GAO 

United States Government Accountability Office

Report to Congressional Addressees

DEFENSE HEALTH 

CARE 

Post-Deployment 

Health Reassessment 

Documentation Needs 

Improvement 

November 2009 

GAO-10-56 
What GAO Found

United States Government Accountability Office

Why GAO Did This Study

Highlights

Accountability Integrity Reliability

November 2009

DEFENSE HEALTH CARE

Post-Deployment Health Reassessment 

Documentation Needs Improvement 

Highlights of GAO-10-56, a report to 

congressional addressees 

The Department of Defense (DOD) 

implemented the post-deployment 

health reassessment (PDHRA), 

which is required to be 

administered to servicemembers 90 

to 180 days after their return from 

deployment. DOD established the 

PDHRA program to identify and 

address servicemembers’ health 

concerns that emerge over time 

following deployments. This report 

is the second in response to a 

Senate Armed Services Committee 

report directing GAO to review 

DOD’s administration of the 

PDHRA, and to additional 

congressional requests. In this 

report, GAO examined (1) the 

extent to which DOD’s central 

repository contains PDHRA 

questionnaires for active and 

Reserve component 

servicemembers who returned 

from deployment to Iraq or 

Afghanistan and (2) how DOD 

monitors the administration of the 

PDHRA to Reserve component 

servicemembers. To conduct this 

review, GAO performed a 

quantitative analysis using DOD 

deployment and PDHRA data, 

reviewed relevant PDHRA policies, 

and interviewed DOD officials. 

What GAO Recommends

GAO recommends that DOD (1) 

ensure that PDHRA questionnaires 

for all servicemembers to whom 

the requirement applies are in 

DOD’s central repository and (2) 

require that the information 

obtained when monitoring the 

PDHRA program is documented in 

a manner consistent with internal 

control standards. DOD concurred 

with the recommendations. 

DOD policy requires that the military services electronically submit PDHRA 

questionnaires to DOD’s central repository. Based on two separate queries to 

this repository in 2009, GAO did not find PDHRA questionnaires for a 

substantial percentage of the 319,000 active and Reserve component 

servicemembers who returned from deployment to Iraq or Afghanistan 

between January 1, 2007, and May 31, 2008. GAO’s first query on April 15, 

2009, showed that only 77 percent of this population of interest had 

questionnaires in the central repository, leaving approximately 74,000 

servicemembers without questionnaires in the repository. On September 4, 

2009, GAO queried DOD’s central repository again to update its April 2009 

data and found that DOD’s central repository was still missing PDHRA 

questionnaires for about 72,000 servicemembers, or 23 percent of the 

servicemembers in GAO’s original population of interest. When PDHRA 

questionnaires are not in DOD’s central repository, DOD does not have 

reasonable assurance that servicemembers to whom the PDHRA requirement 

applies were given the opportunity to fill out the questionnaire and identify 

and address health concerns that could emerge over time following 

deployment. 

DOD uses four methods to monitor the contractor, Logistics Health, Inc. 

(LHI), that administers the PDHRA to Reserve component servicemembers. 

The four monitoring methods are: (1) reviews of periodic reports from LHI; 

(2) inspections of LHI’s administration of the PDHRA; (3) feedback on LHI’s 

administration of the PDHRA from military service officials; and (4) weekly 

telephone discussions with LHI staff. These methods are used to help ensure 

that the objective of the PDHRA program is being met for Reserve component 

servicemembers. Through these methods, DOD identified a number of 

potential problems that may pose risks to the PDHRA program objective and 

to the welfare and safety of Reserve component servicemembers. However, 

GAO found that when monitoring the administration of the PDHRA to Reserve 

component servicemembers, DOD does not maintain clear documentation 

that is consistent with federal internal control standards. GAO found that the 

documentation generated by DOD generally did not clearly describe the 

potential problems, the actions taken to address the problems, and whether 

these actions had resolved the problems. Overall, this lack of clear 

documentation does not allow DOD to have reasonable assurance that 

potential problems related to the administration of the PDHRA to Reserve 

component servicemembers have been addressed and resolved. 

View GAO-10-56 or key components.

For more information, contact Randall B. 

Williamson at (202) 512-7114 or 

williamsonr@gao.gov. 
Page i GAO-10-56 

Contents 

Letter 1

Background 8 

DOD’s Central Repository Did Not Contain PDHRA Questionnaires 

for a Substantial Percentage of Servicemembers Who Returned 

from Deployment to Iraq or Afghanistan 14 

DOD Uses Four Methods to Monitor the Administration of the 

PDHRA to Reserve Component Servicemembers, but Does Not 

Clearly Document Its Monitoring 18 

Conclusions 24 

Recommendations for Executive Action 25 

Agency Comments and Our Evaluation 25 

Appendix I Scope and Methodology 28 

Appendix II Sample Post-Deployment Health Reassessment 

Questionnaire (DD 2900), January 2008 34 

Appendix III Post-Deployment Health Reassessment Questionnaires 

in DOD’s Central Repository and Services’ 

Databases 40 

Appendix IV DOD’s Documentation of Its Monitoring of the 

Administration of the Post-Deployment Health 

Reassessment 44 

Appendix V Comments from the Department of Defense 47 

Appendix VI GAO Contact and Staff Acknowledgments 50 

 PDHRA Administration 
Related GAO Products 51 

Tables 

Table 1: Servicemembers Who Returned from Deployment to Iraq 

or Afghanistan Between January 1, 2007, and May 31, 2008, 

without a PDHRA Questionnaire in DOD’s Central 

Repository, as of September 4, 2009 17 

Table 2: Servicemembers Who Returned from Deployment to Iraq 

or Afghanistan Between January 1, 2007, and May 31, 2008, 

without a PDHRA Questionnaire in DOD’s Central 

Repository, as of April 15, 2009 41 

Table 3: Number of Servicemembers Who Returned from 

Deployment to Iraq or Afghanistan between January 1, 

2007, and May 31, 2008, with a PDHRA Questionnaire in 

Military Services’ Databases That Was Not in DOD’s 

Central Repository as of April 15, 2009, and Number of 

These Servicemembers with Questionnaire in Central 

Repository, as of September 4, 2009 43 

Table 4: Fifteen Selected Potential Problems Related to the 

Administration of the PDHRA to Reserve Component 

Servicemembers, Identified by the DOD RHRP Office 45 

Figure 

Figure 1: Time Line of GAO’s Quantitative Analysis 5 

Page ii GAO-10-56 PDHRA Administration
Abbreviations 

AFHSC Armed Forces Health Surveillance Center 

CTS Contingency Tracking System 

DMDC Defense Manpower Data Center 

DMSS Defense Medical Surveillance System 

DOD Department of Defense 

LHI Logistics Health, Inc. 

PDHRA post-deployment health reassessment 

RHRP Reserve Health Readiness Program 

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Page iii GAO-10-56 PDHRA Administration
Page 1 GAO-10-56 

 

United States Government Accountability Office

Washington, DC 20548 

 

November 19, 2009 

Since September 2001, the Department of Defense (DOD) has relied on 

almost 2 million servicemembers to support ongoing contingency 

operations in Iraq and Afghanistan.1

 Servicemembers deployed to Iraq and 

Afghanistan have engaged in intense and prolonged combat, placing them 

at risk for developing various physical and mental health conditions, such 

as post-traumatic stress disorder. In many cases, mental health conditions 

do not emerge until months after servicemembers return from 

deployment. As a result, in 2005, DOD implemented the post-deployment 

health reassessment (PDHRA), which is required to be administered 90 to 

180 days after servicemembers return from deployment.2

The PDHRA is one of three deployment health assessments that DOD uses 

to assess the physical and mental health condition of servicemembers 

before and after their overseas deployments to such locations as Iraq and 

Afghanistan.3

 DOD established the PDHRA to identify servicemembers’ 

health concerns, including mental health concerns, that may surface 

several months following their return from deployment and to assess 

whether servicemembers need referrals for a further evaluation to address 

these health concerns. The PDHRA questionnaire consists of a 

demographic section to be filled out by the servicemember, a medical 

section for self-reported medical information from the servicemember, 

and a third section for a health care provider to fill out and sign. 

A recent study found that latent mental health concerns may 

disproportionately affect Army Reserve and Army National Guard soldiers 

over their active component counterparts.4

 This 2007 study on 

1

After the terrorist attacks of September 11, 2001, the President announced a Global War on 

Terrorism, now known as the Overseas Contingency Operations which includes operations 

in Iraq and Afghanistan. 

2

Assistant Secretary of Defense for Health Affairs Memorandum, “Post-Deployment Health 

Reassessment,” (Mar. 10, 2005). The post-deployment health reassessment (PDHRA) is 

administered on Department of Defense (DOD) form DD 2900. 

3

The other assessments are the pre-deployment health assessment, which is administered 

before deployment, and the post-deployment health assessment, which is administered 

about the time servicemembers return from deployment. 

4

C.S. Milliken, J.L. Auchterlonie, and C.W. Hoge, “Longitudinal Assessment of Mental 

Health Problems Among Active and Reserve Component Soldiers Returning from the Iraq 

War,” Journal of the American Medical Association, vol. 298, no. 18 (2007). 

 PDHRA Administration 
 

servicemembers deployed to Iraq found that when the PDHRA was 

administered 90 to 180 days following deployment, Army Reserve and 

Army National Guard servicemembers reported higher rates of mental 

health concerns and were referred at substantially higher rates than their 

active component counterparts.5

 Researchers noted that Army Reserve 

and Army National Guard servicemembers, unlike their active component 

peers, typically transition back to civilian life after their deployments. 

They may be particularly at risk for developing mental health conditions, 

due to their lack of interaction with fellow servicemembers following their 

return from deployment and the added stress of transitioning back to 

civilian life. 

DOD’s military services administer the PDHRA to active component 

servicemembers, and DOD contracts with Logistics Health, Inc. (LHI) to 

administer the PDHRA to servicemembers in the Reserve component.6,7

While filling out the entire PDHRA questionnaire is encouraged, part of it 

is voluntary. The military services require active and Reserve component 

servicemembers to fill out only the demographic section of the 

questionnaire;8

 servicemembers are not required to answer questions 

concerning their physical and mental health. The PDHRA questionnaire is 

filled out electronically and DOD requires that the military services 

electronically submit the questionnaires for both active and Reserve 

component servicemembers to DOD’s central repository.9

 For Reserve 

 

5

Milliken, Auchterlonie, and Hoge, “Longitudinal Assessment of Mental Health Problems 

Among Active and Reserve Component Soldiers Returning from the Iraq War,” 2141. 

6

DOD’s Reserve components include servicemembers in the Army and Air National Guard, 

as well as the Army, Air Force, Navy, and Marine Corps Reserves. As of May 2008, Reserve 

component servicemembers made up almost 28 percent of those deployed to Iraq and 

Afghanistan. 

7

Although Logistics Health, Inc. (LHI) administers the PDHRA to Reserve component 

servicemembers, the military services are responsible for identifying and notifying 

servicemembers to whom the PDHRA requirement applies. 

8

Military service officials stated that they do not have requirements related to the PDHRA 

once servicemembers are separated from military service. For the purposes of our review, 

the term “separated servicemembers” includes active component, Reserve, and National 

Guard servicemembers who, following return from deployment, have separated from 

military service and have no further military service obligation. 

9

DOD’s central repository is the Armed Forces Health Surveillance Center’s (AFHSC), 

formerly known as the Army Medical Surveillance Activity, Defense Medical Surveillance 

System. AFHSC is supported by the U.S. Army Center for Health Promotion and Preventive 

Medicine and performs comprehensive medical surveillance and reporting of rates of 

diseases and injuries among DOD servicemembers. 

