DOD Civilian Personnel: Greater Oversight and Quality Assurance  
Needed to Ensure Force Health Protection and Surveillance for	 
Those Deployed (29-SEP-06, GAO-06-1085).			 
                                                                 
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.							 
-------------------------Indexing Terms------------------------- 
REPORTNUM:   GAO-06-1085					        
    ACCNO:   A61612						        
  TITLE:     DOD Civilian Personnel: Greater Oversight and Quality    
Assurance Needed to Ensure Force Health Protection and		 
Surveillance for Those Deployed 				 
     DATE:   09/29/2006 
  SUBJECT:   Civilian employees 				 
	     Claims processing					 
	     Employee medical benefits				 
	     Health care programs				 
	     Health policy					 
	     Military policies					 
	     Policy evaluation					 
	     Records						 
	     Contingency operations				 
	     Iraq						 
	     Afghanistan					 

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GAO-06-1085

     

     * Results in Brief
     * Background
     * DOD Has Established Force Health Protection and Surveillance
          * DOD Components Did Not Always Implement All Force Health Pro
               * Pre-deployment health assessments
               * Pre-deployment Immunizations
               * Pre-deployment Medical Screenings
               * Post-deployment Health Assessments
          * Lack of Centralized Deployment Information Hinders the Overa
          * DOD Has Taken Steps to Address Policy Shortcomings, but Lack
     * DOD Has Established and Implemented Medical Treatment Polici
     * Special Pays and Benefits Provided to Deployed DOD Federal C
          * Deployed DOD Federal Civilian and Military Personnel General
          * DOD Federal Civilian and Military Personnel Receive Differen
               * Temporary Disability Benefits
               * Permanent Partial Disability Benefits
               * Permanent Total Disability Benefits
          * Survivors of DOD Federal Civilian and Military Personnel Rec
     * Conclusions
     * Recommendation for Executive Action
     * Agency Comments and Our Evaluation
     * Appendix I: Scope and Methodology
     * Appendix II: Temporary and Permanent Partial Disability Bene
     * Appendix III: Comments from the Department of Defense
     * Appendix IV: GAO Contact and Staff Acknowledgments
          * GAO Contact
          * Acknowledgments
               * Order by Mail or Phone

Report to Congressional Committees

United States Government Accountability Office

GAO

September 2006

DOD CIVILIAN PERSONNEL

Greater Oversight and Quality Assurance Needed to Ensure Force Health
Protection and Surveillance for Those Deployed

GAO-06-1085

Contents

Letter 1

Results in Brief 5
Background 7
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 8
DOD Has Established and Implemented Medical Treatment Policies Which
Provide for the Care of Its Deployed Federal Civilians 20
Special Pays and Benefits Provided to Deployed DOD Federal Civilian and
Military Personnel Generally Vary in Type and Amount 23
Conclusions 34
Recommendation for Executive Action 35
Agency Comments and Our Evaluation 35
Appendix I Scope and Methodology 40
Appendix II Temporary and Permanent Partial Disability Benefits Provided
to DOD Federal Civilian and Military Personnel 47
Appendix III Comments from the Department of Defense 50
Appendix IV GAO Contact and Staff Acknowledgments 55

Tables

Table 1: DOD Federal Civilian Deployment Records Lacking Documentation of
Pre-deployment Health Assessments 10
Table 2: DOD Federal Civilian Deployment Records Lacking Documentation of
Required Immunizations 12
Table 3: DOD Federal Civilian Deployment Records Lacking Documentation of
Current Tuberculosis or HIV Screenings 14
Table 4: DOD Federal Civilian Deployment Records Lacking Documentation of
Post-deployment Health Assessments 16
Table 5: Overview of Selected Types of Special Pays for Deployed DOD
Federal Civilian and Military Personnel 24
Table 6: Scenario 1: Comparisons of Compensation Provided to DOD Federal
Civilian and Military Personnel Deployed to Afghanistan or Iraq for One
Year 25
Table 7: Scenario 2: Comparisons of Compensation Provided to DOD Federal
Civilian and Military Personnel Deployed to Afghanistan or Iraq for Six
Months 26
Table 8: Overview of the Type and Amount of Lump Sum Benefits Provided to
Survivors of DOD Federal Civilian and Military Personnel 32
Table 9: Overview of the Type and Amount of Recurring Benefits Provided to
Survivors of DOD Federal Civilian and Military Personnel 33
Table 10: Summary of Noncash Benefits Provided to Survivors of DOD Federal
Civilian and Military Personnel 34
Table 11: DOD Component Locations and Number of DOD Federal Civilian
Deployment Records Included in Our Review 41
Table 12: Sample Disposition for Fort Benning Federal Civilian Deployment
Records 43
Table 13: Temporary Disability Compensation Payments, Payment Formula, and
2006 Payment Caps for DOD Federal Civilian and Military Personnel 47
Table 14: Permanent Partial Disability Compensation Payment Formulas and
Time Limits on Benefits for DOD Federal Civilian and Military Personnel 48

Figures

Figure 1: Overview of the Levels of DOD Medical Care Provided While
Deployed 20
Figure 2: Medical Treatment and Claims Processes for DOD Federal Civilians
Who Require Treatment for Deployment-Related Injuries or Diseases After
They Return to the United States 22

Abbreviations

AMSA Army Medical Surveillance Activity CITA Comprehensive Immunization
Tracking Application CONUS Continental United States CSRS Civil Service
Retirement System DCMA Defense Contract Management Agency DEERS Defense
Enrollment Eligibility Reporting System DMDC Defense Manpower Data Center
DMSS Defense Medical Surveillance System DOD Department of Defense FECA
Federal Employees' Compensation Act FERS Federal Employees' Retirement
System HIV Human Immunodeficiency Virus MEDPROS Medical Protection System
OWCP Office of Workers' Compensation Programs PIMR Preventive Health
Assessment and Individual Medical Readiness SSDI Social Security
Disability Insurance TPC Transatlantic Programs Center TSP Thrift Savings
Plan VA Veterans Affairs

This is a work of the U.S. government and is not subject to copyright
protection in the United States. It may be reproduced and distributed in
its entirety without further permission from GAO. However, because this
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copyright holder may be necessary if you wish to reproduce this material
separately.

United States Government Accountability Office

Washington, DC 20548

September 29, 2006

Congressional Committees

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.1 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.2 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.

