a

GAO

United States Government Accountability Office

Report to the Chairman, Subcommittee 

on National Security, Emerging Threats, 

and International Relations, Committee 

on Government Reform, House of 

Representatives

July 2005 DEFENSE HEALTH 

CARE

Improvements Needed 

in Occupational and 

Environmental Health 

Surveillance during 

Deployments to 

Address Immediate 

and Long-term Health 

Issues

GAO-05-632
What GAO Found

United States Government Accountability Office

Why GAO Did This Study

Highlights

Accountability Integrity Reliability

www.gao.gov/cgi-bin/getrpt?GAO-05-632.

To view the full product, including the scope 

and methodology, click on the link above. 

For more information, contact Marcia Crosse 

at (202) 512-7119. 

Highlights of GAO-05-632, a report to the 

Chairman, Subcommittee on National 

Security, Emerging Threats, and 

International Relations, Committee on 

Government Reform, House of 

Representatives 

July 2005

DEFENSE HEALTH CARE 

Improvements Needed in Occupational 

and Environmental Health Surveillance 

during Deployments to Address 

Immediate and Long-term Health Issues 

Although OEHS data generally have been collected and reported for OIF, as 

required by DOD policy, the deployed military services have used different 

data collection methods and have not submitted all of the OEHS reports that 

have been completed. Data collection methods for air and soil surveillance 

have varied across the services, for example, although they have been using 

the same monitoring standard for water surveillance. Variations in data 

collection have been compounded by different levels of training and 

expertise among service personnel responsible for OEHS. For some OEHS 

activities, a cross-service working group has been developing standards and 

practices to increase uniformity of data collection among the services. In 

addition, while the deployed military services have been conducting OEHS 

activities, they have not submitted all of the OEHS reports that have been 

completed during OIF, which DOD officials attribute to various obstacles, 

such as limited access to communication equipment to transmit reports for 

archiving. Moreover, DOD officials did not have the required consolidated 

lists of all OEHS reports completed during each quarter in OIF and therefore 

could not identify the reports they had not received to determine the extent 

of noncompliance. To improve OEHS reporting compliance, DOD officials 

said they were revising an existing policy to add additional and more specific 

OEHS requirements. 

DOD has made progress in using OEHS reports to address immediate health 

risks during OIF, but limitations remain in employing these reports to 

address both immediate and long-term health issues. OIF was the first major 

deployment in which OEHS reports have been used consistently as part of 

operational risk management activities intended to identify and address 

immediate health risks and to make servicemembers aware of the health 

risks of potential exposures. While these efforts may help reduce health 

risks, DOD has no systematic efforts to evaluate their implementation in 

OIF. In addition, DOD’s centralized archive of OEHS reports for OIF has 

several limitations for addressing potential long-term health effects related 

to occupational and environmental exposures. First, access to the 

centralized archive has been limited due to the security classification of 

most OEHS reports. Second, it will be difficult to link most OEHS reports to 

individual servicemembers’ records because not all data on servicemembers’ 

deployment locations have been submitted to DOD’s centralized tracking 

database. For example, none of the military services submitted location data 

for the first several months of OIF. To address problems with linking OEHS 

reports to individual servicemembers, the deployed military services have 

made efforts to include OEHS monitoring summaries in the medical records 

of some servicemembers for either specific incidents of potential exposure 

or for specific locations within OIF. Third, according to DOD and VA 

officials, no federal research plan has been developed to evaluate the longterm health of servicemembers deployed in support of OIF, including the 

effects of potential exposures to occupational or environmental hazards. 

Following the 1991 Persian Gulf 

War, research and investigations 

into the causes of servicemembers’ 

unexplained illnesses were 

hampered by inadequate 

occupational and environmental 

exposure data. In 1997, the 

Department of Defense (DOD) 

developed a militarywide health 

surveillance framework that 

includes occupational and 

environmental health surveillance 

(OEHS)—the regular collection 

and reporting of occupational and 

environmental health hazard data 

by the military services. GAO is 

reporting on (1) how the deployed 

military services have implemented 

DOD’s policies for collecting and 

reporting OEHS data for Operation 

Iraqi Freedom (OIF) and (2) the 

efforts under way to use OEHS 

reports to address both immediate 

and long-term health issues of 

servicemembers deployed in 

support of OIF. 

What GAO Recommends

GAO recommends that the 

Secretary of Defense improve 

deployment OEHS data collection 

and reporting and evaluate OEHS 

risk management activities. GAO 

also recommends that the 

Secretaries of Defense and 

Veterans Affairs (VA) jointly 

develop a federal research plan to 

address long-term health effects of 

OIF deployment. DOD plans to take

steps to meet the intent of our first 

recommendation and partially 

concurred with the other 

recommendations. VA concurred 

with our recommendation for a 

joint federal research plan. 

 
Page i GAO-05-632 Deployment Surveillance

Contents

Letter 1

Results in Brief 3

Background 5

Deployed Military Services Use Varying Approaches to Collect 

OEHS Data and Have Not Submitted All OEHS Reports 

for OIF 15

Progress Made in Using OEHS Reports to Address Immediate Health 

Risks, Though Limitations Remain for Addressing Both 

Immediate and 

Long-term Health Issues 18

Conclusions 26

Recommendations for Executive Action 27

Agency Comments and Our Evaluation 28

Appendixes

Appendix I: Scope and Methodology 32

Appendix II: Example of an Occupational and Environmental Health 

Surveillance Summary Created by the Air Force during 

Operation Iraqi Freedom 35

Appendix III: Comments from the Department of Defense 37

Appendix IV: Comments from the Department of Veterans Affairs 39

Table Table 1: Selected DOD Policies for the Collection and Reporting of 

Deployment Occupational and Environmental Health 

Surveillance (OEHS) Data 7

Figures Figure 1: Entities Involved in Setting or Implementing 

Occupational and Environmental Health Surveillance 

(OEHS) Policy 9

Figure 2: Submittal of Deployment Occupational and 

Environmental Health Surveillance (OEHS) Reports to 

the Centralized Archive 12
Contents

Page ii GAO-05-632 Deployment Surveillance

Abbreviations

CENTCOM U.S. Central Command

CHPPM U.S. Army Center for Health Promotion and Preventive 

Medicine

DHSD Deployment Health Support Directorate

DMDC Defense Manpower Data Center

DOD Department of Defense

HHS Department of Health and Human Services

OEF Operation Enduring Freedom

OEHS occupational and environmental health surveillance

OIF Operation Iraqi Freedom

VA Department of Veterans Affairs

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Page 1 GAO-05-632 Deployment Surveillance

United States Government Accountability Office

Washington, D.C. 20548

A

July 14, 2005 Letr

The Honorable Christopher Shays

Chairman

Subcommittee on National Security,

 Emerging Threats, and International Relations

Committee on Government Reform

House of Representatives

Dear Mr. Chairman:

The health effects from service in military operations have been of 

increasing interest, particularly since the end of the 1991 Persian Gulf War. 

Following that war, many servicemembers reported suffering from 

unexplained illnesses that they attributed to their service in the Persian 

Gulf and expressed concerns regarding possible exposures to chemical or 

biological warfare agents or environmental contaminants. Subsequent 

research and investigations into the nature and causes of these illnesses by 

the Department of Defense (DOD), the Department of Veterans Affairs 

(VA), the Department of Health and Human Services (HHS), the Institute of 

Medicine, and a Presidential Advisory Committee were hampered by a lack 

of servicemember health and deployment data, including inadequate 

occupational and environmental exposure data. During deployments—

particularly combat situations—the health of servicemembers can 

potentially be affected by exposure to hazardous agents contained in or 

produced by weapons systems, as well as exposure to environmental 

contamination or toxic industrial materials.

In an effort to address continuing concerns about the health of 

servicemembers during and after deployments and to improve health data 

collection on potential exposures, DOD developed a militarywide health 

surveillance framework in 1997 for use during deployments. A key 

component of this framework is occupational and environmental health 

surveillance (OEHS), an activity that includes the regular collection and 

reporting of occupational and environmental health hazard data by the 

military services during a deployment that can be used to monitor the 

health of servicemembers and to prevent, treat, or control disease or injury. 

DOD has created policies for OEHS data collection during a deployment 

and for the submittal of OEHS reports to a centralized archive within 

certain time frames. The military services are responsible for implementing 

these policies in preparation for deployments. During a deployment, the 

military services are unified under a deployment command structure and 
Page 2 GAO-05-632 Deployment Surveillance

are responsible for conducting OEHS activities in accordance with DOD 

policy. For this report, we identify the military services operating in a 

deployment as deployed military services.

In early 2003, servicemembers were deployed again to the Persian Gulf in 

support of Operation Iraqi Freedom (OIF), and you and others raised anew 

concerns about potential exposure to hazardous agents or environmental 

contaminants. We are reporting on (1) how the deployed military services 

have implemented DOD’s policies for collecting and reporting OEHS data 

for OIF and (2) the efforts under way to use OEHS reports to address both 

the immediate and long-term health issues of servicemembers deployed in 

support of OIF.

To conduct our work, we reviewed pertinent policies, guidance, and 

reports related to collecting and reporting OEHS data obtained from 

officials at the Deployment Health Support Directorate (DHSD), the 

military services, and the Joint Staff, which supports the Chairman of the 

Joint Chiefs of Staff.1

 We also conducted site visits to the Army, Navy, and 

Air Force health surveillance centers that develop standards and guidance 

for conducting OEHS.2

 We interviewed DOD officials and reviewed reports 

and documents identifying occupational and environmental health risks 

and outlining recommendations for addressing risks at deployment sites. 

We interviewed officials at the U.S. Army’s Center for Health Promotion 

and Preventive Medicine (CHPPM), which archives OEHS reports, both 

classified and unclassified, for all the military services. We also interviewed 

officials and military service representatives at DOD’s Defense Manpower 

Data Center (DMDC) on the status of a centralized deployment tracking 

database to identify deployed servicemembers and record their locations 

within the theater of operations. Additionally, we interviewed VA officials 

on their experience in obtaining and using OEHS reports from OIF to 

address the health care needs of veterans. Finally, we interviewed DOD and 

VA officials to examine whether the agencies have planned or initiated 

health research using OEHS reports.

