Within DOD’s Office of the Assistant Secretary of Defense for Health Affairs, the office of Force Health Protection & Readiness provides support for all medically related DOD policies, programs, and activities. This includes responsibility for the development of most deployment- related health policies, including those related to OEHS. The service component commands include U.S. Army Central (USARCENT), U.S. Air Force Central Command, and U.S. Naval Forces Central Command. that unit. As of February 1, 2015, there was one preventive medicine unit available to conduct OEHS activities in Iraq and one in Afghanistan, which reported to USARCENT and U.S. Forces-Afghanistan, respectively. Each of the military services has a public health surveillance center that provides support and technical guidance on reporting on potential environmental risks to combatant commands and their subordinate commands. These public health surveillance centers include the U.S. Army Public Health Command, the U.S. Air Force School of Aerospace Medicine, and the Navy & Marine Corps Public Health Center. In addition, these centers provide technical expertise and support for the subordinate commands’ preventive medicine units in theater. These surveillance centers have also developed and adapted military exposure guidelines for deployment using existing U.S. national standards for human health exposure limits and technical monitoring procedures (e.g., standards of the U.S. Environmental Protection Agency and the National Institute for Occupational Safety and Health). As part of DOD’s health surveillance framework, Force Health Protection & Readiness deployment health policies require the preventive medicine units to regularly collect and report a variety of data during deployments to identify and respond to health threats that servicemembers may have encountered. Health surveillance during deployments includes identifying the deployed population at risk, recognizing and assessing potentially hazardous health exposures and conditions, employing specific preventive countermeasures, daily monitoring of real-time health outcomes, and reporting of disease and injury data. DOD collects and stores three types of data during deployments: (1) daily individual servicemember location data—such as the duty station—which is stored by DOD’s Defense Manpower Data Center; (2) medical data— including data on health outcomes acquired from servicemember medical records—which is stored by DOD’s Armed Forces Health Surveillance Center; and (3) OEHS data, including ambient air, water, and soil samples. Once collected, DOD currently uses two separate IT systems for the storage of OEHS data—MESL and DOEHRS: MESL, originally implemented in 2003, contains both classified and unclassified documents that have been scanned and uploaded into the system. Officials can use MESL for submitting OEHS documents, conducting searches based on key words, and downloading OEHS documents. DOD subsequently began implementing DOEHRS in 2006. Unlike MESL, DOEHRS is a database that incorporates additional functionalities including OEHS data collection, management, and assessment—including the ability to query data—in a single system. It allows users in theatre to capture field data, such as air, water, and soil samples; compare sample results with exposure guidelines; report sampling data; and view laboratory data instantly once data are loaded into the system. Unlike MESL, DOEHRS only contains unclassified data. While there are some departmental requirements for some OEHS reports for deployment sites—such as an initial assessment—the total number of OEHS reports for each deployment site varies because these reports reflect the specific occupational and environmental circumstances unique to each location. VA is comprised of three administrations, two of which focus on benefits for veterans: VBA and VHA. VBA processes veterans’ claims for monthly compensation for service-connected disabilities. VBA determines eligibility criteria for disability compensation, which can include identifying specific health conditions, like those associated with occupational and environmental hazards in Iraq and Afghanistan, and determining whether these conditions are service-connected. VHA operates the VA health care system, which provides health care to veterans through its various facilities, including outpatient clinics and medical centers. VHA also may provide health coverage to spouses, survivors, and children of veterans who are permanently and totally disabled from a service-connected disability, or who died in the line of duty or from a service-connected disability. VHA also conducts or sponsors research on veterans’ illnesses related to military occupational and environmental exposures. Inconsistencies between DOD and military service-specific policies regarding OEHS data storage has led to fragmentation and duplication of OEHS data between the department’s two systems—MESL and DOEHRS. Officials with Force Health Protection & Readiness told us that DOD is transitioning from the use of MESL to DOEHRS, which has greater functionality. However, the departmental policy