1 DOD's civilian workforce includes federal government employees, foreign
nationals hired directly or indirectly to work for DOD, and contractor
personnel. This review focuses on DOD's federal government employees, whom
we refer to in this report as DOD's federal civilians.

2 GAO, DOD Force Mix Issues: Greater Reliance on Civilians in Support
Roles Could Provide Significant Benefits, GAO/NSIAD-95-5 (Washington,
D.C.: Oct. 19, 1994).

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.3 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)4 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, 2006.5 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.

3 S.R. No. 109-69, at 380 (2005).

4 For this report, we examined the Departments of the Army, Navy, and Air
Force, and the Defense Contract Management Agency (DCMA). We selected DCMA
because it deployed the largest numbers of federal civilian personnel
compared to other defense agencies.

5 For the purposes of health surveillance, DOD considers a deployment to
be 30 continuous days or greater to a land-based location outside the
continental United States that does not have a permanent U.S. military
treatment facility. We selected these deployment dates to incorporate
DOD's most recent changes to the post-deployment health assessment
criteria.

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 Act6 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.

6 The Federal Employees' Compensation Act is a comprehensive workers'
compensation law for federal employees that calls for medical coverage and
compensation for federal employees with injuries and occupational
illnesses incurred in the performance of their duties.

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.

                                Results in Brief

DOD has established force health protection and surveillance policies
aimed at assessing and reducing or preventing health risks for its
deployed federal civilian personnel, but it lacks procedures to ensure the
components' full implementation of these policies. Our review of
deployment records at eight locations found that the components lacked
documentation to show 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 at one Army
location. As a larger issue, DOD lacked complete and centralized data to
ensure that it could identify its deployed civilians and track their
movement in theater, further hindering its efforts to assess the overall
effectiveness of its force health protection and surveillance
capabilities. As a positive step, in August 2006, DOD issued a revised
policy (to be effective in December 2006) that outlines procedures for
addressing these shortcomings. However, the procedures are not
comprehensive enough to ensure that DOD will be sufficiently informed of
the extent to which its components are complying with the department's
health protection requirements for deployed federal civilians. In
particular, the procedures do not establish an oversight and quality
assurance mechanism to enable DOD to effectively assess and ensure the
full implementation of its force health protection requirements. Until DOD
establishes an oversight and quality control mechanism to strengthen its
force health protection and surveillance oversight, it will not be
effectively positioned to ensure the components' compliance with its
policies, or ensure the health care and protection of its deployed federal
civilian personnel.

DOD has also established medical treatment policies that cover its federal
civilians while they are deployed in support of contingency operations in
Afghanistan and Iraq, and selected workers' compensation claims that we
reviewed confirmed that those deployed federal civilians received care
that was consistent with the policies. These policies state that DOD
civilians who require treatment for injuries, illnesses, or diseases
sustained during overseas hostilities may be provided care equivalent in
scope to that provided to active duty military personnel under the DOD
military health system. In this regard, DOD's military health system
provides four levels of medical care to military service personnel, as
well as DOD federal civilians, while they are deployed in support of
contingency operations in Afghanistan or Iraq-ranging from level one,
which consists of basic first aid and emergency care in theater, to level
four, involving medical treatment at DOD's Regional Medical Center in
Landstuhl, Germany. Our review of 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, found that
in three cases where care was initiated in theater, the affected civilians
had received treatment in accordance with DOD's policies. Further, DOD's
policies state that civilian personnel who require treatment for
deployment-related injuries or illnesses after they return to the United
States may select either a qualified local physician or hospital of their
choice, or a military medical treatment facility to provide the necessary
treatment. We found that in the seven cases reviewed, 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 illnesses and 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, in cases where injuries are
sustained while deployed, both DOD federal civilian and military personnel
are eligible to receive two broad categories of disability
benefits-disability compensation7 and disability retirement;8 however, the
type and amount of the benefits vary, and some are unique to each group.
In addition, while survivors of deceased DOD federal civilian and military
personnel generally receive similar types of cash survivor benefits for
Social Security, burial expenses, and death gratuity, the comparative
amounts of these benefits differ. However, survivors of DOD federal
civilian personnel almost always receive lower noncash benefits than
military personnel.

In written comments on a draft of this report, DOD partially concurred
with our recommendation to establish an oversight and quality assurance
mechanism to ensure that the components comply with its force health
protection and surveillance requirements. The department outlined several
steps it is taking to determine appropriate implementation of our
recommendation but took issue with some of our specific findings. DOD's
comments and our evaluation of them are discussed in the agency comments
section of this report.

                                   Background

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.9

7Under workers' compensation and veterans' compensation programs, benefits
typically include medical treatment for the injury, vocational
rehabilitation services, and cash payment to replace a percentage of the
individual's loss in wages while injured and unable to work.

8Disability retirement programs typically provide benefits that allow
qualified individuals who are unable to return to work to retire earlier
and/or to retire with a higher percentage of their pre-injury salary level
than would otherwise be permitted with normal retirement based on age and
length of service at the time of injury.

DOD relies on the federal civilian personnel it deploys to support a range
of essential missions, including intelligence collection, criminal
investigations, and weapon systems acquisition and maintenance. To ensure
that its federal civilian employees will deploy to combat zones and
perform critical combat support functions in theater, DOD established the
emergency-essential program in 1985. Under this program, DOD designates as
"emergency-essential" those civilian employees whose positions are
required to ensure the success of combat operations or the availability of
combat-essential systems. DOD can deploy federal civilian employees either
on a voluntary or involuntary basis to accomplish the DOD mission.

DOD Has Established Force Health Protection and Surveillance Policies for
Deployed Federal Civilians, but Should Do More to Ensure That Components Comply
                             with Its Requirements

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
documentation10 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.

9Operation Enduring Freedom includes ongoing operations in Afghanistan and
in certain other countries; Operation Iraqi Freedom includes ongoing
operations in Iraq.

10In addition to DOD federal civilian deployment records, other
documentation reviewed included data from information systems used by the
components to capture deployment and related health information. Although
we found these data not to be sufficiently reliable for (1) identifying
the universe of DOD federal civilian deployments or (2) use as the sole
source for reviewing the health and immunization information for all DOD
federal civilian deployments, we found the information systems to be
sufficiently reliable when used as one of several sources in our review of
deployment records.

DOD Components Did Not Always Implement All Force Health Protection and
Surveillance Requirements

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.