Page 2 GAO-10-56 PDHRA Administration
 

component servicemembers who fill out the PDHRA questionnaire 

through LHI, LHI staff are responsible for verifying that the questionnaires 

are transferred to the appropriate military service so that the military 

service can submit them to DOD’s central repository. The central 

repository contains information from various health assessments and is 

used for many purposes, including health surveillance. 

We previously identified problems with DOD’s oversight of the PDHRA. In 

2008, we reported that DOD’s deployment health quality assurance 

program, which DOD established to assess compliance with DOD’s various 

deployment health assessments, lacked data that would allow the 

program—and therefore DOD—to accurately assess whether the military 

services ensure that servicemembers fill out the PDHRA questionnaire.10

DOD’s quality assurance program uses data from DOD’s central repository 

to monitor the extent to which active and Reserve component 

servicemembers fill out the PDHRA questionnaire and other DOD 

deployment health assessments, as required. However, DOD’s quality 

assurance program does not monitor LHI’s administration of the PDHRA 

to Reserve component servicemembers, and we did not include this in our 

2008 report. The program also does not monitor whether separated 

servicemembers fill out the PDHRA questionnaire. 

In its report accompanying the National Defense Authorization Act for 

Fiscal Year 2008,11 the Senate Committee on Armed Services directed us to 

review DOD’s implementation of the PDHRA to active component, 

Reserve component, and separated servicemembers. The House 

Committee on Armed Services and eight senators also expressed interest 

in this work. In this report, we examine: (1) the extent to which DOD’s 

central repository contains PDHRA questionnaires for active and Reserve 

component servicemembers who returned from deployment to Iraq or 

Afghanistan and (2) how DOD monitors the administration of the PDHRA 

to Reserve component servicemembers. 

 

10GAO, Defense Health Care: Oversight of Military Services’ Post-Deployment Health 

Reassessment Completion Rates Is Limited, GAO-08-1025R (Washington, D.C.: Sept. 4, 

2008). 

11S. Rep. No. 110-77, at 360 (2007). 

Page 3 GAO-10-56 PDHRA Administration
 

To determine the extent to which DOD’s central repository contains 

PDHRA questionnaires for active and Reserve component servicemembers 

who returned from deployment to Iraq or Afghanistan, we conducted a 

quantitative analysis using DOD deployment and PDHRA data and 

reviewed our prior work on DOD’s deployment health quality assurance 

program. We conducted our quantitative analysis using DOD data from 

two sources—the Defense Manpower Data Center’s (DMDC) Contingency 

Tracking System (CTS) and the Armed Forces Health Surveillance 

Center’s (AFHSC) Defense Medical Surveillance System (DMSS). DMDC’s 

CTS contains data on servicemembers deployed in support of the Overseas 

Contingency Operations including servicemembers’ deployment dates and 

location of deployment. AFHSC’s DMSS is DOD’s central repository for 

various health assessments and other health surveillance data, including 

PDHRA questionnaires. We used CTS data to identify a population of 

interest: active component, Reserve, and National Guard servicemembers 

who had returned from deployments of greater than 30 days to Iraq or 

Afghanistan from January 1, 2007, through May 31, 2008.12 (See fig. 1.) 

 

12DOD Defense Manpower Data Center (DMDC) data indicate that our population of 

interest returned from deployment between January 1, 2007, and May 31, 2008. Given this 

timeframe, the last date on which servicemembers in our population could have filled out 

the PDHRA questionnaire within 180 days after their return from deployment, as required 

by DOD policy, was approximately November 30, 2008. However, servicemembers may 

have filled out the questionnaire after the 90- to 180-day reassessment period had elapsed. 

Page 4 GAO-10-56 PDHRA Administration
 

Figure 1: Time Line of GAO’s Quantitative Analysis 

Source: GAO.

Jan. Feb. Mar. Apr. May Jun. Jul. Aug. Sep. Oct. Nov. Dec.

2007

Jan. Feb. Mar. Apr. May Jun. Jul. Aug. Sep. Oct. Nov. Dec.

2008

September 4, 2009:

GAO’s second query of DOD’s central repository.

Late May and June, 2009:

GAO’s query of military services’ databases.

April 15, 2009:

GAO’s first query of DOD’s central repository.

Approximately April 1, 2007 to November 30, 2008:

Servicemembers in this population fill out PDHRA questionnaire 

90 to 180 days after returning from deployment.a

January 1, 2007 to May 31, 2008:

Servicemembers return from deployment to Iraq or Afghanistan.

Jan. Feb. Mar. Apr. May Jun. Jul. Aug. Sep.

2009

a

Servicemembers may have also filled out the questionnaire after the 90- to 180-day reassessment 

period had elapsed. 

We determined the extent to which servicemembers in our population of 

interest had PDHRA questionnaires in DOD’s central repository, AFHSC’s 

DMSS, by asking AFHSC officials to query DMSS on two occasions—April 

2009 and September 2009.13 We made our second query to account for any 

PDHRA questionnaires incorporated into DMSS after our initial analysis. 

On both occasions, AFHSC officials matched PDHRA questionnaires to 

CTS data using servicemembers’ personal identifying information and the 

beginning and end deployment dates of a servicemember’s most recent 

return from deployment during our time period. 

If a PDHRA questionnaire could not be identified in AFHSC’s DMSS for a 

servicemember in our population of interest during our April 2009 query, 

we asked officials from the military services to query their own databases 

to identify PDHRA questionnaires for these servicemembers, as the 

military services collect PDHRA questionnaires in their own databases 

before transmitting them to DOD’s central repository. Specifically, for this 

group of servicemembers, we asked military service officials to send us 

information from any questionnaires that they considered ready for 

 

13We considered servicemembers to have a PDHRA questionnaire if one could be identified 

in DOD’s central repository, regardless of whether servicemembers filled out the entire 

questionnaire or only the demographic section. 

Page 5 GAO-10-56 PDHRA Administration
 

transmission to DMSS that were filled out after the servicemember’s end 

deployment date in CTS. We received these data from the military 

in late May and June 2009. Next, using servicemembers’ personal 

identifying information and end deployment dates, we matched the

information from the PDHRA questionnaires the military services 

identified in their databases to our population of interest from CTS. 

Finally, we reviewed DOD policies, as well as those of the Army, Air 

Force, Navy, and Marine Corps, for submitting PDHRA questionnaire

DOD’s central repository and interviewed DO

services 

s to 

D and military service 

officials knowledgeable about this process.14

ry 

d 

 servicemembers 

may have actually filled out a PDHRA questionnaire. 

rvice 

e 

h 

these monitoring efforts were consistent with GAO’s Standards for 

 

We conducted data reliability assessments for each DOD and milita

service data source we used by reviewing related documentation, 

interviewing knowledgeable agency officials, and performing electronic 

data testing for missing data, outliers, and obvious errors. We determine

that these data sources were sufficiently reliable for our purposes. We

determined only the extent to which PDHRA questionnaires could be 

identified in AFHSC’s DMSS or the military services’ databases for our 

population of interest, and not the extent to which the

To determine how DOD monitors the administration of the PDHRA to 

Reserve component servicemembers, we reviewed DOD’s policies for 

monitoring its contract with LHI and interviewed DOD and military se

officials responsible for the administration of the PDHRA to Reserve 

component servicemembers. We also reviewed DOD’s contract with LHI 

and obtained and analyzed required reports and other documentation on 

LHI’s performance related to the PDHRA portion of DOD’s contract with

LHI.15 We visited LHI’s headquarters in La Crosse, Wisconsin, where w

interviewed LHI staff to confirm our understanding of how LHI staff 

administers the PDHRA to Reserve component servicemembers. We

reviewed DOD’s monitoring of the administration of the PDHRA to 

Reserve component servicemembers to determine the extent to whic

14The Coast Guard was excluded from our review because it is under the direction of the 

Department of Homeland Security and represents a very small portion of servicemembers 

deployed to Iraq and Afghanistan. 

15DOD also contracts with LHI for the provision of other health services to Reserve 

component servicemembers. 

Page 6 GAO-10-56 PDHRA Administration
 

Internal Control in the Federal Government.

16 Internal controls include 

components of an organization’s management that provide reasonable 

assurance that program objectives are being achieved.17

To obtain more in-depth information on how DOD documents the 

information it obtains through its monitoring efforts, we examined 

documentation maintained by DOD’s Reserve Health Readiness Program 

(RHRP) office, which is responsible for monitoring DOD’s contract with 

LHI. Specifically, from among the potential problems that the RHRP office 

had identified as possibly posing a risk to the objective of the PDHRA 

program, we judgmentally selected 15 to review in detail and obtained all 

readily available RHRP documentation on those problems. We selected 

these 15 potential problems because the subject of each of these may have 

involved welfare and safety concerns for Reserve component 

servicemembers. Our findings related to the documentation of the 15 

potential problems are for illustrative purposes only and are not 

generalizable to other RHRP office documentation. 

We conducted this performance audit from October 2008 to October 2009 

in accordance with generally accepted government auditing standards. 

Those standards require that we plan and perform the audit to obtain 

sufficient, appropriate evidence to provide a reasonable basis for our 

findings and conclusions based on our audit objectives. We believe that 

the evidence obtained provides a reasonable basis for our findings and 

conclusions based on our audit objectives. For more detailed information 

on our scope and methodology, see appendix I. 

 

16See GAO, Standards for Internal Control in the Federal Government, GAO/AIMD-00-21.3.1

(Washington, D.C.: November 1999). Internal control standards provide the overall 

framework for establishing and maintaining internal controls in the federal government. 

We reviewed the consistency of DOD’s monitoring with a subset of these internal control 

standards, the monitoring and control activities standards. 

17In order to assess how DOD monitors the administration of the PDHRA to Reserve 

component servicemembers, we reviewed how DOD monitors LHI’s administration of the 

PDHRA. We did not evaluate the sufficiency or appropriateness of the methods used by 

DOD to monitor LHI’s compliance with the terms of the contract generally. 

Page 7 GAO-10-56 PDHRA Administration
 

DOD policy18 states that each military service must administer the PDHRA 

to active component, Reserve component, and separated servicemembers 

90 to 180 days following deployment if they meet the following conditions: 

Background 

• deployed for greater than 30 days, 

• deployed to locations outside the continental United States, and 

• deployed to locations without permanent military treatment facilities.19,20

The military services, using service-specific databases, identify active and 

Reserve component servicemembers to whom the PDHRA requirement 

applies and notify these servicemembers via various methods, such as 

postcards, e-mail, telephone, and face-to-face contact. 

The DOD policy that initiated the PDHRA program stated that the military 

services should contact servicemembers who separate before or during 

the reassessment period to offer them the opportunity to fill out the 

PDHRA questionnaire. However, there is no mechanism in place to offer 

separated servicemembers the opportunity to fill out the PDHRA 

questionnaire. Once these servicemembers have separated from military 

service, they have no further obligation to the military services and 

accordingly, cannot be required to fill out the PDHRA questionnaire. It can 

also be difficult to locate and contact servicemembers after they separate. 

Instead, the military services, with the exception of the Air Force, 

implemented policies to administer the PDHRA to active and Reserve 

component servicemembers as part of the separation process from the 

 

18Assistant Secretary of Defense for Health Affairs Memorandum, “Post-Deployment Health 

Reassessment,” (Mar. 10, 2005), and Department of Defense Instruction 6490.03, 

“Deployment Health,” (Aug. 11, 2006). 

