DOD Civilian Personnel: Greater Oversight and Quality Assurance Needed to Ensure Force Health Protection and Surveillance for Those Deployed
Published: 2006-09-29T00:00:00

Fast Facts:

Highlights:
section_title: Why GAO Did This Study
paragraphs: As the Department of Defense (DOD) has expanded its involvement in overseas military operations, it has grown increasingly reliant on its federal civilian workforce to support contingency operations. The Senate Armed Services Committee required GAO to examine DOD's policies concerning the health care for DOD civilians who deploy in support of contingency operations in Afghanistan and Iraq. GAO analyzed over 3,400 deployment-related records for deployed federal civilians and interviewed department officials to determine the extent to which DOD has established and the military services and defense agencies (hereafter referred to as DOD components) have implemented (1) force health protection and surveillance policies and (2) medical treatment policies and procedures for its deployed federal civilians. GAO also examined the differences in special pays and benefits provided to DOD's deployed federal civilians and military personnel.
section_title: What GAO Found
paragraphs: DOD has established force health protection and surveillance policies to assess and reduce or prevent health risks for its deployed federal civilian personnel, but it lacks procedures to ensure implementation. Our review of over 3,400 deployment records at eight component locations found that components lacked documentation that some federal civilian personnel who deployed to Afghanistan and Iraq had received, among other things, required pre- and post-deployment health assessments and immunizations. These deficiencies were most prevalent at Air Force and Navy locations, and one Army location. As a larger issue, DOD lacked complete and centralized data to readily identify its deployed federal civilians and their movement in theater, further hindering its efforts to assess the overall effectiveness of its force health protection and surveillance capabilities. In August 2006, DOD issued a revised policy which outlined procedures that are intended to address these shortcomings. However, these procedures are not comprehensive enough to ensure that DOD will know the extent to which its components are complying with existing health protection requirements. In particular, the procedures do not establish an oversight and quality assurance mechanism for assessing the implementation of its force health protection and surveillance requirements. Until DOD establishes a mechanism to strengthen its force health protection and surveillance oversight, it will not be effectively positioned to ensure compliance with its policies, or the health care and protection of deployed federal civilians. DOD has also established medical treatment policies for its deployed federal civilians which provide those who require treatment for injuries or diseases sustained during overseas hostilities with care that is equivalent in scope to that provided to active duty military personnel under the DOD military health system. GAO reviewed a sample of seven workers' compensation claims (out of a universe of 83) filed under the Federal Employees' Compensation Act by DOD federal civilians who deployed to Iraq. GAO found in three cases where care was initiated in theater, that the affected civilians had received treatment in accordance with DOD's policies. In all seven cases, DOD federal civilians who requested care after returning to the United States had, in accordance with DOD's policies, received medical examinations and/or treatment for their deployment-related injuries or diseases through either military or civilian treatment facilities. DOD provides certain special pays and benefits to its deployed federal civilians, which generally differ in type and/or amount from those provided to deployed military personnel. For example, both civilian and military personnel are eligible to receive disability benefits for deployment-related injuries; however, the type and amount of these benefits vary, and some are unique to each group. Further, while the survivors of deceased federal civilian and military personnel generally receive similar types of cash survivor benefits, the comparative amounts of these benefits differ.

section_title: Letter
paragraphs: As the Department of Defense (DOD) has expanded its involvement in  overseas military operations, it has grown increasingly reliant on its  federal civilian workforce to provide support in times of war or national  emergency. In recent years, DOD has undertaken efforts to expand the  use of its civilian workforce to perform combat support functions  traditionally performed by military personnel. Since fiscal year 2004, it has  been in the process of converting thousands of military positions to  civilian positions, with additional conversions planned in the future.  DOD’s 2006 Quadrennial Defense Review Report has acknowledged the  department’s growing dependence on its civilian personnel to support  contingency operations beyond Afghanistan and Iraq.
However, DOD’s use of its civilian personnel to support military  operations has long raised questions about its policies relating to the  deployment of civilians in support of contingency operations. In 1994, we  reported on the adequacy of DOD’s planning for the future use of civilian  personnel to support military operations in combat areas and noted a  number of problems in deploying civilians to the Gulf War and caring for  them in theater. For example, we noted that many civilians had not been  screened to ensure that they were medically fit to serve in desert  conditions. Thus, some had arrived in the desert with medical and physical  limitations, such as severe heart problems and kidney disorders that  precluded them from effectively performing their duties. Other problems,  while not as grave, indicated a lack of preparation for civilians in theater.  For example, clear procedures did not exist to ensure that civilians  received medical care comparable to that received by military personnel.  In addition, procedures were not in place to provide for overtime or  danger pay that the deployed civilians were eligible to receive. Questions  had also existed concerning whether civilian life insurance policies  contained war exclusion clauses that would preclude survivors of  deceased civilian personnel from receiving accidental death benefits if  civilians were killed while deployed in support of the Gulf War.
The Senate Armed Services Committee required us to examine DOD’s  policies concerning its federal civilians who deploy in support of  contingency operations in Afghanistan and Iraq. In accordance with that  requirement and agreements with your offices, we examined the extent to  which DOD has established and the military services and one defense  agency (hereafter referred to as DOD components) have implemented   (1) force health protection and surveillance policies for the department’s  deployed federal civilians and (2) medical treatment policies and  procedures for the department’s deployed federal civilians who require  treatment for injuries and diseases. In addition, per your request, we  examined the special pays and benefits provided to DOD’s deployed  federal civilian personnel, including the extent to which these special pays  and benefits differ from those provided to deployed active duty military  personnel. We provided briefings on the preliminary results of our work to  congressional committees in March 2006. This report updates our  preliminary observations and provides further information regarding DOD  federal civilian deployments to Afghanistan and Iraq.
To determine the extent to which DOD has established force health  protection and surveillance policies for its deployed federal civilians, we  reviewed DOD deployment health requirements for contingency  operations in Afghanistan and Iraq and discussed these policies with the  appropriate DOD officials. Our review focused on DOD federal civilians  who (1) deployed to Afghanistan or Iraq for 30 continuous days or more  between June 1, 2003, and September 30, 2005, and (2) returned to the  United States by February 28, 2006. Because DOD had difficulty  identifying the total number of federal civilians who had deployed to  Afghanistan or Iraq, we assessed the implementation of DOD’s deployment  health requirements at eight component locations that were selected using  a number of approaches. Given that DOD components have flexibility in  where they conduct deployment processing, we selected the locations for  our review accordingly. Specifically, the Army uses a centralized  approach, deploying its federal civilians at three primary locations;  therefore, we selected all three locations for review. By contrast, the Navy  and Air Force use a decentralized approach, deploying their federal  civilians at their home stations. For these components, we selected five  locations based on data which indicated that these locations had deployed  the largest numbers of federal civilian personnel to Afghanistan and Iraq.  Through an informal agreement between DCMA and Army, the Army  processes DCMA’s federal civilians for deployment through two of the  Army’s three deployment locations. Therefore, DCMA deployment data in  this report are included in the Army results to the extent that DCMA  federal civilian deployments were documented at the two relevant Army  locations. At all eight component locations, we reviewed either all  available hard copy or electronic deployment records, or in one instance, a  sample of the deployment records for deployed federal civilian personnel  who met our criteria above. In total, we reviewed hard copies of records  for 454 (out of the reported 822) federal civilian deployments at seven  component locations and electronic records for 2,977 (out of the reported  2,977) federal civilian deployments at the other location where all  deployment records were being maintained electronically. Deployed  federal civilians included in our review may have deployed more than once  during our selected deployment time frame; consequently, there may be  fewer unique civilians than deployments reviewed. The results of these  deployment record reviews, however, could not be projected beyond the  reviewed records to all federal civilians who had deployed during this time  frame. To facilitate our review of federal civilian deployment records at  the selected component locations, we developed a data collection  instrument to review and collect deployment health information from each  individual civilian’s deployment record. After our review of hard copy  deployment records, we requested each component’s medical personnel to  reexamine those hard copy deployment records that were missing  required health documentation, and we adjusted our results where  documentation was subsequently provided. We also obtained and analyzed  other documentation from information systems used by the components  to capture deployment and related health information, making  adjustments to our results where documentation was subsequently found  in the systems. We took steps to assess the reliability of the civilian  deployment and related health data for the purposes of this review,  including consideration of issues such as the completeness of the data  from the respective information systems’ program managers and  administrators. We also examined whether the data were subjected to  quality control measures, such as periodic testing of the data against  deployment records to ensure the accuracy and completeness of the data.  In addition, we reviewed existing documentation related to the data  sources and interviewed knowledgeable agency officials about the data.  Although we found these deployment and health data not sufficiently  reliable for (1) identifying the universe of deployed DOD federal civilians  or (2) use as the sole source for reviewing the health and immunization  information for DOD federal civilian deployments, we found the data in  the information systems sufficiently reliable when used as one of several  sources in our review of deployment records. In those instances where we  did not find evidence of a deployment health assessment or immunization  in either the deployment records or in the electronic data systems, we  concluded that the health assessment or immunization was not  documented.
