy and automated records for federal
civilian personnel who deployed to Afghanistan and Iraq. Specifically,
we reviewed hard copies of deployment records for 454 (out of a
reported 822) federal civilian personnel at seven component locations
and automated deployment records for 2,977 (out of the reported 2,977)
federal civilian personnel at the other location where all deployment
records were being maintained electronically. The results of deployment
record reviews, however, could not be projected beyond the samples to
all DOD federal civilians who had deployed during this time frame. To
facilitate our review of federal civilian deployment records at the
selected component locations, we developed a data collection instrument
to review and collect deployment health information from each
individual civilian's deployment record.
For federal civilians in our review at each location, we reviewed
deployment records for documentation that the following force health
protection and surveillance policy requirements were met:
* Pre-and post-deployment health assessments;
* Tuberculosis screening test (within 1 year of deployment);
* Human Immunodeficiency Virus (HIV) screening test;
* Pre-deployment immunizations:
- hepatitis A (first and second course);
- influenza (within 1 year of deployment);
- tetanus-diphtheria (within 10 years of deployment);
- typhoid; and:
- smallpox (within 5 years of deployment):
After our review of hard copy deployment records, we requested each
component's medical personnel to reexamine those hard copy deployment
records that were missing required health documentation, and we
adjusted our results where documentation was subsequently provided. We
also requested and queried other documentation from information systems
used by the components to capture deployment and related health
information, making adjustments to our results where documentation was
found in the systems. These data sources included the Army's Medical
Protection System (MEDPROS), the Army's medical database (MedBase), the
Air Force's Preventive Health Assessment and Individual Medical
Readiness (PIMR) system and its Comprehensive Immunization Tracking
Application (CITA), DOD's Defense Enrollment Eligibility Reporting
System (DEERS), which is used by the Navy, and the Army Medical
Surveillance Activity's Defense Medical Surveillance System (DMSS).
At the Army's Fort Benning, we created a sampling frame (i.e., total
population) of records for 606 federal civilian deployments between
June 1, 2003, and September 30, 2005. Our study population was limited
to DOD federal civilians who deployed to Afghanistan or Iraq. We then
drew a stratified random sample of 288 deployment records and
stratified the sample to isolate potential duplicate deployment records
for the same federal civilian. We found two duplicate records and
removed them from both the population and sample, as shown in table 12.
We also removed another 14 deployment records from our sample because
those DOD federal civilians had been deployed to locations other than
Afghanistan or Iraq, and were not eligible for the duty population. In
addition, we removed another 13 deployment records that were originally
selected as potential replacement records; however, we found that those
replacements were not needed. Ultimately, we identified 238 in-scope
responses, for a weighted response rate of 87 percent. Each sampled
record was subsequently weighted in the analysis to represent all DOD
federal civilians deployed to Afghanistan or Iraq. The disposition of
the federal civilian deployment records we reviewed at Fort Benning are
summarized in the following table:
Table 12: Sample Disposition for Fort Benning Federal Civilian
Deployment Records:
Stratum description: Stratum 1: Records with potential duplicates;
Total population size: 2;
Total sample size: 2;
Number of respondents: 2.
Stratum description: Stratum 2: Records without potential duplicates;
Total population size: 604;
Total sample size: 286;
Number of respondents: 236.
Stratum description: Total;
Total population size: 606;
Total sample size: 288;
Number of respondents: 238.
Source: GAO.
[End of table]
Our probability sample is only one of a large number of samples that we
might have drawn. Because each sample could have provided different
estimates, we express our confidence in the precision of our particular
sample's results as a 95 percent confidence interval. This is the
interval that would contain the actual population value for 95 percent
of the Fort Benning, Ga., samples we could have drawn. All percentage
estimates from our sample have margins of error (that is, widths of
confidence intervals) of plus or minus 5 percentage points or less, at
the 95 percent confidence level, unless otherwise noted.
We took steps to assess the reliability of DOD federal civilian
deployment and health data for the purposes of this review, including
consideration of issues such as the completeness of the data from the
respective information systems' program managers and administrators. We
also examined whether the data were subjected to quality control
measures such as periodic testing of the data against deployment
records to ensure the accuracy and reliability of the data. In
addition, we reviewed existing documentation related to the data
sources and interviewed knowledgeable agency officials about the data.