19For active and Reserve component servicemembers who are frequent deployers—those 

who deploy for greater than 30 days more than once during any 365-day period—the 

military services maintain policies stating that these servicemembers will only have to fill 

out one PDHRA questionnaire in any 365-day period. The Army implemented a frequent 

deployer policy in May 2008, the Air Force in February 2006, and the Navy—whose medical 

policies also apply to the Marine Corps—in January 2009. However, a post-deployment 

health assessment is still administered to these servicemembers about the time they return 

from each deployment. 

20Servicemembers whose deployments are primarily aboard ships and do not include 

onshore operations are exempt from filling out the PDHRA questionnaire. 

Page 8 GAO-10-56 PDHRA Administration
 

military.21 Although the Army formally implemented its policy to 

administer the PDHRA to servicemembers before they separate in April 

2008, the practice had been in effect as early as January 2006. The Navy 

and Marine Corps implemented a similar policy in January 2009. According 

to Air Force officials, there are plans to implement a policy by December 

2009. 

The PDHRA involves two steps—active or Reserve component 

servicemembers fill out a PDHRA questionnaire and then discuss their 

questionnaire health concern responses with health care providers. The 

PDHRA questionnaire consists of a demographic section, a medical 

section, and a third section for a health care provider to fill out and sign. 

The demographic section asks for servicemembers to provide information 

such as date of birth, gender, and marital status. The medical section of 

the questionnaire asks servicemembers to self-report information on their 

current physical and mental health condition and concerns. DOD 

considers a PDHRA questionnaire complete when a health care provider 

reviews and signs the questionnaire, regardless of whether 

servicemembers fill out the entire PDHRA questionnaire or only the 

demographic section.22 (See app. II for a sample PDHRA questionnaire.) 

Methods of PDHRA 

Administration 

The Army, Air Force, Navy, and Marine Corps require active and Reserve 

component servicemembers to whom the PDHRA requirement applies to 

fill out at least the demographic section of the PDHRA questionnaire. 

Although filling out the medical section is voluntary, DOD officials 

estimate that less than 1 percent of servicemembers who fill out the 

PDHRA questionnaire decline to fill out the medical section, with the 

exception of the Air Force, which reported a higher declination rate.23

 

21Due to challenges of administering the PDHRA to separated servicemembers, DOD’s 

PDHRA program manager stated that DOD encouraged the military services to administer 

the PDHRA as part of the separation process. 

22The Air Force does not require a review by a health care provider if the servicemember 

declines to fill out the medical section of the PDHRA questionnaire. In addition, for active 

component Air Force and Air Force Reserve servicemembers who fill out the PDHRA 

questionnaire, but do not respond positively to certain questions, the PDHRA questionnaire 

is electronically closed out and forwarded to DOD’s central repository without a health 

care provider’s review. 

23According to DOD’s former PDHRA program manager, the Air Force declination rate is 

less than 5 percent. 

Page 9 GAO-10-56 PDHRA Administration
 

Active component servicemembers typically fill out the PDHRA 

questionnaire online either prior to PDHRA on-site events or during such 

events, which are usually held at military installations. Similarly, Reserve 

component servicemembers may fill out the PDHRA questionnaire—

administered by the contractor, LHI—online, prior to or during on-site 

events. In addition, LHI maintains call centers to administer the PDHRA to 

Reserve component servicemembers.24 Reserve component 

servicemembers who use LHI’s call centers may fill out the demographic 

and medical sections of the questionnaire online or, with the help of call 

center staff, may fill out both sections of the questionnaire through the call 

centers.25,26 

Health Care Provider 

Review and Referral for 

Further Evaluation 

DOD requires that a health care provider27 review and discuss active and 

Reserve component servicemembers’ health concern responses on the 

PDHRA questionnaire, including any physical and mental health concerns 

that servicemembers self-identify on their questionnaires.28,29 Health care 

providers use professional judgment to decide whether a further 

 

24LHI operates two call centers 24 hours a day, 7 days a week: one in La Crosse, Wisconsin 

and one in Detroit, Michigan. LHI’s call centers have the same phone number, so when 

servicemembers call in to the number, they are directed to one of the two call centers. 

25In certain circumstances, LHI may, through its call centers, administer the PDHRA 

questionnaire to remotely located active component servicemembers, such as remotely 

located military service recruiters, who are unable to attend PDHRA on-site events at 

military installations. 

26Servicemembers who are administered the PDHRA questionnaire before they separate 

from the military fill out the questionnaire either online or with LHI staff, along with their 

active or Reserve component counterparts. 

27Consistent with DOD policy, the four military services’ health care providers include 

physicians, physician assistants, nurse practitioners, independent duty corpsmen (an 

enlisted person that has been trained to give first aid and basic medical treatment, 

especially in combat situations), and independent duty medical technicians (an enlisted 

person who receives advanced training to provide treatment and administer medication). 

LHI PDHRA health care providers include physicians, physician assistants, nurse 

practitioners, and licensed clinical social workers, according to LHI staff. 

28Assistant Secretary of Defense for Health Affairs Memorandum, “Post-Deployment Health 

Reassessment,” (Mar. 10, 2005). 

29As stated previously, the Air Force does not require a review by a health care provider if 

the servicemember declines to fill out the medical section of the PDHRA questionnaire. In 

addition, for active component Air Force and Air Force Reserve servicemembers who fill 

out the PDHRA questionnaire, but do not respond positively to certain questions, the 

PDHRA questionnaire is electronically closed out and forwarded to DOD’s central 

repository without a health care provider’s review. 

Page 10 GAO-10-56 PDHRA Administration
 

evaluation is needed, based on servicemembers’ responses and other 

information revealed from the discussions with servicemembers.30 If 

referrals for a further evaluation are recommended, health care providers 

offer servicemembers information on obtaining a referral appointment. 

For example, a health care provider may provide information on obtaining 

an appointment at a military treatment facility or a Vet Center.31

Once a referral for a further evaluation is made, DOD does not require the 

military services to follow up to determine if active and Reserve 

component servicemembers have made or attended an appointment 

generated as a result of the health care provider’s assessment. However, 

for Reserve component servicemembers, referral follow-up is part of LHI’s 

administration of the PDHRA. LHI staff follow up within 72 hours with 

Reserve component servicemembers who have been issued a referral for a 

further evaluation through the call centers to ensure that these 

servicemembers have the information needed to obtain an appointment 

and to encourage servicemembers to schedule an appointment.32 In 

addition, LHI staff attempt to contact Reserve component servicemembers 

30 days after medical referrals are issued, whether issued through PDHRA 

on-site events or through the call centers, to ask whether they scheduled 

and attended an appointment.33 If servicemembers did not, LHI staff ask if 

assistance is needed in scheduling an appointment. 

Each of the military services is required to electronically submit PDHRA 

questionnaires for both active and Reserve component servicemembers to 

DOD’s central repository.34 The central repository is the single source of 

DOD-level health surveillance information. The central repository contains 

 

30Other information could include both verbal and nonverbal information servicemembers 

offer during the discussion with the health care provider. 

31Vet Centers are run by the Department of Veterans Affairs and offer mental health 

services, including readjustment counseling, to all veterans who served in any combat 

zone. 

32According to a DOD official, during PDHRA on-site events, LHI provides a similar service 

to ensure servicemembers who have been issued a referral for a further evaluation have the 

information needed to obtain an appointment. 

33LHI does not perform a 30-day follow-up on servicemembers who receive non-medical 

referrals, such as a referral to Military OneSource or to a chaplain. Military OneSource is a 

free resource that provides a wide variety of support and educational resources to 

servicemembers and their families, available 24 hours a day, 7 days a week. 

34DOD policy also requires that a copy be placed in each servicemember’s medical record. 

Page 11 GAO-10-56 PDHRA Administration
 

data on diseases and medical events and longitudinal data on personnel 

and deployments, including information from DOD’s various deployment 

health assessments, such as the PDHRA. For Reserve component 

servicemembers who fill out PDHRA questionnaires through LHI, LHI staff 

are responsible for verifying that the questionnaires are submitted to the 

appropriate military service’s database. The military services are then 

responsible for submitting the questionnaires from their respective 

databases to DOD’s central repository. 

DOD’s Deployment Health 

Quality Assurance 

Program 

DOD established a deployment health quality assurance program in 

January 2004 to assess whether DOD’s deployment health assessments, 

including the PDHRA, are conducted as required.35 The deployment health 

quality assurance program relies on data from DOD’s central repository, 

data from the military services, and site visits to military installations to 

monitor and report on the extent of compliance among the military 

services with DOD’s deployment health requirements, such as the number 

of active and Reserve component servicemembers that filled out the 

PDHRA questionnaire.36 According to DOD’s deployment health quality 

assurance program manager, the program performed a site visit to Reserve 

units to validate data provided by the military services for the first time in 

October 2008, as part of its oversight of deployment health assessments, 

including the PDHRA. Prior to that, the quality assurance program only 

performed site visits to active component sites.37 On a quarterly basis, the 

quality assurance program reports to the military services on each 

service’s compliance with deployment health requirements. The quality 

assurance program also reports annually to the Armed Services 

Committees of the House of Representatives and Senate on site visit 

 

35The quality assurance program was required by the National Defense Authorization Act 

for Fiscal Year 1998, Pub. L. No. 105-85, § 765(a)(1), 111 Stat. 1629, 1826 (1997) (codified as 

amended at 10 U.S.C. § 1074f(d)). Although DOD’s program predates the PDHRA, DOD 

uses the quality assurance program to monitor compliance with PDHRA requirements. The 

quality assurance program is overseen by the Office of the Assistant Secretary of Defense 

for Health Affairs. 

36DOD receives quarterly reports from each of the military services containing information 

on the number of servicemembers who returned from deployment and the number of 

PDHRA questionnaires filled out. The Army and Marine Corps use data from the central 

repository in their quarterly reports to report the number of PDHRA questionnaires filled 

out. 

37Our previous report discussed DOD’s deployment health quality assurance program, but 

at that time, the program largely focused on active component servicemembers. 

Page 12 GAO-10-56 PDHRA Administration
 

findings and on deployment health assessment data, including the number 

and percentage of servicemembers with PDHRA questionnaires in DOD’s 

central repository. Through its monitoring and reporting, DOD’s quality 

assurance program helps ensure that DOD’s deployment health 

assessments are conducted for active and Reserve component 

servicemembers as required. 

DOD’s Contract with LHI 

to Administer the PDHRA 

to Reserve Component 

Servicemembers 

DOD contracts with LHI to administer the PDHRA to Reserve component 

servicemembers.38 Although LHI administers the PDHRA to Reserve 

component servicemembers on behalf of DOD, the military services are 

responsible for identifying and notifying servicemembers to whom the 

PDHRA requirement applies and for submitting questionnaires to DOD’s 

central repository. DOD’s RHRP office is responsible for monitoring 

DOD’s contract with LHI, which includes the administration of the PDHRA 

to Reserve component servicemembers, as well as the provision of other 

health services for this population, such as immunizations, physical 

examinations, and dental examinations and X-rays.39,40

DOD’s contract with LHI is a performance-based contract and, as such, 

establishes performance standards that the RHRP office uses in 

monitoring and assessing LHI’s performance in providing services to 

Reserve component servicemembers, including the administration of the 

PDHRA. For example, under its contract with DOD, LHI call center staff 

are required to answer 80 percent of incoming calls within 120 seconds. In 

monitoring LHI’s performance, DOD’s RHRP office helps ensure that the 

objective of the PDHRA program—to identify and address 

 

38DOD’s Reserve components began using LHI for PDHRA services through pilot programs 

on the following dates: the Army Reserve and Army National Guard, November 2005; Air 

National Guard, February 2006; Marine Corps Reserve, March 2006; Navy Reserve, May 

2006; and the Air Force Reserve, August 2008. The Air Force Reserve had been using its 

own resources to administer the PDHRA prior to August 2008. 