developed by this office—updated in 2011—states that all classified and unclassified OEHS data should be stored in MESL even though DOEHRS was implemented in 2006. Officials from the U.S. Army Public Health Command—the office that maintains MESL and has technical expertise in DOEHRS— confirmed the department’s intent to transition from MESL to DOEHRS, and told us that this transition would eventually include the transfer of all unclassified documents currently in MESL to DOEHRS (once DOEHRS had been sufficiently upgraded) while classified data would remain in MESL. However, these same officials told us that resources have not been obtained to complete this task, and that the upgrades are time- and resource-intensive. Force Health Protection & Readiness officials explained that DOD’s current policy does not reflect the potential transition from MESL to DOEHRS because developing the functionality of DOEHRS in archiving data from deployments was still under way when the policy was last updated in 2011—about 5 years after DOEHRS was implemented.being revised to require the storage of unclassified OEHS data in DOEHRS, and they expect the updated policy to be released in 2016. However, these officials told us that the policy is currently Further, when we reviewed all of DOD’s relevant OEHS policies as well as corresponding policies developed by each of the military services—all dated after 2006—we identified inconsistencies about which system should be used to store OEHS data. Only 3 of the 14 policies we reviewed instruct officials to store OEHS data in DOEHRS, while 4 policies instruct officials to store OEHS data in MESL. Six of the policies instruct the use of both systems as appropriate, depending on the type of document being submitted and the availability of DOEHRS during a deployment. Further, one of the policies does not list either system, as it says that databases are necessary for OEHS data storage but does not specifically mention DOEHRS or MESL. See Table 1 for the list of 14 policies related to OEHS data storage. Inconsistent policies are contrary to federal standards for internal control, which state that management should have policies in place that are both appropriate and clear. MESL and DOEHRS store similar types of unclassified OEHS data, such as environmental sample data (e.g., water and soil samples) and risk assessments for deployment sites. (See table 2.) Our prior work has found that inefficiencies can occur when there is fragmentation and duplication, such as when more than one system offers the same services.store unclassified OEHS data, officials’ efforts to store these data are inefficient and have resulted in both fragmentation and duplication. This has occurred because, in some cases, similar types of unclassified OEHS Without consistent policies on which system should be used to data have been submitted to both MESL and DOEHRS, and in other cases, identical OEHS data has been submitted to both systems. However, neither system serves as a central repository for these data. As a result, it is difficult to identify complete and comprehensive data sets for specific types of OEHS data, which may lead to problems when officials attempt to use these data in the future. A U.S. Army Public Health Command official who has technical expertise in both systems confirmed that there is duplication of OEHS data storage, but stated that there is no reasonable way to determine the extent because only DOEHRS has specific data level querying capabilities. Therefore, this could only be determined by comparing individual documents, which is not feasible because there are thousands of records in each system. DOD’s department-wide policy that governs the collection and storage of OEHS data during deployments does not specifically address quality assurance for OEHS data. As a result, the military services lack specific and consistent guidance on performing quality assurance reviews, which may impact the reliability of these data. According to military service officials, quality assurance reviews of OEHS data collected at deployment sites are generally performed once the data have been submitted to DOEHRS. As a result, it is not always feasible to verify the accuracy of the samples, and the quality assurance reviews are focused more on the completeness and reasonableness of data entry. Officials may perform these quality assurance checks while at a deployment site. However, the services’ public health surveillance centers in the United States may also conduct these reviews. According to officials, quality assurance reviews are limited to OEHS data that have been submitted to DOEHRS because MESL only contains uploaded documents that cannot be edited or modified. Data in DOEHRS can be reviewed for quality assurance purposes after it has been submitted, and the system has the capability of documenting that a quality assurance process has occurred. A Force Health Protection & Readiness official told us that the department’s deployment health policy was focused on monitoring the implementation of the policy as a whole and did not specifically address quality assurance for OEHS data in DOEHRS.