We did not find these deployment and health data to be sufficiently
reliable for (1) identifying the universe of DOD federal civilian
deployments or (2) use as the sole source for reviewing the health and
immunization information for all DOD federal civilian deployments, but
we found the information systems to be sufficiently reliable when used
as one of several sources in our review of deployment records. In those
instances where we did not find a deployment health assessment or
immunization in either the deployment records or in the electronic data
systems, we concluded that the health assessment or immunization was
not documented.
To determine the extent to which DOD has established and the components
have implemented medical treatment policies for DOD federal civilians
who deployed in support of contingency operations, we examined
pertinent medical treatment policies for DOD federal civilian employees
who required treatment for injuries and diseases sustained while
supporting contingency operations. In addition, we obtained workers'
compensation claims filed by DOD federal civilian personnel with the
Department of Labor's Office of Workers' Compensation Programs(OWCP)
showing those civilians who sustained injuries and diseases during
deployment. We selected and reviewed a non-probability sample of claims
to assess the components' processes and procedures for implementing
DOD's medical treatment policies across a range of civilian casualties
including injuries, physical and mental illnesses, and diseases. The
scope of our review did not extend to the Department of Labor's claims
review process.
To identify special pays and benefits provided to DOD federal civilians
who deployed in support of contingency operations and to assess the
extent that special pays and benefits differ from those provided to
deployed active duty military personnel, we examined major statutory
provisions for special pays, disability and death benefits for federal
civilians and military personnel, including relevant chapters of Title
5 of the U.S. Code governing federal civilian personnel management;
relevant chapters of Title 10 of the U.S. Code governing armed forces
personnel management; Section 112 of Title 26 of the U.S. Code
governing combat zone tax exemption; relevant chapters of Title 37 of
the U.S. Code governing pay and allowances for the uniformed services;
relevant chapters of Title 38 of the U.S. Code governing veterans'
benefits; relevant provisions of applicable public laws governing
military and civilian pay and benefits; applicable directives and
instructions related to active duty military and DOD federal civilian
benefits and entitlements; DOD financial management regulations;
Department of State regulations; and prior GAO reports. In addition, we
discussed the statutes and guidance with cognizant officials of the
Office of the Under Secretary of Defense for Personnel and Readiness,
military services' headquarters, and the Defense Contract Management
Agency involved with the administration of active duty and federal
civilian personnel entitlements. We did not perform a comprehensive
review of all compensation--comprised of a myriad of pays and benefits-
-offered to active duty military and federal civilian personnel in
general. Our analysis focused on selected elements of compensation such
as special pays (e.g., hostile fire/imminent danger pay). Also, we did
not make direct analytical comparisons between compensation and
benefits offered by DOD to deployed federal civilian and military
personnel because such comparisons must account for the demands of the
military service, such as involuntary relocation, frequent and lengthy
separations from family, and liability for combat.
After reviewing documents and interviewing officials, we then compiled
and analyzed the information on the types and amounts of special pays
and benefits available to active duty military and DOD federal civilian
personnel who deployed to Afghanistan or Iraq. We interviewed DOD
officials to discuss the basis for any differences in compensation. In
addition, to illustrate how special pays affect overall compensation
provided to DOD federal civilian and military personnel, we modeled
scenarios for both groups using similar circumstances, such as length
of deployment, pay grades, special pays (e.g., post differential pay,
danger pay, overtime pay, family separation allowance, basic allowance
for housing, basic allowance for subsistence), and duty location.
Through discussions with senior DOD officials, we made an assumption
that deployed DOD federal civilians worked 30 hours of overtime per
week. For deployed DOD federal civilians, we subtracted a contribution
of $15,000 to the Thrift Savings Plan (TSP) to obtain the adjusted
gross income. We assumed that DOD federal civilians, temporarily at a
higher tax bracket, would take maximum advantage of the opportunity to
defer taxes. We assumed that the military personnel would contribute a
smaller percentage of pay, 5 percent of gross income, to TSP. We made
this assumption because much of the military pay was not subject to
federal taxes, which removes the incentive to contribute to TSP, and
because unlike for federal workers, military TSP does not have a
matching component. For military personnel, we also deducted the amount
of pay not subject to taxes due to the combat zone exclusion, family
separation allowance, basic allowance for subsistence, and basic
allowance for housing. Using these assumptions, we generated an
adjusted gross income and used that as input into a commercial tax
program, Turbo Tax, to obtain federal taxes owed. We assumed that both
DOD federal civilian and military personnel were married, filing
jointly, with a spouse that earned no income. We assumed that the
family had two children and qualified for two child tax credits, and
the Earned Income Tax Credit, if at that income level. This resulted in
four exemptions and a standard deduction of $10,000 in 2005. For
purposes of validation, we repeated this exercise using an alternate
tax program, Tax Cut, and obtained identical results.
