DOD Civilian Personnel
Medical Policies for Deployed DOD Federal Civilians and Associated Compensation for Those Deployed Gao ID: GAO-07-1235T September 18, 2007As 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. GAO was asked to discuss DOD's (1) force health protection and surveillance policies, (2) medical treatment policies that cover federal civilians while they are deployed to support contingency operations in Afghanistan and Iraq, and (3) differences in special pays and benefits provided to DOD's deployed federal civilian and military personnel. For this statement, GAO primarily drew on its September 2006 report that addressed these objectives. For its report, GAO analyzed over 3,400 deployment-related records at eight component locations for deployed federal civilians and policies related to defense health care, reviewed claims filed under the Federal Employees' Compensation Act (FECA); and examined major provisions of special pays and disability and death benefits provided to DOD's deployed federal civilians and military personnel.
In 2006, GAO reported that DOD had established force health protection and surveillance policies to assess and reduce or prevent health risks for its deployed federal civilians, but it lacked procedures to ensure implementation. GAO's review of over 3,400 deployment records found that components lacked documentation that some federal civilians who deployed to Afghanistan and Iraq had received, among other things, required pre- and post-deployment health assessments and immunizations. Also, DOD lacked centralized data to readily identify its deployed civilians and their movement in theater, thus hindering its efforts to assess the overall effectiveness of its force health protection and surveillance capabilities. GAO noted that until DOD establishes a mechanism to strengthen its oversight of this area, it would not be effectively positioned to ensure compliance with its policies, or the health care of deployed federal civilians. GAO also reported that DOD had 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 under the DOD military health system. GAO reviewed a sample of seven workers' compensation claims (out of a universe of 83) filed under FECA 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 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. GAO reported that 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 government-provided disability benefits; however, the type and amount of the benefits vary, and some are unique to each group. Importantly, continuing challenges with modernizing federal disability programs have been the basis for GAO's designation of this as a high-risk area since 2003. In addition, while the 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 civilians almost always receive lower noncash benefits than military personnel. GAO does not take a position on the adequacy or appropriateness of the special pays and benefits provided to DOD federal civilian and military personnel. Any deliberations on this topic should include an examination of how such changes would affect ensuring adequate and appropriate benefits for those who serve their country, as well as the long-term fiscal well-being of the nation.
GAO-07-1235T, DOD Civilian Personnel: Medical Policies for Deployed DOD Federal Civilians and Associated Compensation for Those Deployed
This is the accessible text file for GAO report number GAO-07-1235T
entitled 'DOD Civilian Personnel: Medical Policies Deployed DOD Federal
Civilians and Associated Compensation for Those Deployed' which was
released on September 18, 2007.
This text file was formatted by the U.S. Government Accountability
Office (GAO) to be accessible to users with visual impairments, as part
of a longer term project to improve GAO products' accessibility. Every
attempt has been made to maintain the structural and data integrity of
the original printed product. Accessibility features, such as text
descriptions of tables, consecutively numbered footnotes placed at the
end of the file, and the text of agency comment letters, are provided
but may not exactly duplicate the presentation or format of the printed
version. The portable document format (PDF) file is an exact electronic
replica of the printed version. We welcome your feedback. Please E-mail
your comments regarding the contents or accessibility features of this
document to Webmaster@gao.gov.
This is a work of the U.S. government and is not subject to copyright
protection in the United States. It may be reproduced and distributed
in its entirety without further permission from GAO. Because this work
may contain copyrighted images or other material, permission from the
copyright holder may be necessary if you wish to reproduce this
material separately.
Testimony:
Before the Subcommittee on Oversight and Investigations, Committee on
Armed Services, House of Representatives:
United States Government Accountability Office:
GAO:
For Release on Delivery Expected at 10:00 a.m. EDT:
Tuesday, September 18, 2007:
DOD Civilian Personnel:
Medical Policies for Deployed DOD Federal Civilians and Associated
Compensation for Those Deployed:
Statement of Brenda S. Farrell, Director Defense Capabilities and
Management:
GAO-07-1235T:
GAO Highlights:
Highlights of GAO-07-1235T, a testimony before the Subcommittee on
Oversight and Investigations, Committee on Armed Services, House of
Representatives.