  Pre-deployment health assessments

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.11 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.

11 DOD Instruction 1400.32, DOD Civilian Workforce Contingency and
Emergency Planning Guidelines and Procedures, April 24, 1995; DOD
Instruction 6490.3, Implementation and Application of Joint Medical
Surveillance for Deployments, August 7, 1997; DOD Directive 6490.2,
Comprehensive Health Surveillance, October 21, 2004; and Office of the
Chairman, The Joint Chiefs of Staff, Memorandum MCM-0006-2, Updated
Procedures for Deployment Health Surveillance and Readiness, February 1,
2002.

Table 1: DOD Federal Civilian Deployment Records Lacking Documentation of
Pre-deployment Health Assessments

                                Number of federal   Number (and percent) with 
                              civilian deployment  no documentation in either 
Location                      records reviewed       records or data files 
Army                                           
Fort Benning CONUS                         578                     2 (0.3) 
Replacement Centera                            
Fort Bliss CONUS                        2,977b                    0 (0.0)b 
Replacement Centera                            
U.S. Army Corps of                         127                     2 (1.6) 
Engineers Transatlantic                        
Programs Center                                
Total                                    3,682                           4 
Navy                                           
Naval Air Depot Cherry                      52                   19 (36.5) 
Point                                          
Total                                       52                          19 
Air Force                                      
Andrews Air Force Base                      10                    9 (90.0) 
Hill Air Force Base                          8                    5 (62.5) 
Hurlburt Field                              12                   11 (91.7) 
Wright-Patterson Air Force                   7                    4 (57.1) 
Base                                           
Total                                       37                          29 
Grand Total                             3,771c                          52 

Source: GAO analysis of documentation from DOD federal civilian deployment
records and component medical databases.

Note: CONUS refers to the continental United States.

aDCMA federal civilians deployed through Forts Benning and Bliss CONUS
Replacement Centers. At Fort Benning, we selected a probability sample of
238 out of 606 deployment records for deployed federal civilians;
consequently, the numbers and percentages shown are weighted estimates to
provide 95 percent confidence with a margin of error of 5 percentage
points.

bAlthough the Army deploys its federal civilian personnel at three primary
sites, Fort Bliss deployed the largest number of federal civilians during
our time frame. We reviewed the entire universe of deployment records for
federal civilian personnel deployed from this location because the records
were being maintained electronically, which facilitated the review of all
records. According to the program manager and database administrator, the
quality of these data, in terms of their completeness and accuracy, is
questionable because there are no assurances that all DOD federal civilian
personnel who deployed are included in the database.

cDeployed federal civilians included in our review may have deployed more
than once during our deployment time frame; consequently, there may be
fewer than 3,771 unique federal civilians.

As shown in table 1, the federal civilian deployment records we included
in our review showed wide variation by location regarding documentation of
pre-deployment health assessments, ranging from less than 1 percent to
more than 90 percent. On an aggregate component-level basis, at the Navy
location in our review, we found that documentation was missing for 19 of
the 52 records in our review. At the Air Force locations, documentation
was missing for 29 of the 37 records in our review. In contrast, all three
Army locations had hard copy or electronic records which indicated that
almost all of their federal deployed civilians had received pre-deployment
health assessments.

  Pre-deployment Immunizations

In addition to completing pre-deployment health assessment forms, DOD's
force health protection and surveillance policies stipulate that all DOD
deploying federal civilians receive theater-specific immunizations to
address possible health threats in deployment locations.12 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.

12U.S. Central Command, Individual Protection and Individual/Unit
Deployment Policy, January 6, 2005, and DOD Instruction 1400.32, DOD
Civilian Work Force Contingency and Emergency Planning Guidelines and
Procedures, April 24, 1995.

                                  Number of                                   
                                    federal                                   
                                   civilian      Number (and      Number (and 
                                 deployment percent) missing percent) missing 
                                    records         only one      two or more
Location                        reviewed     immunization    immunizations
Army                                                      
Fort Benning CONUS                   578       246 (42.6)       195 (33.7) 
Replacement Centera                                       
Fort Bliss CONUS Replacement      2,977b          0 (0.0)    2,977 (100.0) 
Centera                                                   
U.S. Army Corps of Engineers         127        25 (19.7)        85 (66.9) 
Transatlantic Programs Center                             
Total                              3,682              271            3,257 
Navy                                                      
Naval Air Depot Cherry Point          52         8 (15.4)        39 (75.0) 
Total                                 52                8               39 
Air Force                                                 
Andrews Air Force Base                10         2 (20.0)         7 (70.0) 
Hill Air Force Base                    8          0 (0.0)         3 (37.5) 
Hurlburt Field                        12         3 (25.0)         3 (25.0) 
Wright-Patterson Air Force             7         1 (14.3)         4 (57.1) 
Base                                                      
Total                                 37                6               17 
Grand Total                       3,771c              285            3,313 

Table 2: DOD Federal Civilian Deployment Records Lacking Documentation of
Required Immunizations

Source: GAO analysis of documentation from DOD federal civilian deployment
records and component medical databases.

Note: CONUS refers to the continental United States.

aDCMA federal civilians deployed through Forts Benning and Bliss CONUS
Replacement Centers. At Fort Benning, we selected a probability sample of
238 out of 606 deployment records for deployed federal civilians;
consequently, the numbers and percentages shown are weighted estimates to
provide 95 percent confidence with a margin of error of 5 percentage
points.

bAlthough the Army deploys its federal civilian personnel at three primary
sites, Fort Bliss deployed the largest number of federal civilians during
our time frame. We reviewed the entire universe of deployment records for
federal civilian personnel deployed from this location because the records
were being maintained electronically, which facilitated the review of all
records. According to the program manager and database administrator, the
quality of these data, in terms of their completeness and accuracy, is
questionable because there are no assurances that all DOD federal civilian
personnel who deployed are included in the database.

cDeployed federal civilians included in our review may have deployed more
than once during our deployment time frame; consequently, there may be
fewer than 3,771 unique federal civilians.

At the Army's Fort Bliss, our review of its electronic deployment data
determined that none of its deployed federal civilians had documentation
to show that they had received immunizations. Officials at this location
stated that they believed some immunizations had been given; however, they
could not provide documentation as evidence of this.

  Pre-deployment Medical Screenings

DOD policies require deploying federal civilians to receive certain
screenings, such as for tuberculosis and HIV.13 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.