We conducted our review from March 2006 to August 2006 in accordance
with generally accepted government auditing standards.
[End of section]
Appendix II: Temporary and Permanent Partial Disability Benefits
Provided to DOD Federal Civilian and Military Personnel:
Both DOD federal civilian and military personnel are eligible to
receive disability benefits when they sustain a line-of-duty injury.
However, these benefits vary in amount. Table 13 shows the temporary
disability benefits available to eligible DOD federal civilian and
military personnel.
Table 13: Temporary Disability Compensation Payments, Payment Formula,
and 2006 Payment Caps for DOD Federal Civilian and Military Personnel:
DOD Personnel: Civilian;
Payment calculation for temporary partial and temporary total
disability: Continuation of pay up to 45 days, followed by a recurring
payment for wage loss (based on a percentage of salary, up to a cap);
* Partial disability (when able to work, but at a reduced salary):
Payments are 66-2/3 percent of the wage loss (that is, the difference
between the part-time and full-time wages) without dependents;
75 percent with dependents;
* Total disability (when unable to work): Payments are 66-2/3 percent
of the employee's average weekly wage without dependents;
75 percent with dependents;
Maximum monthly payment cap in 2006: $6,608 per month without
dependents;
$7,435 per month with dependents.
DOD Personnel: Military;
Payment calculation for temporary partial and temporary total
disability: Continuation of pay for generally no longer than a year,
followed by recurring VA disability compensation payments;
A servicemember's disability rating ranging from 0 to 100 percent, in
10 percent increments.[A];
Maximum monthly payment cap in 2006: Each disability rating level
corresponds to an annually fixed monthly VA payment amount. During
2006, amounts ranged from $112 to $2,393 per month;
"Add-ons" to basic payments;
If the disability rating is 30 percent or more, the individual is
entitled to additional compensation for each dependent. During 2006,
the additional amounts ranged from $40-$233 for a spouse, and $27-$91
for a child, depending on the level of disability.
Source: GAO analysis of federal statutes.
[A] Unlike civilian personnel, military personnel also can be
temporarily released from service and be eligible to receive temporary
DOD disability retirement benefits if they are found unfit for duty,
and they may continue to receive a recurring VA disability compensation
payment for wage loss. However, the amount of the DOD retirement
payment is reduced (offset) dollar-for-dollar by the amount of the
recurring VA payment, unless they have at least 20 years of service and
can qualify for an exception to this offset due to a disability rating
of 50 percent or more, or combat-related disabilities. In our report on
disability benefits provided to military personnel and civilian public
safety officers, we noted that the added increment available from
disability retirement, even with applicable offsets, can increase
military personnel's monthly benefits significantly above that of
comparable public safety officers at all levels.
[End of table]
As table 13 shows, DOD federal civilians who are injured in the line of
duty are eligible to receive continuation of their salary up to 45
days, followed by a recurring payment for wage loss that is based on a
percentage of their salary and the existence of dependents, up to a
cap. In contrast, military personnel receive continuation of their
salaries for generally no longer than a year, followed by a recurring
payment for wage loss, which is based on the degree of disability and
their number of dependents, and temporary retirement pay based on
salary for up to 5 years.
When a partial disability is determined to be permanent, both DOD
federal civilians and military personnel are eligible to continue
receiving recurring compensation payments, but again, the amounts of
these benefits vary, as shown in table 14.
Table 14: Permanent Partial Disability Compensation Payment Formulas
and Time Limits on Benefits for DOD Federal Civilian and Military
Personnel:
Compensation payments;
Civilian personnel:
* Payment calculation;
* When able to work, but at a reduced salary, payments are 66-2/3
percent of the wage loss (that is, the difference between the part-time
and full-time wages) without dependents;
75 percent with dependents.[A];
Maximum period of time payments can be provided;
Payments provided for the remainder of life, as long as the impairment
persists;
Schedule award;
Schedule of payments are based on the specific type of impairment. For
example, up to 312 weeks (6 years) compensation due to the loss of an
arm, or the loss (or loss of use) of any other important external or
internal organ of the body;
Military personnel: Payment calculation;
* VA basic payment amounts established annually for disability ratings
ranging from 10 percent to 90 percent. During 2006, amounts ranged from
$112 to $1,436 per month.[ A];
"Add-ons" to basic payments;
If the disability rating is 30 percent or more, the individual is
entitled to additional VA compensation for each dependent. During 2006,
the additional amounts ranged from $40-$233 for a spouse, and $27-$91
for a child, depending on the level of disability;
Special monthly VA compensation payments up to $4,176, depending on the
specific type and degree of impairment;
Maximum period of time payments can be provided;
No time limit regardless of degree of impairment;
payments provided for the remainder of life, as long as the impairment
persists.
Source: GAO analysis of federal statutes.
[A] Under the Civil Service Retirement System (CSRS), DOD federal
civilian personnel must be unfit for duty and have 5 years of service
to qualify for disability retirement. Under the Federal Employees'
Retirement System (FERS), civilian personnel must be unfit for duty and
have 18 months of service. DOD federal civilian personnel must elect
either compensation benefits or disability retirement. Military
personnel who are unfit for duty are eligible for DOD disability
retirement benefits if they have a disability rating of 30 percent or
more regardless of length of service, of if they have 20 years or more
of service regardless of disability. The amount of the DOD retirement
payment is offset dollar for dollar, however, by the amount of the
monthly VA compensation payment unless the servicemember has at least
20 years of service and a disability rating of 50 percent or more, or
combat-related disabilities.
[End of table]
As table 14 shows, DOD federal civilian personnel with permanent
partial disabilities receive payments based on salary and dependents
while military personnel receive payments based on the severity of the
injury and their number of dependents, as long as the condition
persists.
[End of section]
Appendix III: Comments from the Department of Defense:
Under Secretary Of Defense:
4000 Defense Pentagon:
Washington, D.C. 20301-4000:
Sep 20 2006:
Personnel And Readiness:
Ms. Valerie C. Melvin:
Acting Director, Defense Capabilities and Management:
U.S. Government Accountability Office:
441 G Street, N. W.
Washington, DC 20548:
Dear Ms. Melvin:
This is the Department of Defense (DoD) response to the Government
Accountability Office (GAO) draft report, GAO-06-1085, "DOD Civilian
Personnel: Greater Oversight and Quality Assurance Needed to Ensure
Force Health Protection and Surveillance for Those Deployed," dated
September 1, 2006 (GAO Code 350829). We appreciate the GAO's efforts to
comply with the broad review requirements established by Senate Armed
Services Committee. The GAO's observations with respect to DoD policies
regarding deployment of civilians confirm that the Department has come
a long way since its 1994 review (GAO report, GAO/NSIAD-95-5, "DoD
Force Mix Issues: Greater Reliance on Civilians in Support Roles Could
Provide Significant Benefits," dated October 19, 1994, GAO Code
391217). The draft report's findings provide reassurance that DoD
policies are now in place that resolve GAO's previous concerns.
The draft GAO report provides the following recommendation: "To
strengthen DoD's force health protection and surveillance for its
federal civilian personnel who deploy in support of contingency
operations, we recommend that the Secretary of Defense direct the Under
Secretary of Defense (Personnel and Readiness) to establish an
oversight and quality assurance mechanism to ensure that all Components
fully comply with its requirements" (Page 36/GAO draft report). In
arriving at this recommendation, GAO observed that in a number of
cases, DoD was unable to produce documentation confirming that deployed
civilians received necessary immunizations, or pre-or post-medical
assessments.
DoD partially concurs. In reviewing the draft report, DoD activities,
particularly the Army Corps of Engineers, Transatlantic Programs
Center, determined that for many of the records studied by GAO,
documentation did exist, thus raising reservations about GAO's
findings. For example, many immunizations were, in fact, documented in
nurse's notes, or were not required at the time of deployment and
should not have been reported as "missing". While we question the
accuracy of the GAO's findings with respect to medical documentation,
we acknowledge the necessity for all deployed civilians to receive
required immunizations and medical assessments. Further, confirmation
documentation must be available in every instance. We intend to take
the steps outlined below to determine appropriate implementation of the
recommendation.