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. GAO was
asked to discuss DOD‘s (1) force health protection and surveillance
policies, (2) medical treatment policies that cover federal civilians
while they are deployed to support contingency operations in
Afghanistan and Iraq, and (3) differences in special pays and benefits
provided to DOD‘s deployed federal civilian and military personnel.
For this statement, GAO primarily drew on its September 2006 report
that addressed these objectives. For its report, GAO analyzed over
3,400 deployment-related records at eight component locations for
deployed federal civilians and policies related to defense health care,
reviewed claims filed under the Federal Employees‘ Compensation Act
(FECA); and examined major provisions of special pays and disability
and death benefits provided to DOD‘s deployed federal civilians and
military personnel.
What GAO Found:
In 2006, GAO reported that DOD had established force health protection
and surveillance policies to assess and reduce or prevent health risks
for its deployed federal civilians, but it lacked procedures to ensure
implementation. GAO‘s review of over 3,400 deployment records found
that components lacked documentation that some federal civilians who
deployed to Afghanistan and Iraq had received, among other things,
required pre- and post-deployment health assessments and immunizations.
Also, DOD lacked centralized data to readily identify its deployed
civilians and their movement in theater, thus hindering its efforts to
assess the overall effectiveness of its force health protection and
surveillance capabilities. GAO noted that until DOD establishes a
mechanism to strengthen its oversight of this area, it would not be
effectively positioned to ensure compliance with its policies, or the
health care of deployed federal civilians.
GAO also reported that DOD had 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 under the DOD military health system. GAO
reviewed a sample of seven workers‘ compensation claims (out of a
universe of 83) filed under FECA 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 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.
GAO reported that 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 government-
provided disability benefits; however, the type and amount of the
benefits vary, and some are unique to each group. Importantly,
continuing challenges with modernizing federal disability programs have
been the basis for GAO‘s designation of this as a high-risk area since
2003. In addition, while the 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 civilians almost always receive lower noncash benefits than
military personnel. GAO does not take a position on the adequacy or
appropriateness of the special pays and benefits provided to DOD
federal civilian and military personnel. Any deliberations on this
topic should include an examination of how such changes would affect
ensuring adequate and appropriate benefits for those who serve their
country, as well as the long-term fiscal well-being of the nation.
What GAO Recommends:
GAO recommended that DOD establish an oversight and quality assurance
mechanism to ensure that all components fully comply with its
requirements. In 2007, DOD issued a new force health protection and
surveillance policy that if effectively implemented will establish such
a mechanism.
To view the full product, including the scope and methodology, click on
GAO-07-1235T. For more information, contact Brenda S. Farrell at (202)
512-3604 or farrellb@gao.gov.
[End of section]
Mr. Chairman and Members of the Subcommittee:
Thank you for the opportunity to be here today to discuss the
Department of Defense's (DOD) policies for its federal
civilians[Footnote 1] who deploy in support of contingency operations
in Afghanistan and Iraq. First, let me emphasize that as 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. Further, 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. Therefore, the need for attention to the
policies and benefits that affect the health and welfare of these
individuals becomes increasingly significant. Today's hearing is
particularly timely considering the continuing role of the United
States in Afghanistan and Iraq as discussed during last week's
hearings.
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 2]
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'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 3] 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.
My testimony today will focus on (1) the extent to which DOD has
established and implemented force health protection and surveillance
policies, (2) medical treatment policies and procedures for its
deployed DOD federal civilians who require treatment for injuries and
diseases, and (3) the differences in special pays and benefits provided
to DOD's deployed federal civilians and military personnel. My remarks
today are primarily based on our September 2006 report on DOD's
policies concerning its federal civilians who have deployed in support
of operations in Afghanistan and Iraq.[Footnote 4] For the 2006 report,
we reviewed DOD deployment health requirements for contingency
operations in Afghanistan and Iraq. To assess the implementation of
these requirements, we analyzed over 3,400 deployment-related records
for deployed federal civilians. We also 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 these policies, we requested all workers' compensation claims that
had been filed under the Federal Employees' Compensation Act[Footnote
5] (FECA) by DOD federal civilians who had deployed to Afghanistan and
Iraq. 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. We also
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. We
performed our review in accordance with generally accepted government
auditing standards.