To determine the extent to which DOD and the selected components had  established medical treatment policies for deployed federal civilian  personnel who required treatment for injuries, illnesses, and diseases, we  analyzed DOD policies and guidance related to defense health care and  discussed these with senior DOD and service surgeon general officials. To  assess the implementation of the policies, we requested all of the workers’  compensation claims that had been filed under the Federal Employees’  Compensation Act by DOD federal civilians who had deployed to  Afghanistan and Iraq. However, our actual review of claims filed by DOD  federal civilian personnel was limited to those who had deployed to Iraq  because the responsible DOD officials were unable to identify the specific  claims that had been filed by those federal civilians who had deployed to  Afghanistan. We selected and reviewed a non-probability sample of  workers’ compensation claims to reflect a range of casualties, including  injuries, physical and mental illnesses, and diseases. The scope of our  review did not extend to the Department of Labor’s claims review process,  which covers the workers’ compensation claims process.
To determine the types of and differences in special pays and benefits  provided to DOD federal civilian and military personnel who deploy in  support of contingency operations in Afghanistan and Iraq, we examined  the major provisions for special pays and disability and death benefits for  civilian and military personnel, relying primarily on statutes, Department  of State regulations, and DOD guidance. To illustrate how special pays  affected overall compensation provided to DOD federal civilian and  military personnel, we modeled scenarios for both groups based on similar  circumstances, such as pay grades, length of deployment, and special pays.  With regard to disability benefits, we compared benefits provided to DOD  federal civilians for line-of-duty injuries with benefits provided to military  personnel for service-connected injuries, focusing on three main  categories of disability: (1) temporary disability, (2) permanent partial  disability, and (3) permanent total disability. With regard to death benefits,  we primarily reviewed statutes governing both cash and noncash  government-provided benefits. In this report, we do not take a position  regarding the adequacy or appropriateness of the special pays and benefits  provided to DOD federal civilian and military personnel.
We performed our review from March 2006 through August 2006 in  accordance with generally accepted government auditing standards. For  more detailed information on our scope and methodology, see appendix I.
subsections: section_title: Background
paragraphs: The structure of the armed forces is based on the Total Force concept,  which recognizes that all elements of the structure—active duty military  personnel, reservists, defense contractors, host nation military and civilian  personnel, and DOD federal civilian employees—contribute to national  defense. In recent years, federal civilian personnel have deployed along  with military personnel to participate in Operations Joint Endeavor,  conducted in the countries of Bosnia-Herzegovina, Croatia, and Hungary;  Joint Guardian, in Kosovo; and Desert Storm, in Southwest Asia. Further,  since the beginning of the Global War on Terrorism, the role of DOD’s  federal civilian personnel has expanded to include participation in combat  support functions in Operations Enduring Freedom and Iraqi Freedom.
DOD relies on the federal civilian personnel it deploys to support a range  of essential missions, including intelligence collection, criminal  investigations, and weapon systems acquisition and maintenance. To  ensure that its federal civilian employees will deploy to combat zones and  perform critical combat support functions in theater, DOD established the  emergency-essential program in 1985. Under this program, DOD  designates as “emergency-essential” those civilian employees whose  positions are required to ensure the success of combat operations or the  availability of combat-essential systems. DOD can deploy federal civilian  employees either on a voluntary or involuntary basis to accomplish the  DOD mission.
section_title: DOD Has Established Force Health Protection and Surveillance Policies for Deployed Federal Civilians, but Should Do More to Ensure That Components Comply with Its Requirements
paragraphs: DOD has established force health protection and surveillance policies  aimed at assessing and reducing or preventing health risks for its deployed  federal civilian personnel; however, the department lacks procedures to  ensure the components’ full implementation of its policies. In reviewing  DOD federal civilian deployment records and other electronic  documentation at selected component locations, we found that these  components lacked documentation to show that they had fully complied  with DOD’s force health protection and surveillance policy requirements  for some federal civilian personnel who deployed to Afghanistan and Iraq.  As a larger issue, DOD’s policies did not require the centralized collection  of data on the identity of its deployed civilians, their movements in theater,  or their health status, further hindering its efforts to assess the overall  effectiveness of its force health protection and surveillance capabilities. In  August 2006, DOD issued a revised policy (to be effective in December  2006) that outlines procedures to address its lack of centralized  deployment and health-related data. However, the procedures are not  comprehensive enough to ensure that DOD will be sufficiently informed of  the extent to which its components fully comply with its requirements to  monitor the health of deployed federal civilians.
subsections: section_title: DOD Components Did Not Always Implement All Force Health Protection and Surveillance Requirements
paragraphs: The DOD components included in our review lacked documentation to  show that they always implemented force health protection and  surveillance requirements for deployed federal civilians. These  requirements include completing (1) pre-deployment health assessments  to ensure that only medically fit personnel deploy outside of the United  States as part of a contingency or combat operation; (2) pre-deployment  immunizations to address possible health threats in deployment locations;  (3) pre-deployment medical screenings for tuberculosis and human  immunodeficiency virus (HIV); and (4) post-deployment health  assessments to document current health status, experiences,  environmental exposures, and health concerns related to their work while  deployed.
DOD’s force health protection and surveillance policies require the  components to assess the medical condition of federal civilians to ensure  that only medically fit personnel deploy outside of the United States as  part of a contingency or combat operation. The policies stipulate that all  deploying civilian personnel are to complete pre-deployment health  assessment forms within 30 days of their deployments, and health care  providers are to review the assessments to confirm the civilians’ health  readiness status and identify any needs for additional clinical evaluations  prior to their deployments.
While the components that we included in our review had procedures in  place that would enable them to implement DOD’s pre-deployment health  assessment policies, it was not clear to what extent they had done so. Our  review of deployment records and other documentation at the selected  component locations found that these components lacked documentation  to show that some federal civilian personnel who deployed to Afghanistan  and Iraq had received the required pre-deployment health assessments.  For those deployed federal civilians in our review, we found that, overall, a  small number of deployment records (52 out of 3,771) were missing  documentation to show that they had received their pre-deployment health  assessments, as reflected in table 1.
As shown in table 1, the federal civilian deployment records we included  in our review showed wide variation by location regarding documentation  of pre-deployment health assessments, ranging from less than 1 percent to  more than 90 percent. On an aggregate component-level basis, at the Navy  location in our review, we found that documentation was missing for 19 of  the 52 records in our review. At the Air Force locations, documentation  was missing for 29 of the 37 records in our review. In contrast, all three  Army locations had hard copy or electronic records which indicated that  almost all of their federal deployed civilians had received pre-deployment  health assessments.
subsections: section_title: Pre-deployment Immunizations
paragraphs: In addition to completing pre-deployment health assessment forms, DOD’s  force health protection and surveillance policies stipulate that all DOD  deploying federal civilians receive theater-specific immunizations to  address possible health threats in deployment locations. Immunizations  required for all civilian personnel who deploy to Afghanistan and Iraq  include: hepatitis A (two-shot series); tetanus-diphtheria (within 10 years  of deployment); smallpox (within 5 years of deployment); typhoid; and  influenza (within the last 12 months of deployment).
As reflected in table 2, based on the deployment records maintained by the  components at locations included in our review, the overall number of  federal civilian deployment records lacking documentation of only one of  the required immunizations for deployment to Afghanistan and Iraq was  285 out of 3,771. However, 3,313 of the records we reviewed were missing  documentation of two or more immunizations.
At the Army’s Fort Bliss, our review of its electronic deployment data  determined that none of its deployed federal civilians had documentation  to show that they had received immunizations. Officials at this location  stated that they believed some immunizations had been given; however,  they could not provide documentation as evidence of this.
section_title: Pre-deployment Medical Screenings
paragraphs: DOD policies require deploying federal civilians to receive certain  screenings, such as for tuberculosis and HIV. Table 3 indicates that 55 of  the 3,771 federal civilian deployment records included in our review were  lacking documentation of the required tuberculosis screening; and  approximately 35 were lacking documentation of HIV screenings prior to  deployment.
DOD’s force health protection and surveillance policies also require  returning DOD federal civilian personnel to undergo post-deployment  health assessments to document current health status, experiences,  environmental exposures, and health concerns related to their work while  deployed. The post-deployment process begins within 5 days of civilians’  redeployment from the theater to their home or demobilization processing  stations. DOD’s policies require civilian personnel to complete a post- deployment assessment that includes questions on health and exposure  concerns. A health care provider is to review each assessment and  recommend additional clinical evaluation or treatment as needed.
As reflected in table 4, our review of deployment records at the selected  component locations found that these components lacked documentation  to show that most deployed federal civilians (3,525 out of 3,771) who  deployed to Afghanistan and Iraq had received the required post- deployment health assessments upon their return to the United States.  Federal civilian deployment records lacking evidence of post-deployment  health assessments ranged from 3 at the U.S. Army Corps of Engineers  Transatlantic Programs Center and Wright-Patterson Air Force Base,  respectively, to 2,977 at Fort Bliss.
section_title: Lack of Centralized Deployment Information Hinders the Overall Effectiveness of Force Health Protection and Surveillance for Deployed Federal Civilian Personnel
paragraphs: Beyond the aforementioned weaknesses found in the selected  components’ implementation of force health protection and surveillance  requirements for deploying federal civilians, as a larger issue, DOD lacks  comprehensive, centralized data that would enable it to readily identify its  deployed civilians, track their movements in theater, or monitor their  health status, further hindering efforts to assess the overall effectiveness  of its force health protection and surveillance capabilities. The Defense  Manpower Data Center (DMDC) is responsible for maintaining the  department’s centralized system that currently collects location-specific  deployment information for military servicemembers, such as grid  coordinates, latitude/longitude coordinates, or geographic location codes.  However, DOD has not taken steps to similarly maintain centralized data  on its deployed federal civilians. In addition, DOD had not provided  guidance that would require its components to track and report data on  the locations and movements of DOD federal civilian personnel in theaters  of operations. In the absence of such a requirement, each DOD component  collected and reported aggregated data that identified the total number of  DOD federal civilian personnel in a theater of operations, but each lacked  the ability to gather, analyze, and report information that could be used to  specifically identify individuals at risk for occupational and environmental  exposures during deployments.
In previously reporting on the military services’ implementation of DOD’s  force health protection and surveillance policies in 2003, we highlighted  the importance of knowing the identity of servicemembers who deployed  during a given operation and of tracking their movements within the  theater of operations as major elements of a military medical surveillance  system. We further noted the Institute of Medicine’s finding that  documentation on the location of units and individuals during a given  deployment is important for epidemiological studies and appropriate  medical care during and after deployments. For example, this information  allows epidemiologists to study the incidences of disease patterns across  populations of deployed servicemembers who may have been exposed to  diseases and hazards within the theater, and health care professionals to  treat their medical problems appropriately. Without location-specific  information for all of its deployed federal civilians and centralized data in  its department-level system, DOD limits its ability to ensure that sufficient  and appropriate consideration will also be given to addressing the health  care concerns of these individuals.
DOD also had not provided guidance to the components that would  require them to forward completed deployment health assessments for all  federal civilians to the Army Medical Surveillance Activity (AMSA), where  these assessments are suppose to be archived in the Defense Medical  Surveillance System (DMSS), integrated with other historical and current  data on personnel and deployments, and used to monitor the health of  personnel who participate in deployments. The overall success of  deployment force protection and surveillance efforts, in large measure,  depends on the completeness of health assessment data. The lack of such  data may hamper DOD’s ability to intervene in a timely manner to address  health care problems that may arise from DOD federal civilian  deployments to overseas locations in support of contingency operations.
section_title: DOD Has Taken Steps to Address Policy Shortcomings, but Lacks Mechanism to Oversee Components’ Compliance
paragraphs: With increases in the department’s use of federal civilian personnel to  support military operations, DOD officials have recognized the need for  more complete and centralized location-specific deployment information  and deployment-related health information on its deployed federal  civilians. In this regard, in August 2006, the Office of the Under Secretary  of Defense for Personnel and Readiness issued revised policy and program  guidance that generally addressed the shortcomings in DOD’s force health  protection and surveillance capabilities. The revised policy and guidance,  scheduled to become effective in December 2006, require the components  within 3 years, to electronically report (at least weekly) to DMDC,  location-specific data for all deployed personnel, including federal  civilians. In addition, the policy and guidance require the components to  submit all completed health assessment forms to the AMSA for inclusion  in DMSS.
Nonetheless, DOD’s new policy is not comprehensive enough to ensure  that the department will be sufficiently informed of the extent to which its  components are complying with existing health protection requirements  for its deployed federal civilians. Although the policy requires DOD  components to report certain location-specific and health data for all of  their deployed personnel, including federal civilians, it does not establish  an oversight and quality assurance mechanism for assessing and ensuring  the full implementation of the force health protection and surveillance  requirements by all DOD components that our prior work has identified as  essential in providing care to military personnel.