We determined that the data from CHPPM’s OEHS archive and DMDC’s 

Contingency Tracking System were sufficiently reliable for the purposes of 

1

The Chairman of the Joint Chiefs of Staff is the principal military adviser to the President, 

the National Security Council, and the Secretary of Defense.

2

The Navy supports OEHS activities for the Marine Corps.
Page 3 GAO-05-632 Deployment Surveillance

this report. To assess the reliability of the data, we (1) confirmed that the 

data included the elements that we requested and were consistent with 

provided documentation and (2) conducted detailed fact-finding interviews 

with CHPPM and DMDC officials to understand how the databases were 

created and to determine the limitations of the data. We conducted our 

work from September 2004 through June 2005 in accordance with generally 

accepted government auditing standards. (See app. I for further detail on 

our scope and methodology.)

Results in Brief Although OEHS data generally have been collected and reported for OIF, as 

required by DOD policy, the deployed military services have used different 

data collection methods and have not submitted all of the OEHS reports 

that have been completed. Data collection methods for air and soil 

surveillance have varied across the services, for example, although they 

have been using the same monitoring standard for water surveillance. 

Compounding these differences among the services were the varying levels 

of training and expertise among the deployed military service personnel 

who were responsible for conducting OEHS activities, resulting in differing 

practices for implementing data collection standards. For some OEHS 

activities, a cross-service working group, called the Joint Environmental 

Surveillance Working Group, has been developing standards and practices 

to increase uniformity of data collection among the services. In addition, 

the deployed military services have not submitted to CHPPM all OEHS 

reports that have been completed during OIF, in accordance with DOD 

policy. While 239 of the 277 OIF bases had at least one OEHS report 

submitted to CHPPM’s centralized archive as of December 2004, CHPPM 

could not measure the magnitude of noncompliance because not all of the 

required consolidated lists that identify all OEHS reports completed during 

each quarter in OIF had been submitted. Therefore, CHPPM could not 

compare the reports that it had received against the list of reports that had 

been completed. According to CHPPM officials, obstacles to reporting 

compliance may have included a lack of understanding by some within the 

deployed military services about the type of OEHS reports that should have 

been submitted or the lower priority given to report submission compared 

to other deployment mission activities. Also, while CHPPM is responsible 

for OEHS archiving, it has no authority to enforce report submission 

requirements. To improve OEHS reporting compliance, DOD officials said 

they were revising an existing policy to add additional and more specific 

OEHS requirements.
Page 4 GAO-05-632 Deployment Surveillance

DOD has made progress using OEHS reports to address immediate health 

risks during OIF, but limitations remain in employing these reports to 

address both immediate and long-term health issues. OIF was the first 

major deployment in which OEHS reports have been used consistently as 

part of operational risk management activities intended to identify and 

address immediate health risks. These activities included health risk 

assessments that described and measured the potential hazards at a site, 

risk mitigation activities intended to reduce potential exposure, and risk 

communication efforts undertaken to make servicemembers aware of the 

possible health risks of potential exposures. While these efforts may help 

reduce health risks, there is no assurance that they have been effective 

because DOD has not systematically evaluated the implementation of 

OEHS risk management activities in OIF. Despite progress in the use of 

OEHS information to identify and address immediate health risks, 

CHPPM’s centralized archive of OEHS reports for OIF has limitations for 

addressing potential long-term health effects related to occupational and 

environmental exposures for several reasons. First, access to CHPPM’s 

OEHS archive has been limited because most OEHS reports are 

classified—which restricts their use by VA, medical professionals, and 

interested researchers. Second, it will be difficult to link most OEHS 

reports to individual servicemembers because not all data on 

servicemembers’ deployment locations have been submitted to DOD’s 

centralized tracking database. For example, none of the military services 

submitted location data for the first several months of OIF. To address 

problems with linking OEHS reports to individual servicemembers, the 

deployed military services have made efforts to include OEHS summaries 

in the medical records of some servicemembers for either specific 

incidents of potential exposure or for specific locations within OIF, such as 

air bases. Third, according to DOD and VA officials, no comprehensive 

federal research plan incorporating the use of the archived OEHS reports 

has been developed to address the long-term health consequences of 

service in OIF.

We are making recommendations to the Secretary of Defense to ensure that 

cross-service guidance be developed to implement DOD’s revised policy for 

OEHS during deployments and to ensure that the military services jointly 

establish and implement procedures to evaluate the effectiveness of risk 

management strategies during deployments. We are also recommending 

that the Secretary of Defense and the Secretary of Veterans Affairs work 

together to develop a federal research plan to follow the health of OIF 

servicemembers over time that would include the use of OEHS reports. In 

commenting on a draft of this report, DOD did not concur with our original 
Page 5 GAO-05-632 Deployment Surveillance

recommendation that the military services jointly develop guidance to 

implement DOD’s revised policy for OEHS during deployments; rather, the 

agency stated that cross-service guidance meeting the intent of our 

recommendation would be developed by the Joint Staff instead of the 

military services. In response, we modified the wording of our 

recommendation to clarify our intent that joint guidance be developed. 

DOD partially concurred with our other recommendations. VA concurred 

with our recommendation to work with DOD to jointly develop a federal 

research plan to follow the long-term health of OIF servicemembers.

Background On March 19, 2003, the United States launched military operations in Iraq. 

As of the end of February 2005, an estimated 827,277 servicemembers had 

been deployed in support of OIF. Deployed servicemembers, such as those 

in OIF, are potentially subject to occupational and environmental hazards 

that can include exposure to harmful levels of environmental contaminants 

such as industrial toxic chemicals, chemical and biological warfare agents, 

and radiological and nuclear contaminants. Harmful levels include highlevel exposures that result in immediate health effects.3

 Health hazards 

may also include low-level exposures that could result in delayed or longterm health effects. Occupational and environmental health hazards may 

include contamination from the past use of a site, from battle damage, from 

stored stockpiles, from military use of hazardous materials, or from other 

sources.

3

Harmful levels of environmental contaminants are determined by the concentration of the 

substance and the duration of exposure. 
Page 6 GAO-05-632 Deployment Surveillance

Federal OEHS Policy As a result of numerous investigations that found inadequate data on 

deployment occupational and environmental exposures to identify the 

potential causes of unexplained illnesses among veterans who served in the 

1991 Persian Gulf War, the federal government has increased efforts to 

identify potential occupational and environmental hazards during 

deployments. In 1997, a Presidential Review Directive called for a report by 

the National Science and Technology Council to establish an interagency 

plan to improve the federal response to the health needs of veterans and 

their families related to the adverse effects of deployment.4

 The Council 

published a report that set a goal for the federal government to develop the 

capability to collect and assess data associated with anticipated exposure 

during deployments. Additionally, the report called for the maintenance of 

the capability to identify and link exposure and health data by Social 

Security number and unit identification code. Also in 1997, Public Law 105-

85 included a provision recommending that DOD ensure the deployment of 

specialized units to theaters of operations to detect and monitor chemical, 

biological, and similar hazards.5

 The Presidential Review Directive and the 

public law led to a number of DOD instructions, directives, and 

memoranda, which have guided the collection and reporting of deployment 

OEHS data. See table 1 for a list of selected DOD policies for collecting and 

reporting deployment OEHS data.

4

Presidential Review Directive, National Science and Technology Council – 5 (Apr. 21, 1997). 

The National Science and Technology Council is a cabinet-level council that helps 

coordinate federal science, space, and technology research and development for the 

President.

5

National Defense Authorization Act for Fiscal Year 1998. Pub. L. No. 105-85, §768, 111 Stat. 

1629, 1828 (1997) (“Sense of Congress”).
Page 7 GAO-05-632 Deployment Surveillance

Table 1: Selected DOD Policies for the Collection and Reporting of Deployment Occupational and Environmental Health 

Surveillance (OEHS) Data 

Source: DOD.

Date Policy OEHS data collection OEHS reporting

August 1997 Department of Defense 

Instruction 6490.3,

“Implementation and Application 

of Joint Medical Surveillance for 

Deployment” (under revision)

Directs military services to 

deploy specialized units to 

conduct environmental health 

assessments of potential 

exposure to occupational and 

environmental hazards.

February 2002 Office of the Chairman, The 

Joint Chiefs of Staff, 

Memorandum MCM-0006-02, 

“Updated Procedures for 

Deployment Health Surveillance 

and Readiness”

Directs the combatant 

command—which is responsible 

for the deployment—to develop 

and maintain an appropriate 

OEHS program for the 

deployment.

Directs deployed military 

commands to continuously 

review and update 

environmental health 

assessments throughout 

deployments using data 

collected in the theater.

Directs deployed military 

commands to ensure that 

requirements are met for 

reporting and archiving OEHS 

data and sets out requirements 

for record keeping and reporting.

May 2003 Under Secretary of Defense for 

Personnel and Readiness, 

Memorandum, “Improved 

Occupational and Environmental 

Health Surveillance Reporting 

and Archiving”

Directs the Joint Staff to issue 

additional guidance for more 

comprehensive OEHS reporting 

requirements for Operation Iraqi 

Freedom and provides specific 

guidance for required reports 

that should be submitted for 

archiving, and time frames for 

submittal.

June 2003 The Joint Staff, Memorandum 

DJSM-0613-03, “Improved 

Occupational and Environmental 

Health Surveillance (OEHS) 

Reporting and Archiving”

Directs personnel involved in 

OEHS to submit all deployment 

OEHS reports to the U.S. Army 

Center for Health Promotion and 

Preventive Medicine (CHPPM) 

and to provide complete lists (on 

a quarterly basis) of all 

deployment OEHS reports that 

were completed to CHPPM as 

well as to the medical 

commander of the deployment.
Page 8 GAO-05-632 Deployment Surveillance

DOD Entities Involved with 

Setting and Implementing 

OEHS Policy

DHSD makes recommendations for DOD-wide policies on OEHS data 

collection and reporting during deployments to the Office of the Assistant 

Secretary of Defense for Health Affairs. DHSD is assisted by the Joint 

Environmental Surveillance Working Group, established in 1997, which 

serves as a coordinating body to develop and make recommendations for 

DOD-wide OEHS policy.6

 The working group includes representatives from 

the Army, Navy, and Air Force health surveillance centers, the Joint Staff, 

other DOD entities, and VA.

Each service has a health surveillance center—CHPPM, the Navy 

Environmental Health Center, and the Air Force Institute for Operational 

Health—that provides training, technical guidance and assistance, 

analytical support, and support for preventive medicine units7

 in theater in 

order to carry out deployment OEHS activities in accordance with DOD 

policy. In addition, these consulting centers have developed and adapted 

military exposure guidelines for deployment using existing national 

standards for human health exposure limits and technical monitoring 

procedures (e.g., standards of the U.S. Environmental Protection Agency 

and the National Institute for Occupational Safety and Health) and have 

worked with other agencies to develop new guidelines when none existed. 

(See fig. 1.)

6

 The working group makes recommendations for deployment OEHS policy to the Deputy 

Assistant Secretary of Defense for Force Health Protection and Readiness, who serves as 

the director of DHSD.

7

 Each military service has preventive medicine units, though they may be named differently. 

Throughout this report, we use the term preventive medicine unit to apply to the units 

fielded by all military services.
Page 9 GAO-05-632 Deployment Surveillance

Figure 1: Entities Involved in Setting or Implementing Occupational and Environmental Health Surveillance (OEHS) Policy

Source: DOD policies, Deployment Health Support Directorate, U.S. Army Center for Health Promotion and Preventive Medicine,

Navy Environmental Health Center, Air Force Institute for Operational Health, and Art Explosion.

Implementation of OEHS policy

Setting of OEHS policy

Joint Environmental 

Surveillance 

Working Group

(includes DOD and 

VA representatives)

Office of the Assistant 

Secretary of Defense 

for Health Affairs

 Deployment Health 

Support Directorate

DOD

policy

DOD

Department of 

the Army

Department of 

the Air Force

Department of 

the Navy

Army’s

guidance

of DOD 

policy

Air Force

guidance

’s

of DOD 

policy

Navy’s

guidance

of DOD 

policy

Training

Manual

Training

Manual

Training

Manual

United States Army 

Center for Health 

Promotion and 

Preventive Medicine

Air Force Institute for 

Operational Health

Navy Environmental 

Health Center
Page 10 GAO-05-632 Deployment Surveillance

Deployment OEHS Reports DOD policies and military service guidelines require that the preventive 

medicine units of each military service be responsible for collecting and 

reporting deployment OEHS data.8

 Deployment OEHS data are generally 

categorized into three types of reports: baseline, routine, or incidentdriven.

• Baseline reports generally include site surveys and assessments of 

occupational and environmental hazards prior to deployment of 

servicemembers and initial environmental health site assessments once 

servicemembers are deployed.9

• Routine reports record the results of regular monitoring of air, water, 

and soil, and of monitoring for known or possible hazards identified in 

the baseline assessment.

• Incident-driven reports document exposure or outbreak investigations.10

There are no DOD-wide requirements on the specific number or type of 

OEHS reports that must be created for each deployment location because 

reports generated for each reflect the specific occupational and 

environmental circumstances unique to that location. CHPPM officials said 

that reports generally reflect deployment OEHS activities that are limited 

to established sites such as base camps or forward operating bases; 11 an 

exception is an investigation during an incident outside these locations. 

Constraints to conducting OEHS outside of bases include risks to 

servicemembers encountered while in combat and limits on the portability 

of OEHS equipment. In addition, DHSD officials said that preventive 

8

While in the deployment location, preventive medicine units create and store reports both 

electronically and using paper-based formats.

9

Some bases can have more than one baseline report. 

10DOD officials said the analysis of servicemembers’ responses to a post-deployment health 

assessment questionnaire is another means to identify potential exposures that should be 

investigated. These assessments, designed to identify health issues or concerns that may 

require medical attention, use a questionnaire that is to be completed in theater and asks 

servicemembers if they believe they have been exposed to a hazardous agent. 

11Throughout the report we refer to both base camps and forward operating bases 

collectively as bases. A forward operating base is usually smaller than a base camp in troop 

strength and infrastructure and is normally constructed for short-duration occupation.
Page 11 GAO-05-632 Deployment Surveillance

medicine units might not be aware of every potential health hazard and 

therefore might be unable to conduct appropriate OEHS activities.

OEHS Reporting and 

Archiving Activities during 

Deployment

According to DOD policy, various entities must submit their completed 

OEHS reports to CHPPM during a deployment. The deployed military 

services have preventive medicine units that submit OEHS reports to their 

command surgeons12 who review all reports and ensure that they are sent 

to a centralized archive that is maintained by CHPPM.13 Alternatively, 

preventive medicine units can be authorized to submit OEHS reports 

directly to CHPPM for archiving. (See fig. 2.)

12 The command surgeons of deployed preventive medicine units are either Joint Task Force 

command surgeons or military service component command surgeons. In OIF, there are two 

Joint Task Forces, each with a command surgeon. In addition, the Army, Navy, Air Force, 

and Marine Corps have their own subordinate component commands in a deployment, each 

with a command surgeon. 

13DOD has designated CHPPM as the entity responsible for archiving all OEHS reports from 

deployments. 
Page 12 GAO-05-632 Deployment Surveillance

Figure 2: Submittal of Deployment Occupational and Environmental Health 

Surveillance (OEHS) Reports to the Centralized Archive

a

The command surgeons of deployed preventive medicine units are either Joint Task Force command 

surgeons or military service component command surgeons. In OIF, there are two Joint Task Forces, 

Source: DOD and Art Explosion.

DOD

Centralized archives maintained by United States Army 

Center for Health Promotion and Preventive Medicine

Department of 

the Army

Preventive 

medicine unit

Preventive 

medicine unit

Preventive 

medicine unit

OEHS reports 

may go directly to 

CHPPM in certain 

circumstances.

ARR ME MATEY

OEHS

report

OEHS

report

OEHS

report

Command Surgeonsa

Standard reporting structure

Alternate reporting structure
Page 13 GAO-05-632 Deployment Surveillance

each with a command surgeon. In addition, the Army, Navy, Air Force, and Marine Corps have their 

own subordinate component commands in a deployment, each with a command surgeon.

According to DOD policy, baseline and routine reports should be submitted 

within 30 days of report completion.14 Initial incident-driven reports should 

be submitted within 7 days of an incident or outbreak. Interim and final 

reports for an incident should be submitted within 7 days of report 

completion. In addition, the preventive medicine units are required to 

provide quarterly lists of all completed deployment OEHS reports to the 

command surgeons. The command surgeons review these lists, merge 

them, and send CHPPM a quarterly consolidated list of all the deployment 

OEHS reports it should have received.

To assess the completeness of its centralized OEHS archive, CHPPM 

develops a quarterly summary report that identifies the number of baseline, 

routine, and incident-driven reports that have been submitted for all bases 

in a command. Additionally, this report summarizes the status of OEHS 

report15 submissions by comparing the reports CHPPM received with the 

quarterly consolidated lists from the command surgeons that outline each 

of the OEHS reports that have been completed. For OIF, CHPPM is required 

to provide a quarterly summary report to the commander of U.S. Central 

Command16 on the deployed military services’ compliance with deployment 

OEHS reporting requirements.

Uses of Deployment OEHS 

Reports

During deployments, military commanders can use deployment OEHS 

reports completed and maintained by preventive medicine units to identify 

occupational and environmental health hazards17 and to help guide their 

risk management decision making. Commanders use an operational risk 

management process to estimate health risks based on both the severity of 

the risks to servicemembers and the likelihood of encountering specific 

14DOD policy does not prescribe a time frame for how long preventive medicine units have 

to complete a report.

15CHPPM also receives some deployment OEHS data that have not been incorporated into a 

report, such as tables of water sampling measurements.

16The U.S. Central Command is the combatant command responsible for all OIF operations.

17Along with deployment OEHS reports, commanders also examine medical intelligence, 

operational data, and medical surveillance (such as reports of servicemembers seen by 

medical units for injury or illness) to identify occupational and environmental health 

hazards.
Page 14 GAO-05-632 Deployment Surveillance

hazards. The operational risk management process, which varies slightly 

across the services, includes

• risk assessment, including hazard identification, to describe and 

measure the potential hazards at a location;

• risk control and mitigation activities intended to reduce potential 

exposures; and

• risk communication efforts to make servicemembers aware of possible 

exposures, any risks to health that the exposures may pose, the 

countermeasures to be employed to mitigate exposure or disease, and 

any necessary medical measures or follow-up required during or after 

the deployment.

Commanders balance the risk to servicemembers of encountering 

occupational and environmental health hazards while deployed, even 

following mitigation efforts, against the need to accomplish specific 

mission requirements.

Along with health encounter18 and servicemember location data, archived 

deployment OEHS reports are needed by researchers to conduct 

epidemiologic studies on the long-term health issues of deployed 

servicemembers. These data are needed, for example, by VA, which in 2002 

expanded the scope of its health research to include research on the 

potential long-term health effects of hazardous military deployments on 

servicemembers. In a letter to the Secretary of Defense in 2003, VA said it 

was important for DOD to collect adequate health and exposure data from 

deployed servicemembers to ensure VA’s ability to provide veterans’ health 

care and disability compensation. VA noted in the letter that much of the 

controversy over the health problems of veterans who fought in the 1991 

Persian Gulf War could have been avoided had more extensive surveillance 

data been collected. VA asked in the letter that it be allowed access to any 

unclassified data collected during deployments on the possible exposure of 

servicemembers to environmental hazards of all kinds.

18Examples of health encounter data are medical records of in-patient and out-patient care, 

health assessments completed by servicemembers before and after a deployment, and blood 

serum samples. 
Page 15 GAO-05-632 Deployment Surveillance

Deployed Military 

Services Use Varying 

Approaches to Collect 

OEHS Data and Have 

Not Submitted All 

OEHS Reports for OIF

The deployed military services generally have collected and reported OEHS 

data for OIF, as required by DOD policy. However, the deployed military 

services have not used all of the same OEHS data collection standards and 

practices, because each service has its own authority to implement broad 

DOD policies. To increase data collection uniformity, the Joint 

Environmental Surveillance Working Group has made some progress in 

devising cross-service standards and practices for some OEHS activities. In 

addition, the deployed military services have not submitted all of the OEHS 

reports they have completed for OIF to CHPPM’s centralized archive, as 

required by DOD policy. However, CHPPM officials said that they could not 

measure the magnitude of noncompliance because they have not received 

all of the required quarterly consolidated lists of OEHS reports that have 

been completed. To improve OEHS reporting compliance, DOD officials 

said they were revising an existing policy to add additional and more 

specific OEHS requirements.

Data Collection Standards 

and Practices Vary by 

Service, Although 

Preliminary Efforts Are 

Under Way to Increase 

Uniformity

OEHS data collection standards19 and practices have varied among the 

military services because each service has its own authority to implement 

broad DOD policies and the services have taken somewhat different 

approaches. For example, although one water monitoring standard has 

been adopted by all military services, the services have different standards 

for both air and soil monitoring. As a result, for similar OEHS events, 

preventive medicine units may collect and report different types of data. 

Each military service’s OEHS practices for implementing data collection 

standards also have differed, due to the varying levels of training and 

expertise among the service’s preventive medicine units. For example, 

CHPPM officials said that Air Force and Navy preventive medicine units 

had more specialized personnel with a narrower focus on specific OEHS 

activities than Army preventive medicine units, which included more 

generalist personnel who conducted a broader range of OEHS activities. 

Air Force preventive medicine units generally have included a flight 

surgeon, a public health officer, and bioenvironmental engineers. Navy 

preventive medicine units generally have included a preventive medicine 

physician, an industrial hygienist, a microbiologist, and an entomologist. In 

contrast, Army preventive medicine unit personnel generally have 

consisted of environmental science officers and technicians.

19OEHS standards generally set out technical requirements for monitoring, including the 

type of equipment needed and the appropriate frequency of monitoring.
Page 16 GAO-05-632 Deployment Surveillance

DOD officials also said other issues could contribute to differences in data 

collected during OIF. DHSD officials said that variation in OEHS data 

collection practices could occur as a result of resource limitations during a 

deployment. For example, some preventive medicine units may not be fully 

staffed at some bases. A Navy official also said that OEHS data collection 

can vary as different commanders set guidelines for implementing OEHS 

activities in the deployment theater.

To increase the uniformity of OEHS standards and practices for 

deployments, the military services have made some progress—particularly 

in the last 2 years—through their collaboration as members of the Joint 

Environmental Surveillance Working Group. For example, the working 

group has developed a uniform standard, which has been adopted by all the 

military services, for conducting environmental health site assessments, 

which are a type of baseline OEHS report.20 These assessments have been 

used in OIF to evaluate potential environmental exposures that could have 

an impact on the health of deployed servicemembers and determine the 

types of routine OEHS monitoring that should be conducted. Also, within 

the working group, three subgroups—laboratory, field water, and 

equipment—have been formed to foster the exchange of information 

among the military services in developing uniform joint OEHS standards 

and practices for deployments. For example, DHSD officials said the 

equipment subgroup has been working collaboratively to determine the 

best OEHS instruments to use for a particular type of location in a 

deployment. Another effort by the working group included devising a joint 

standard for the amount of OEHS data needed to sufficiently determine the 

severity of potential health hazards at a site. However, DOD officials 

estimated in late 2004 that it would take 2 years or more for this standard to 

be completed and approved.

20This standard was approved in October 2003.
Page 17 GAO-05-632 Deployment Surveillance

Deployed Military Services 

Have Not Submitted All 

Required OEHS Reports for 

OIF, and the Magnitude of 

Noncompliance Is Unknown

The deployed military services have not submitted all the OEHS reports 

that the preventive medicine units completed during OIF to CHPPM for 

archiving, according to CHPPM officials. Since January 2004, CHPPM has 

compiled four summary reports that included data on the number of OEHS 

reports submitted to CHPPM’s archive for OIF. However, these summary 

reports have not provided information on the actual magnitude of 

noncompliance with report submission requirements because CHPPM has 

not received all consolidated lists of completed OEHS reports that should 

be submitted quarterly. These consolidated lists were intended to provide a 

key inventory of all OEHS reports that had been completed during OIF. 

Because there are no requirements on the specific number or type of OEHS 

reports that must be created for each base, the quarterly consolidated lists 

are CHPPM’s only means of assessing compliance with OEHS report 

submission requirements. Our analysis of data supporting the four 

summary reports21 found that, overall, 239 of the 277 bases22 had at least 

one OEHS baseline (139) or routine (211) report submitted to CHPPM’s 

centralized archive through December 2004.23

DOD officials suggested several obstacles that may have hindered OEHS 

reporting compliance during OIF. For example, CHPPM officials said there 

are other, higher priority operational demands that commanders must 

address during a deployment, so OEHS report submission may be a lower 

priority. In addition, CHPPM officials said that some of the deployed 

military services’ preventive medicine units might not understand the types 

of OEHS reports to be submitted or might view them as an additional 

paperwork burden. CHPPM and other DOD officials added that some 

preventive medicine units might have limited access to communication 

equipment to send reports to CHPPM for archiving.24 CHPPM officials also 

said that while they had the sole archiving responsibility, CHPPM did not 

21Incident-driven reports reflect OEHS investigations of unexpected incidents and would not 

be submitted to CHPPM’s archive according to any identified pattern. Therefore, we did not 

comment on the services’ submission of incident-driven reports.

22The U.S. Central Command has established and closed bases throughout the OIF 

deployment; therefore, the number of bases for each summary report varied. 

23A base may have had both baseline and routine reports submitted to the OEHS archive.

24DOD officials said that during a deployment, preventive medicine units share the military’s 

classified communication system with all other deployed units and transmission of OEHS 

reports might be a lower priority than other mission communications traffic. Also, 

preventive medicine units might not deploy with communications equipment.
Page 18 GAO-05-632 Deployment Surveillance

have the authority to enforce OEHS reporting compliance for OIF; this 

authority rests with the Joint Staff and the commander in charge of the 

deployment.

DOD has several efforts under way to improve OEHS reporting 

compliance. CHPPM officials said they have increased communication 

with deployed preventive medicine units and have facilitated coordination 

among each service’s preventive medicine units prior to deployment. 

CHPPM has also conducted additional OEHS training for some preventive 

medicine units prior to deployment, including both refresher courses and 

information about potential hazards specific to the locations where the 

units were being deployed. In addition, DHSD officials said they were 

revising an existing policy (DOD Instruction 6490.3; see table 1) to add 

additional and more specific OEHS requirements. However, at the time of 

our review, a draft of the revision had not been released and, therefore, 

specific details about these revisions were not available.

Progress Made in Using 

OEHS Reports to 

Address Immediate 

Health Risks, Though 

Limitations Remain for 

Addressing Both 

Immediate and 

Long-term Health 

Issues

DOD has made progress using OEHS reports to address immediate health 

risks during OIF, but limitations remain in employing these reports to 

address both immediate and long-term health issues. During OIF, OEHS 

reports have been used as part of operational risk management activities 

intended to assess, mitigate, and communicate to servicemembers any 

potential hazards at a location. While there have been no systematic efforts 

by DOD or the military services to establish a system to monitor the 

implementation of OEHS risk management activities, DHSD officials said 

relatively low rates of disease and nonbattle injury in OIF were considered 

an indication of OEHS effectiveness. In addition, DOD’s centralized archive 

of OEHS reports for OIF is limited in its ability to provide information on 

the potential long-term health effects related to occupational and 

environmental exposures for several reasons, including limited access to 

most OEHS reports because of security classification, incomplete data on 

servicemembers’ deployment locations, and the lack of a comprehensive 

federal research plan incorporating the use of archived OEHS reports.
Page 19 GAO-05-632 Deployment Surveillance

Progress Made in Using 

Deployment OEHS Data and 

Reports in Risk 

Management, but DOD Does 

Not Monitor 

Implementation of These 

Efforts

To identify and reduce the risk of immediate health hazards in OIF, all of 

the military services have used preventive medicine units’ OEHS data and 

reports in an operational risk management process. A DOD official said 

that while DOD had begun to implement risk management to address 

occupational and environmental hazards in other recent deployments, OIF 

was the first major deployment to apply this process throughout the 

deployed military services’ day-to-day activities, beginning at the start of 

the operation.25 The operational risk management process includes risk 

assessments of deployment locations, risk mitigation activities to limit 

potential exposures, and risk communication to servicemembers and 

commanders about potential hazards. 

• Risk Assessments. Preventive medicine units from each of the services 

have generally used OEHS information and reports to develop risk 

assessments that characterized known or potential hazards when new 

bases were opened in OIF. CHPPM’s formal risk assessments have also 

been summarized or updated to include the findings of baseline and 

routine OEHS monitoring conducted while bases are occupied by 

servicemembers, CHPPM officials said. During deployments, 

commanders have used risk assessments to balance the identified risk 

of occupational and environmental health hazards, and other 

operational risks, with mission requirements. Alternatively, some 

preventive medicine units have addressed hazards identified through 

risk assessments without initially involving a commander. A Navy 

official said that, for example, if a preventive medicine unit found 

elevated bacteria levels when monitoring a drinking water purification 

system, the unit would likely order that the system be shut down and 

corrected and then notify the commander of the action in a summary 

report of OEHS activities. Generally, OEHS risk assessments for OIF 

have involved analysis of the results of air, water, or soil monitoring.26

CHPPM officials said that most risk assessments that they have received 

25OEHS risk management began to be employed during previous deployments, such as 

Operation Joint Guardian in Kosovo and Operation Enduring Freedom in Central Asia, but it 

was not formally adopted as a tool to assess deployment health hazards until 2002. See 

Office of the Chairman, The Joint Chiefs of Staff, Memorandum MCM-0006-02, “Updated 

Procedures for Deployment Health Surveillance and Readiness,” Feb. 1, 2002.

26An Army operational risk management field manual describes the steps in determining risk 

level, including identifying the hazard, assessing the severity of the hazard, and determining 

the probability that the hazard will occur. DOD has also developed technical guides that 

detail toxicity thresholds and associated potential health effects from exposure to hazards.
Page 20 GAO-05-632 Deployment Surveillance

characterized locations in OIF as having a low risk of posing health 

hazards to servicemembers.27

• Risk Control and Mitigation. Using risk assessment findings, preventive 

medicine units have recommended risk control and mitigation activities 

to commanders that were intended to reduce potential exposures at 

specific locations. For OIF, risk control and mitigation 

recommendations at bases have included such actions as modifying 

work schedules, requiring individuals to wear protective equipment, and 

increasing sampling to assess any changes and improve confidence in 

the accuracy of the risk estimate.