In summary, we found DOD had established force health protection and
surveillance policies aimed at assessing and reducing or preventing
health risks for its deployed federal civilian personnel, but lacked a
quality assurance mechanism to ensure the components' full compliance
with its policies, or the health care and protection of its deployed
federal civilians. DOD has taken steps in the right direction by
issuing a new policy in February 2007 toward that end. 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. Further, 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. We are not taking a position on the adequacy or
appropriateness of the special pays and benefits provided to DOD
federal civilian and military personnel. We believe that any
deliberations on this topic should include an examination of how such
changes would affect ensuring adequate and appropriate benefits for
those who serve their country, as well as the long-term fiscal well-
being of the nation.
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:
We reported in 2006 that DOD had established force health protection
and surveillance policies aimed at assessing and reducing or preventing
health risks for its deployed federal civilian personnel; however, at
the time of our review, the department lacked a quality assurance
mechanism to ensure the components' full implementation of its
policies. In reviewing DOD federal civilian deployment records and
other electronic documentation[Footnote 6] 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 that became
effective in December 2006, outlining procedures to address its lack of
centralized deployment and health-related data. However, at the time of
our review, the procedures were not comprehensive enough to ensure that
DOD would 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:
Our 2006 report noted that 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 included 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 required 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 7] At the
time of our review, the policies stipulated that all deploying civilian
personnel were to complete pre-deployment health assessment forms
within 30 days[Footnote 8] of their deployments, and health care
providers were 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: Airforce: 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: Airforce: 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: Airforce: 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: Airforce: 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: Airforce: 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.
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 stipulated that all
DOD deploying federal civilians receive theater-specific immunizations
to address possible health threats in deployment locations.[Footnote 9]
Immunizations required for all civilian personnel who deployed to
Afghanistan and Iraq included: 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: Airforce: 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: Airforce: 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: Airforce: 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: Airforce: 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: Airforce: 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 required deploying federal civilians to receive certain
screenings, such as for tuberculosis and HIV.[Footnote 10] Table 3
indicates that, at the time of our review, 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: Airforce: 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: Airforce: 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: Airforce: 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: Airforce: 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: Airforce: 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 required
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 11] At the time of our review, the post-
deployment process began within 5 days of civilians' redeployment from
the theater to their home or demobilization processing stations. DOD's
policies required civilian personnel to complete a post-deployment
assessment that included questions on health and exposure concerns. A
health care provider was 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. At the time of our review, 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: Airforce: 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: Airforce: 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: Airforce: 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: Airforce: 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: Airforce: 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, we noted in our
2006 report that DOD lacked 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 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
12] However, at the time of our review, DOD had 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 13] 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.
At the time of our review, 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, where these assessments are supposed to be
archived in the Defense Medical Surveillance System, 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. In our report, we noted that 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:
With increases in the department's use of federal civilian personnel to
support military operations, we noted in our report that 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, we
further noted that 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 14] The
revised policy and guidance, that became effective in December 2006,
require the components within 3 years, to electronically report (at
least weekly) to the Defense Manpower Data Center, 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 Army Medical Surveillance
Activity for inclusion in the Defense Medical Surveillance System.
Nonetheless, in our 2006 report we noted that 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, we noted that 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.