13 U.S. Central Command, Individual Protection and Individual/Unit
Deployment Policy, January 6, 2005, and DOD Instruction 1400.32, DOD
Civilian Workforce Contingency and Emergency Planning Guidelines and
Procedures, April 24, 1995.

                               Number of federal      Number (and Number (and 
                                        civilian percent) missing    percent) 
                                      deployment     tuberculosis missing HIV 
Location                     records reviewed        screening   screening 
Army                                                           
Fort Benning CONUS                        578          2 (0.3)    12 (2.1) 
Replacement Centera                                            
Fort Bliss CONUS                       2,977b          3 (0.1)     2 (0.1) 
Replacement Centera                                            
U.S. Army Corps of                        127        28 (22.0)     2 (1.6) 
Engineers Transatlantic                                        
Programs Center                                                
Total                                   3,682               33          16 
Navy                                                           
Naval Air Depot Cherry                     52        10 (19.2)   10 (19.2) 
Point                                                          
Total                                      52               10          10 
Air Force                                                      
Andrews Air Force Base                     10         6 (60.0)     0 (0.0) 
Hill Air Force Base                         8         5 (62.5)     0 (0.0) 
Hurlburt Field                             12          1 (8.3)    8 (66.7) 
USAF Wright-Patterson                       7          0 (0.0)    1 (14.3) 
Total                                      37               12           9 
Grand Total                            3,771c               55          35 

Table 3: DOD Federal Civilian Deployment Records Lacking Documentation of
Current Tuberculosis or HIV Screenings

Source: GAO analysis of documentation from DOD federal civilian deployment
records and component medical databases.

Note: CONUS refers to the continental United States.

aDCMA federal civilians deployed through Forts Benning and Bliss CONUS
Replacement Centers. At Fort Benning, we selected a probability sample of
238 out of 606 deployment records for deployed federal civilians;
consequently, the numbers and percentages shown are weighted estimates to
provide 95 percent confidence with a margin of error of 5 percentage
points.

bAlthough the Army deploys its federal civilian personnel at three primary
sites, Fort Bliss deployed the largest number of federal civilians during
our time frame. We reviewed the entire universe of deployment records for
federal civilian personnel deployed from this location because the records
were being maintained electronically, which facilitated the review of all
records. According to the program manager and database administrator, the
quality of these data, in terms of their completeness and accuracy, is
questionable because there are no assurances that all civilian personnel
who deployed are included in the database.

cDeployed federal civilians included in our review may have deployed more
than once during our deployment time frame; consequently, there may be
fewer than 3,771 unique federal civilians.

  Post-deployment Health Assessments

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.14 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.

14 U.S. Central Command, Individual Protection and Individual/Unit
Deployment Policy, January 6, 2005, and DOD Instruction 1400.32, DOD
Civilian Workforce Contingency and Emergency Planning Guidelines and
Procedures, April 24, 1995.

                                Number of federal   Number (and percent) with 
                              civilian deployment no documentation in records 
Location                      records reviewed               or data files 
Army                                           
Fort Benning CONUS                         578                  502 (86.9) 
Replacement Centera                            
Fort Bliss CONUS                        2,977b               2,977 (100.0) 
Replacement Centera                            
U.S. Army Corps of                         127                     3 (2.4) 
Engineers Transatlantic                        
Programs Center                                
Total                                    3,682                       3,482 
Navy                                           
Naval Air Depot Cherry                      52                   15 (28.8) 
Point                                          
Total                                       52                          15 
Air Force                                      
Andrews Air Force Base                      10                    9 (90.0) 
Hill Air Force Base                          8                    6 (75.0) 
Hurlburt Field                              12                   10 (83.3) 
Wright-Patterson Air Force                   7                    3 (42.9) 
Base                                           
Total                                       37                          28 
Grand Total                             3,771c                       3,525 

Table 4: DOD Federal Civilian Deployment Records Lacking Documentation of
Post-deployment Health Assessments

Source: GAO analysis of documentation from DOD federal civilian deployment
records and component medical databases.

Note: CONUS refers to the continental United States.

aDCMA federal civilians deployed through Forts Benning and Bliss CONUS
Replacement Centers. At Fort Benning, we selected a probability sample of
238 out of 606 deployment records for deployed federal civilians;
consequently, the numbers and percentages shown are weighted estimates to
provide 95 percent confidence with a margin of error of 5 percentage
points.

bAlthough the Army deploys its federal civilian personnel at three primary
sites, Fort Bliss deployed the largest number of federal civilians during
our time frame. We reviewed the entire universe of deployment records for
federal civilian personnel deployed from this location because the records
were being maintained electronically, which facilitated the review of all
records. According to the program manager and database administrator, the
quality of these data, in terms of their completeness and accuracy, is
questionable because there are no assurances that all civilian personnel
who deployed are included in the database.

cDeployed federal civilians included in our review may have deployed more
than once during our deployment time frame; consequently, there may be
fewer than 3,771 unique federal civilians.

Lack of Centralized Deployment Information Hinders the Overall Effectiveness of
Force Health Protection and Surveillance for Deployed Federal Civilian Personnel

Beyond the aforementioned weaknesses found in the selected components'
implementation of force health protection and surveillance requirements
for deploying federal civilians, as a larger issue, 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.15 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.16 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.

15 DOD Instruction 6490.3, Implementation and Application of Joint Medical
Surveillance for Deployments, August 7, 1997.

16 GAO, Defense Health Care: Quality Assurance Process Needed to Improve
Force Health Protection and Surveillance,  GAO-03-1041 (Washington, D.C.:
Sept. 19, 2003).

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.

DOD Has Taken Steps to Address Policy Shortcomings, but Lacks Mechanism to
Oversee Components' Compliance

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.17 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.

17 DOD Instruction 6490.3, Deployment Health, August 11, 2006 (to be
effective December 2006).

In a September 2003 report18 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 mandate19 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.

18 GAO-03-1041 .

1910 U.S.C. S: 1074f.

DOD Has Established and Implemented Medical Treatment Policies Which Provide for
                   the Care of Its Deployed Federal Civilians

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.20 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.

Figure 1: Overview of the Levels of DOD Medical Care Provided 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.

20 DOD Directive 1404.10, Emergency Essential (E-E) DOD U.S. Citizen
Civilian Employees, April 10, 1992, and DOD 1400.25-M, Department of
Defense Civilian Personnel Manual, April 12, 2005.