We are already aware of the challenges to assuring that all deploying
military and civilian personnel receive necessary force health
protection services. We have written and coordinated a new DoD
Instruction that establishes a comprehensive DoD force health
protection quality assurance program, with an expected publication
before the end of 2006. With this Instruction, the current DoD
deployment health quality assurance program will be expanded to
encompass the full breadth of health surveillance activities, and apply
to DoD civilian and DoD contractor personnel accompanying deployed
military forces as well as all military personnel. Initially, the
expanded program will focus on process issues to ensure that deployed
federal civilians receive the same pre-and post-deployment assessments
as military Service members (for example, that deployment health
assessment documents are completed, that necessary immunizations are
obtained, that serum samples are collected and sent to the designated
central repository, and that education and risk communication is
provided). Additionally, proposed revisions to DoD Directives and
Instructions that specifically address planning, preparation, and
utilization of DoD civilians in support of contingencies and
emergencies include new accountability obligations, to include annual
assessments for compliance with pre-and post-deployment medical
assessment requirements. In June 2006, as an interim measure, we
established a requirement for Components to document in the Defense
Civilian Personnel Data System the deployment of civilian employees who
are assigned to contingency operations overseas. We anticipate that
enhanced capabilities of the Defense Integrated Military Human
Resources System (DIMHRS) will ultimately provide DoD with
comprehensive, centralized data regarding its deployed personnel.
In addition, we intend to further expand our force health protection
quality assurance program to focus on the clinical quality of care. Our
civilians have several options for health care (for example, through
the Federal Employees Health Benefits Program or in appropriate
circumstances, space available in DoD medical treatment facilities).
DoD has neither direct access to civilian medical records nor influence
over how care is provided in the private sector. Accordingly, we intend
to form a multi-functional working group under the direction of the
Office of the Under Secretary of Defense for Personnel and Readiness,
to address and propose integrated solutions to implementing these
provisions of the expanded quality assurance program.
The draft report reflects substantial research and review of
information and data provided by numerous sources and many DoD
activities. Of particular note is the draft report's discussion of the
special pays and benefits provided to DoD civilians and military
personnel. GAO does not take a position regarding the adequacy or
appropriateness of these benefits and compensation; however, the
selection and presentation of the associated data could easily mislead
the reader into drawing erroneous conclusions. Moreover, the
comparisons do not take into account the relative value of certain key
benefits for which explicit dollar amounts cannot be measured, such as
retirement systems, health care systems, military commissary and
exchange privileges. We strongly suggest that GAO amend the report to
place its comparison of pay and benefits in appropriate context.
Therefore, we request that you clearly acknowledge the fundamental
differences between the military and civilian systems within the
introduction of the aforementioned discussion. We offer the following
concepts for consideration.
It is difficult to compare the pay and benefits entitlements of
civilian employees to the entitlements of military members with enough
normalization to ensure the comparative analysis is not misinterpreted.
DoD civilians and military members are key components of the Total
Force, yet are governed by distinctly different systems. The precept of
total service to protect and defend our country is the foundation of
the military system, requiring worldwide mobility, availability for
duty around the clock, and the expectation that members will engage in
combat and other contingency situations. In contrast, DoD civilian
employees are designated as noncombatants, and their deployment to
contingency situations generally occurs on a voluntary basis. DoD
civilians are governed by Federal employment and compensation statutes,
and are expected to spend most of their careers in the United States or
in non-hardship overseas postings. With these contrasts in mind, the
civilian and military systems have been constructed to provide
incentives that respond to the basic perspectives of civilian and
military service, particularly when it comes to contingency deployment.
For members of the military, long-term career prospects and a variety
of life-long benefits function as key incentives for military service.
In contrast, more immediate, short-term benefits serve as incentives to
ensure the availability of a sufficient number of civilian employees
with the needed skills to accomplish immediate contingency
requirements. Recognizing this fundamental dichotomy is critical to any
analysis that seeks to compare pay and benefits afforded to DoD
civilian and military personnel.