To strengthen DOD's force health protection and surveillance for its
deployed federal civilians, in our 2006 report, we recommended that DOD
establish an oversight and quality assurance mechanism to ensure that
all components fully comply with its requirements. In February 2007,
the Office of the Deputy Assistant Secretary of Defense for Force
Health Protection and Readiness published a new instruction[Footnote
15] on force health protection quality assurance. This policy applies
to military servicemembers as well as applicable DOD and contractor
personnel. The new policy requires the military services to implement
procedures to monitor key force health protection elements such as pre-
and post-deployment health assessments. In addition, the policy
requires each military service to report its force health protection
and quality assurance findings to the Assistant Secretary of Defense
(Health Affairs) through the Deputy Assistant Secretary of Defense for
Force Health Protection and Readiness. In our June 2007 report[Footnote
16] on DOD's compliance with the legislative requirement to perform pre-
and post-deployment medical examinations on military servicemembers, we
noted that DOD lacked a comprehensive oversight framework to help
ensure effective implementation of its deployment health quality
assurance program, which included specific reporting requirements and
results-oriented performance measures to evaluate the services'
adherence to deployment health requirements. Also, we noted in our 2007
report that the department's new instruction and planned actions
indicate that DOD is taking steps in the right direction. We stated and
still believe that if the department follows through with its efforts,
it will be responsive to several of our reports' recommendations to
improve DOD's force health protection and surveillance for the Total
Force.
DOD Has Established and Implemented Medical Treatment Policies Which
Provide for the Care of Its Deployed Federal Civilians:
In our 2006 report, we found that DOD had 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 17] DOD's
military health system provides four levels of medical care to
personnel who are injured or become ill while deployed, as shown in
figure 1.
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]
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.
In our 2006 report, we found that 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 FECA
claim[Footnote 18] 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, as noted in
our report, 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 employees 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)[Footnote 19] 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, 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.
DOD Provides Special Pays and Benefits to Deployed DOD Federal Civilian
and Military Personnel, but the Types and Amounts Differ:
Our 2006 report found that 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. It should be
noted that while DOD federal civilian and military personnel are key
elements (components) of the Total Force, each is governed by a
distinctly different system. Both groups receive special pays, but the
types and amounts differ. DOD federal civilian personnel also receive
different types and amounts of disability benefits, depending on
specific program provisions and individual circumstances. In 2003, we
designated federal disability programs as a high-risk area because of
continuing challenges with modernizing those programs.[Footnote 20]
Importantly, our work examining federal disability programs has found
that the major disability programs are neither well aligned with the
21st century environment nor positioned to provide meaningful and
timely support. 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 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 government-provided disability benefits--disability
compensation[Footnote 21] and disability retirement.[Footnote 22]
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. In 2003, we designated federal
disability programs as a high-risk area because of continuing
challenges with modernizing those programs. Importantly, our work
examining federal disability programs has found that the major
disability programs are neither well aligned with the 21st century
environment nor positioned to provide meaningful and timely
support.[Footnote 23]
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, as
shown in table 6. 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.
Table 6: 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]
Permanent Partial Disability Benefits:
When a partial disability is determined to be permanent, DOD federal
civilian and military personnel can to continue to receive recurring
compensation payments, as shown in table 7. 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.
Table 7: 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, or 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]
Permanent Total Disability Benefits:
When an injury is severe enough to be deemed permanent and
total,[Footnote 25] 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 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 2003, we designated federal disability
programs as a high-risk area because of continuing challenges with
modernizing those programs. Our work examining federal disability
programs found that the major disability programs are neither well
aligned with the 21st century environment nor positioned to provide
meaningful and timely support.[Footnote 26]
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 civilian and military personnel also receive noncash benefits, which
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]
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]
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]
Concluding Observations:
DOD currently has important policies in place that relate to the
deployment of its federal civilians. Moreover, DOD's issuance of its
new instruction on force health quality assurance further indicates
that DOD is taking steps in the right direction. If the department
follows through with its efforts, we believe it will strengthen its
force health protection and surveillance oversight for the Total Force.
Mr. Chairman and Members of the Subcommittee, this concludes my
prepared statement. I would be happy to answer any questions you may
have.
Contacts and Acknowledgments:
If you or your staffs have any questions about this testimony, please
contact Brenda S. Farrell at (202) 512-3604 or farrellb@gao.gov.
Contact points for our Offices of Congressional Relations and Public
Affairs may be found on the last page of this statement. Key
contributors to this testimony include Sandra B. Burrell, Assistant
Director; Julie C. Matta; and John S. Townes.
Footnotes:
[1] DOD's civilian workforce includes federal government employees,
foreign nationals hired directly or indirectly to work for DOD, and
contractor personnel. This statement focuses on DOD's federal
government employees, who we refer to as DOD's federal civilians.