39DOD’s contract with LHI is a 1-year contract with four 1-year option periods and a 

2-month transition period. The dollar amount invoiced for the PDHRA portion of the 

contract for fiscal year 2008 was $9,438,137. For fiscal year 2009 through May 15, 2009, the 

invoiced amount for the PDHRA portion of the contract was $6,136,134. 

40DOD’s Reserve Health Readiness Program (RHRP) office is staffed by a contracting 

officer’s representative, who is responsible for verifying that LHI complies with contractual 

standards for all provided health services and for managing the RHRP program, and with 

other staff who work for the contracting officer’s representative to monitor specific 

aspects of the RHRP program. The RHRP office is ultimately overseen by the Office of the 

Assistant Secretary of Defense for Health Affairs. 

Page 13 GAO-10-56 PDHRA Administration
 

servicemembers’ health concerns, including mental health concerns, that 

emerge over time following deployments—is achieved for Reserve 

component servicemembers. 

On the two occasions we queried DOD’s central repository, we did not find 

PDHRA questionnaires for a substantial percentage of the active and 

Reserve component servicemembers in our population of interest. DOD 

policy requires that the military services electronically submit 

questionnaires to DOD’s central repository, which DOD uses as a key 

source of health surveillance information. The first of our two queries of 

DOD’s central repository occurred on April 15, 2009. On this date, we 

found that the central repository contained PDHRA questionnaires for 

only 77 percent of the roughly 319,000 active component, Reserve, and 

National Guard servicemembers who, according to DOD DMDC 

deployment data, returned from deployment to Iraq or Afghanistan 

between January 1, 2007, and May 31, 2008.41,42

We could not identify PDHRA questionnaires in DOD’s central repository 

on April 15, 2009, for a large number of servicemembers in our 

population—about 74,000 servicemembers—which represents the 

remaining 23 percent of our population of interest. We made our query 

DOD’s Central 

Repository Did Not 

Contain PDHRA 

Questionnaires for a 

Substantial 

Percentage of 

Servicemembers Who 

Returned from 

Deployment to Iraq or 

Afghanistan 

 

41DOD policy states that the PDHRA should be administered to servicemembers 90 to 

180 days following their return from a deployment of greater than 30 days, to a location 

outside the continental United States without permanent military treatment facilities, such 

as Iraq or Afghanistan. 

42While the majority of the roughly 319,000 servicemembers in our population of interest 

were required to fill out the questionnaire, our population includes about 19,000 

servicemembers who, according to DOD DMDC data, had separated from military service 

between January 1, 2007, and May 31, 2008. As stated earlier, although DOD initially 

required the military services to contact servicemembers who separated before or during 

the reassessment period to offer them the opportunity to fill out the PDHRA questionnaire, 

implementation of this policy posed challenges. Once servicemembers have separated from 

military service, they cannot be required to fill out the PDHRA questionnaire. Instead, the 

military services implemented, or plan to implement, policies to administer the PDHRA to 

servicemembers as part of the separation process from the military. However, the Army 

was the only service that had this practice in effect for servicemembers who returned from 

deployment between January 1, 2007, and May 31, 2008. If the 19,000 servicemembers in 

our population separated prior to or during the reassessment period, they may not have 

been required to fill out the questionnaire. Because we do not know the extent to which 

these 19,000 servicemembers in our population of interest separated before or during the 

reassessment period, we include separated servicemembers in our analysis as part of the 

military service and component with which they were affiliated at the end of their 

deployment. If we had excluded these separated servicemembers from our analysis, as of 

April 15, 2009, DOD’s central repository would have contained PDHRA questionnaires for 

78 percent of servicemembers in our population of interest, rather than 77 percent. 

Page 14 GAO-10-56 PDHRA Administration
 

nearly 1 year after the last servicemembers in our population returned 

from deployment.43 The percentage of PDHRA questionnaires absent from 

DOD’s central repository for our population of interest varied by military 

service and component. For example, among military service components, 

this percentage ranged from a low of about 10 percent to a high of about 

61 percent.44 (For more information on the extent to which 

servicemembers in our population of interest did not have PDHRA 

questionnaires in DOD’s central repository as of April 15, 2009, see 

app. III.) 

After determining that about 74,000 servicemembers in our population of 

interest did not have questionnaires in DOD’s central repository based on 

our first query, we asked the military services whether these 

servicemembers had PDHRA questionnaires that could be identified in the 

services’ own databases.45 With the help of the services, we found that 

approximately 7,000 servicemembers—or about 9 percent of the 74,000 

servicemembers—had questionnaires in their respective military services’ 

databases, but not in DOD’s central repository.46 The number of 

questionnaires identified in the military services’ databases that were not 

in the central repository varied by military service—ranging from over 300 

 

43DOD DMDC data indicate that our population of interest returned from deployment 

between January 1, 2007, and May 31, 2008. Given this time frame, the last date on which 

servicemembers in our population could have filled out the PDHRA questionnaire within 

180 days after their return from deployment, as required by DOD policy, was approximately 

November 30, 2008. However, servicemembers may have filled out the questionnaire after 

the 90- to 180-day reassessment period had elapsed. 

44The Air National Guard had the lowest percentage of servicemembers—about 800 of 

9,000—without a questionnaire in the central repository, while the Air Force Reserve had 

the highest percentage of servicemembers—about 2,000 of 3,000—without a questionnaire. 

45We received data in May 2009 from the Air Force, and in June 2009 from the Army and 

Navy. As the Navy manages PDHRA data for the Marine Corps, the Navy data also included 

data for Marine Corps servicemembers. 

46The 7,000 questionnaires found in the military services’ databases, but not in the central 

repository, were filled out by servicemembers prior to April 15, 2009—the date we first 

queried DOD’s central repository. 

Page 15 GAO-10-56 PDHRA Administration
 

questionnaires for Air Force and Navy servicemembers to about 3,000 for 

Army and Marine Corps servicemembers.47

On September 4, 2009, we queried DOD’s central repository again to 

update our April 2009 data and determine whether any progress had been 

made in reporting questionnaires to the central repository. On this second 

query—15 months after the last servicemembers in our population of 

interest returned from deployment—we found that DOD’s central 

repository was missing the same percentage of PDHRA questionnaires as 

had been missing in April. As a result of our September 2009 query, we still 

found PDHRA questionnaires for only 77 percent of the approximately 

319,000 servicemembers in our original population of interest.48,49 While we 

identified slightly more questionnaires than we identified in our April 

query, we were still unable to identify questionnaires in the central 

repository for about 72,000 servicemembers.50,51 (See table 1.) 

 

47The military services could not definitively tell us why these PDHRA questionnaires could 

be identified in the military services databases, but not in DOD’s central repository. Some 

officials speculated that the questionnaires might not have been incorporated into DOD’s 

central repository because they did not meet data rules. Questionnaires must meet data 

rules, such as the dates of deployment being filled out on the questionnaire, before the 

questionnaires are incorporated into DOD’s central repository. 

48For more information on the extent to which the approximately 7,000 questionnaires 

identified in the military services databases could later be identified in the central 

repository as of September 4, 2009, see appendix III. 

49If we had excluded separated servicemembers from our analysis, as of September 4, 2009, 

DOD’s central repository would have contained PDHRA questionnaires for 79 percent of 

servicemembers in our population of interest. 

50Of these 72,000 servicemembers without a PDHRA questionnaire in DOD’s central 

repository, about 9,000 separated from military service between January 1, 2007, and 

May 31, 2008. About 10,000, or 53 percent of the 19,000 separated servicemembers in our 

original population of interest, had a PDHRA questionnaire in DOD’s central repository. 

51Air Force officials also told us that a small subset of servicemembers in our population of 

interest may not have been required to fill out a PDHRA questionnaire for this deployment 

because of their status as frequent deployers (servicemembers who deploy for greater than 

30 days more than once during a 365-day period only need to fill out one PDHRA 

questionnaire in any 365-day period). Although Air Force officials could not quantify the 

size of this population, they told us it is a small subset of the servicemembers who should 

fill out a PDHRA questionnaire. In addition, Army officials told us that a small population of 

Army servicemembers does not have a PDHRA questionnaire either in the Army database 

or in the central repository. The officials explained that out of concerns of being tracked, 

Army Special Forces can comply with Army PDHRA requirements by filling out a hard copy 

PDHRA questionnaire, blacking out all of their demographic information, and storing a 

copy of the questionnaire in their physical medical records. 

Page 16 GAO-10-56 PDHRA Administration
 

Table 1: Servicemembers Who Returned from Deployment to Iraq or Afghanistan 

Between January 1, 2007, and May 31, 2008, without a PDHRA Questionnaire in 

DOD’s Central Repository, as of September 4, 2009 

Military 

service Component 

Number of 

returning 

servicemembers 

Number of 

servicemembers 

without PDHRA 

questionnaire in 

central repository 

Percentage of 

servicemembers 

without PDHRA 

questionnaire in 

central repository 

Army Active 

component 132,247 27,789 21.01

National 

Guard 38,231 6,018 15.74

Reserve 15,817 2,703 17.09

Total 186,295 36,510 19.60

Air Force Active 

component 39,792 5,487 13.79

National 

Guard 8,583 796 9.27

Reserve 3,341 1,879 56.24

Total 51,716 8,162 15.78

Navy Active 

component 10,412 4,882 46.89

Reserve 2,983 1,056 35.40

Total 13,395 5,938 44.33

Marine 

Corps 

Active 

component 61,006 19,761 32.39

Reserve 6,644 1,990 29.95

Total 67,650 21,751 32.15

Total Active 

component 243,457 57,919 23.79

Reserve 

component 75,599 14,442 19.10

Grand total 319,056 72,361 22.68

Source: GAO analysis of DOD data. 

Notes: This table displays information on servicemembers without a PDHRA questionnaire in DOD’s 

central repository for a servicemember’s most recent return from deployment from Iraq or Afghanistan 

between January 1, 2007, and May 31, 2008. We did not examine the extent to which a 

servicemember filled out a questionnaire for each return from deployment during this time period. 

DOD’s Reserve components include servicemembers in the Army and Air National Guard, as well as 

the Army, Air Force, Navy, and Marine Corps Reserves. 

Page 17 GAO-10-56 PDHRA Administration
 

The absence of 72,000 PDHRA questionnaires from DOD’s central 

repository for servicemembers who should have filled them out hinders 

DOD’s deployment health quality assurance program from effectively 

assessing the military services’ compliance with PDHRA requirements. 

The program, which DOD established to assess whether DOD’s 

deployment health assessments are conducted as required, relies in part 

on the presence of PDHRA questionnaires in the central repository. These 

questionnaires document the extent to which servicemembers were given 

the opportunity to fill out the questionnaire, as required under DOD policy. 

DOD officials specifically cited the importance of this documentation for 

helping the quality assurance program ensure that servicemembers have 

the opportunity to have their health concerns identified and addressed. 

However, the absence of questionnaires from the central repository for 

servicemembers who should have filled them out suggests either that not 

all of these servicemembers filled out the questionnaire or that 

questionnaires were filled out, but were not incorporated into DOD’s 

central repository. When questionnaires for servicemembers from our 

population of interest are not in the central repository, DOD does not have 

reasonable assurance that all members of this vulnerable population of 

active component, Reserve, and National Guard servicemembers that 

deployed to Iraq or Afghanistan were administered the PDHRA 

questionnaire, which is intended to help identify deployment-related 

health concerns that emerge over time and facilitate the opportunity for 

servicemembers to address these concerns. 

DOD’s Reserve Health Readiness Program (RHRP) office uses four 

methods to monitor LHI’s administration of the PDHRA to Reserve 

component servicemembers. However, in using these methods, DOD’s 

RHRP office does not always clearly document its monitoring of the 

PDHRA program. The office’s documentation does not allow DOD to have 

reasonable assurance that potential problems that may relate to the 

welfare and safety of servicemembers have been addressed and resolved. 

DOD Uses Four 

Methods to Monitor 

the Administration of 

the PDHRA to 

Reserve Component 

Servicemembers, but 

Does Not Clearly 

Document Its 

Monitoring 

Page 18 GAO-10-56 PDHRA Administration
 

DOD’s RHRP office uses four methods to monitor LHI’s performance in 

administering the PDHRA to Reserve component servicemembers. More 

broadly, the RHRP office also uses the four methods to monitor whether 

the objective of the PDHRA program—to identify and address 

servicemembers’ health concerns that emerge over time following 

deployments—is being met for Reserve component servicemembers. The 

four methods, which are identified in DOD’s contract with LHI, are the 

following: 

DOD Uses Four Methods 

to Monitor the 

Administration of the 

PDHRA to Reserve 

Component 

Servicemembers 

• Reviews of periodic reports.

52 The RHRP office receives several periodic 

reports that DOD requires from LHI on LHI’s administration of the PDHRA 

to Reserve component servicemembers. DOD requires LHI to report 

aggregate information on LHI’s administration of the PDHRA, including 

reports on its compliance with performance standards. For instance, the 

RHRP office receives a report on LHI’s compliance with the performance 

standard requiring that LHI call center staff answer 80 percent of incoming 

calls within 120 seconds.53 In addition, LHI provides descriptive 

information on the number of Reserve component servicemembers 

administered the PDHRA, referred for a further evaluation, and contacted 

by LHI staff 30 days after receiving referrals.54 An RHRP official told us 

that the office reviews LHI’s reports to examine data related to the 

administration of the PDHRA and identifies potential problems that could 

pose risks to servicemembers and the objective of the PDHRA program. 

For example, the number of servicemembers referred each month is 

compared against historical data to monitor any changes in the rate at 

which servicemembers receive referrals for physical and mental health 

concerns. 

 

52DOD requires LHI to submit some reports on a monthly basis and some on a weekly basis. 

53The RHRP office also receives reports on other performance standards, such as a report 

detailing LHI’s compliance with a standard that requires LHI to enter 95 percent of 

servicemembers’ PDHRA information into the military services’ databases within 5 days of 

administering the PDHRA. 

54The RHRP office provides the military services copies of LHI’s periodic reports on the 

number of servicemembers administered the PDHRA and referred for a further evaluation. 

According to an RHRP official, the military services can compare information in the reports 

with the services’ own data. Accordingly, the RHRP office relies, in part, on feedback from 

the military services to monitor and check the accuracy of the information presented in the 

reports. An RHRP official also compares weekly and monthly reports to check the 

consistency of the information presented in the reports. 

Page 19 GAO-10-56 PDHRA Administration
 

• Inspections of the administration of PDHRA. The RHRP office also 

conducts inspections related to LHI’s administration of the PDHRA to 

Reserve component servicemembers. The inspections have included 

observing PDHRA on-site events, at which servicemembers are 

administered the PDHRA, to assess the quality of LHI services delivered 

during the events. For instance, an RHRP official told us that he checks 

whether the events are staffed with a sufficient number of health care 

providers and administrative staff. In another instance, an RHRP official 

listened to LHI call center discussions between LHI staff and Reserve 

component servicemembers to examine how LHI staff administer the 

PDHRA.55

• Feedback on the administration of the PDHRA from military service 

officials. The RHRP office obtains informal feedback about how the 

PDHRA is being administered to Reserve component servicemembers 

through e-mail correspondence, telephone conversations, and in-person 

discussions with military service officials who are responsible for 

managing the PDHRA for their respective services. These officials told us 

that the RHRP office generally maintains open, informal communication 

channels through which they can and do express their concerns. 

• Weekly telephone discussions with LHI staff. An RHRP official said that 

weekly telephone discussions with LHI staff are held to obtain their 

feedback on the administration of the PDHRA to Reserve component 

servicemembers. In addition, during these discussions, an RHRP official 

and LHI staff discuss and address potential problems identified through 

the periodic reports, inspections, and military service feedback. The 

potential problems staff discuss may include those that could pose a risk 

to the PDHRA program objective and to the welfare and safety of Reserve 

component servicemembers. For example, some problems concerned how 

servicemembers were responding to questions on the PDHRA 

questionnaire. According to an RHRP official, these discussions serve as a 

forum to determine the actions DOD officials or LHI staff need to take to 

address identified problems and to verify that problems raised during 

previous discussions have been properly resolved. 

 

55LHI maintains its own quality assurance program to internally monitor the services being 

provided to servicemembers. The RHRP office’s inspections have also involved reviews of 

LHI’s internal quality assurance efforts related to the administration of PDHRA. 

Page 20 GAO-10-56 PDHRA Administration
 

When monitoring the administration of the PDHRA to Reserve component 

servicemembers, DOD does not maintain clear documentation that is 

consistent with good management practices outlined in federal internal 

control standards.56 According to these standards, internal control 

activities such as monitoring should be clearly documented in a manner 

that is accurate, timely, and helps provide reasonable assurance that 

program objectives are being achieved. Further, such documentation 

should be properly managed and maintained so that it is readily accessible 

and should allow someone other than the assigned officials to understand 

the identified potential problem, the actions taken to address the problem, 

and whether these actions have resolved the problem. 

DOD Generally Does Not 

Clearly Document Its 

Monitoring of the PDHRA 

Program 

Instead of adopting an approach that generated documentation consistent 

with management practices outlined in federal internal control standards, 

the RHRP office created an unsystematic, improvised approach for 

documenting potential problems that were identified through review of 

periodic reports, inspections, and feedback from military service officials 

and LHI staff. These problems may pose a risk to the PDHRA program 

objective. The RHRP office’s approach solely relies on agendas and e-mail 

correspondence to document these potential problems and the actions 

taken to resolve them. 

• Weekly agendas with related notes. Prior to the weekly discussions with 

LHI staff, a typed agenda is prepared for discussion that lists the potential 

problems identified through monitoring activities. During these 

discussions, annotated brief handwritten notes are made on an agenda 

item and these notes are used to indicate that certain actions need to be 

taken by DOD officials or LHI staff to address an identified problem. When 

it appears that problems have been resolved, instead of documenting how 

the problem was resolved, the problem is not included on the agenda for 

the next week’s discussion.57 A hard copy of the agenda is retained and 

filed in the RHRP office after each weekly discussion with LHI staff. 

• E-mail correspondence. The RHRP office receives and generates e-mail 

correspondence with LHI staff and military service officials that discusses 

potential problems identified through monitoring the administration of the 

PDHRA to Reserve component servicemembers. 

 

56GAO/AIMD-00-21.3.1. 

57Potential problems that have not been resolved are generally carried over to the following 

week’s agenda. 

Page 21 GAO-10-56 PDHRA Administration
 

We found that the RHRP office’s sole reliance on these agendas and e-mail 

correspondence did not always result in clear documentation—that is, 

documentation that is understandable and readily accessible to others 

outside the RHRP office. In particular, the agendas and e-mail 

correspondence we reviewed did not always clearly describe the decisions 

made and the actions taken to address identified problems in a manner 

that provides reasonable assurance that the problems have been 

resolved.58 An RHRP official acknowledged that he could not consistently 

rely on the agendas and e-mail correspondence to reconstruct information 

obtained through the office’s internal control responsibility to monitor and 

address problems associated with the administration of the PDHRA to 

Reserve component servicemembers. Instead, this official relies on 

memory to recall such information. 

In our review of the documentation related to 15 potential problems we 

selected, we found that the RHRP office’s documentation generally did not 

clearly describe the problem, the actions taken to address the problem, 

and whether these actions have resolved the problem.59 For example, on 

two September 2008 agendas for the weekly discussions with LHI staff, the 

agendas include a potential problem identified by DOD officials that 25 to 

30 percent of servicemembers were not responding to questions on the 

PDHRA questionnaire about the number of alcoholic drinks they 

consumed on a typical day, and 18 percent were not responding to the 

questions about whether they were depressed. The RHRP office asked LHI 

staff if they were finding similar nonresponses to these questions from 

Reserve component servicemembers. However, the subsequent agendas—

which the RHRP office relies on to track problems—do not contain any 

additional information about how this potential problem was resolved. 

There is no further information, including any related e-mail 

correspondence, on how this potential problem was addressed. This 

example raises questions about whether Reserve component 

servicemembers’ mental health concerns—specifically those related to 

 

58The RHRP office was asked to provide documentation related to a sample of potential 

problems we selected. 

59The RHRP office’s documentation for 9 of the 15 potential problems that we reviewed did 

not clearly describe the potential problem. In addition, for 13 of the 15 potential problems, 

documentation did not allow us to understand the actions taken to address the problems 

and the problems’ resolutions. Documentation did, however, allow us to understand the 

nature of the actions taken to address the problems and the problems’ resolution for the 

other 2 of the 15 potential problems. 

Page 22 GAO-10-56 PDHRA Administration
 

alcohol use and depression—are being consistently identified or whether 

any follow-up actions are needed to address this problem. 

We also reviewed e-mail correspondence related to the 15 selected 

potential problems, dated between March 4, 2008, and May 19, 2009, and 

found that it often contained vague information about the identified 

problems and the actions taken to resolve them.60 Some of these problems 

relate to the welfare and safety of servicemembers and require more 

information than is present in the available documentation to understand 

whether or how the problems were resolved. For example, we asked about 

an instance in which a military service official reported that an LHI health 

care provider failed to document on a Reserve component 

servicemember’s PDHRA questionnaire why the servicemember with 

reported suicidal ideations did not get an immediate referral.61 The e-mail 

correspondence about this potential problem had gaps. For instance, while 

the e-mail correspondence indicates that the RHRP office asked LHI staff 

to look into the incident and contains a reply from LHI staff stating that 

they would investigate further, the e-mail correspondence does not 

document the final results of the LHI staff’s investigation, including 

whether or how this potential problem was resolved. Although this 

potential problem is listed on several agendas, the agendas do not provide 

any more information about the problem or how it was resolved. Instead, 

an RHRP official told us that he relied on his memory to explain to us what 

happened and how it was resolved.62 This official told us he requested that 

LHI staff remind its health care providers to fully document the results of 

their physical and mental health assessments on Reserve component 

servicemembers’ PDHRA questionnaires in the future. However, there is 

no documentation of this request to LHI staff or any documentation of 

plans to follow up to ensure that LHI staff carried out the request. (For 

 

60The RHRP office did not have e-mail correspondence for 6 of the 15 potential problems. 

61LHI is required to seek emergency care for Reserve component servicemembers 

indicating serious mental health concerns. 

62The RHRP official recalled that in this situation the LHI health care provider had 

determined the Reserve component servicemember’s suicidal ideations—thoughts of 

harming or killing oneself, the severity of which can be determined by an assessment of 

these thoughts—were not serious in nature and that the servicemember had no plans for 

self harm. This official also said the servicemember had been offered a referral to obtain a 

further evaluation and had refused the referral. However, the health care provider did not 

document this on the servicemember’s PDHRA questionnaire, so anyone reviewing this 

questionnaire would assume, in error, that the servicemember should have been referred 

for immediate care. 

Page 23 GAO-10-56 PDHRA Administration
 

more information on the documentation related to the 15 potential 

problems, see app. IV.) 

In addition to being generally incomplete and unclear, the e-mail 

correspondence related to the potential problems is not readily accessible. 

E-mail correspondence about identified problems is placed into labeled 

folders within the office’s e-mail system, but the labels are general and email correspondence could appropriately be placed in a number of folders. 

An official told us that, as a result, he struggles in remembering into which 

folder a specific e-mail was placed. For example, e-mail correspondence 

about an identified problem about an Army Reserve servicemember’s 

PDHRA questionnaire may be placed in either an Army PDHRA folder, a 

PDHRA complaints folder, or a standard operating procedures folder. Not 

having documentation that is readily accessible hinders the RHRP office’s 

ability to promptly ensure that identified problems have been properly 

addressed. In addition, should LHI’s performance diminish—for example, 

if LHI was not resolving identified problems—the lack of readily available 

documentation could compromise DOD’s ability to take appropriate 

action. 

DOD established the PDHRA program in order to identify and address 

servicemembers’ health concerns—including mental health concerns—

that emerge over time following deployments. The PDHRA questionnaire 

is a key tool in DOD’s efforts to assess the physical and mental health 

condition of servicemembers who have returned from deployments to Iraq 

and Afghanistan, where exposure to intense combat can place 

servicemembers at risk for developing conditions, such as post-traumatic 

stress disorder. DOD’s deployment health quality assurance program 

assesses the military services’ compliance with the requirement to 

administer the PDHRA to active and Reserve component servicemembers 

to help ensure that servicemembers have the opportunity to have their 

health concerns identified and addressed through the PDHRA. 

Conclusions 

However, our current findings show that the concerns we previously 

raised about DOD’s quality assurance program remain. Specifically, the 

absence of PDHRA questionnaires in DOD’s central repository for 

thousands of eligible active and Reserve component servicemembers 

continues to hinder the program’s ability to assess the extent to which 

these servicemembers fill out the PDHRA questionnaire and have the 

opportunity to identify any health concerns that emerge over time 

following deployments. DOD officials have identified the presence of 

questionnaires in the central repository as important for the efforts of 

Page 24 GAO-10-56 PDHRA Administration
 

DOD’s quality assurance program. Without this information, the program 

may not be able to accurately determine completion rates among the 

military services and thus provide reasonable assurance to DOD or to 

Congress that one of DOD’s key health assessments is being administered 

as required. 

Ensuring that Reserve component servicemembers fill out the PDHRA 

questionnaire may be particularly important, as some evidence suggests 

that these servicemembers may be more likely to develop mental health 

conditions after returning from deployment when compared with their 

active component counterparts. Although DOD monitors the 

administration of the PDHRA to Reserve component servicemembers, 

documentation associated with this monitoring needs to be strengthened. 

The RHRP office has not always clearly documented—in a way that is 

consistent with federal internal control standards—information related to 

problems that may pose risks to the objective of the PDHRA program. 

Some of these potential problems also involve Reserve component 

servicemembers’ welfare and safety. The office’s improvised, unsystematic 

approach to documenting potential problems results in documentation 

that does not provide DOD with reasonable assurance that these problems 

have been resolved. 

To help DOD obtain reasonable assurance that all active and Reserve 

component servicemembers to whom the PDHRA requirement applies are 

provided the opportunity to have their health concerns identified, we 

recommend that the Assistant Secretary of Defense for Health Affairs and 

the military services take steps to ensure that PDHRA questionnaires are 

included in DOD’s central repository for each of these servicemembers. 

To ensure adequate documentation of problems that may pose risks to the 

objective of the PDHRA program for Reserve component servicemembers, 

we recommend that the Assistant Secretary of Defense for Health Affairs 

require the RHRP office to document the information obtained through 

monitoring the PDHRA program in a manner consistent with federal 

internal control standards. 

In written comments on a draft of this report, DOD concurred with our 

two recommendations. Specifically, DOD agreed with our 

recommendation that it take steps to ensure that PDHRA questionnaires 

are included in DOD’s central repository for each servicemember to whom 

the PDHRA requirement applies. DOD stated that to implement this 

Recommendations for 

Executive Action 

Agency Comments 

and Our Evaluation 

Page 25 GAO-10-56 PDHRA Administration
 

recommendation, it will take the following actions: work to correctly 

identify servicemembers who need to receive the PDHRA and work to 

identify and resolve any obstacles to transmission of data from the military 

services to AFHSC. Additionally, DOD stated that it sent a memorandum 

on October 15, 2009, to the military services’ Surgeons General reemphasizing the importance of deployment health requirements. DOD also 

agreed with our recommendation concerning documentation of problems 

that may pose risks to the objective of the PDHRA program for Reserve 

component servicemembers. DOD stated that during our engagement, the 

RHRP office recognized a need to improve documentation of its 

monitoring of the PDHRA program. DOD also stated in its response that 

the RHRP office established a more distinct and clear electronic filing 

system and began documenting not only potential problems with the 

PDHRA program, but also their resolution in a manner that DOD reports is 

sufficiently comprehensive, accessible, and understandable. We did not 

assess this new approach to documentation. DOD’s written comments are 

included in their entirety in appendix V. DOD did not provide technical 

comments. 

We are sending copies of this report to the Secretary of the Department of 

Defense. The report will be available at no charge on GAO’s Web site at 

http://www.gao.gov. 

If you or your staff have questions about this report, please contact me at 

(202) 512-7114 or williamsonr@gao.gov. Contact points for our Office of 

Congressional Relations and Public Affairs may be found on the last page 

of this report. GAO staff who made major contributions to this report are 

Randall B. Williamson 

listed in appendix VI. 

Director, Health Care 

Page 26 GAO-10-56 PDHRA Administration
Page 27 GAO-10-56 

List of Congressional Addressees 

The Honorable Carl Levin 

Chairman 

The Honorable John McCain 

Ranking Member 

Committee on Armed Services 

United States Senate 

The Honorable Ike Skelton 

Chairman 

The Honorable Howard P. McKeon 

Ranking Member 

Committee on Armed Services 

House of Representatives 

The Honorable Daniel K. Akaka 

United States Senate 

The Honorable Christopher S. Bond 

United States Senate 

The Honorable Barbara Boxer 

United States Senate 

The Honorable Tom Harkin 

United States Senate 

The Honorable Joseph I. Lieberman 

United States Senate 

The Honorable Claire McCaskill 

United States Senate 

The Honorable Patty Murray 

United States Senate 

The Honorable Bernard Sanders 

United States Senate 

 PDHRA Administration 
Appendix I: Scope and Methodology Appendix I: Scope and Methodology 

To determine the extent to which post-deployment health reassessment 

(PDHRA) questionnaires are contained in the Department of Defense’s 

(DOD) central repository for active and Reserve component1

servicemembers who returned from deployment to Iraq or Afghanistan, we 

conducted a quantitative analysis using DOD data from two sources—the 

Defense Manpower Data Center’s (DMDC) Contingency Tracking System 

(CTS) and the Armed Forces Health Surveillance Center’s (AFHSC) 

Defense Medical Surveillance System (DMSS).2

 DMDC’s CTS contains data 

on servicemembers deployed in support of the Overseas Contingency 

Operations3

—including data on servicemembers’ deployment dates and 

location of deployment. We used CTS data to identify a selected 

population of interest: active component, Reserve, and National Guard 

servicemembers who had returned from deployments of greater than 30 

days to Iraq or Afghanistan between January 1, 2007, and May 31, 2008.4

 

1

The Department of Defense’s (DOD) Reserve components include servicemembers in the 

Army and Air National Guard, as well as the Army, Air Force, Navy, and Marine Corps 

Reserves. The Coast Guard was excluded from our review because it is under the direction 

of the Department of Homeland Security and represents a very small portion of 

servicemembers deployed to Iraq and Afghanistan. 

2

The Armed Forces Health Surveillance Center (AFHSC), formerly known as the Army 

Medical Surveillance Activity, is supported by the U.S. Army Center for Health Promotion 

and Preventive Medicine and performs comprehensive medical surveillance and reporting 

of rates of diseases and injuries among DOD servicemembers. 

3

After the terrorist attacks of September 11, 2001, the President announced a Global War on 

Terrorism, now known as the Overseas Contingency Operations. Ongoing military and 

diplomatic operations overseas, especially in Iraq and Afghanistan, constitute a key part of 

the Overseas Contingency Operations. 

4

While the majority of servicemembers in our population were required to fill out the 

questionnaire, our population also includes separated servicemembers—servicemembers 

who, following return from deployment, separated from military service and have no 

further military service obligation. Servicemembers are required to fill out the PDHRA 

questionnaire 90 to 180 days following their return from deployment. Although DOD 

initially required the military services to contact servicemembers who separated before or 

during the reassessment period to offer them the opportunity to fill out the PDHRA 

questionnaire, implementation of this policy posed challenges. Once servicemembers have 

separated from military service, they cannot be required to fill out the PDHRA 

questionnaire. Instead, the military services implemented policies to administer the PDHRA 

to servicemembers as part of the separation process from the military. However, the Army 

was the only service that had this practice in effect for servicemembers who returned from 

deployment between January 1, 2007, and May 31, 2008. If the servicemembers in our 

population separated prior to or during the reassessment period, they may not have been 

required to fill out the questionnaire. Because we do not know the extent to which 

servicemembers in our population separated before or during the reassessment period, we 

include separated servicemembers in our analysis as part of the military service and 

component with which they were affiliated at the end of their deployment. 

Page 28 GAO-10-56 PDHRA Administration
Appendix I: Scope and Methodology 

DMDC officials identified this population for us using servicemembers’ 

deployment dates and locations. If a servicemember had multiple 

deployments during this period, we received data on a servicemember’s 

most recent return from deployment during this time period. Although 

DOD initiated the PDHRA program in March 2005, the military services 

implemented the program at different times, with full implementation 

across all services in late 2006. In addition, servicemembers are not 

eligible to fill out a PDHRA questionnaire until 90 to 180 days after they 

have returned from deployment. Thus, when we requested data from 

DMDC in late fall 2008, we needed to focus on a population of 

servicemembers who had returned from deployment at least 180 days 

prior to our data request. Therefore, we focused our analysis on 

servicemembers who returned from deployment on or after January 1, 

2007, and on or before May 31, 2008. As a secondary check that this 

population of interest had, in fact, deployed, we sent our population of 

interest to AFHSC officials, who compared our population to two other 

deployment rosters. The results of this match identified our final 

population of interest of approximately 319,000 servicemembers. 

AFHSC’s DMSS is DOD’s central repository for PDHRA questionnaires and 

the military services are required to submit questionnaires to this central 

repository. To determine the extent to which servicemembers in our 

population of interest had PDHRA questionnaires in DOD’s central 

repository, we sent personal identifying information and beginning and 

end deployment dates from CTS for the servicemembers in our population 

of interest to AFHSC. AFHSC officials matched our population of interest 

to the PDHRA questionnaires in DMSS using a servicemember’s personal 

identifying information and the beginning and end deployment dates as 

recorded in CTS and as reported by the servicemember on the PDHRA 

questionnaire.5

 AFHSC officials then sent us data from identified 

questionnaires that had been incorporated into DMSS as of April 15, 2009. 