• Risk Communication. Risk assessment findings have also been used in 

risk communication efforts, such as providing access to information on 

a Web site or conducting health briefings to make servicemembers 

aware of occupational and environmental health risks during a 

deployment and the recommended efforts to control or mitigate those 

risks, including the need for medical follow-up. Many of the risk 

assessments for OIF we reviewed recommended that health risks be 

communicated to servicemembers.

The experience at Port Shuaiba, Kuwait, provides an illustration of the risk 

management process. Officials determined that Port Shuaiba, which had a 

moderate risk rating in numerous OEHS risk assessments, had the highest 

assessed risk for potential environmental exposures identified in OIF. The 

site is a deepwater port used for bringing in heavy equipment in support of 

OIF, and a large number of servicemembers have been permanently or 

temporarily stationed at this site. CHPPM officials said reported concerns 

about air quality problems, such as sulfur dioxide emissions and 

windblown dust and sand particles, and the concentration of a large 

number of industrial facilities28 at Port Shuaiba led to this risk 

characterization as a result of multiple OEHS risk assessments conducted 

before and during OIF.29 Risk mitigation recommendations that have been 

27Risk assessments are used to designate identified occupational or environmental health 

risks as posing a low, moderate, high, or extremely high risk to servicemembers.

28Industrial facilities located at Port Shuaiba include a fertilizer plant; natural gas processing 

and liquid petroleum gas storage facilities; a concrete company; petrochemical, 

hydrochloric acid, chlorine, caustic soda, and methanol plants; and three petroleum 

refineries.

29OEHS activities have been conducted at Port Shuaiba since 1999.
Page 21 GAO-05-632 Deployment Surveillance

implemented at Port Shuaiba include increasing air monitoring to 

continuous, 24-hour sampling; implementing the use of standard protective 

equipment, such as goggles and face kerchiefs; and using dust suppression 

measures, such as laying gravel over the entire location to reduce dust. 

CHPPM officials said they were uncertain whether some other risk 

mitigation recommendations for Port Shuaiba had been implemented, such 

as requiring servicemembers to stay inside buildings or tents as much as 

possible when air pollution levels are high or increasing the number of 

servicemembers available for operations to reduce the duration of shifts. 

On the basis of recommendations from the risk assessments, military 

officials have been attempting to transfer the activities at Port Shuaiba to a 

nearby port that does not have industrial facilities,30 but servicemembers 

have continued to live and work at the site, though in greatly reduced 

numbers, CHPPM officials said. CHPPM officials said they have 

recommended extensive risk communication activities at Port Shuaiba, 

including providing information to servicemembers in town hall meetings 

and through posters and handouts in dining facilities. In addition, CHPPM 

officials said they have worked with commanders to allow CHPPM to 

provide briefings about the identified and potential health hazards as soon 

as new military units arrive at Port Shuaiba.

While risk management activities have become more widespread in OIF 

compared with previous deployments, DOD officials have not conducted 

systematic monitoring of deployed military services’ efforts to conduct 

OEHS risk management activities. As of March 2005, neither DOD nor the 

military services had established a system to examine whether required 

risk assessments had been conducted, or to record and track resulting 

recommendations for risk mitigation or risk communication activities. In 

the absence of a systematic monitoring process, CHPPM officials said they 

conducted ad hoc reviews of implementation of risk management 

recommendations for sites where continued, widespread OEHS monitoring 

has occurred, such as at Port Shuaiba and other locations with elevated 

risks. DHSD officials said they have initiated planning for a comprehensive 

quality assurance program for deployment health that would address OEHS 

risk management, but the program was still under development.

30Port Shuaiba has been the only deepwater port able to accommodate the unloading of 

heavy military equipment in support of OIF; however, efforts are under way to refurbish a 

nearby port to provide this capability. 
Page 22 GAO-05-632 Deployment Surveillance

DHSD and military service officials said that developing a monitoring 

system for risk management activities would face several challenges. In 

response to recommendations for risk mitigation and risk communication 

activities, commanders may have issued written orders and guidance that 

were not always stored in a centralized, permanent database that could be 

used to track risk management activities. Additionally, DHSD officials told 

us that risk management decisions have sometimes been recorded in 

commanders’ personal journals or diaries, rather than issued as orders that 

could be stored in a centralized, permanent database.

In lieu of a monitoring system, DHSD officials said the rates of disease and 

nonbattle injury in OIF are considered by DOD as a general measure or 

indicator of OEHS effectiveness. As of January 2005, OIF had a 4 percent 

total disease and nonbattle injury rate—in other words, an average of 4 

percent of servicemembers deployed in support of OIF had been seen by 

medical units for an injury or illness in any given week. This rate is the 

lowest DOD has ever documented for a major deployment, according to 

DHSD officials. For example, the total disease and nonbattle injury rate for 

the 1991 Gulf War was about 6.5 percent, and the total rate for Operation 

Enduring Freedom in Central Asia has been about 5 percent. However, 

while this indicator provides general information on servicemembers’ 

health status, it is not directly linked to specific OEHS activities and 

therefore is not a clear measure of their effectiveness.

Access to Most Archived 

OEHS Reports Is Limited by 

Security Classification

Access to archived OEHS reports by VA, medical professionals, and 

interested researchers has been limited by the security classification of 

most OEHS reports.31 Typically, OEHS reports are classified if the specific 

location where monitoring activities occur is identified. VA officials said 

they would like to have access to OEHS reports in order to ensure 

appropriate postwar health care and disability compensation for veterans, 

and to assist in future research studies. However, VA officials said that they 

did not expect access to OEHS reports to improve until OIF has ended 

because of security concerns.

Although access to OEHS reports has been restricted, VA officials said they 

have tried to anticipate likely occupational and environmental health 

31Individuals desiring to review classified documents must have the appropriate level of 

security clearance and a need to access the information. VA officials have been able to 

access some OEHS data on a case-by-case basis.
Page 23 GAO-05-632 Deployment Surveillance

concerns for OIF based on experience from the 1991 Persian Gulf War and 

on CHPPM’s research on the medical and environmental health conditions 

that exist or might develop in the region. Using this information, VA has 

developed study guides for physicians on such topics as health effects from 

radiation and traumatic brain injury and also has written letters for OIF 

veterans about these issues.

DOD has begun reviewing classification policies for OEHS reports, as 

required by the Ronald W. Reagan National Defense Authorization Act for 

Fiscal Year 2005.32 A DHSD official said that DOD’s newly created Joint 

Medical Readiness Oversight Committee is expected to review ways to 

reduce or limit the classification of data, including data that are potentially 

useful for monitoring and assessing the health of servicemembers who 

have been exposed to occupational or environmental hazards during 

deployments.

Difficulties Exist in Linking 

Archived OEHS Reports to 

Individual Servicemembers, 

but Some Efforts Are Under 

Way to Include Information 

in Medical Records

Linking OEHS reports from the archive to individual servicemembers will 

be difficult because DOD’s centralized tracking database for recording 

servicemembers’ deployment locations currently does not contain 

complete or comparable data. In May 1997, we reported that the ability to 

track the movement of individual servicemembers within the theater is 

important for accurately identifying exposures of servicemembers to 

health hazards.33 However, DMDC’s centralized database has continued to 

experience problems in obtaining complete, comparable data from the 

services on the location of servicemembers during deployments, as 

required by DOD policies.34 DMDC officials said the military services had 

not reported location data for all servicemembers for OIF. As of October 

32Pub. L. No. 108-375, §735, 118 Stat. 1811, 1999 (2004). 

33GAO, Defense Health Care: Medical Surveillance Improved Since Gulf War, but Mixed 

Results in Bosnia, GAO/NSIAD-97-136 (Washington D.C.: May 13, 1997).

34DOD policy requires DMDC to maintain a system that collects information on deployed 

forces, including daily-deployed strength, in total and by unit; grid coordinate locations for 

each unit (company size and larger); and inclusive dates of individual servicemembers’ 

deployment. See DOD Instruction 6490.3, “Implementation and Application of Joint Medical 

Surveillance for Deployment,” Aug. 7, 1997. In addition, a 2002 DOD policy requires 

combatant commands to provide DMDC with rosters of all deployed personnel, their unit 

assignments, and the unit’s geographic locations while deployed. See Office of the 

Chairman, The Joint Chiefs of Staff, Memorandum MCM-0006-02, “Updated Procedures for 

Deployment Health Surveillance and Readiness,” Feb. 1, 2002.
Page 24 GAO-05-632 Deployment Surveillance

2004, the Army, Air Force, and Marine Corps each had submitted location 

data for approximately 80 percent of their deployed servicemembers, and 

the Navy had submitted location data for about 60 percent of its deployed 

servicemembers.35 Additionally, the specificity of location data has varied 

by service. For example, the Marine Corps has provided location of 

servicemembers only by country, whereas each of the other military 

services has provided more detailed location information for some of their 

servicemembers, such as base camp name or grid coordinate locations. 

Furthermore, the military services did not begin providing detailed location 

data until OIF had been ongoing for several months.

DHSD officials said they have been revising an existing policy36 to provide 

additional requirements for location data that are collected by the military 

services, such as a daily location record with grid coordinates or latitude 

and longitude coordinates for all servicemembers. Though the revised 

policy has not been published, as of May 2005 the Army and the Marine 

Corps had implemented a new joint location database in support of OIF 

that addresses these revisions.

During OIF, some efforts have been made to include information about 

specific incidents of potential and actual exposure to occupational or 

environmental health hazards in the medical records of servicemembers 

who may be affected. According to DOD officials, after preventive 

medicine units have investigated incidents involving potential exposure, 

they generally have developed narrative summaries of events and the 

results of any medical procedures for inclusion in affected 

servicemembers’ medical records. Additionally, rosters were generally 

developed of servicemembers directly affected and of servicemembers 

who did not have any acute symptoms but were in the vicinity of the 

incident. For example, in investigating an incident involving a chemical 

agent used in an improvised explosive device, CHPPM officials said that 

two soldiers who were directly involved were treated at a medical clinic, 

and their treatment and the exposure were recorded in their medical 

records. Although 31 servicemembers who were providing security in the 

35The military services submitted location data for both OIF and Operation Enduring 

Freedom in Central Asia; DMDC officials said they were unable to separate the data from 

the two operations. 

36DOD Instruction 6490.3, “Implementation and Application of Joint Medical Surveillance for 

Deployment,” Aug. 7, 1997.
Page 25 GAO-05-632 Deployment Surveillance

area were asymptomatic, doctors were documenting this potential 

exposure in their medical records.

In addition, the military services have taken some steps to include 

summaries of potential exposures to occupational and environmental 

health hazards in the medical records of servicemembers deployed to 

specific locations. The Air Force has created summaries of these hazards at 

deployed air bases and has required that these be placed in the medical 

records of all Air Force servicemembers stationed at these bases. (See app. 

II for an example.) However, Air Force officials said no follow-up activities 

have been conducted specifically to determine whether all Air Force 

servicemembers have had the summaries placed in their medical records. 

In addition, the Army and Navy jointly created a summary of potential 

exposure for the medical records of servicemembers stationed at Port 

Shuaiba. Since December 2004, port officials have made efforts to make the 

summary available to servicemembers stationed at Port Shuaiba so that 

these servicemembers can include the summary in their medical records. 

However, there has been no effort to retroactively include the summary in 

the medical records of servicemembers stationed at the port prior to that 

time.

No Federal Research Plan 

Exists for Using OEHS 

Reports to Follow the 

Health of OIF 

Servicemembers over Time

According to DOD and VA officials, no federal research plan that includes 

the use of archived OEHS reports has been developed to evaluate the longterm health of servicemembers deployed in support of OIF, including the 

effects of potential exposure to occupational or environmental hazards. In 

February 1998 we noted that the federal government lacked a proactive 

strategy to conduct research into Gulf War veterans’ health problems and 

suggested that delays in planning complicated researchers’ tasks by 

limiting opportunities to collect critical data.37 However, the Deployment 

Health Working Group, a federal interagency body responsible for 

coordinating research on all hazardous deployments, recently began 

discussions on the first steps needed to develop a research plan for OIF.38

At its January 2005 meeting, the working group tasked its research 

subcommittee to develop a complete list of research projects currently 

under way that may be related to OIF.39 VA officials noted that because OIF 

37GAO, Gulf War Illnesses: Federal Research Strategy Needs Reexamination, 

GAO/T-NSIAD-98-104 (Washington D.C.: Feb. 24, 1998).

38The Deployment Health Working Group includes representatives from DOD, VA, and HHS.
Page 26 GAO-05-632 Deployment Surveillance

is ongoing, the working group would have to determine how to address a 

study population that changes as the number of servicemembers deployed 

in support of OIF changes.40

Although no coordinated federal research plan has been developed, there 

are some separate federal research studies under way that may follow the 

health of OIF servicemembers. For example, in 2000 VA and DOD 

collaborated to develop the Millennium Cohort study, a 21-year longitudinal 

study evaluating the health of both deployed and nondeployed military 

personnel throughout their military careers and after leaving military 

service. According to the principal investigator, the Millennium Cohort 

study was designed to examine the health effects of specific deployments if 

enough servicemembers in that deployment enrolled in the study. However, 

the principal investigator said that as of February 2005 researchers had not 

identified how many servicemembers deployed in support of OIF had 

enrolled in the study. Additionally, a VA researcher has received funding to 

study mortality rates among OIF servicemembers. According to the 

researcher, if occupational and environmental data are available, the study 

will include the evaluation of mortality outcomes in relation to potential 

exposure for OIF servicemembers.

Conclusions Since the 1991 Persian Gulf War, DOD has made progress in improving 

occupational and environmental health data collection through its 

development of a militarywide health surveillance framework for use 

during deployments. However, these efforts still could be strengthened. 

OEHS data that the deployed military services have collected during OIF 

may not always be comparable because of variations among the services’ 

data collection standards and practices. As a result of these variations, the 

amount and comprehensiveness of data for servicemembers from one 

military service may be more extensive than for servicemembers from 

another service. Additionally, the deployed military services’ uncertain 

compliance with OEHS report submission requirements casts doubts on 

the completeness of CHPPM’s OEHS archive. These data shortcomings, in 

conjunction with the incomplete data in DOD’s centralized tracking 

database of servicemembers’ deployment locations, limit CHPPM’s ability 

39This effort also includes identifying research for Operation Enduring Freedom.

40Epidemiologic studies generally have a fixed study population that does not vary over 

time, according to VA officials.
Page 27 GAO-05-632 Deployment Surveillance

to respond to requests for OEHS information about possible exposure to 

occupational and environmental health hazards of those who are serving or 

have served in OIF. Other limitations may also impede the 

comprehensiveness of the archived OEHS reports, including the inability to 

collect OEHS data outside of base camps and a lack of knowledge of all 

potential health hazards. Nonetheless, these limitations do not outweigh 

the need to collect data on known or expected hazards in order to make 

every effort to address potential health issues. DHSD officials have said 

they are revising an existing policy on OEHS data collection and reporting 

to add additional and more specific OEHS requirements. However, unless 

the military services take measures to direct those responsible for OEHS 

activities to proactively implement the new requirements, the services’ 

efforts to collect and report OEHS data may not improve.

DOD’s risk management efforts during OIF represent a positive step in 

helping to mitigate potential environmental and occupational risks of 

deployment. But the effects of such efforts are unknown without 

systematic monitoring of the deployed military services’ implementation 

activities. Rates of disease and nonbattle injury have been used as an 

overall surrogate outcome measure for risk management in OIF, but DOD 

and the military services currently are unable to ascertain how and to what 

extent risk management efforts have contributed to the relatively low 

disease and nonbattle injury rate for OIF.

Although OEHS reports alone are not sufficient to identify the causes of 

potential long-term health effects in deployed servicemembers, they are an 

integral component of research to evaluate the long-term health of 

deployed servicemembers. However, efforts by a joint DOD and VA 

working group to develop a federal research plan for OIF that would 

include examining the effects of potential exposure to occupational and 

environmental health hazards have just begun, despite similarities in 

deployment location to the 1991 Persian Gulf War. Unless DOD addresses 

OEHS data collection and reporting weaknesses and develops a federal 

research plan for OIF with VA, the departments ultimately may face the 

same criticisms they faced following the first Gulf War over their inability 

to adequately address the long-term health issues of servicemembers.

Recommendations for 

Executive Action

We are making recommendations aimed at improving the collection and 

reporting of OEHS data during deployments and improving OEHS risk 

management. To improve the collection and reporting of OEHS data during 

deployments and the linking of OEHS reports to servicemembers, we 
Page 28 GAO-05-632 Deployment Surveillance

recommend that the Secretary of Defense ensure that cross-service 

guidance is created to implement DOD’s policy, once that policy has been 

revised, which addresses improvements to conducting OEHS activities and 

to reporting the locations of servicemembers during deployment.

To improve the use of OEHS reports to address the immediate health risks 

of servicemembers during deployments, we recommend that the Secretary 

of Defense ensure that the military services jointly establish and implement 

procedures to evaluate the effectiveness of risk management efforts.

To better anticipate and understand the potential long-term health effects 

of deployment in support of OIF, we recommend that the Secretary of 

Defense and the Secretary of Veterans Affairs work together to develop a 

federal research plan to follow the health of these servicemembers that 

would include the use of archived OEHS reports.

Agency Comments and 

Our Evaluation

We requested comments on a draft of this report from DOD and VA. Both 

agencies provided written comments that are reprinted in appendixes III 

and IV. DOD also provided technical comments that we incorporated where 

appropriate.

In commenting on this draft, DOD did not concur with our 

recommendation that the military services jointly develop implementation 

guidance for DOD’s policy on OEHS during deployments, once that policy 

has been revised. However, DOD stated that officials are planning steps 

that will meet the intent of our recommendation to improve the collection 

and reporting of OEHS data during deployments. DHSD officials stated that 

cross-service implementation guidance for the revised policy on 

deployment OEHS would be developed by the Joint Staff instead of by the 

individual military services, as we originally recommended. We believe that 

the development of cross-service implementation guidance is a critical 

element needed to improve OEHS data collection and reporting during 

deployments, regardless of the entity responsible for developing this 

guidance. Therefore, we modified the wording of our recommendation to 

clarify our intent that joint guidance be developed.

DOD partially concurred with our recommendation that the military 

services jointly establish and implement procedures to evaluate the 

effectiveness of risk management efforts. DOD stated that OEHS reports 

would be of no value for “immediate” health risks, except for incidentdriven reports, and assumed that we were referring to health risks that may 
Page 29 GAO-05-632 Deployment Surveillance

occur once servicemembers return from a deployment. However, our 

findings describe the OEHS operational risk management process that is 

specifically conducted during a deployment, including risk assessment, risk 

mitigation, and risk communication activities that are used to identify and 

reduce the risk of immediate health hazards. Additionally, DOD stated that 

it has procedures in place to evaluate OEHS risk management through a 

jointly established and implemented lessons learned process. Because the 

lessons learned process was not raised by agency officials during our 

review, we did not determine whether it would systematically monitor or 

evaluate the effectiveness of OEHS risk management activities. However, 

in further discussions, DHSD officials told us that they were not aware of 

any lessons learned reports related to OEHS risk management for OIF.

DOD partially concurs with our recommendation that DOD and VA work 

together to develop a federal research plan to follow the health of 

servicemembers deployed in support of OIF that would include the use of 

archived OEHS reports. Although DOD states that it agrees with the 

importance of following the health of its servicemembers, its response 

focuses on initiatives for the electronic exchange of clinical health 

information with VA. In further discussions, DHSD officials explained that 

analysis of this clinical information could lead to the development of 

research hypotheses and, ultimately, research questions that would guide 

federal health research. Although DOD officials stated that they have not 

yet linked any occupational or environmental exposures to specific adverse 

health effects, there is no certainty that long-term health effects related to 

these types of exposures will not appear in veterans of OIF. Federal 

research has not clearly identified the causes of unexplained illnesses 

reported by servicemembers who served in the 1991 Persian Gulf War, and 

OIF servicemembers are serving in the same region for longer periods of 

time.

Separately, VA concurred with our recommendation to work jointly with 

DOD to develop a federal research plan to follow the health of OIF 

servicemembers. VA confirmed that the Deployment Health Working 

Group, which includes DOD officials, had initiated steps in January 2005 

toward developing a comprehensive joint federal surveillance plan to 

evaluate the long-term health of servicemembers returning from both OIF 

and Operation Enduring Freedom (OEF). However, more importantly, the 

difference in VA and DOD’s responses to this recommendation illustrates a 

disconnect between each agency’s understanding of whether and how such 

a federal research plan should be established. Therefore, continued 

collaboration between the agencies to formulate a mutually agreeable 
Page 30 GAO-05-632 Deployment Surveillance

process for proactively creating a federal research plan would be beneficial 

in facilitating both agencies’ ability to anticipate and understand the 

potential long-term health effects related to OIF deployment versus taking 

a more reactive stance in waiting to see what types of health problems may 

surface.

In its response, VA also contends that we overstate problems related to its 

ability to access DOD’s classified occupational and environmental health 

data. VA notes that it has staff with the necessary security clearances to 

examine classified OEHS reports, so that there is no barrier to access. 

However, during our review VA officials expressed concerns that they did 

not have OEHS data and that access to the data was difficult. Even if VA 

staff have security clearances that enable them to examine OEHS data, any 

materials that arise from the use of classified documents, such as research 

papers or other publications, would likely be restricted. Therefore, these 

results would have limited use, as they cannot be broadly shared with other 

researchers and the general public. Nonetheless, VA maintains that 

development of a systematic method to tabulate and organize the exposure 

data is needed, as is a complete roster of OIF and OEF veterans, pre- and 

post-deployment health screening data, and a complete roster of the most 

seriously injured veterans. We agree that a systematic method to organize 

and share OEHS data is important. This issue could be addressed within 

the efforts to develop a federal research plan.

As arranged with your office, unless you release its contents earlier, we 

plan no further distribution of this report until 30 days after its issuance 

date. At that time, we will send copies of this report to the Secretary of 

Defense and the Secretary of Veterans Affairs. We will also provide copies 

to others upon request. In addition, the report will be available at no charge 

on GAO’s Web site at http://www.gao.gov.
Page 31 GAO-05-632 Deployment Surveillance

If you or your staff has any questions about this report, please call me at 

(202) 512-7119. Bonnie Anderson, Karen Doran, John Oh, Danielle Organek, 

and Roseanne Price also made key contributions to this report.

Sincerely yours,

Marcia Crosse

Director, Health Care
Page 32 GAO-05-632 Deployment Surveillance

Appendix I

Scope and Methodology ApApenednxidexiIs

To describe how the military services have implemented the Department of 

Defense’s (DOD) policies for collecting and reporting occupational and 

environmental health surveillance (OEHS) data for Operation Iraqi 

Freedom (OIF), we reviewed pertinent DOD policies and military services’ 

guidance that delineated the requirements for OEHS data collection and 

reporting. We interviewed officials at the Deployment Health Support 

Directorate (DHSD) and the Joint Staff to obtain a broad overview of 

DOD’s OEHS activities in OIF. We also interviewed officials at each of the 

military services’ health centers—the U.S. Army Center for Health 

Promotion and Preventive Medicine (CHPPM), the Navy Environmental 

Health Center, and the Air Force Institute for Operational Health—to 

obtain information about each service’s OEHS data collection standards 

and practices, training of preventive medicine units for OIF, obstacles that 

could hinder OEHS data collection and reporting, and efforts to improve 

reporting compliance. Additionally, we interviewed members of the Joint 

Environmental Surveillance Working Group to discuss the purpose and 

structure of the working group and efforts related to increasing the 

uniformity of OEHS standards and practices for deployments.

To determine if the military services were submitting OEHS reports to 

CHPPM’s centralized archive, we obtained and reviewed CHPPM’s 

quarterly summary reports, which provided the total number of bases that 

have submitted at least one report in each of the categories of baseline, 

routine, or incident-driven reports for the U.S. Central Command’s 

(CENTCOM) area of responsibility, details about consolidated lists of 

reports, and information about other OEHS reporting compliance issues. 

The summary reports did not show report submission by individual bases 

or, other than for the first summary report, separately identify OIF bases 

from all others in the CENTCOM area of responsibility. For each of the 

summary reports, CHPPM provided us with supporting documents that 

included lists of the bases specific to OIF and, for each base, whether it had 

submitted baseline, routine, or incident-driven reports. We attempted to 

include only unique OIF bases in our analysis; however, CHPPM officials 

told us that a few duplicate OIF bases may be included in our analysis due 

to reasons such as frequent base openings and closures and base name 

changes. We used these supporting documents to identify the number and 

percentage of bases with and without baseline or routine reports during the 

reporting periods. Incident-driven reports reflect OEHS investigations of 

unexpected incidents and would not be submitted to CHPPM’s archive 

according to any identified pattern. Therefore, we did not review the 

services’ submission of incident-driven reports. Because OEHS reports 
Appendix I

Scope and Methodology

Page 33 GAO-05-632 Deployment Surveillance

generally are classified, we did not report on the specifics contained in 

these reports.

We determined that the data from CHPPM’s OEHS archive were sufficiently 

reliable for the purposes of this report by (1) confirming the data included 

the elements that we requested and were consistent with provided 

documentation and (2) conducting detailed fact-finding interviews with 

CHPPM officials to understand how the data were obtained and to 

determine the limitations of the data. To characterize the OEHS reports for 

OIF submitted to CHPPM, we discussed the numbers of reports submitted 

and characterized the categories of reports using percentages. While the 

OEHS reports were contained in a computerized archive, there was no 

formal database in which the information from the reports could have been 

extracted into data fields. Instead, the archived reports were Microsoft 

Word documents, Microsoft Excel spreadsheets, Adobe Acrobat files, 

scanned images, or e-mail text that were organized by either military base 

or type of report. Therefore, there was no specific database with data fields 

that could be examined through a data reliability test.

To identify the efforts to use OEHS reports to address the more immediate 

health issues of servicemembers deployed in support of OIF, we reviewed 

DOD policies and documents describing the operational risk management 

process. Additionally, we reviewed 28 risk assessment reports and the risk 

mitigation efforts and risk communication activities that resulted from 

these assessments. We also reviewed and summarized risk management 

activities for Port Shuaiba, Kuwait. We interviewed officials from CHPPM 

responsible for OEHS risk management activities at Port Shuaiba and 

discussed quality assurance efforts related to these activities. We also 

interviewed officials from DHSD about additional OEHS-related quality 

assurance programs.

To identify the efforts under way to use OEHS reports to address the longterm health issues of servicemembers deployed in support of OIF, we 

interviewed Department of Veterans Affairs (VA) and DOD officials to 

examine access to OEHS reports and use of OEHS reports for VA, and 

reviewed laws relating to classification of documents. Additionally, we 

reviewed relevant VA documents to determine the ways in which VA can 

use OEHS reports and to determine its efforts to anticipate OEHS issues.

To determine the difficulties in linking OEHS reports to the individual 

records of servicemembers, we interviewed officials and military 

representatives at DOD’s Defense Manpower Data Center (DMDC) 
Appendix I

Scope and Methodology

Page 34 GAO-05-632 Deployment Surveillance

regarding the status of the Contingency Tracking System, a centralized 

tracking database to identify deployed servicemembers and track their 

movements within the theater of operations. To help identify problems with 

this system, we asked DMDC to provide information about the amount of 

location data submitted by each military service to this database. To assess 

the reliability of the data submitted by each military service, we (1) 

interviewed DMDC officials about limitations of the system and (2) 

confirmed that the data included the elements we requested and were 

consistent with provided documentation. We tested the data electronically 

to ensure that the numbers were accurately calculated. Given our research 

questions and discussions with DMCD officials regarding the centralized 

system, we determined that these data were reliable for our purposes.

We interviewed CHPPM officials to examine efforts to include information 

from investigations of potential exposures to occupational and 

environmental health hazards in servicemembers’ medical records, and 

reviewed summary documents related to potential occupational and 

environmental exposures. We also interviewed Army, Air Force, and Navy 

officials to discuss these summary documents and determine efforts in 

place to ensure that these documents were placed in the medical records. 

We also examined other documents, including DOD policies, federal laws, 

and interagency coordinating council meeting minutes relating to OEHS.

We interviewed DOD and VA officials to determine whether a federal 

research plan using OEHS reports had been developed to evaluate the longterm health of servicemembers deployed in support of OIF. We also 

reviewed documents, including the meeting minutes of an interagency 

group and documents relating to a current collaborative study between 

DOD and VA. We performed our work from September 2004 through June 

2005 in accordance with generally accepted government auditing 

standards.
Page 35 GAO-05-632 Deployment Surveillance

Appendix II

Example of an Occupational and Environmental 

Health Surveillance Summary Created by the 

Air Force during Operation Iraqi Freedom ApendxiI

PREVIOUS EDITION IS USABLE AUTHORIZED FOR LOCAL REPRODUCTION 

MEDICAL RECORD CHRONOLOGICAL RECORD OF MEDICAL CARE 

DATE SYMPTOMS, DIAGNOSIS, TREATMENT, TREATING ORGANIZATION (Sign each entry)

HOSPITAL OR MEDICAL FACILITY 

447 EMEDS, Baghdad Air Base Iraq 

STATUS DEPART./SERVICE RECORDS MAINTAINED AT 

SPONSOR S NAME SSN/ID NO. RELATIONSHIP TO SPONSOR 

Self PATIENT S IDENTIFICATION: (For typed or written entries, give: Name last, first, middle; ID No or SSN; Sex; Date of Birth; 

Rank/Grade.) 

REGISTER NO. WARD NO. 

CHRONOLOGICAL RECORD OF MEDICAL CARE 

Medical Record 

STANDARD FORM 600 (REV. 6-97) Prescribed by GSA/ICMR 

 FIRMR (41 CFR) 201-9.202-1 

ENVIRONMENTAL/OCCUPATIONAL HEAL TH WORKPLACE EXPOSURE DATA

This asse ssm ent covers individuals deployed to BAGHDAD AIR B ASE (BDAB), IRAQ for the time period 15 DEC 03 to 30 APR 2004. 

Purpose: To comply with the deployment health surveillance requirements of Presidential Review Directive 5 and JCSM 0006-02, 

Updated Procedures for Deployment Health Surveillance and Readiness. CENTAF/SG officially sanctions use of this form and 

recommends it be maintained in the individual s permanent medical record with the DD Form 2796, Post Deployment Health 

Assessment, covering the same time period. 