Finally, it is necessary to point out several technical corrections
that GAO should make to the report prior to its issuance.
* Page 4 of the draft report, middle paragraph, 3rD sentence: Revise
sentence to read, "However, our actual review of claims filed by the
DoD federal civilian personnel was limited to those who had deployed to
Iraq because the Department of Labor did not assign a unique identifier
for claims that had been filed by those federal civilians who had
deployed to Afghanistan." Injury claim information is owned by the
Department of Labor, Office of Workers Compensation (OWCP).
* Page 12 of the draft report, Table 2, "DoD Federal Civilian
Deployment Records Lacking Documentation of Required Immunizations" The
number (and percent) of records missing two or more immunizations
reported for the U.S. Army Corps of Engineers Transatlantic Program
Center (TPC) is inaccurate. In the draft report, GAO identified 85
records as missing at least two immunizations. TPC requested the
specific documentation that GAO used to support its findings, as part
of TPC's review of the draft report. In its response to TPC, GAO
identified 69 records (54.3%) for this category, instead of 85 (66.9%).
Thus, the correct number of records missing this documentation should
be 69 (54.3%).
* Page 23 of the draft report, Figure 2, "DoD Medical Treatment
Processes for Federal Civilians Who Require Treatment for Deployment-
Related Injuries or Diseases After They Return to the United States"
Revise Figure 2 to correctly reflect the procedures followed by DoD as
follows:
- Right column, 2nd box: Replace "specialist" with "physician selected
by the employee". Treatment is not limited to that provided by a
specialist.
- Right column, 3'D box: Delete box entirely. Authorization of medical
treatment in occupational disease cases is not a question of
authorizing "further" medical treatment but of authorizing initial
medical treatment. Unless OWCP approves the issuance of the medical
authorization form (Form CA-16) in occupational disease cases, the only
medical treatment that can be considered "authorized" is that rendered
by the DoD medical treatment facility, and such authorizing flows from
DoD, not OWCP.
* Pages 26 to 28 of the draft report, Tables 6 and 7: Both of these
tables erroneously reflect the basic pay for both civilian and military
personnel, overtime payments, Federal taxes due, and tax relief
amounts. The following specific examples illustrate the scope of the
miscalculations and misinterpretations, and suggest the need for GAO to
thoroughly review the tables and associated footnotes.
- Both tables underestimate the years of service and corresponding
basic pay for the military 05 and 06 comparisons. Most members have 16
to 17 years of service upon promotion to 05, and 21 to 22 years of
service upon promotion to 06. The use of 7 years of service
underestimates the rate of base pay by $1,400 per month ($16,800 per
year) for an 05, and $2,000 per month ($24,000 per year) for an O6.
- All comparisons on both tables overstate overtime compensation. For
example, the overtime rate corresponding to a GS-11 earning $61,510 per
annum is $35.51 per hour. At this rate, 30 hours of overtime per week
for a period of 1 year produces total overtime earnings of $55,395.60,
instead of $55,588 as reflected Table 6. The adjusted overtime earnings
affect the amounts reflected for gross pay and income after taxes.
Similar miscalculations are evident for all of the civilian overtime
comparisons.
- Footnote c misstates the authorization provided to DoD to increase
the premium pay cap, and should be revised to read: "Section 5307 of
title 5, United States Code provides that employees may be paid
compensation only to the extent that their total annual compensation
does not cause the aggregate of total compensation (i.e., total
compensation of all types, as defined in Subpart B of title 5, Code of
Federal Regulations, including allowances, bonuses, awards, and
differentials) for the calendar year to exceed the annual rate of basic
pay for Level I of the Executive Schedule (currently $183,500 for
2006). Section 1105 of Pub. L. No. 109-163 authorized the Secretary of
Defense to increase the annual premium pay limitation for 2006 to
$200,000 for employees serving overseas in the U.S. Central Command
area of responsibility. Thus, premium pay in excess of $183,500, up to
$200,000, will be paid to such employees during the first pay period of
2007. Deferred payments count towards employees' 2007 aggregate
limitation."
- Table 7 reflects base pay at an annual amount (i.e., 12 months) for
all civilian and military comparisons, rather than for a period of 6
months, which the table intends to illustrate. Similarly, the amounts
reflected for gross pay, TSP contribution, adjusted gross income,
Federal taxes due, and income after taxes should be computed to cover a
period of 6 months, instead of 1 year.
- Both tables omit hostile fire pay/imminent danger pay for military
members assigned to Iraq or Afghanistan, which is $225 per month.
- Both tables fail to recognize that military members can contribute
their tax exempt pay up to $44,000 into the TSP, rather than the
regular annual limit of $15,000.
- Both tables overstate the value of the Combat Zone Tax Exemption
(CZTE) for military members. The comparisons reflect the maximum amount
of compensation that can be excluded under CZTE provisions from
taxation, but in none of the comparisons is that amount of income
actually earned. Further, the comparisons fail to acknowledge
deductions military and civilian taxpayers would have (i.e., standard
deductions, itemized deductions, other tax exemptions and tax credits,
etc.)
* Pages 29 - 36, and Appendix II on pages 46 and 47 of the draft
report, "Disability and Survivor Benefits" These sections and Appendix
II inappropriately mix discussion of Veterans Affairs (VA) and DoD
benefits for military members without in any way distinguishing between
the two. Further, the discussion presents incorrect information in many
cases. For example, the first paragraph on page 30 states, "We found
that compensation payments for military personnel were based on a
disability rating, regardless of salary level." This statement is only
true with regard to VA disability benefits. DoD disability payments do,
in fact, take into account salary level. If a former member is entitled
to both, there is an offsetting mechanism.
DoD appreciates the opportunity to comment on the draft report. GAO may
direct any questions to my action officer, Mr. Richard Nicholson, 703-
571-9287.
Sincerely,
Signed by:
David S. C. Chu:
[End of section]
Appendix IV: GAO Contact and Staff Acknowledgments:
GAO Contact:
Valerie Melvin, (202) 512-6304:
Acknowledgments:
In addition to the contact named above, Sandra Burrell, Assistant
Director; William Bates; Dr. Benjamin Bolitzer; Alissa Czyz; George
Duncan; Steve Fox; Dawn Godfrey; Nancy Hess; Lynn Johnson; Barbara
Joyce; Dr. Ronald La Due Lake; William Mathers; Paul Newton; Dr.
Charles Perdue; Jason Porter; Julia Matta; Susan Tieh; John Townes; and
Dr. Monica Wolford made key contributions to this report.
FOOTNOTES
[1] DOD's civilian workforce includes federal government employees,
foreign nationals hired directly or indirectly to work for DOD, and
contractor personnel. This review focuses on DOD's federal government
employees, whom we refer to in this report as DOD's federal civilians.
[2] GAO, DOD Force Mix Issues: Greater Reliance on Civilians in Support
Roles Could Provide Significant Benefits, GAO/NSIAD-95-5 (Washington,
D.C.: Oct. 19, 1994).
[3] S.R. No. 109-69, at 380 (2005).
[4] For this report, we examined the Departments of the Army, Navy, and
Air Force, and the Defense Contract Management Agency (DCMA). We
selected DCMA because it deployed the largest numbers of federal
civilian personnel compared to other defense agencies.
[5] For the purposes of health surveillance, DOD considers a deployment
to be 30 continuous days or greater to a land-based location outside
the continental United States that does not have a permanent U.S.
military treatment facility. We selected these deployment dates to
incorporate DOD's most recent changes to the post-deployment health
assessment criteria.
[6] The Federal Employees' Compensation Act is a comprehensive workers'
compensation law for federal employees that calls for medical coverage
and compensation for federal employees with injuries and occupational
illnesses incurred in the performance of their duties.
[7] Under workers' compensation and veterans' compensation programs,
benefits typically include medical treatment for the injury, vocational
rehabilitation services, and cash payment to replace a percentage of
the individual's loss in wages while injured and unable to work.
[8] Disability retirement programs typically provide benefits that
allow qualified individuals who are unable to return to work to retire
earlier and/or to retire with a higher percentage of their pre-injury
salary level than would otherwise be permitted with normal retirement
based on age and length of service at the time of injury.
[9] Operation Enduring Freedom includes ongoing operations in
Afghanistan and in certain other countries;
Operation Iraqi Freedom includes ongoing operations in Iraq.
[10] In addition to DOD federal civilian deployment records, other
documentation reviewed included data from information systems used by
the components to capture deployment and related health information.