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) claim21 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.

21 The Federal Employees' Compensation Act, 5 U.S.C. S:S: 8101 et seq., is
a comprehensive workers' compensation law for federal employees.

Figure 2: Medical Treatment and Claims Processes for DOD Federal Civilians
Who Require Treatment for Deployment-Related Injuries or Diseases After
They Return to the United States

Note: OWCP refers to the Office of Workers' Compensation Programs.

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.

Special Pays and Benefits Provided to Deployed DOD Federal Civilian and Military
                  Personnel Generally Vary in Type and Amount

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.

Deployed DOD Federal Civilian and Military Personnel Generally Receive Various
Special Pays to Compensate Them for Conditions of Deployment, but the Types and
Amounts Differ

DOD federal civilian and military personnel are both eligible to receive
special pays to compensate them for the conditions of deployment. As shown
in table 5, some of the types of special pays are similar for both DOD
federal civilian and military personnel, although the amounts paid to each
group differ. Other special pays were unique to each group.

Table 5: Overview of Selected Types of Special Pays for Deployed DOD
Federal Civilian and Military Personnel

Type of special pay   Civilian personnel      Military personnel           
Premium pay           Overtime, night         No equivalent                
                         differential,           
                         Sunday/holiday work,    
                         compensatory time off   
Post differential     35 percent of basic pay $100 per month               
(Civilian)                                    
                                                 
Hardship duty pay                             
(Military)                                    
Danger pay (Civilian) 35 percent of basic pay $225 per month               
                                                 
Hostile fire                                  
pay/imminent danger                           
pay (Military)                                
Family separation     No equivalent           $250 per month               
allowance                                     
Combat zone tax       No equivalent           For enlisted personnel, all  
exclusion                                     compensation is tax-free;    
                                                 officers are capped at       
                                                 $6,724.50 per month          
Savings deposit       No equivalent           10 percent interest on       
program                                       savings deposits up to       
                                                 $10,000                      

Source: GAO analysis of military and federal data.

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.

Table 6: Scenario 1: Comparisons of Compensation Provided to DOD Federal
Civilian and Military Personnel Deployed to Afghanistan or Iraq for One
Year

                              Comparison 1                 Comparison 2                Comparison 3
                                                                     Military                                
Types of Compensation Civilian(GS-11) Military(O-3)  Civilian(GS-13)    (O-5)  Civilian(GS-15) Military(O-6)
Base pay                      $61,510       $54,036          $87,664  $79,567         $121,856       $98,575 
Basic allowance for                 0         2,250                0    2,250                0         2,250 
subsistence (BAS)a                                                                             
Basic allowance for                 0        26,784                0   31,644                0        31,908 
housing (BAH)a                                                                                 
30 hours overtime              55,396             0           65,520        0           91,088             0 
(per week)                                                                                     
Post                           21,529         1,200           30,682    1,200           42,650         1,200 
differential/hardship                                                                          
duty payb                                                                                      
Danger pay/ hostile            21,529         2,700           30,682    2,700           42,650         2,700 
fire/imminent danger                                                                           
pay b                                                                                          
Family separation                   0         3,000                0    3,000                0         3,000 
allowancea                                                                                     
Gross Pay                     159,963        89,970         183,500c  120,361         183,500c       139,633 
TSP contributiond              15,000         4,498           15,000    6,018           15,000         6,982 
Combat zone tax                     0        56,736                0   80,694                0        80,694 
exclusione                                                                                     
Military tax                        0        32,034                0   36,894                0        37,158 
exclusionf                                                                                     
Adjusted gross                144,963             0          168,500        0          168,500        14,799 
incomeg                                                                                        
Federal taxes dueh             23,687             0           30,528        0           30,528        -4,970 
Income After Taxes           $136,276       $89,970         $152,972 $120,361         $152,972      $144,603 

Source: GAO's analysis.

Notes: Scenario assumes comparable pay grades, Washington, D.C., location,
and married with two children. Numbers may not add due to rounding.

aNot taxable for military personnel.

bPost differential and danger pays are 35 percent of base pay for deployed
DOD federal civilians. Hardship duty and hostile fire/imminent danger pays
are $100 and $225 per month, respectively, for deployed military
personnel.

cAlthough total compensation for the calendar year is capped at $200,000,
Title 5 S: 5307 provides that an employee may be paid premium pay only to
the extent that the premium pay does not cause the aggregate of total
compensation for the calendar year to exceed the annual rate of basic pay
for Level I of the Executive Schedule (currently $183,500 for 2006).
Section 1105 of Pub. L. No. 109-163 authorized the Secretary of Defense to
increase the annual premium pay limitation for 2006 to $200,000 for
employees serving overseas in the U.S. Central Command area of
responsibility. Premium pay in excess of $183,500, up to $200,000, will be
paid to employees during the first pay period of 2007.

dAssumes $15,000 was paid into the Thrift Savings Plan (TSP) by DOD
federal civilians, and 5 percent of gross pay for military personnel. TSP
is a retirement savings plan for civilians who are employed by the United
States government and members of the uniformed services.

eThe combat zone tax exclusion is authorized by 26 U.S.C. S: 112. Military
personnel serving in direct support of operations in the combat zone are
eligible for the combat zone tax exclusion. All enlisted income is
eligible for this exclusion. Officers are capped at the highest enlisted
basic pay plus any imminent danger pay received, which currently is
$6,724.50 per month.

fIncludes nontaxable family separation allowance, BAS, and BAH.

gAdjusted Gross income minus TSP, combat zone tax exclusion, and other
military tax exclusions.

hComputed using commercial tax preparation software.

Table 7: Scenario 2: Comparisons of Compensation Provided to DOD Federal
Civilian and Military Personnel Deployed to Afghanistan or Iraq for Six
Months

                              Comparison 1                 Comparison 2                Comparison 3
                                                                     Military                                
Types of Compensation Civilian(GS-11) Military(O-3)  Civilian(GS-13)    (O-5)  Civilian(GS-15) Military(O-6)
Base pay                      $61,510       $54,036          $87,664  $79,567         $121,856       $98,575 
Basic allowance for                 0         2,250                0    2,250                0         2,250 
subsistence (BAS)a                                                                             
Basic allowance for                 0        26,784                0   31,644                0        31,908 
housing (BAH)a                                                                                 
30 hours overtime              27,698             0           32,760        0           45,544             0 
(per week)                                                                                     
Post                           10,764           600           15,341      600           21,325           600 
differential/hardship                                                                          
duty payb                                                                                      
Danger pay/ hostile            10,764         1,350           15,341    1,350           21,325         1,350 
fire/imminent danger                                                                           
pay b                                                                                          
Family separation                   0         1,500                0    1,500                0         1,500 
allowancea                                                                                     
Gross Pay                     110,736        86,520          151,106  116,911         183,500c       136,183 
TSP contributiond              15,000         4,326           15,000    5,846           15,000         6,809 
Combat zone tax                     0        28,368                0   40,347                0        40,347 
exclusione                                                                                     
Military tax                        0        30,534                0   35,394                0        35,658 
exclusionf                                                                                     
Adjusted gross                 95,736        23,292          136,106   35,324          168,500        53,369 
incomeg                                                                                        
Federal taxes dueh              9,561        -4,790           21,007   -1,155           30,528         1,856 
Income After Taxes           $101,175       $91,310         $130,099 $118,066         $152,972      $134,327 

Source: GAO's analysis.

Notes: Scenario assumes comparable grades, Washington, D.C. location, and
married with two children. Numbers may not add due to rounding.

aNot taxable for military personnel.

bPost differential and danger pays are 35% of base pay for deployed DOD
federal civilians. Hardship duty and hostile fire/imminent danger pays are
$100 and $225 per month, respectively, for deployed military personnel.

cAlthough total compensation for the calendar year is capped at $200,000,
Title 5 S: 5307 provides that an employee may be paid premium pay only to
the extent that the premium pay does not cause the aggregate of total
compensation for the calendar year to exceed the annual rate of basic pay
for Level I of the Executive Schedule (currently $183,500 for 2006).
Section 1105 of Pub. L. No. 109-163 authorized the Secretary of Defense to
increase the annual premium pay limitation for 2006 to $200,000 for
employees serving overseas in the U.S. Central Command area of
responsibility. Premium pay in excess of $183,500, up to $200,000, will be
paid to employees during the first pay period of 2007.

dAssumes $15,000 was paid into Thrift Savings Plan (TSP) by DOD federal
civilians, and 5% of gross pay for military personnel. TSP is a retirement
savings plan for civilians who are employed by the United States
government and members of the uniformed services.

eThe combat zone tax exclusion is authorized by 26 U.S.C. S: 112. Military
personnel serving in direct support of operations in the combat zone are
eligible for the combat zone tax exclusion. All enlisted income is
eligible for this exclusion. Officers are capped at the highest enlisted
basic pay plus any imminent danger pay received, which currently is
$6,724.50 per month.

fIncludes nontaxable family separation allowance, BAS, and BAH.

gAdjusted Gross income minus TSP, combat zone tax exclusion, and other
military tax exclusions.

hComputed using commercial tax preparation software.

DOD Federal Civilian and Military Personnel Receive Different Types and Amounts
of Disability Benefits, Depending on Specific Program Provisions and Individual
Circumstances

In the event of sustaining an injury while deployed, DOD federal civilian
and military personnel are eligible to receive two broad categories of
disability benefits-disability compensation22 and disability retirement.23
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.

22 Under workers' compensation and veterans' compensation programs,
benefits typically include medical treatment for the injury, vocational
rehabilitation services, and cash payment to replace a percentage of the
individual's loss in wages while injured and unable to work.

23Disability retirement programs typically provide benefits that allow
qualified individuals who are unable to work to retire earlier and/or to
retire with a higher percentage of their pre-injury salary level than
would otherwise be permitted with normal retirement based on age and
length of service at the time of injury.

  Temporary Disability Benefits

Both DOD federal civilian and military personnel who are injured in the
line of duty are eligible to receive continuation of their pay during the
initial period of treatment and may be eligible to receive recurring
payments for lost wages. However, the payments to DOD federal civilian
personnel are based on their salaries and whether the employee has any
dependents, regardless of the number, which can vary significantly,
whereas disability compensation payments made by the Department of
Veterans Affairs (VA) to injured military personnel are based on the
severity of the injury and their number of dependents. 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.24 In contrast, military personnel receive continuation of pay of
their salary for generally no longer than a year, followed by a recurring
VA disability compensation payment for wage loss that is based on the
degree of disability and their number of dependents, and temporary DOD
disability retirement for up to 5 years. 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,25 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.

24 Payment caps for federal civilians are based on the pay level for a
General Schedule (GS)-15, step 10 position, which was $118,957 per year or
($6,608 per month without dependents or $7,435 per month with dependent)
in 2006.

25 GAO, Disability Benefits: Benefit Amounts for Military Personnel and
Civilian Public Safety Officers Vary by Program Provisions and Individual
Circumstances, GAO-06-4 (Washington, D.C.: Apr. 7, 2006).

  Permanent Partial Disability Benefits

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 review26 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.27 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.

26 GAO-06-4 .

Our April 2006 review of disability benefits28 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.

  Permanent Total Disability Benefits

When an injury is severe enough to be deemed permanent and total,29 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.

27 The Federal Employees' Retirement System (FERS) generally covers all
federal employees hired after January 1, 1984. Those hired before 1984
still may be covered by the Civil Service Retirement System; however, that
system has been closed to new members since FERS was implemented in 1984.

28 GAO-06-4 .

29 Permanent total disability generally means that an individual is unable
to maintain gainful employment.

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.30

Survivors of DOD Federal Civilian and Military Personnel Received Comparable
Types of Benefits, but Benefit Amounts Differ

Survivors of deceased DOD federal civilian and military personnel
generally receive similar types of cash survivor benefits-either as a lump
sum, a recurring payment, or both-through comparable sources. However, the
benefit amounts generally differ for each group. Survivors of 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.

30 In the first year of FERS disability retirement benefits, FERS reduces
the retirement payment by the full amount of any SSDI payment. In
subsequent years, FERS reduces the disability retirement payment by 60
percent of the SSDI payment.

Table 8: Overview of the Type and Amount of Lump Sum Benefits Provided to
Survivors of DOD Federal Civilian and Military Personnel

Selected types of                                                          
survivor benefits Civilian personnel                 Military personnel
Social Security   Lump sum: $255                     Lump sum: $255        
Death gratuity    Up to $10,000                      $100,000              
Burial expenses   Up to $800, plus $200 for costs    Up to $7,700          
                     associated with terminating        
                     employee status                    
Life insurance    Basic pay, rounded to the nearest  Servicemembers' Group 
                     thousand, plus $2,000              Life Insurance up to  
                                                        $400,000              
Retirement plan   Basic death benefit of $24,866.19  No equivalent         
                     (for fiscal year 2006) plus 50     
                     percent of the civilian's final    
                     salary or an average of the        
                     civilian's highest 3 years of      
                     salary                             

Source: GAO analysis of federal data.

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.

Table 9: Overview of the Type and Amount of Recurring Benefits Provided to
Survivors of DOD Federal Civilian and Military Personnel

Type of recurring                                                          
survivor benefit       Civilian personnel    Military personnel
Social Security        Recurring payment     Recurring payment based on    
                          based on earnings in  earnings in covered           
                          covered employment    employment                    
Survivor benefit plan  No equivalent         55 percent of the military    
                                                member's monthly retirement   
                                                pay, offset by Dependency     
                                                Indemnity Compensation        
Dependency and         No equivalent         $1,033 per month plus $257    
indemnity compensation                       per month for each dependent  
                                                child, plus an additional     
                                                $250 for the first 2 years    
                                                for dependent children        
Workers' compensation  Up to 75 percent of   No equivalent                 
(only if the death     employee's monthly    
occurs while in the    salarya               
line of duty)                                
Retirement plan        50 percent of monthly No equivalent                 
(included if DOD       retirement payment if 
contributes to the     the employee had 10   
survivor benefit)      years of servicea     

Source: GAO analysis of federal data.

aThe survivor of a deceased DOD federal civilian can choose the benefit
through either the retirement plan or workers' compensation, which
normally pays a higher amount.

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.

Table 10: Summary of Noncash Benefits Provided to Survivors of DOD Federal
Civilian and Military Personnel

Noncash Benefit        Civilian personnel        Military personnel        
Continuation of health Survivors may continue to Surviving family members  
insurance coverage     participate in the        of the deceased           
                          Federal Employees' Health servicemember remain      
                          Benefits Program at the   eligible for health care  
                          same cost as a federal    benefits under TRICAREa   
                          employee if, prior to     at active duty dependent  
                          employee's death, these   rates for a 3-year        
                          individuals were covered  period, after which they  
                          as family members under   are eligible for retiree  
                          the plan.                 dependent rates.          
Education benefits for No equivalent             Surviving spouse and      
spouse, children, or                             children are eligible for 
both                                             up to 45 months of        
                                                    education benefits.       
Military-specific      No equivalent             Surviving spouse and      
                                                    children are eligible for 
                                                    rent-free government      
                                                    housing or tax-free       
                                                    housing allowance up to   
                                                    365 days, relocation      
                                                    assistance, and           
                                                    commissary and exchange   
                                                    privileges.               

Source: GAO analysis of federal data.

aTRICARE is a regionally structured program that uses civilian contractors
to maintain health care provider networks that complement health care
provided at military treatment facilities.

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.

                                  Conclusions

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.

                      Recommendation for Executive Action

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.

                       Agency Comments and Our Evaluation

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 [email protected] . 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.

Valerie C. Melvin Acting Director, Defense Capabilities and Management

List of Congressional Committees

The Honorable John Warner Chairman The Honorable Carl Levin Ranking
Minority Member Committee on Armed Services United States Senate

The Honorable Ted Stevens Chairman The Honorable Daniel K. Inouye Ranking
Minority Member Subcommittee on Defense Committee on Appropriations United
States Senate

The Honorable Duncan L. Hunter Chairman The Honorable Ike Skelton Ranking
Minority Member Committee on Armed Services House of Representatives

The Honorable C.W. Bill Young Chairman The Honorable John P. Murtha
Ranking Minority Member Subcommittee on Defense Committee on
Appropriations House of Representatives

Appendix I: Scope and Methodology

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, 2006.1 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.

1 For the purposes of health surveillance, DOD considers a deployment to
be 30 continuous days or greater to a land-based location outside the
continental United States that does not have a permanent U.S. military
treatment facility. We selected these deployment dates to incorporate
DOD's most recent changes to the post-deployment health assessment
criteria.

Table 11: DOD Component Locations and Number of DOD Federal Civilian
Deployment Records Included in Our Review

                                               Number of DOD federal civilian 
DOD component locations                        deployment records reviewed 
Army                                        
Fort Benning CONUS Replacement Center,                                 238 
Georgiaa                                    
Fort Bliss CONUS Replacement Center, Texasa                         2,977b 
U.S. Army Corps of Engineers Transatlantic                             127 
Programs Center, Virginia                   
Navy                                        
Naval Air Depot, Cherry Point, North                                    52 
Carolina                                    
Air Force                                   
Andrews Air Force Base, Maryland                                        10 
Hill Air Force Base, Utah                                                8 
Hurlburt Field, Florida                                                 12 
Wright-Patterson Air Force Base, Ohio                                    7 
Total                                                                3,431 

Source: GAO.

Note: CONUS refers to the continental United States.

aDCMA federal civilians deployed through Forts Benning and Bliss CONUS
Replacement Centers. At Fort Benning, we selected a probability sample of
238 out of 606 deployment records for deployed federal civilians and we
reviewed those 238 deployment records. When presenting the Fort Benning
review results in this report, we show numbers and percentages that are
weighted estimates to provide a 95 percent confidence with a margin of
error of 5 percentage points.

bAlthough the Army deploys its federal civilian personnel at three primary
sites, Fort Bliss deployed the largest number of federal civilians during
our time frame. We reviewed the entire universe of deployment records for
federal civilian personnel deployed from this location because the
deployment records were being maintained electronically, which facilitated
the review of all records.

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:

           o  Pre-and post-deployment health assessments;
           o  Tuberculosis screening test (within 1 year of deployment);
           o  Human Immunodeficiency Virus (HIV) screening test;
           o  Pre-deployment immunizations:

                        o  hepatitis A (first and second course);
                        o  influenza (within 1 year of deployment);
                        o  tetanus-diphtheria (within 10 years of
                        deployment);
                        o  typhoid; and
                        o  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:

           Table 12: Sample Disposition for Fort Benning Federal Civilian
           Deployment Records

           Source: GAO.

           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.