Camps Sather and Griffin, the primary AF locations on Baghdad International A irport (BIAP), were part of the Iraqi Military Training 

portion of BIAP. However, this specific area was not heavily used. The small Iraqi terminal on site was for military guests and 

distinguished visitors. Base housing and training was on the other side of the main road outside Camp Sather. While there is farming 

around BIAP, we are not aware of any specific farming activities within Camp Sather; however, there is evidence of flooded fields 

in/around Camp Griffin. We are als o not aware of any major spills within the BIAP AF cantonment. BDAB refers to both Camps 

Sather and Griffin.

Environmental Exposure Data and Risk Assessment:

1. Airborne Dust: The level of airborne particulate matter is high throughout the Middle Eas t due to wind blown dust and sand. 

Expected health effects associated with exposures to airborne particulates include eye, nose, and throat irritation, sneezing, coughing, 

sinus congestion, sinus drainage, and aggravation of asthma conditions. Based on air sampling performed in and around BIAP, the 

overall health risk to personnel from exposure to airborne dust is assessed as low. PM10 and manganese air samples taken in late May 

2003 indicated concentrations nearly double their respective military exposure guidelines. However, no long-term health affects are 

anticipated for personnel as signed/deployed for a period less than two years. 

2. Airborne Emissions From Petroleum Production/Other Nearby Industrial/Disposal Activities: There are multiple industrial 

activities near BIAP. Chemical s torage and processing plants are located within 5-10 miles of BIAP, primarily to the east and south. 

However, operations at these facilities are severely limited in the aftermath of combat activities in/around BIAP. Multiple industrial 

activities, to include manufacturing, construction, and petroleum refining are located in the greater Baghdad metropolitan area. With 

the prevailing winds from the northwest, BIAP is located downwind from only a few industrial ac tivities, primarily light to medium 

manufacturing facilities. Routine exposure of BIAP personnel to airborne emissions from off-base industrial s ources is assessed as 

minimal to nonexistent, with no increased risk to health resulting from routine exposure. Army units in/around BIAP no longer burn 

out human and other waste products, and no units BIAP burn trash/garbage. There is no health risk expected from these intermittent 

exposures. 

3. Endemic Diseases: Leishmaniasis (both cutaneous and visceral) occurs in Iraq at a sporadic level. On-base vector surveillance, 

during transmission season, yielded many sand flies from unbated traps, some of which tested positive for leishmaniasis. Risk to BDAB 

personnel is assessed as low, so long as the sand fly burden is kept under control. Cases may not present with symptoms until 4-6 

months post-redeployment. Malar ia is present in Iraq, but to date has not been a significant issue in the Baghdad area. Anophe les

mosquitoes are present on BIAP and 95% of endemic malar ia is Plas modi um vivax. CENTCOM reporting instructions require 

personnel to treat uniforms with permethrin and apply DEET to exposed skin as necessary to prevent bites. Sanitation varies within the 

country, but typically is well below U.S. standards. Consuming local food or water poses a significant risk to personnel for bacterial 

diarrhea. Personnel were advised to consume only food, water, and ice from approved sources. Tuberculosis (TB) disease risk 

assessment for Iraq is low. Unless individuals had exposure to anyone known or suspected of having active TB, worked closely with 

refugees or prisoners, or had prolonged contact with the local populace, a post-deployment tuberculin skin test is not required. Plague is 

restricted to focal ar eas; enzootic foci historically have existed along the Tigris-Euphrates River--extending to Kuwait. Plague risk 

asse ssm ent is low.

4. Drinking Wate r: Bottled water is the source of 100% of the drinking water used on BDAB. All bottled water comes from 

approved sources and is tested by 447 EMEDS to ensure water quality meets all applic able standards. BDAB has a water distribution 

system that is supplied via truck by US Army reverse osmosis purification units located at North Palace, using water from a lak e fed by 

the Tigris River. Tap water is considered non-potable and only recommended for cleaning and hygiene purposes. 

5. Hazardous Animals and Insects: Several species of ve nomous snakes, scorpions and spiders have been identified on base. 

Generally, they are limited in number and BDAB personnel experience minimal s ightings or contact. Unless otherwise specified in the
Appendix II

Example of an Occupational and 

Environmental Health Surveillance Summary 

Created by the Air Force during Operation 

Iraqi Freedom

Page 36 GAO-05-632 Deployment Surveillance

DATE SYMPTOMS, DIAGNOSIS, TREATMENT, TREATING ORGANIZATION (Sign each entry)

STANDARD FORM 600 (REV. 6-97) BACK

ENVIRONMENTAL/OCCUPATIONAL HEAL TH WORKPLACE EXPOSURE DATA (continued)

medical record, individual reported no adverse contact (i.e. bites). Feral cats and dogs have als o been noted in the area. Rats and mice 

have been a nuisance; one rat bite was reported in the summer of 2003.

6. Waste Sites/Waste Disposal: Hazar dous waste storage on BDAB is limited to used and off-spec POL products, and small s pill 

cleanup residue. Currently, proper handling, storage, and disposal of industrial waste generated on base (mainly oil, fuel and hydraulic 

fluid) are strictly enforced. Airborne exposure to base personnel from stored waste is assessed as minimal to nonexistent. No obvious 

signs of significant past spills or tank leakage were noted when coalition forces occupied BIAP, although POL personnel did drain and 

remove several extant tanks. Trash and garbage are containerized and routinely collected by contractors. Latrines are pumped out by 

trucks and waste is disposed off-BIAP. 

7. Nuclear, Biological or Chemical (NBC) Weapon Exposure: There has been no evidence of any use, storage, release, or exposure 

of NBC agents to personnel at this site. 

8. Agricultural Emissions: Surrounding land is moderately agricultural. Many farms are within 1-2 miles of the perimeter fence, 

with numerous potentially flooded fields for rice cultivation. Aerial photos previous to May 2003 revealed that much of BIAP, 

including parts of the AF cantonment, were rice cultivation areas. While we haven t witnessed any significant application, 

herbicide/pesticide use probably routinely occurs just outside the base. However, airborne exposure to base personnel is assessed as 

minimal to nonexistent. 

9. Depleted Uranium (DU): DU is a component of some aircraft present and/or transient on/through BDAB. There is no evidence of 

DU munitions having been expended at BIAP. Therefore, there is no potential air borne exposure to DU. Exposure is classified as far 

below permissible exposure levels. 

10. Hazardous Materia ls: There are only a few permanent structures on BDAB. Both lead-based paint and potential as bestoscontaining material have been tentatively identified in various locations on BIAP; however, personnel are not performing activities that 

involve routine exposure, thereby minimizing health risk. There were multiple sites where Iraqi hazar dous materials caches were 

located; however, personnel exposures were minimize d/eliminated by removing or limiting access to the materials . 

Occupational Exposure Data and Risk Asse ssment: 

1. Noise: Aircraft, aircraft ground equipment, generators and other equipment produce hazar dous noise. Workers routinely exposed to 

hazar dous noise are those working on or near the flight line and/or in selected industrial shops. These workers have comparable noise 

exposure at home station and are on the hearing conservation program. For all individuals, appropriate hearing protection is provided 

for protection again st hazar dous noise. Additionally, the whole of Camp Sather is within 300 yards of an extremely active flightline. 

2. Heat Stress: Daily temperature range: Mar - Oct from 75 F to 125 F ; Nov - Feb from 55 F to 95 F. Personnel are continually 

educated on heat stress dangers, water intake and work/rest cycles. Unless separately documented, individual had no heat related 

injury. 

3. Airborne Exposure to Chemical Hazards: Unless sp ecified in a duty-specific supplement, individual exposure to chemical 

inhalation is considered similar to duties performed at home station. On base industrial ac tivities include routine aircraft, equipment 

and installation maintenance. Generally, majority of the chemicals used on BDAB are oils, greases, lubricants, hydraulic fluids and 

fuel. Little to no corrosion control activities are performed and no solvent tanks exist on site. No industrial ac tivity is performed that 

generates, or has been expected to generate, airborne exposures above permissible exposure levels or medical action levels. 

4. Chemical Contact and Eye Protection: Unless sp ecified in a job-specific supplement, individual exposure to chemical contact is 

considered similar to duties performed at home station. Workers are provided appropriate protective equipment (i.e. nitrile/rubber 

gloves, goggles, safety glasses and face s hields) when and where needed. 

5. Radiation: Ionizing radiation is emitted from medical/dental x-ray and OSI operations, and low-level radioactive materials present 

in equipment such as chemical ag ent monitors and alar ms. No worker has been identified as exceed ing 10% of the 5 REM/year OSHA 

permissible exposure level. Radio frequency (RF) radiation is emitted from multiple radar systems and communication equipment.

Systems are marked with warning signs and communication workers recei ve appropriate training. Unless otherwise documented, no 

worker has been identified as exceed ing RF-radiation permissible ex posure limits. Significant UV radiation from the sun is expected on 

exposed unprotected skin. BDAB personnel have been advised to minimize sun exposure through the use of sunscreen and wear of 

sleeves down. Additionally, BDAB is a high light level environment. Many cases of photosensitivity dermatitis were observed. Some 

were no doubt exacerbated by the use of doxycycline for malaria prophylaxis. Unless otherwise stated in medical record, individual 

reported no radiation/light related injuries. 

6. Er gonomics: Individual exposure to ergonomic stress from job related duty is substantially similar to duties performed at home 

station, with potential moderate increase in lifting involved with unique deployment requirements such as erection of tents and shelters. 

Unless otherwise stated in medical record, individual reported no ergonomic stress related injuries. 

7. Bloodborne Pathogens: Individual exposure to bloodborne pathogens from job related duty is considered similar to duties 

performed at home station. Applicable workers are provided appropriate protective equipment and have been placed on the bloodborne 

pathogen program. Unless otherwise stated elsewhere in the medical record, individual reported no significant unprotected exposures. 

 

 //SIGNED// 
Page 37 GAO-05-632 Deployment Surveillance

Appendix III

Comments from the Department of Defense ApendxiI
Appendix III

Comments from the Department of Defense

Page 38 GAO-05-632 Deployment Surveillance
Page 39 GAO-05-632 Deployment Surveillance

Appendix IV

Comments from the Department of Veterans 

Affairs ApendxiIV
Appendix IV

Comments from the Department of Veterans 

Affairs

Page 40 GAO-05-632 Deployment Surveillance
Appendix IV

Comments from the Department of Veterans 

Affairs

(290338) Page 41 GAO-05-632 Deployment Surveillance
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