As the military services collect PDHRA questionnaires in their own 

databases before transmitting them to AFHSC’s DMSS, we then asked 

officials from the military services to query their own databases to identify 

PDHRA questionnaires for servicemembers in our population of interest 

for which a PDHRA questionnaire could not be identified in DMSS. We 

 

5

We considered servicemembers to have a PDHRA questionnaire if one could be identified 

in DOD’s central repository, regardless of whether servicemembers filled out the entire 

questionnaire or only the demographic section. 

Page 29 GAO-10-56 PDHRA Administration
Appendix I: Scope and Methodology 

provided the military services with a servicemember’s personal identifying 

information and deployment end date from CTS and asked them to query 

their databases for any questionnaires that they would consider to be 

ready to transmit to AFHSC that were filled out after the deployment end 

date listed in CTS. The military services then queried their own databases 

and, for each servicemember that we sent to them for which they could 

identify a PDHRA questionnaire, returned to us the end deployment date 

listed on the PDHRA questionnaire and date of questionnaire completion. 

If a servicemember filled out multiple PDHRA questionnaires after the 

deployment end date listed in CTS, we received information from each of 

these questionnaires. We received these data from the military services in 

late May and June 2009. We then matched our population of interest to the 

information from the PDHRA questionnaires received from the military 

services’ databases using a servicemember’s personal identifying 

information and the end deployment date as recorded in CTS and as 

reported by the servicemember on the PDHRA questionnaire. 

Finally, in September 2009, we obtained additional data from AFHSC to 

update our April 2009 data. AFHSC officials matched information from the 

servicemembers in our population of interest without a questionnaire in 

DMSS as of April 15, 2009, to the PDHRA questionnaires in DMSS as of 

September 4, 2009, using a servicemember’s personal identifying 

information and the beginning and end deployment dates as recorded in 

CTS and as reported by the servicemember on the PDHRA questionnaire. 

AFHSC officials then sent us data from identified questionnaires that had 

been incorporated into DMSS as of September 4, 2009. 

We conducted data reliability assessments for each DOD and military 

service data source we used by reviewing related documentation, 

interviewing knowledgeable agency officials, and performing electronic 

data testing for missing data, outliers, and obvious errors. We determined 

that these data sources were sufficiently reliable for our purposes. We 

determined only the extent to which questionnaires could be identified in 

AFHSC’s DMSS or the military services databases for our population of 

interest, and not the extent to which the servicemembers actually filled 

out a PDHRA questionnaire. 

We interviewed officials from DMDC and AFHSC, the DOD deployment 

health quality assurance program, and Army, Air Force, Navy, and Marine 

Corps officials involved in the collection and transfer of PDHRA 

questionnaires from the military services’ databases to AFHSC. We also 

reviewed DOD policies, as well as those of the Army, Air Force, Navy, and 

Marine Corps, for submitting PDHRA questionnaires to DOD’s central 

Page 30 GAO-10-56 PDHRA Administration
Appendix I: Scope and Methodology 

repository. Finally, we reviewed our prior work on DOD’s deployment 

health quality assurance program. 

To determine how DOD monitors the administration of the PDHRA to 

Reserve component servicemembers, we reviewed DOD’s policies for 

monitoring its contract with Logistics Health, Inc. (LHI), the contractor 

that administers the PDHRA to Reserve component servicemembers. We 

also interviewed officials with DOD’s Reserve Health Readiness Program 

(RHRP)—the DOD office responsible for monitoring LHI—along with 

military service officials responsible for managing the administration of 

the PDHRA to Reserve component servicemembers. We reviewed DOD’s 

contract with LHI and obtained and analyzed contractually required 

reports and other documentation on LHI’s performance related to the 

PDHRA portion of DOD’s contract with LHI.6

 We visited LHI’s 

headquarters in La Crosse, Wisconsin, where we interviewed LHI staff to 

confirm our understanding of how LHI staff administers the PDHRA to 

Reserve component servicemembers. We additionally interviewed officials 

with the U.S. Army Medical Research Acquisition Activity, which provides 

support to DOD for the contract with LHI. We reviewed DOD’s monitoring 

of the administration of the PDHRA to Reserve component 

servicemembers to determine the extent to which these monitoring efforts 

met or were consistent with GAO’s Standards for Internal Control in the 

Federal Government.

7

 Internal controls include components of an 

organization’s management that provide reasonable assurance that 

program objectives are being achieved.8

 

6

DOD’s contract with LHI also includes the provision of other health services for Reserve 

component servicemembers, such as immunizations, physical examinations, and dental 

examinations and X-rays. 

7

See GAO, Standards for Internal Control in the Federal Government, GAO/AIMD-00-21.3.1

(Washington, D.C.: November 1999). We used the criteria in these standards, which provide 

the overall framework for establishing and maintaining internal control in the federal 

government. We reviewed the consistency of DOD’s monitoring with a subset of these 

internal control standards, the monitoring and control activities standards. 

8

In order to assess how DOD ensures that program objectives are being met, we reviewed 

how DOD monitors LHI’s administration of the PDHRA to Reserve component 

servicemembers. We did not evaluate the sufficiency or appropriateness of the methods 

used by DOD to monitor LHI’s compliance with the terms of the contract. 

Page 31 GAO-10-56 PDHRA Administration
Appendix I: Scope and Methodology 

The RHRP office receives contractually required reports from LHI on its 

administration of the PDHRA and we obtained and reviewed monthly 

reports from May 2008 through April 2009 for the following four required 

reports: (1) the PDHRA monthly activity report, (2) the call center access 

report, (3) the data entry report, and (4) the PDHRA customer satisfaction 

survey report. We selected the PDHRA monthly activity and the call center 

access reports to review because the RHRP office told us that these 

reports provide information that is needed to monitor LHI’s activities in 

administering the PDHRA to Reserve component servicemembers. The 

PDHRA monthly activity report provides aggregate information on LHI’s 

PDHRA administration, such as the number of Reserve component 

servicemembers administered the PDHRA, referred for a further 

evaluation, and contacted by LHI 30 days after receiving referrals. The call 

center access report provides information on LHI’s performance in 

operating its call center. In addition, we selected the data entry and 

PDHRA customer satisfaction survey reports to review because both 

reports provide information on performance standards associated with the 

PDHRA that LHI must meet to comply with the contract. The data entry 

report provides information on LHI’s performance in entering PDHRA data 

into military services’ databases, and the PDHRA customer satisfaction 

survey report provides information on whether LHI meets a performance 

standard associated with servicemember feedback on LHI’s administration 

of the PDHRA. We also reviewed the documentation associated with the 

RHRP office’s inspections of LHI’s administration of the PDHRA from 

October 1, 2007, through May 6, 2009. We reviewed a list, provided by the 

RHRP office, of the feedback received from military service officials 

between January 1, 2008, and April 30, 2009. 

To obtain more in-depth information on how DOD documents the 

information it obtains through its monitoring efforts, we examined 

documentation maintained by the RHRP office on its monitoring. 

Specifically, we reviewed the RHRP office’s agendas from the weekly 

telephone discussions with LHI staff and the office’s e-mail 

correspondence, which the RHRP office uses to document its monitoring. 

We reviewed approximately 70 of the RHRP office’s agendas for the period 

between October 1, 2007, and May 11, 2009. From the agendas and the 

provided list of military service feedback, we judgmentally selected 15 

potential problems to review in further detail and asked the RHRP office 

to provide us with all of the documentation available on these problems, 

including any e-mail correspondence that related to the problem. We 

selected these 15 potential problems because the subject of each of these 

may have involved welfare and safety concerns for Reserve component 

servicemembers. The RHRP office provided us with e-mail 

Page 32 GAO-10-56 PDHRA Administration
Appendix I: Scope and Methodology 

correspondence dated between March 4, 2008, and May 19, 2009, related to 

the 15 potential problems. We reviewed the agendas and the available email correspondence for the 15 selected problems to determine the actions 

taken to resolve the problems and how this information is documented 

and maintained. Our findings related to the documentation of the 15 

potential problems are for illustrative purposes only and are not 

generalizable to other RHRP office documentation. 

We conducted this performance audit from October 2008 to October 2009 

in accordance with generally accepted government auditing standards. 

Those standards require that we plan and perform the audit to obtain 

sufficient, appropriate evidence to provide a reasonable basis for our 

findings and conclusions based on our audit objectives. We believe that 

the evidence obtained provides a reasonable basis for our findings and 

conclusions based on our audit objectives. 

Page 33 GAO-10-56 PDHRA Administration
Appendix II: Sample Post-Deployment Health Reassessment Appendix II: Sample Post-Deployment Health Questionnaire (DD 2900), January 2008 

Reassessment Questionnaire (DD 2900), 

January 2008 

Servicemembers fill out the post-deployment health reassessment (PDHRA) 

questionnaire electronically on form DD 2900, which was originally issued in June 

2005. The Department of Defense (DOD) issued a revised form DD 2900 in January 

2008. 

Page 34 GAO-10-56 PDHRA Administration 
Appendix II: Sample Post-Deployment Health Reassessment 

Questionnaire (DD 2900), January 2008 

Page 35 GAO-10-56 PDHRA Administration
Appendix II: Sample Post-Deployment Health Reassessment 

Questionnaire (DD 2900), January 2008 

Page 36 GAO-10-56 PDHRA Administration
Appendix II: Sample Post-Deployment Health Reassessment 

Questionnaire (DD 2900), January 2008 

Page 37 GAO-10-56 PDHRA Administration
Appendix II: Sample Post-Deployment Health Reassessment 

Questionnaire (DD 2900), January 2008 

Page 38 GAO-10-56 PDHRA Administration
Appendix II: Sample Post-Deployment Health Reassessment 

Questionnaire (DD 2900), January 2008 

Source: DOD.

Page 39 GAO-10-56 PDHRA Administration
Appendix III: Post-Deployment Health Reassessment 

Questionnaires in DOD’s Central Repository and Services’ Appendix III: Post-Deployment Health Databases 

Reassessment Questionnaires in DOD’s 

Central Repository and Services’ Databases 

Department of Defense (DOD) policy requires that the military services electronically 

submit post-deployment health reassessment (PDHRA) questionnaires to DOD’s 

central repository, which DOD uses as a key source of health surveillance 

information. We queried DOD’s central repository on two occasions—April 2009 and 

September 2009. On April 15, 2009, we found that for approximately 23 percent of the 

roughly 319,000 servicemembers1

 who, according to DOD deployment data, returned 

from deployment to Iraq or Afghanistan between January 1, 2007, and May 31, 2008, 

we could not identify questionnaires in the central repository (see table 2). 

 

1

While the majority of servicemembers in our population of interest were required to fill out the 

questionnaire, our population includes about 19,000 servicemembers who, according to DOD Defense 

Manpower Data Center (DMDC) data, had separated from military service between January 1, 2007, and 

May 31, 2008. Although DOD initially required the military services to contact servicemembers who 

separated before or during the reassessment period to offer them the opportunity to fill out the PDHRA 

questionnaire, implementation of this policy posed challenges. Once servicemembers have separated 

from military service, they cannot be required to fill out the PDHRA questionnaire. Instead, the military 

services implemented, or plan to implement, policies to administer the PDHRA to servicemembers as 

part of the separation process from the military. However, the Army was the only service that had this 

practice in effect for servicemembers who returned from deployment between January 1, 2007, and May 

31, 2008. If the 19,000 servicemembers in our population separated prior to or during the reassessment 

period, they may not have been required to fill out the questionnaire. Because we do not know the extent 

to which these 19,000 servicemembers in our population of interest separated before or during the 

reassessment period, we include separated servicemembers in our analysis as part of the military service 

and component with which they were affiliated at the end of their deployment. If we had excluded these 

separated servicemembers from our analysis, as of April 15, 2009, DOD’s central repository would have 

been missing PDHRA questionnaires for 22 percent of servicemembers in our population of interest, 

rather than 23 percent. 