           Appendix II: Temporary and Permanent Partial Disability Benefits
			  Provided to DOD Federal Civilian and Military Personnel
			  
			  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.

                                    Total population Total sample   Number of 
Stratum description                          size         size respondents 
Stratum 1: Records with                                                    
potential duplicates                            2            2           2
Stratum 2: Records without                                                 
potential duplicates                          604          286         236
Total                                         606          288         238 

Appendix II: Temporary and Permanent Partial Disability Benefits Provided
to DOD Federal Civilian and Military Personnel Appendix II: Temporary and
Permanent Partial Disability Benefits Provided to DOD Federal Civilian and
Military Personnel

Table 13: Temporary Disability Compensation Payments, Payment Formula, and
2006 Payment Caps for DOD Federal Civilian and Military Personnel

                 Payment calculation for                                      
                 temporary partial and temporary Maximum monthly payment cap  
DOD Personnel total disability                in 2006
Civilian      Continuation of pay up to 45    $6,608 per month without     
                 days, followed by a recurring   dependents.                  
                 payment for wage loss (based on                              
                 a percentage of salary, up to a $7,435 per month with        
                 cap).                           dependents.                  
                                                 
                    o  Partial disability (when  
                    able to work, but at a       
                    reduced salary): Payments    
                    are 66-2/3 percent of the    
                    wage loss (that is, the      
                    difference between the       
                    part-time and full-time      
                    wages) without dependents;   
                    75 percent with dependents.  
                    o  Total disability (when    
                    unable to work): Payments    
                    are 66-2/3 percent of the    
                    employee's average weekly    
                    wage without dependents; 75  
                    percent with dependents.     
Military      Continuation of pay for         Each disability rating level 
                 generally no longer than a      corresponds to an annually   
                 year, followed by recurring VA  fixed monthly VA payment     
                 disability compensation         amount. During 2006, amounts 
                 payments.                       ranged from $112 to $2,393   
                                                 per month.                   
                 A servicemember's disability                                 
                 rating ranging from 0 to 100    "Add-ons" to basic payments  
                 percent, in 10 percent                                       
                 increments.a                    If the disability rating is  
                                                 30 percent or more, the      
                                                 individual is entitled to    
                                                 additional compensation for  
                                                 each dependent. During 2006, 
                                                 the additional amounts       
                                                 ranged from $40-$233 for a   
                                                 spouse, and $27-$91 for a    
                                                 child, depending on the      
                                                 level of disability.         

Source: GAO analysis of federal statutes.

aUnlike civilian personnel, military personnel also can be temporarily
released from service and be eligible to receive temporary DOD disability
retirement benefits if they are found unfit for duty, and they may
continue to receive a recurring VA disability compensation payment for
wage loss. However, the amount of the DOD retirement payment is reduced
(offset) dollar-for-dollar by the amount of the recurring VA payment,
unless they have at least 20 years of service and can qualify for an
exception to this offset due to a disability rating of 50 percent or more,
or combat-related disabilities. In our report on disability benefits
provided to military personnel and civilian public safety officers, we
noted that the added increment available from disability retirement, even
with applicable offsets, can increase military personnel's monthly
benefits significantly above that of comparable public safety officers at
all levels.

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.

Table 14: Permanent Partial Disability Compensation Payment Formulas and
Time Limits on Benefits for DOD Federal Civilian and Military Personnel

                Civilian personnel          Military personnel                
Compensation Payment calculation         Payment calculation               
payments                                                                   
                When able to work, but at a VA basic payment amounts          
                reduced salary, payments    established annually for          
                are 66-2/3 percent of the   disability ratings ranging from   
                wage loss (that is, the     10 percent to 90 percent. During  
                difference between the      2006, amounts ranged from $112 to 
                part-time and full-time     $1,436 per month. a               
                wages) without dependents;                                    
                75 percent with             "Add-ons" to basic payments       
                dependents.a                                                  
                                            If the disability rating is 30    
                Maximum period of time      percent or more, the individual   
                payments can be provided    is entitled to additional VA      
                                            compensation for each dependent.  
                Payments provided for the   During 2006, the additional       
                remainder of life, as long  amounts ranged from $40-$233 for  
                as the impairment persists. a spouse, and $27-$91 for a       
                                            child, depending on the level of  
                Schedule award              disability.                       
                                                                              
                Schedule of payments are    Special monthly VA compensation   
                based on the specific type  payments up to $4,176, depending  
                of impairment. For example, on the specific type and degree   
                up to 312 weeks (6 years)   of impairment.                    
                compensation due to the                                       
                loss of an arm, or the loss Maximum period of time payments   
                (or loss of use) of any     can be provided                   
                other important external or                                   
                internal organ of the body. No time limit regardless of       
                                            degree of impairment; payments    
                                            provided for the remainder of     
                                            life, as long as the impairment   
                                            persists.                         

Source: GAO analysis of federal statutes.

a Under the Civil Service Retirement System (CSRS), DOD federal civilian
personnel must be unfit for duty and have 5 years of service to qualify
for disability retirement. Under the Federal Employees' Retirement System
(FERS), civilian personnel must be unfit for duty and have 18 months of
service. DOD federal civilian personnel must elect either compensation
benefits or disability retirement. Military personnel who are unfit for
duty are eligible for DOD disability retirement benefits if they have a
disability rating of 30 percent or more regardless of length of service,
of if they have 20 years or more of service regardless of disability. The
amount of the DOD retirement payment is offset dollar for dollar, however,
by the amount of the monthly VA compensation payment unless the
servicemember has at least 20 years of service and a disability rating of
50 percent or more, or combat-related disabilities.

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.

Appendix III: Comments from the Department of Defense

Appendix IV: GAO Contact and Staff Acknowledgments

                                  GAO Contact

Valerie Melvin, (202) 512-6304

                                Acknowledgments

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.

(350829)

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Highlights of GAO-06-1085 , a report to congressional committees

September 2006

DOD CIVILIAN PERSONNEL

Greater Oversight and Quality Assurance Needed to Ensure Force Health
Protection and Surveillance for Those Deployed

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.

What GAO Recommends

To strengthen DOD's force health protection and surveillance for its
deployed federal civilians, GAO recommends that the Secretary of Defense
establish an oversight and quality assurance mechanism to ensure that all
components fully comply with its requirements. In commenting on a draft of
this report, DOD partially concurred with GAO's recommendation.

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.
*** End of document. ***