In a September 2003 report on the Army’s and the Air Force’s compliance  with force health protection policy for servicemembers, we noted that  neither of the military services had fully complied with DOD’s force health  protection and surveillance policies for many active duty servicemembers,  including the policies requiring that servicemembers be assessed before  and after deploying overseas and receive certain immunizations. We  further noted that DOD, at that time, did not have an effective quality  assurance program to provide oversight of, and ensure compliance with,  the department’s force health protection and surveillance requirements,  and that the lack of such a system was a major cause of the high rate of  noncompliance that we identified at the units we visited. In response to a  legislative mandate and our recommendation, DOD established an  oversight mechanism to evaluate the success of its force health protection  and surveillance policies in ensuring that servicemembers received pre-  and post-deployment medical examinations and that record-keeping  requirements were met. This oversight mechanism included (1) periodic  site visits jointly conducted with staff from the Office of the Assistant  Secretary for Health Affairs and staff from the military services to assess  compliance with the deployment health requirements, (2) periodic reports  from the services on their quality assurance programs, and (3) periodic  reports from AMSA on health assessment data maintained in the  centralized database. Until the department provides a similar oversight  and quality assurance mechanism for its deployed federal civilians, it will  not be effectively positioned to ensure compliance with its policies, or  ensure the health care and protection of these individuals as they continue  to support contingency operations.
section_title: DOD Has Established and Implemented Medical Treatment Policies Which Provide for the Care of Its Deployed Federal Civilians
paragraphs: DOD has established medical treatment policies that cover its federal  civilians while they are deployed to support contingency operations in  Afghanistan and Iraq, and available workers’ compensation claims we  reviewed confirmed that those deployed federal civilians received care  consistent with the policies. These policies state that DOD federal civilians  who require treatment for injuries or diseases sustained during overseas  hostilities may be provided care under the DOD military health system.  Thus, DOD’s deployed federal civilians may receive care through the  military’s treatment facilities. As shown in figure 1, DOD’s military health  system provides four levels of medical care to personnel who are injured  or become ill while deployed.
Specifically, medical treatment during a military contingency begins with  level one care, which consists of basic first aid and emergency care at a  unit in the theater of operation. The treatment then moves to a second  level of care, where, at an Aid station, injured or ill personnel are  examined and evaluated to determine their priority for continued  movement outside of the theater of operation and to the next (third) level  of care. At the third level, injured or ill personnel are treated in a medical  installation staffed and equipped for resuscitation, surgery, and  postoperative care. Finally, at the fourth level of care, which occurs far  from the theater of operation, injured or ill personnel are treated in a  hospital staffed and equipped for definitive care. Injured or ill DOD federal  civilians deployed in support of contingency operations in Afghanistan and  Iraq who require level four medical care are transported to DOD’s  Regional Medical Center in Landstuhl, Germany.
Injured or ill DOD federal civilians who cannot be returned to duty in  theater are evacuated to the United States for continuation of medical  care. In these cases (or where previously deployed federal civilians later  identify injuries or diseases and subsequently request medical treatment),  DOD’s policy provides for its federal civilians who require treatment for  deployment-related injuries or occupational illnesses to receive medical  care through either the military’s medical treatment facilities or civilian  facilities. The policy stipulates that federal civilians who are injured or  become ill as a result of their deployment must file a Federal Employees’  Compensation Act (FECA) claim with DOD, which then files a claim with  the Department of Labor’s Office of Workers’ Compensation Programs  (OWCP).
The Department of Labor’s OWCP is responsible for making a decision to  award or deny medical benefits. OWCP must establish—based on evidence  provided by the DOD civilian—that the employee is eligible for workers’  compensation benefits due to the injury or disease for which the benefits  are claimed. To obtain benefits under FECA, DOD federal civilians must  show that (1) they were employed by the U.S. government, (2) they were  injured (exposed) in the workplace, (3) they have filed a claim in a timely  manner, (4) they have a disabling medical condition, and (5) there is a  causal link between their medical condition and the injury or exposure.  Three avenues of appeal are provided for DOD federal civilians in the  event that the initial claim is denied: (1) reconsideration by an OWCP  claims examiner, (2) a hearing or review of the written record by OWCP’s  Branch of Hearings and Review, and (3) a review by the Employees’  Compensation Appeals Board. DOD’s medical treatment process and the  OWCP’s claims process are shown in figure 2.
Overall, the claims we reviewed showed that the DOD federal civilians  who sustained injuries or diseases while deployed had received care that  was consistent with DOD’s medical treatment policies. Specifically, in  reviewing a sample of seven workers’ compensation claims (out of a  universe of 83) filed under the Federal Employees’ Compensation Act by  DOD federal civilians who deployed to Iraq, we found that in three cases  where care was initiated in theater the affected federal civilians had  received treatment in accordance with DOD’s policies. For example, in  one case, a deployed federal civilian was treated for traumatic injuries at a  hospital outside of the theater of operation and could not return to duty in  theater because of the severity of the injuries sustained. The civilian was  evacuated to the United States and received medical care through several  of the military’s medical treatment facilities as well as through a civilian  facility. Further, in all seven claims that we reviewed, DOD federal  civilians who requested medical care after returning to the United States,  had, in accordance with DOD’s policy, received initial medical  examinations and/or treatment for their deployment-related injuries or  illnesses and diseases through either military or civilian treatment  facilities. While OWCP has primary responsibility for processing and  approving all FECA claims for medical benefits, as noted earlier, the scope  of our review did not include assessing actions taken by the Department of  Labor’s OWCP in further processing workers’ compensation claims for  injured or ill civilians and authorizing continuation of medical care once  their claims were submitted for review.
section_title: Special Pays and Benefits Provided to Deployed DOD Federal Civilian and Military Personnel Generally Vary in Type and Amount
paragraphs: DOD provides a number of special pays and benefits to its federal civilian  personnel who deploy in support of contingency operations, which are  generally different in type and in amount from those provided to deployed  military personnel. Both groups receive special pays, but the types and  amounts differ. In our modeled scenarios, the overall amounts of  compensation, which include special pays, were higher for DOD federal  civilian personnel than for military personnel. DOD federal civilian  personnel also receive different types and amounts of disability benefits,  depending on specific program provisions and individual circumstances.  Further, survivors of deceased DOD federal civilian and military personnel  generally receive comparable types of cash survivor benefits—lump sum,  recurring, or both—but benefit amounts differ for the two groups.  Survivors of DOD federal civilian personnel, however, almost always  receive lower noncash benefits than military personnel.
subsections: section_title: Deployed DOD Federal Civilian and Military Personnel Generally Receive Various Special Pays to Compensate Them for Conditions of Deployment, but the Types and Amounts Differ
paragraphs: DOD federal civilian and military personnel are both eligible to receive  special pays to compensate them for the conditions of deployment. As  shown in table 5, some of the types of special pays are similar for both  DOD federal civilian and military personnel, although the amounts paid to  each group differ. Other special pays were unique to each group.
DOD federal civilian and military personnel deployed to posts with  unusually difficult or unhealthful conditions or severe physical hardships  are authorized a similar type of post (hardship) differential. In addition,  danger pay is granted to both groups serving at a post where civil  insurrection, civil war, or war-like conditions exist. In this context, DOD  federal civilian personnel who are deployed to Afghanistan and Iraq are  eligible to receive post (hardship) differential and danger pay, each  equivalent to 35 percent of their base salaries. In contrast, military  personnel receive monthly pays of $100 for hardship duty and $225 for  imminent danger.
However, some special pays are unique to each group. For example, to  partially reimburse those who are involuntarily separated from their  dependents, military personnel are eligible to receive a family separation  allowance that is not available to deployed DOD federal civilian personnel.  Additionally, unlike DOD federal civilian personnel, military personnel  also receive a combat zone tax exclusion while deployed to Afghanistan  and Iraq that excludes certain income from federal taxes. DOD federal  civilian personnel, by contrast, are eligible for a variety of premium pays,  such as overtime and night differential, that are not available to military  personnel.
Although DOD federal civilian and military personnel generally receive  various special pays to compensate them for conditions of deployment, in  certain scenarios that we modeled, the overall amounts of compensation  payments were higher for DOD federal civilian personnel than for military  personnel, as illustrated in tables 6 and 7.
section_title: DOD Federal Civilian and Military Personnel Receive Different Types and Amounts of Disability Benefits, Depending on Specific Program Provisions and Individual Circumstances
paragraphs: In the event of sustaining an injury while deployed, DOD federal civilian  and military personnel are eligible to receive two broad categories of  disability benefits—disability compensation and disability retirement.  However, the benefits applicable to each group vary by type and amount,  depending on specific program provisions and individual circumstances.  Within these broad categories, there are three main types of disability: (1)  temporary disability, (2) permanent partial disability, and (3) permanent  total disability.
subsections: section_title: Temporary Disability Benefits
paragraphs: Both DOD federal civilian and military personnel who are injured in the  line of duty are eligible to receive continuation of their pay during the  initial period of treatment and may be eligible to receive recurring  payments for lost wages. However, the payments to DOD federal civilian  personnel are based on their salaries and whether the employee has any  dependents, regardless of the number, which can vary significantly,  whereas disability compensation payments made by the Department of  Veterans Affairs (VA) to injured military personnel are based on the  severity of the injury and their number of dependents. DOD federal civilian  personnel are eligible to receive continuation of pay (salary) for up to 45  days, followed by a recurring payment for wage loss which is based on a  percentage of salary and whether they have any dependents, up to a cap.  In contrast, military personnel receive continuation of pay of their salary  for generally no longer than a year, followed by a recurring VA disability  compensation payment for wage loss that is based on the degree of  disability and their number of dependents, and temporary DOD disability  retirement for up to 5 years. Appendix II provides additional information  on temporary disability compensation payments for federal civilian and  military personnel.
To illustrate the way in which the degree of impairment and an individual’s  salary can affect temporary disability compensation, in our April 2006  review, we compared the disability benefits available to military  personnel with those available to comparable civilian public safety officers  at the federal, state, and local levels. We found that VA compensation  payments for military personnel were based on a disability rating,  regardless of salary level; in contrast, compensation payments for civilian  public safety officers were based on salary level, regardless of disability  level. Thus, for an individual with severe injuries and relatively low wages,  VA compensation payments for military personnel were generally higher  than those of the civilian public safety officers included in the reviews.  However, if an individual had less severe injuries and high wages, VA  compensation payments for military personnel were generally lower than  those of the civilian public safety officers included in the review.
section_title: Permanent Partial Disability Benefits
paragraphs: When a partial disability is determined to be permanent, DOD federal  civilian and military personnel can continue to receive recurring  compensation payments. For DOD federal civilian personnel, these  payments are provided for the remainder of life as long as the impairment  persists, and can vary significantly depending upon the salary of the  individual and the existence of dependents. Military personnel are also  eligible to receive recurring VA disability compensation payments for the  remainder of their lives, and these payments are based on the severity of  the servicemember’s injury and the number of dependents. In addition,  both groups are eligible to receive additional compensation payments  beyond the recurring payments just discussed, based on the type of  impairment. DOD federal civilians with permanent partial disabilities  receive a schedule of payments based on the specific type of impairment  (sometimes referred to as a schedule award). Some impairments may  result in benefits for a few weeks, while others may result in benefits for  several years. Similarly, military personnel receive special monthly VA  compensation payments depending on the specific type and degree of  impairment. Appendix II provides more detailed information on  permanent partial disability compensation payments for DOD federal  civilian and military personnel.
Our April 2006 review compared the compensation benefits available to  military personnel with those available to federal civilian public safety  officers, among others, using several scenarios. Our analysis showed that  when able to return to duty, military personnel often received a greater  amount of compensation benefits over a lifetime than did civilians, even  when the monthly benefit payment was substantially lower and receipt of  benefits was delayed for several years.
Permanent partial disabilities that prevent civilian and military personnel  from returning to duty in their current jobs may entitle them to receive  disability retirement benefits based on a percentage of salary in addition to  compensation benefits; however, the eligibility criteria and benefit  amounts differ. Under the Civil Service Retirement System (CSRS), DOD  federal civilian personnel must be unfit for duty and have 5 years of  service to qualify for disability retirement benefits. Under the Federal  Employees’ Retirement System (FERS), civilian personnel must be unfit  for duty and have 18 months of service. DOD federal civilian personnel  must elect either compensation benefits or disability retirement. Military  personnel who are unfit for duty are eligible for DOD disability retirement  benefits if they have a disability rating of 30 percent or more regardless of  length of service, or if they have 20 years or more of service regardless of  disability rating. The amount of the DOD disability retirement payment is  offset dollar for dollar, however, by the amount of the monthly VA  disability compensation payment unless they have at least 20 years of  service and a disability rating of 50 percent or more, or combat-related  disabilities.
Our April 2006 review of disability benefits showed that when military  personnel and federal civilian public safety officers were unable to return  to duty due to a permanent partial disability, such as a leg amputation, the  combined compensation and retirement benefits provided to the military  personnel over a lifetime were sometimes more, and sometimes less, than  the combined benefits provided to civilian public safety officers.
section_title: Permanent Total Disability Benefits
paragraphs: When an injury is severe enough to be deemed permanent and total, DOD  federal civilian and military personnel may receive similar types of  benefits such as disability compensation and retirement payments;  however, the amounts paid to each group vary. For civilian personnel, the  monthly payment amounts for total disability are generally similar to those  for permanent partial disability described earlier, but unlike with  permanent partial disabilities, the payments do not take into account any  wage earning capacity. Both groups are eligible to receive additional  compensation payments beyond the recurring payments that are similar to  those for permanent partial disability. DOD federal civilians with  permanent disabilities receive a schedule award based on the specific type  of impairment. In addition, DOD federal civilian personnel may be eligible  for an additional attendant allowance—up to $1,500 per month during  2006—if such care is needed. Military personnel receive special monthly  VA compensation payments for particularly severe injuries, such as  amputations, blindness, or other loss of use of organs and extremities. The  payments are designed to account for attendant care or other special  needs deriving from the disability.
In addition to disability compensation, both DOD federal civilian and  military personnel have access to disability retirement benefits for  permanent total disabilities. The provisions for election and offset of  disability compensation and disability retirement benefits in cases of  permanent total disability are similar to provisions in cases of permanent  partial disability discussed earlier.
Another benefit available to DOD federal civilian and military personnel  with permanent total disabilities is Social Security Disability Insurance  (SSDI). SSDI benefits are available to individuals who incur a physical or  mental impairment that prevents them from performing substantial gainful  activity and that is expected to last at least 1 year or to result in death. The  benefit is based on the employee’s earnings history and lifetime  contributions to Social Security; therefore, the benefit amounts vary  widely among individuals. DOD federal civilian personnel covered by  FERS and military personnel pay into Social Security and thus may be  eligible to receive SSDI benefits. The maximum benefit to both groups in  2006 was $2,053 per month. However, DOD federal civilian personnel must  choose between either compensation payments and SSDI benefits or have  their disability retirement payments reduced when receiving SSDI  benefits.
section_title: Survivors of DOD Federal Civilian and Military Personnel Received Comparable Types of Benefits, but Benefit Amounts Differ
paragraphs: Survivors of deceased DOD federal civilian and military personnel  generally receive similar types of cash survivor benefits—either as a lump  sum, a recurring payment, or both—through comparable sources.  However, the benefit amounts generally differ for each group. Survivors of  DOD federal civilian and military personnel also receive noncash benefits  that differ in type and amounts.
As shown in table 8, survivors of deceased DOD federal civilian and  military personnel both receive lump sum benefits in the form of Social  Security, a death gratuity, burial expenses, and life insurance.
Social Security provides $255 upon the death of a DOD federal civilian  employee or military member. In addition, survivors of deceased DOD  federal civilian personnel receive a death gratuity of up to $10,000, while  survivors of deceased military personnel receive $100,000. The payment  for funeral expenses provided to survivors of deceased DOD federal  civilian personnel can be as high as $800, plus $200 for costs associated  with terminating employee status, while it can be $7,700 for deceased  military personnel. Life insurance is another common source of benefits  for the survivors of many deceased civilian and military personnel.  Survivors of deceased federal civilian personnel receive a payment equal  to the civilian’s rate of basic pay, rounded to the nearest thousand, plus  $2,000. Military personnel automatically are insured as part of the  Servicemembers’ Group Life Insurance for up to $400,000, unless they  elect less or no coverage. DOD federal civilian employees also receive a  survivor benefit in their retirement plans.
Survivors of deceased DOD federal civilian and military personnel are also  eligible for recurring benefits, some of which are specific to each group, as  shown in table 9.
Survivors of both deceased DOD federal civilian and military personnel  may be eligible to receive recurring Social Security payments based on the  deceased individual’s earnings in a covered period. However, other types  of recurring payments are specific to either civilian or military personnel.  For example, survivors of DOD federal civilian personnel may receive  recurring payments from a retirement plan or workers’ compensation if  the death occurred while in the line of duty. Survivors of deceased military  personnel also receive payments through the Survivor Benefit Plan,  Dependency and Indemnity Compensation, or both.
In addition to lump sum and recurring benefits, survivors of deceased  DOD federal civilians and military personnel receive noncash benefits. As  shown in table 10, survivors of deceased military personnel receive more  noncash benefits than do those of deceased DOD federal civilian  personnel, with few benefits being comparable in type.
For example, eligible survivors of military personnel who die while on  active duty obtain benefits such as rent-free government housing or tax- free housing allowances for up to 365 days, relocation assistance, and  lifetime access to commissaries and exchanges that are not available to  civilian personnel who die in the line-of-duty. However, survivors of both  deceased DOD federal civilian and military personnel do continue to  receive health insurance that is wholly or partially subsidized.
section_title: Conclusions
paragraphs: As DOD’s federal civilian employees assume an expanding role in helping  the department support its contingency operations overseas, the need for  attention to the policies and benefits that affect the health and welfare of  these individuals becomes increasingly significant. DOD currently has  important policies in place that relate to the deployment of its federal  civilians. However, it lacks an adequate oversight and quality assurance  mechanism to ensure compliance and quality of service. Thus, not all of its  policies—such as those that define the department’s requirements for  force health protection and surveillance—are being fully implemented by  the DOD components. Until DOD improves its oversight in this area, it will  jeopardize its ability to be effectively informed of the extent to which its  federal civilians are screened and deemed medically fit to deploy in  support of contingency operations; deployed civilian personnel receive  needed immunizations to counter theater disease threats; and what  medical follow-up attention federal civilians require for health problems or  concerns that may arise following their deployment.
section_title: Recommendation for Executive Action
paragraphs: To strengthen DOD’s force health protection and surveillance for its  federal civilian personnel who deploy in support of contingency  operations, we recommend that the Secretary of Defense direct the Office  of the Under Secretary of Defense for Personnel and Readiness to  establish an oversight and quality assurance mechanism to ensure that all  components fully comply with its requirements.
section_title: Agency Comments and Our Evaluation
paragraphs: In written comments on a draft of this report, DOD partially concurred  with our recommendation. The department acknowledged the necessity  for all deployed civilians to receive required medical assessments and  immunizations, and that documentation must be available in every  instance. The department outlined several steps it intends to take to  determine appropriate implementation of our recommendation.  Specifically, the department stated that it has written and coordinated a  new DOD instruction, scheduled to become effective before the end of  2006, that establishes a comprehensive DOD force health protection  quality assurance program that will apply to DOD civilian personnel  accompanying deploying military forces. While DOD’s response is  encouraging, we remain concerned that the department’s description of  the actions it plans to take to assess the components’ compliance with its  requirements lacks sufficient detail. DOD was unable to provide us with a  copy of the new instruction; thus, we could not evaluate the  comprehensiveness of its new force health protection quality assurance  program or determine whether the program identifies specific actions the  department plans to take for assessing and ensuring the full  implementation of the force health protection and surveillance  requirements by all DOD components. DOD also stated that proposed  revisions to its directives and instructions that address the planning,  preparation, and utilization of DOD civilians include, among other things,  annual assessments for compliance with pre-and post-deployment medical  assessment requirements. However, the department did not describe what  actions, if any, it plans to take to ensure that it will be sufficiently  informed of the extent to which its components are complying with  existing health protection requirements for its deployed federal civilians.  In the absence of more specific details on its planned actions, we continue  to emphasize the department’s need for a comprehensive oversight and  quality assurance mechanism without which it will not be effectively  positioned to ensure compliance with its policies, or ensure the health  care and protection of its deployed federal civilians as they continue to  support contingency operations.
In addition to its comments on our recommendation, the department took  issue with some of our specific findings. DOD questioned our findings that  in many cases DOD components were unable to produce documentation  confirming that deployed federal civilians had received necessary pre- or  post-deployment medical assessments, or immunizations. The department  stated that DOD activities, particularly regarding the Army Corps of  Engineers, Transatlantic Programs Center (TPC), had determined that  documentation did exist for many records included in our review, thus  raising reservations about our findings. In particular, the department  stated that the number (and percent) of records missing two or more  immunizations that we reported for TPC was inaccurate. It stated that  based on TPC’s review of the specific documentation that we used to  support our findings, we had actually identified 69 records (54.3 percent)  as missing two or more immunizations, rather than 85 (66.9 percent) noted  in our draft report. We disagree. TPC overlooked 16 records included in  our review that lacked documentation of any immunizations. Moreover, as  we noted in our report, to provide assurances that the results of our  review of hard copy deployment records at the selected component  locations were accurate, we requested that each component’s designated  medical personnel reexamine those deployment records that we  determined were missing required health documentation. We then  adjusted our results in those instances where documentation was  subsequently provided. To provide additional assurances regarding our  determinations, we requested that each component’s designated medical  personnel review and sign the data collection instrument that we used to  collect deployment health information from each individual civilian’s  deployment record attesting to our conclusions regarding the existence of  health assessment or immunization documentation.
DOD also stated that we inappropriately mixed discussion of Veterans  Affairs and DOD benefits without distinguishing between the two.  However, our report appropriately discusses two broad categories of  “government-provided” benefits: (1) those provided by DOD and (2) those  provided by VA. Nonetheless, to further clarify this section of our report,  we added “VA” and “DOD” to our discussions of disability compensation  and retirement benefits for military personnel. DOD also stated that our  discussion of military disability benefits presented incorrect information  in many cases, indicating that our statements that compensation payments  for military personnel were based on a disability rating, regardless of  salary level is only true with regard to VA disability benefits. DOD also  stated that DOD disability payments do, in fact, take into account salary  level, and that if a former member is entitled to both, there is an offsetting  mechanism. We agree. As we state in our report, under veterans’  compensation programs, benefits typically include cash payments to  replace a percentage of the individual’s loss in wages while injured and  unable to work. We also state that disability retirement benefits for  military personnel are based on a percent of salary in addition to  compensation benefits, and that the amount of retirement payment is  offset dollar for dollar by the amount of monthly compensation payment  unless military personnel have at least 20 years of service and a disability  rating of 50 percent or more, or have combat-related disabilities.
Further, DOD submitted detailed comments related to our analysis of  special pays and benefits provided to deployed DOD federal civilian and  military personnel. In particular, the department stated that our selection  and presentation of the associated data on the special pays and benefits  provided to DOD federal civilian and military personnel could easily  mislead the reader into drawing erroneous conclusions. The department  also stated that our comparisons did not take into account the relative  value of certain key benefits for which explicit dollar amounts cannot be  measured, such as retirement systems, health care systems, and military  commissary exchange privileges. To the contrary, our report did discuss  this limitation, and as is the case with any modeled scenarios based on  certain assumptions, some of the factors with the potential to affect the  overall outcomes of our comparisons could not be included because of, as  DOD pointed out, the relative value of certain key benefits for which  explicit dollar amounts cannot be measured. It is partly for this reason that  we acknowledged in the report that we do not take a position on the  adequacy or appropriateness of the special pays and benefits provided to  DOD federal civilian and military personnel. DOD also requested that we  clearly acknowledge the fundamental differences between the military and  civilians systems. We believe that we have done so. As we noted in our  report, we did not make direct analytical comparisons between  compensation and benefits offered by DOD to deployed federal civilian  and military personnel because such comparisons must account for the  demands of the military service, such as involuntary relocation, frequent  and lengthy separations from family, and liability for combat.
DOD provided other technical comments, which we have incorporated as  appropriate.  The department’s comments are reprinted in their entirety in  appendix III.
We are sending copies of this report to the Chairman and Ranking  Minority Member, Senate Committee on Armed Services; the Chairman  and Ranking Minority Member, House Committee on Armed Services; the  Chairman and Ranking Minority Member, Subcommittee on Defense,  Senate Committee on Appropriations; and the Chairman and Ranking  Minority Member, Subcommittee on Defense, House Committee on  Appropriations; and other interested congressional parties. We are also  sending copies to the Secretary of Defense and the Under Secretary of  Defense for Personnel and Readiness. We will make copies available to  other interested parties upon request. Copies of this report will also be  made available at no charge on GAO’s Web site at http://www.gao.gov.
Should you or your staff have any questions about this report, please  contact me at (202) 512-6304 or by e-mail at melvinv@gao.gov. Contact  points for our Offices of Congressional Relations and Public Affairs may  be found on the last page of this report. Key contributors to this report are  listed in appendix IV.
section_title: Appendix I: Scope and Methodology
paragraphs: To assess the extent to which DOD has established force health protection  and surveillance policies for DOD federal civilians who deploy outside of  the United States in support of contingency operations, and how the  components (military services and the Defense Contract Management  Agency) have implemented those policies, we reviewed pertinent force  health protection and surveillance policies and discussed these policies  with the following offices or commands: U.S. Central Command; Joint  Chiefs of Staff, Manpower and Personnel; Under Secretary of Defense for  Personnel and Readiness (including the Assistant Secretary of Defense for  Health Affairs, Deployment Health Support Directorate; Civilian Personnel  Policy; and Civilian Personnel Management Services); the Surgeons  General for the Army, Navy, and Air Force; and the Defense Contract  Management Agency (DCMA).
Our review focused on DOD federal civilians who (1) deployed to  Afghanistan or Iraq for 30 continuous days or more between June 1, 2003,  and September 30, 2005, and (2) returned to the United States by February  28, 2006. Because DOD had difficulty identifying the total number of  federal civilians who deployed to Afghanistan or Iraq, we assessed the  implementation of DOD’s deployment health requirements at eight  component locations that were selected using a number of approaches.  Given that DOD components have flexibility in where they conduct  deployment processing, we selected locations for our review accordingly.  Specifically, the Army uses a centralized approach, deploying its federal  civilians at three primary locations; therefore, we selected all three  locations for review. By contrast, the Navy and Air Force use a  decentralized approach, deploying their federal civilians from their home  stations. For these components, we selected five locations based on data  that indicated that these locations had deployed the largest numbers of  federal civilian personnel. DCMA was included in our review because it  had deployed the largest number of federal civilian personnel compared to  other defense agencies. DCMA has an informal agreement with the Army  to process its federal civilians through two of the Army’s three deployment  locations. Therefore, DCMA federal civilian deployment data in this report  are included in the Army results to the extent that DCMA federal civilian  deployments were documented at the two relevant Army locations. At all  eight component locations, we reviewed either all available hard copy or  electronic deployment records, or in one instance, a sample of the  deployment records for deployed federal civilian personnel who met our  criteria above. Table 11 shows the locations included in our review and the  number of deployment records reviewed at each location.
In total, we reviewed 3,431 hard copy and automated records for federal  civilian personnel who deployed to Afghanistan and Iraq. Specifically, we  reviewed hard copies of deployment records for 454 (out of a reported  822) federal civilian personnel at seven component locations and  automated deployment records for 2,977 (out of the reported 2,977)  federal civilian personnel at the other location where all deployment  records were being maintained electronically. The results of deployment  record reviews, however, could not be projected beyond the samples to all  DOD federal civilians who had deployed during this time frame. To  facilitate our review of federal civilian deployment records at the selected  component locations, we developed a data collection instrument to review  and collect deployment health information from each individual civilian’s  deployment record.
For federal civilians in our review at each location, we reviewed  deployment records for documentation that the following force health  protection and surveillance policy requirements were met:    Pre-and post-deployment health assessments;    Tuberculosis screening test (within 1 year of deployment);    Human Immunodeficiency Virus (HIV) screening test;    Pre-deployment immunizations:    hepatitis A (first and second course);   influenza (within 1 year of deployment);   tetanus-diphtheria (within 10 years of deployment);   typhoid; and    smallpox (within 5 years of deployment)
After our review of hard copy deployment records, we requested each  component’s medical personnel to reexamine those hard copy deployment  records that were missing required health documentation, and we adjusted  our results where documentation was subsequently provided. We also  requested and queried other documentation from information systems  used by the components to capture deployment and related health  information, making adjustments to our results where documentation was  found in the systems. These data sources included the Army’s Medical  Protection System (MEDPROS), the Army’s medical database (MedBase),  the Air Force’s Preventive Health Assessment and Individual Medical  Readiness (PIMR) system and its Comprehensive Immunization Tracking  Application (CITA), DOD’s Defense Enrollment Eligibility Reporting  System (DEERS), which is used by the Navy, and the Army Medical  Surveillance Activity’s Defense Medical Surveillance System (DMSS).
At the Army’s Fort Benning, we created a sampling frame (i.e., total  population) of records for 606 federal civilian deployments between June  1, 2003, and September 30, 2005. Our study population was limited to DOD  federal civilians who deployed to Afghanistan or Iraq. We then drew a  stratified random sample of 288 deployment records and stratified the  sample to isolate potential duplicate deployment records for the same  federal civilian. We found two duplicate records and removed them from  both the population and sample, as shown in table 12. We also removed  another 14 deployment records from our sample because those DOD  federal civilians had been deployed to locations other than Afghanistan or  Iraq, and were not eligible for the duty population. In addition, we  removed another 13 deployment records that were originally selected as  potential replacement records; however, we found that those  replacements were not needed.  Ultimately, we identified 238 in-scope  responses, for a weighted response rate of 87 percent. Each sampled  record was subsequently weighted in the analysis to represent all DOD  federal civilians deployed to Afghanistan or Iraq. The disposition of the  federal civilian deployment records we reviewed at Fort Benning are  summarized in the following table: Our probability sample is only one of a large number of samples that we  might have drawn.  Because each sample could have provided different  estimates, we express our confidence in the precision of our particular  sample’s results as a 95 percent confidence interval.  This is the interval  that would contain the actual population value for 95 percent of the Fort  Benning, Ga., samples we could have drawn.  All percentage estimates  from our sample have margins of error (that is, widths of confidence  intervals) of plus or minus 5 percentage points or less, at the 95 percent  confidence level, unless otherwise noted.