Page 40 GAO-10-56 PDHRA Administration 
Appendix III: Post-Deployment Health Reassessment 

Questionnaires in DOD’s Central Repository and Services’ 

Databases 

Table 2: Servicemembers Who Returned from Deployment to Iraq or Afghanistan Between 

January 1, 2007, and May 31, 2008, without a PDHRA Questionnaire in DOD’s Central 

Repository, as of April 15, 2009 

Military service Component 

Number of 

returning 

servicemembers 

Number of 

servicemembers 

without PDHRA 

questionnaire in 

central repository 

Percentage of 

servicemembers 

without PDHRA 

questionnaire in 

central repository 

Army Active component 132,247 28,572 21.61

National Guard 38,231 6,083 15.91

Reserve 15,817 2,734 17.29

Total 186,295 37,389 20.07

Air Force Active component 39,792 5,622 14.13

National Guard 8,583 842 9.81

Reserve 3,341 2,024 60.58

Total 51,716 8,488 16.41

Navy Active component 10,412 4,968 47.71

Reserve 2,983 1,066 35.74

Total 13,395 6,034 45.05

Marine Corps Active component 61,006 20,203 33.12

Reserve 6,644 2,044 30.76

Total 67,650 22,247 32.89

Total Active component 243,457 59,365 24.38

Reserve component 75,599 14,793 19.57

Grand total 319,056 74,158 23.24

Source: GAO analysis of DOD data. 

Notes: This table displays information on servicemembers without a PDHRA questionnaire in DOD’s central 

repository for a servicemember’s most recent return from deployment from Iraq or Afghanistan between January 1, 

2007, and May 31, 2008. We did not examine the extent to which a servicemember filled out a questionnaire for each 

return from deployment during this time period. DOD’s Reserve components include servicemembers in the Army 

and Air National Guard, as well as the Army, Air Force, Navy, and Marine Corps Reserve. 

Page 41 GAO-10-56 PDHRA Administration
Appendix III: Post-Deployment Health Reassessment 

Questionnaires in DOD’s Central Repository and Services’ 

Databases 

After determining that about 74,000 servicemembers in our population of interest did 

not have questionnaires in DOD’s central repository based on our first query, we 

asked the military services whether these servicemembers had PDHRA 

questionnaires that could be identified in the services’ own databases.2

 With the help 

of the services, we found that approximately 7,000 servicemembers had 

questionnaires in their respective military services’ databases, but not in DOD’s 

central repository (see table 3).3

 On our second query of the central repository, which 

occurred on September 4, 2009, questionnaires for about 1,000 of these 7,000 

servicemembers were in the central repository. 

 

2

We received data in May 2009 from the Air Force, and in June 2009 from the Army and Navy. As the 

Navy manages post-deployment health reassessment data for the Marine Corps, the Navy data also 

included data for Marine Corps servicemembers. 

3

The roughly 7,000 questionnaires found in the military services’ databases, but not in the central 

repository, were filled out prior to April 15, 2009—the date we first queried DOD’s central repository. 

Page 42 GAO-10-56 PDHRA Administration
Appendix III: Post-Deployment Health Reassessment 

Questionnaires in DOD’s Central Repository and Services’ 

Databases 

Table 3: Number of Servicemembers Who Returned from Deployment to Iraq or Afghanistan 

between January 1, 2007, and May 31, 2008, with a PDHRA Questionnaire in Military Services’ 

Databases That Was Not in DOD’s Central Repository as of April 15, 2009, and Number of These 

Servicemembers with Questionnaire in Central Repository, as of September 4, 2009 

Military service Component 

Number of 

servicemembers 

with PDHRA 

questionnaire in military 

services’ database 

Number of these 

servicemembers with 

questionnaire in central 

repository as of 

September 4, 2009

Army Active component 2,389 646

National Guard 198 9

Reserve 89 6

Total 2,676 661

Air Force Active component 281 3

National Guard 70 0

Reserve 3 0

Total 354 3

Navy Active component 284 8

Reserve 71 9

Total 355 17

Marine Corps Active component 2,938 380

Reserve 300 47

Total 3,238 427

Total Active component 5,892 1,037

Reserve component 731 71

Grand total 6,623 1,108

Source: GAO analysis of DOD and military services’ data. 

Notes: DOD’s Reserve components include servicemembers in the Army and Air National Guard, as well as the 

Army, Air Force, Navy, and Marine Corps Reserve. 

Page 43 GAO-10-56 PDHRA Administration
Appendix IV: DOD’s Documentation of Its Monitoring of the 

Administration of the Post-Deployment Health Appendix IV: DOD’s Documentation of Its Reassessment 

Monitoring of the Administration of the PostDeployment Health Reassessment 

The Department of Defense (DOD) contracts with Logistics Health, Inc. (LHI) to 

administer the post-deployment health reassessment (PDHRA) to Reserve component 

servicemembers.1

 DOD’s Reserve Health Readiness Program (RHRP) is responsible 

for monitoring LHI’s administration of the PDHRA. To obtain more in-depth 

information on how the RHRP office documents the information it obtains through its 

monitoring of the administration of the PDHRA to Reserve component 

servicemembers, we examined documentation maintained by the RHRP office on its 

monitoring efforts. Specifically, from the potential problems that the RHRP office had 

identified as possibly posing a risk to the objective of PDHRA program, we 

judgmentally selected 15 to review in detail and obtained all available RHRP 

documentation from the RHRP office on those problems. We selected these 15 

potential problems because the subject of each of these may have involved welfare 

and safety concerns for Reserve component servicemembers. 

We reviewed RHRP’s documentation to determine the extent to which RHRP 

maintains documentation in a manner consistent with GAO’s federal internal control 

standards.2

 In particular, we examined the extent to which RHRP’s documentation 

clearly documented any actions taken to address a problem and indicated whether 

the problem had been resolved. In general, the selected RHRP documentation we 

reviewed did not meet these standards. Nine of the 15 selected potential problems 

lacked documentation on the actions taken to address the problems and/or lacked 

documentation of the problems’ resolutions. Four of the 15 problems had 

documentation of the actions taken and their resolutions, however, RHRP’s 

documentation was not sufficiently clear to allow us to independently understand 

what actions had been taken to address the problem or the problems’ resolutions. 

Rather, an RHRP official had to explain to us what had occurred. Two of the 15 

problems had documentation that allowed us to understand the actions taken to 

address the problems and the problems’ resolutions. Table 4 summarizes the results 

of our analysis of RHRP’s documentation. 

 

1

The Department of Defense’s (DOD) Reserve components include servicemembers in the Army and Air 

National Guard, as well as the Army, Air Force, Navy, and Marine Corps Reserves. 

2

See GAO, Standards for Internal Control in the Federal Government, GAO/AIMD-00-21.3.1

(Washington, D.C.: November 1999). We used the criteria in these standards, which provide the overall 

framework for establishing and maintaining internal control in the federal government. We reviewed the 

consistency of DOD’s monitoring with a subset of these internal control standards, the monitoring and 

control activities standards. 

Page 44 GAO-10-56 PDHRA Administration 
Appendix IV: DOD’s Documentation of Its Monitoring of the 

Administration of the Post-Deployment Health 

Reassessment 

Table 4: Fifteen Selected Potential Problems Related to the Administration of the PDHRA to 

Reserve Component Servicemembers, Identified by the DOD RHRP Office 

Potential problems identified by the RHRP office GAO analysis of RHRP documentation 

1. An LHI health care provider insufficiently 

documented the nature of a servicemember’s 

suicidal ideations on the PDHRA questionnaire.a

For these potential problems, 

documentation was lacking on the actions 

taken to address the problem and/or the 

problem’s resolution. 

2. Reserve component servicemembers may not 

have been responding to questions on the PDHRA 

questionnaire about their alcohol consumption and 

whether they were depressed. 

3. An LHI report may have contained inaccurate data.

4. LHI staff had difficulties contacting Reserve 

component servicemembers in following up on 

those who received medical referrals. 

5. A higher than normal percentage of 

servicemembers were referred for a further 

evaluation. 

6. Reserve component servicemembers may have 

had difficulty accessing the PDHRA call center. 

7. Reserve component servicemembers may have 

been told by a military service official not to answer 

questions in the medical section of the PDHRA 

questionnaire. 

8. Reserve component servicemembers may have 

been refusing to speak with a health care provider 

and refusing to answer specific questions on the 

PDHRA questionnaire. 

9. A Reserve component servicemember calling 

LHI’s call center to be administered the PDHRA 

was initially denied LHI PDHRA services. 

10. Reserve component servicemembers calling LHI’s 

call center to be administered the PDHRA may 

have been denied LHI PDHRA services and not 

administered the PDHRA. 

For these potential problems, the RHRP 

office had some available documentation, 

but this documentation was not sufficiently 

clear to allow us to independently 

determine the actions taken to address 

each problem and to determine the ultimate 

resolution of each problem. 

11. Servicemembers who should not have been called 

by LHI may have been inappropriately called by 

LHI. 

12. A PDHRA event may have lacked sufficient staff. 

13. Health care providers may not have been 

documenting needed referrals for further 

evaluations when servicemembers declined the 

referrals. 

Page 45 GAO-10-56 PDHRA Administration
Appendix IV: DOD’s Documentation of Its Monitoring of the 

Administration of the Post-Deployment Health 

Reassessment 

Potential problems identified by the RHRP office GAO analysis of RHRP documentation 

14. Reserve component servicemembers screened 

through the LHI call center were not receiving the 

same informational brochures as servicemembers 

administered the PDHRA at PDHRA on-site 

events. 

For these potential problems, the RHRP 

office had documentation of the actions 

taken to address each problem and the 

problem’s resolution. 

15. Reserve component servicemembers did not know 

what to do to set up an appointment for a further 

evaluation. 

Source: GAO. 

a

Suicidal ideations are thoughts of harming or killing oneself, the severity of which can be determined by an 

assessment of these thoughts. 

Page 46 GAO-10-56 PDHRA Administration
Appendix V: Comments from the Department Appendix V: Comments from the Department of Defense 

of Defense 

Page 47 GAO-10-56 PDHRA Administration 
Appendix V: Comments from the Department 

of Defense 

Page 48 GAO-10-56 PDHRA Administration
Appendix V: Comments from the Department 

of Defense 

Page 49 GAO-10-56 PDHRA Administration
Appendix VI: GAO Contact and Staff Acknowledgments 

Page 50 GAO-10-56 

Appendix VI: GAO Contact and Staff 

Acknowledgments 

GAO Contact Randall B. Williamson, (202) 512-7114, williamsonr@gao.gov 

In addition to the contact named above, Mary Ann Curran, Assistant 

Director; Katherine L. Amoroso; Helen T. Desaulniers; Michael Erhardt; 

Martha A. Fisher; Krister Friday; Martha Kelly; Carolyn Kirby; Carolina 

Morgan; Lisa A. Motley; Julie E. Pekowski; William Woods; and Suzanne 

Worth made key contributions to this report. 

Staff 

Acknowledgments 

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(290734) Page 52 GAO-10-56 PDHRA Administration
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