Although we found these data not to be sufficiently reliable for (1)
identifying the universe of DOD federal civilian deployments or (2) use
as the sole source for reviewing the health and immunization
information for all DOD federal civilian deployments, we found the
information systems to be sufficiently reliable when used as one of
several sources in our review of deployment records.
[11] DOD Instruction 1400.32, DOD Civilian Workforce Contingency and
Emergency Planning Guidelines and Procedures, April 24, 1995;
DOD Instruction 6490.3, Implementation and Application of Joint Medical
Surveillance for Deployments, August 7, 1997;
DOD Directive 6490.2, Comprehensive Health Surveillance, October 21,
2004;
and Office of the Chairman, The Joint Chiefs of Staff, Memorandum MCM-
0006-2, Updated Procedures for Deployment Health Surveillance and
Readiness, February 1, 2002.
[12] U.S. Central Command, Individual Protection and Individual/Unit
Deployment Policy, January 6, 2005, and DOD Instruction 1400.32, DOD
Civilian Work Force Contingency and Emergency Planning Guidelines and
Procedures, April 24, 1995.
[13] U.S. Central Command, Individual Protection and Individual/Unit
Deployment Policy, January 6, 2005, and DOD Instruction 1400.32, DOD
Civilian Workforce Contingency and Emergency Planning Guidelines and
Procedures, April 24, 1995.
[14] U.S. Central Command, Individual Protection and Individual/Unit
Deployment Policy, January 6, 2005, and DOD Instruction 1400.32, DOD
Civilian Workforce Contingency and Emergency Planning Guidelines and
Procedures, April 24, 1995.
[15] DOD Instruction 6490.3, Implementation and Application of Joint
Medical Surveillance for Deployments, August 7, 1997.
[16] GAO, Defense Health Care: Quality Assurance Process Needed to
Improve Force Health Protection and Surveillance, GAO-03-1041
(Washington, D.C.: Sept. 19, 2003).
[17] DOD Instruction 6490.3, Deployment Health, August 11, 2006 (to be
effective December 2006).
[18] GAO-03-1041.
[19] 10 U.S.C. § 1074f.
[20] DOD Directive 1404.10, Emergency Essential (E-E) DOD U.S. Citizen
Civilian Employees, April 10, 1992, and DOD 1400.25-M, Department of
Defense Civilian Personnel Manual, April 12, 2005.
[21] The Federal Employees' Compensation Act, 5 U.S.C. §§ 8101 et seq.,
is a comprehensive workers' compensation law for federal employees.
[22] Under workers' compensation and veterans' compensation programs,
benefits typically include medical treatment for the injury, vocational
rehabilitation services, and cash payment to replace a percentage of
the individual's loss in wages while injured and unable to work.
[23] Disability retirement programs typically provide benefits that
allow qualified individuals who are unable to work to retire earlier
and/or to retire with a higher percentage of their pre-injury salary
level than would otherwise be permitted with normal retirement based on
age and length of service at the time of injury.
[24] Payment caps for federal civilians are based on the pay level for
a General Schedule (GS)-15, step 10 position, which was $118,957 per
year or ($6,608 per month without dependents or $7,435 per month with
dependent) in 2006.
[25] GAO, Disability Benefits: Benefit Amounts for Military Personnel
and Civilian Public Safety Officers Vary by Program Provisions and
Individual Circumstances, GAO-06-4 (Washington, D.C.: Apr. 7, 2006).
[26] GAO-06-4.
[27] The Federal Employees' Retirement System (FERS) generally covers
all federal employees hired after January 1, 1984. Those hired before
1984 still may be covered by the Civil Service Retirement System;
however, that system has been closed to new members since FERS was
implemented in 1984.
[28] GAO-06-4.
[29] Permanent total disability generally means that an individual is
unable to maintain gainful employment.
[30] In the first year of FERS disability retirement benefits, FERS
reduces the retirement payment by the full amount of any SSDI payment.
In subsequent years, FERS reduces the disability retirement payment by
60 percent of the SSDI payment.
[31] For the purposes of health surveillance, DOD considers a
deployment to be 30 continuous days or greater to a land-based location
outside the continental United States that does not have a permanent
U.S. military treatment facility. We selected these deployment dates to
incorporate DOD's most recent changes to the post-deployment health
assessment criteria.
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