We took steps to assess the reliability of DOD federal civilian deployment  and health data for the purposes of this review, including consideration of  issues such as the completeness of the data from the respective  information systems’ program managers and administrators. We also  examined whether the data were subjected to quality control measures  such as periodic testing of the data against deployment records to ensure  the accuracy and reliability of the data. In addition, we reviewed existing  documentation related to the data sources and interviewed knowledgeable  agency officials about the data. We did not find these deployment and  health data to be sufficiently reliable for (1) identifying the universe of  DOD federal civilian deployments or (2) use as the sole source for  reviewing the health and immunization information for all DOD federal  civilian deployments, but we found the information systems to be  sufficiently reliable when used as one of several sources in our review of  deployment records. In those instances where we did not find a  deployment health assessment or immunization in either the deployment  records or in the electronic data systems, we concluded that the health  assessment or immunization was not documented.
To determine the extent to which DOD has established and the  components have implemented medical treatment policies for DOD  federal civilians who deployed in support of contingency operations, we  examined pertinent medical treatment policies for DOD federal civilian  employees who required treatment for injuries and diseases sustained  while supporting contingency operations. In addition, we obtained  workers’ compensation claims filed by DOD federal civilian personnel  with the Department of Labor’s Office of Workers’ Compensation  Programs(OWCP) showing those civilians who sustained injuries and  diseases during deployment. We selected and reviewed a non-probability  sample of claims to assess the components’ processes and procedures for  implementing DOD’s medical treatment policies across a range of civilian  casualties including injuries, physical and mental illnesses, and diseases.  The scope of our review did not extend to the Department of Labor’s  claims review process.
To identify special pays and benefits provided to DOD federal civilians  who deployed in support of contingency operations and to assess the  extent that special pays and benefits differ from those provided to  deployed active duty military personnel, we examined major statutory  provisions for special pays, disability and death benefits for federal  civilians and military personnel, including relevant chapters of Title 5 of  the U.S. Code governing federal civilian personnel management; relevant  chapters of Title 10 of the U.S. Code governing armed forces personnel  management; Section 112 of Title 26 of the U.S. Code governing combat  zone tax exemption; relevant chapters of Title 37 of the U.S. Code  governing pay and allowances for the uniformed services; relevant  chapters of Title 38 of the U.S. Code governing veterans’ benefits; relevant  provisions of applicable public laws governing military and civilian pay  and benefits; applicable directives and instructions related to active duty  military and DOD federal civilian benefits and entitlements; DOD financial  management regulations; Department of State regulations; and prior GAO  reports. In addition, we discussed the statutes and guidance with  cognizant officials of the Office of the Under Secretary of Defense for  Personnel and Readiness, military services’ headquarters, and the Defense  Contract Management Agency involved with the administration of active  duty and federal civilian personnel entitlements. We did not perform a  comprehensive review of all compensation—comprised of a myriad of  pays and benefits—offered to active duty military and federal civilian  personnel in general. Our analysis focused on selected elements of  compensation such as special pays (e.g., hostile fire/imminent danger pay).  Also, we did not make direct analytical comparisons between  compensation and benefits offered by DOD to deployed federal civilian  and military personnel because such comparisons must account for the  demands of the military service, such as involuntary relocation, frequent  and lengthy separations from family, and liability for combat.
After reviewing documents and interviewing officials, we then compiled  and analyzed the information on the types and amounts of special pays  and benefits available to active duty military and DOD federal civilian  personnel who deployed to Afghanistan or Iraq. We interviewed DOD  officials to discuss the basis for any differences in compensation. In  addition, to illustrate how special pays affect overall compensation  provided to DOD federal civilian and military personnel, we modeled  scenarios for both groups using similar circumstances, such as length of  deployment, pay grades, special pays (e.g., post differential pay, danger  pay, overtime pay, family separation allowance, basic allowance for  housing, basic allowance for subsistence), and duty location. Through  discussions with senior DOD officials, we made an assumption that  deployed DOD federal civilians worked 30 hours of overtime per week.  For deployed DOD federal civilians, we subtracted a contribution of  $15,000 to the Thrift Savings Plan (TSP) to obtain the adjusted gross  income. We assumed that DOD federal civilians, temporarily at a higher  tax bracket, would take maximum advantage of the opportunity to defer  taxes. We assumed that the military personnel would contribute a smaller  percentage of pay, 5 percent of gross income, to TSP. We made this  assumption because much of the military pay was not subject to federal  taxes, which removes the incentive to contribute to TSP, and because  unlike for federal workers, military TSP does not have a matching  component. For military personnel, we also deducted the amount of pay  not subject to taxes due to the combat zone exclusion, family separation  allowance, basic allowance for subsistence, and basic allowance for  housing. Using these assumptions, we generated an adjusted gross income  and used that as input into a commercial tax program, Turbo Tax, to  obtain federal taxes owed. We assumed that both DOD federal civilian and  military personnel were married, filing jointly, with a spouse that earned  no income. We assumed that the family had two children and qualified for  two child tax credits, and the Earned Income Tax Credit, if at that income  level. This resulted in four exemptions and a standard deduction of  $10,000 in 2005. For purposes of validation, we repeated this exercise  using an alternate tax program, Tax Cut, and obtained identical results.
We conducted our review from March 2006 to August 2006 in accordance  with generally accepted government auditing standards.
section_title: Appendix II: Temporary and Permanent Partial Disability Benefits Provided to DOD Federal Civilian and Military Personnel
paragraphs: Both DOD federal civilian and military personnel are eligible to receive  disability benefits when they sustain a line-of-duty injury. However, these  benefits vary in amount. Table 13 shows the temporary disability benefits  available to eligible DOD federal civilian and military personnel.
As table 13 shows, DOD federal civilians who are injured in the line of duty  are eligible to receive continuation of their salary up to 45 days, followed  by a recurring payment for wage loss that is based on a percentage of their  salary and the existence of dependents, up to a cap. In contrast, military  personnel receive continuation of their salaries for generally no longer  than a year, followed by a recurring payment for wage loss, which is based  on the degree of disability and their number of dependents, and temporary  retirement pay based on salary for up to 5 years.
When a partial disability is determined to be permanent, both DOD federal  civilians and military personnel are eligible to continue receiving recurring  compensation payments, but again, the amounts of these benefits vary, as  shown in table 14.
As table 14 shows, DOD federal civilian personnel with permanent partial  disabilities receive payments based on salary and dependents while  military personnel receive payments based on the severity of the injury  and their number of dependents, as long as the condition persists.
section_title: Appendix III: Comments from the Department of Defense
section_title: Appendix IV: GAO Contact and Staff Acknowledgments
subsections: section_title: Acknowledgments
paragraphs: In addition to the contact named above, Sandra Burrell, Assistant Director;  William Bates; Dr. Benjamin Bolitzer; Alissa Czyz; George Duncan; Steve  Fox; Dawn Godfrey; Nancy Hess; Lynn Johnson; Barbara Joyce; Dr.  Ronald La Due Lake; William Mathers; Paul Newton; Dr. Charles Perdue;  Jason Porter; Julia Matta; Susan Tieh; John Townes; and Dr. Monica  Wolford made key contributions to this report.