[2] Operation Enduring Freedom includes ongoing operations in
Afghanistan and in certain other countries; Operation Iraqi Freedom
includes ongoing operations in Iraq.
[3] 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).
[4] GAO, DOD Civilian Personnel: Greater Oversight and Quality
Assurance Needed to Ensure Force Health Protection and Surveillance for
Those Deployed, GAO-06-1085 (Washington, D.C.: Sept. 29, 2006). 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] 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.
[6] 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.
[7] 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.
[8] Subsequent to our review, DOD established a requirement that pre-
deployment health assessments must be confirmed as current within 60
days prior to the expected deployment date.
[9] 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.
[10] 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.
[11] 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.
[12] DOD Instruction 6490.3, Implementation and Application of Joint
Medical Surveillance for Deployments, August 7, 1997.
[13] GAO, Defense Health Care: Quality Assurance Process Needed to
Improve Force Health Protection and Surveillance, GAO-03-1041
(Washington, D.C.: Sept. 19, 2003).
[14] DOD Instruction 6490.3, Deployment Health, August 11, 2006.
[15] DOD Instruction 6200.05, Force Health Protection (FHP) Quality
Assurance Program, February 16, 2007.
[16] GAO, Defense Health Care: Comprehensive Oversight Framework Needed
to Help Ensure Effective Implementation of a Deployment Health Quality
Assurance Program, GAO-07-831 (Washington, D.C.: June 22, 2007).
[17] 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.
[18] The Federal Employees' Compensation Act, 5 U.S.C. §§ 8101 et seq.,
is a comprehensive workers' compensation law for federal employees.
[19] Our actual review of claims filed by DOD federal civilians 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.
[20] GAO, High-Risk Series: An Update, GAO-07-310 (Washington, D.C.:
January 2007), 83-84.
[21] 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.
[22] 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.
[23] GAO-07-310.
[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] Permanent total disability generally means that an individual is
unable to maintain gainful employment.
[26] GAO-07-310.
GAO's Mission:
The Government Accountability Office, the audit, evaluation and
investigative arm of Congress, exists to support Congress in meeting
its constitutional responsibilities and to help improve the performance
and accountability of the federal government for the American people.
GAO examines the use of public funds; evaluates federal programs and
policies; and provides analyses, recommendations, and other assistance
to help Congress make informed oversight, policy, and funding
decisions. GAO's commitment to good government is reflected in its core
values of accountability, integrity, and reliability.
Obtaining Copies of GAO Reports and Testimony:
The fastest and easiest way to obtain copies of GAO documents at no
cost is through GAO's Web site [hyperlink, http://www.gao.gov]. Each
weekday, GAO posts newly released reports, testimony, and
correspondence on its Web site. To have GAO e-mail you a list of newly
posted products every afternoon, go to [hyperlink, http://www.gao.gov]
and select "Subscribe to Updates."
Order by Mail or Phone:
The first copy of each printed report is free. Additional copies are $2
each. A check or money order should be made out to the Superintendent
of Documents. GAO also accepts VISA and Mastercard. Orders for 100 or
more copies mailed to a single address are discounted 25 percent.
Orders should be sent to:
U.S. Government Accountability Office:
441 G Street NW, Room LM:
Washington, D.C. 20548:
To order by Phone:
Voice: (202) 512-6000:
TDD: (202) 512-2537:
Fax: (202) 512-6061:
To Report Fraud, Waste, and Abuse in Federal Programs:
Contact:
Web site: [hyperlink, http://www.gao.gov/fraudnet/fraudnet.htm]:
E-mail: fraudnet@gao.gov:
Automated answering system: (800) 424-5454 or (202) 512-7470:
Congressional Relations:
Gloria Jarmon, Managing Director, JarmonG@gao.gov (202) 512-4400:
U.S. Government Accountability Office:
441 G Street NW, Room 7125:
Washington, D.C. 20548:
Public Affairs:
Susan Becker, Acting Manager, AndersonP1@gao.gov (202) 512-4800:
U.S. Government Accountability Office:
441 G Street NW, Room 7149:
Washington, D.C. 20548:
