DOD Civilian Personnel: Medical Policies for Deployed DOD Federal
Civilians and Associated Compensation for Those Deployed	 
(18-SEP-07, GAO-07-1235T).					 
                                                                 
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. GAO was asked to discuss DOD's (1) force health	 
protection and surveillance policies, (2) medical treatment	 
policies that cover federal civilians while they are deployed to 
support contingency operations in Afghanistan and Iraq, and (3)  
differences in special pays and benefits provided to DOD's	 
deployed federal civilian and military personnel. For this	 
statement, GAO primarily drew on its September 2006 report that  
addressed these objectives. For its report, GAO analyzed over	 
3,400 deployment-related records at eight component locations for
deployed federal civilians and policies related to defense health
care, reviewed claims filed under the Federal Employees'	 
Compensation Act (FECA); and examined major provisions of special
pays and disability and death benefits provided to DOD's deployed
federal civilians and military personnel.			 
-------------------------Indexing Terms------------------------- 
REPORTNUM:   GAO-07-1235T					        
    ACCNO:   A76390						        
  TITLE:     DOD Civilian Personnel: Medical Policies for Deployed DOD
Federal Civilians and Associated Compensation for Those Deployed 
     DATE:   09/18/2007 
  SUBJECT:   Accountability					 
	     Civilian employees 				 
	     Claims processing					 
	     Claims settlement					 
	     Contingency operations				 
	     Disability benefits				 
	     Employee medical benefits				 
	     Federal employee disability programs		 
	     Health care programs				 
	     Health policy					 
	     Iraq War and reconstruction			 
	     Military health services				 
	     Military policies					 
	     Policy evaluation					 
	     Records						 
	     Policies and procedures				 
	     GAO High Risk Series				 

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GAO-07-1235T

   

     * [1]DOD Has Established Force Health Protection and Surveillance

          * [2]DOD Components Did Not Always Implement All Force Health Pro

               * [3]Pre-deployment Health Assessments
               * [4]Pre-deployment Immunizations
               * [5]Pre-deployment Medical Screenings
               * [6]Post-deployment Health Assessments

          * [7]Lack of Centralized Deployment Information Hinders the Overa
          * [8]DOD Has Taken Steps to Address Policy Shortcomings

     * [9]DOD Has Established and Implemented Medical Treatment Polici
     * [10]DOD Provides Special Pays and Benefits to Deployed DOD Feder

          * [11]Deployed DOD Federal Civilian and Military Personnel General
          * [12]DOD Federal Civilian and Military Personnel Receive Differen

               * [13]Temporary Disability Benefits
               * [14]Permanent Partial Disability Benefits
               * [15]Permanent Total Disability Benefits

          * [16]Survivors of DOD Federal Civilian and Military Personnel Rec

     * [17]Concluding Observations
     * [18]Contacts and Acknowledgments
     * [19]PDF6-Ordering Information.pdf

          * [20]Order by Mail or Phone

Testimony

Before the Subcommittee on Oversight and Investigations, Committee on
Armed Services, House of Representatives

United States Government Accountability Office

GAO

For Release on Delivery
Expected at 10:00 a.m. EDT
Tuesday, September 18, 2007

DOD CIVILIAN PERSONNEL

Medical Policies for Deployed DOD Federal Civilians and Associated
Compensation for Those Deployed

Statement of Brenda S. Farrell, Director
Defense Capabilities and Management

GAO-07-1235T

Mr. Chairman and Members of the Subcommittee:

Thank you for the opportunity to be here today to discuss the Department
of Defense's (DOD) policies for its federal civilians^1 who deploy in
support of contingency operations in Afghanistan and Iraq. First, let me
emphasize that as 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.
Further, 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. Therefore, the need for attention to the
policies and benefits that affect the health and welfare of these
individuals becomes increasingly significant. Today's hearing is
particularly timely considering the continuing role of the United States
in Afghanistan and Iraq as discussed during last week's hearings.

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.^2

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.

^1DOD's civilian workforce includes federal government employees, foreign
nationals hired directly or indirectly to work for DOD, and contractor
personnel. This statement focuses on DOD's federal government employees,
who we refer to as DOD's federal civilians.

^2Operation Enduring Freedom includes ongoing operations in Afghanistan
and in certain other countries; Operation Iraqi Freedom includes ongoing
operations in Iraq.

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.^3
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.

My testimony today will focus on (1) the extent to which DOD has
established and implemented force health protection and surveillance
policies, (2) medical treatment policies and procedures for its deployed
DOD federal civilians who require treatment for injuries and diseases, and
(3) the differences in special pays and benefits provided to DOD's
deployed federal civilians and military personnel. My remarks today are
primarily based on our September 2006 report on DOD's policies concerning
its federal civilians who have deployed in support of operations in
Afghanistan and Iraq.^4 For the 2006 report, we reviewed DOD deployment
health requirements for contingency operations in Afghanistan and Iraq. To
assess the implementation of these requirements, we analyzed over 3,400
deployment-related records for deployed federal civilians. We also
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 these policies, we requested all workers'
compensation claims that had been filed under the Federal Employees'
Compensation Act^5 (FECA) by DOD federal civilians who had deployed to
Afghanistan and Iraq. 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. We also 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. We performed our review
in accordance with generally accepted government auditing standards.

^3GAO, 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).

^4GAO, DOD Civilian Personnel: Greater Oversight and Quality Assurance
Needed to Ensure Force Health Protection and Surveillance for Those
Deployed, GAO-06-1085 (Washington, D.C.: Sept. 29, 2006). 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.

In summary, we found DOD had established force health protection and
surveillance policies aimed at assessing and reducing or preventing health
risks for its deployed federal civilian personnel, but lacked a quality
assurance mechanism to ensure the components' full compliance with its
policies, or the health care and protection of its deployed federal
civilians. DOD has taken steps in the right direction by issuing a new
policy in February 2007 toward that end. 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. Further, 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. We are not
taking a position on the adequacy or appropriateness of the special pays
and benefits provided to DOD federal civilian and military personnel. We
believe that any deliberations on this topic should include an examination
of how such changes would affect ensuring adequate and appropriate
benefits for those who serve their country, as well as the long-term
fiscal well-being of the nation.

^5The 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.

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

We reported in 2006 that DOD had established force health protection and
surveillance policies aimed at assessing and reducing or preventing health
risks for its deployed federal civilian personnel; however, at the time of
our review, the department lacked a quality assurance mechanism to ensure
the components' full implementation of its policies. In reviewing DOD
federal civilian deployment records and other electronic documentation^6
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 that became
effective in December 2006, outlining procedures to address its lack of
centralized deployment and health-related data. However, at the time of
our review, the procedures were not comprehensive enough to ensure that
DOD would be sufficiently informed of the extent to which its components
fully comply with its requirements to monitor the health of deployed
federal civilians.

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

Our 2006 report noted that 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 included 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.

^6In 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.

  Pre-deployment Health Assessments

DOD's force health protection and surveillance policies required 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.^7 At the time of our review,
the policies stipulated that all deploying civilian personnel were to
complete pre-deployment health assessment forms within 30 days^8 of their
deployments, and health care providers were 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.

^7DOD 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.

^8Subsequent to our review, DOD established a requirement that
pre-deployment health assessments must be confirmed as current within 60
days prior to the expected deployment date.

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                                                         
Replacement Center^a                       578                     2 (0.3) 
Fort Bliss CONUS                                                           
Replacement Center^a                   2,977^b                   0 (0.0)^b 
U.S. Army Corps of                                                         
Engineers Transatlantic                                                    
Programs Center                            127                     2 (1.6) 
Total                                    3,682                           4 
Navy                                                                       
Naval Air Depot Cherry                                                     
Point                                       52                   19 (36.5) 
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                                                 
Base                                         7                    4 (57.1) 
Total                                       37                          29 
Grand Total                            3,771^c                          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 stipulated that all DOD
deploying federal civilians receive theater-specific immunizations to
address possible health threats in deployment locations.^9 Immunizations
required for all civilian personnel who deployed to Afghanistan and Iraq
included: 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.

^9U.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.

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

                                  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                                                         
Replacement Center^a                 578       246 (42.6)       195 (33.7) 
Fort Bliss CONUS Replacement                                               
Center^a                         2,977^b          0 (0.0)    2,977 (100.0) 
U.S. Army Corps of Engineers                                               
Transatlantic Programs Center        127        25 (19.7)        85 (66.9) 
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                                                 
Base                                   7         1 (14.3)         4 (57.1) 
Total                                 37                6               17 
Grand Total                      3,771^c              285            3,313 

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 required deploying federal civilians to receive certain
screenings, such as for tuberculosis and HIV.^10 Table 3 indicates that,
at the time of our review, 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.

^10U.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.

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

                               Number of federal      Number (and Number (and 
                                        civilian percent) missing    percent) 
                                      deployment     tuberculosis missing HIV 
Location                     records reviewed        screening   screening 
Army                                                                       
Fort Benning CONUS                                                         
Replacement Center^a                      578          2 (0.3)    12 (2.1) 
Fort Bliss CONUS                                                           
Replacement Center^a                  2,977^b          3 (0.1)     2 (0.1) 
U.S. Army Corps of                                                         
Engineers Transatlantic                                                    
Programs Center                           127        28 (22.0)     2 (1.6) 
Total                                   3,682               33          16 
Navy                                                                       
Naval Air Depot Cherry                                                     
Point                                      52        10 (19.2)   10 (19.2) 
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                           3,771^c               55          35 

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 required
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.^11 At
the time of our review, the post-deployment process began within 5 days of
civilians' redeployment from the theater to their home or demobilization
processing stations. DOD's policies required civilian personnel to
complete a post-deployment assessment that included questions on health
and exposure concerns. A health care provider was 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. At the time of
our review, 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.

^11U.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.

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

                                Number of federal   Number (and percent) with 
                              civilian deployment no documentation in records 
Location                      records reviewed               or data files 
Army                                                                       
Fort Benning CONUS                                                         
Replacement Center^a                       578                  502 (86.9) 
Fort Bliss CONUS                                                           
Replacement Center^a                   2,977^b               2,977 (100.0) 
U.S. Army Corps of                                                         
Engineers Transatlantic                                                    
Programs Center                            127                     3 (2.4) 
Total                                    3,682                       3,482 
Navy                                                                       
Naval Air Depot Cherry                                                     
Point                                       52                   15 (28.8) 
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                                                 
Base                                         7                    3 (42.9) 
Total                                       37                          28 
Grand Total                            3,771^c                       3,525 

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, we noted in our 2006
report that DOD lacked 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 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.^12 However, at the time of our review, DOD
had 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.^13 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.

^12DOD Instruction 6490.3, Implementation and Application of Joint Medical
Surveillance for Deployments, August 7, 1997.

^13GAO, Defense Health Care: Quality Assurance Process Needed to Improve
Force Health Protection and Surveillance, [21]GAO-03-1041 (Washington,
D.C.: Sept. 19, 2003).

At the time of our review, 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, where these assessments are supposed to be archived in the
Defense Medical Surveillance System, 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. In our report, we
noted that 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

With increases in the department's use of federal civilian personnel to
support military operations, we noted in our report that 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, we further
noted that 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.^14 The revised policy and guidance, that
became effective in December 2006, require the components within 3 years,
to electronically report (at least weekly) to the Defense Manpower Data
Center, 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 Army
Medical Surveillance Activity for inclusion in the Defense Medical
Surveillance System.

Nonetheless, in our 2006 report we noted that 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, we noted that 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.

^14DOD Instruction 6490.3, Deployment Health, August 11, 2006.

To strengthen DOD's force health protection and surveillance for its
deployed federal civilians, in our 2006 report, we recommended that DOD
establish an oversight and quality assurance mechanism to ensure that all
components fully comply with its requirements. In February 2007, the
Office of the Deputy Assistant Secretary of Defense for Force Health
Protection and Readiness published a new instruction^15 on force health
protection quality assurance. This policy applies to military
servicemembers as well as applicable DOD and contractor personnel. The new
policy requires the military services to implement procedures to monitor
key force health protection elements such as pre- and post-deployment
health assessments. In addition, the policy requires each military service
to report its force health protection and quality assurance findings to
the Assistant Secretary of Defense (Health Affairs) through the Deputy
Assistant Secretary of Defense for Force Health Protection and Readiness.
In our June 2007 report^16 on DOD's compliance with the legislative
requirement to perform pre- and post-deployment medical examinations on
military servicemembers, we noted that DOD lacked a comprehensive
oversight framework to help ensure effective implementation of its
deployment health quality assurance program, which included specific
reporting requirements and results-oriented performance measures to
evaluate the services' adherence to deployment health requirements. Also,
we noted in our 2007 report that the department's new instruction and
planned actions indicate that DOD is taking steps in the right direction.
We stated and still believe that if the department follows through with
its efforts, it will be responsive to several of our reports'
recommendations to improve DOD's force health protection and surveillance
for the Total Force.

^15DOD Instruction 6200.05, Force Health Protection (FHP) Quality
Assurance Program, February 16, 2007.

^16GAO, Defense Health Care: Comprehensive Oversight Framework Needed to
Help Ensure Effective Implementation of a Deployment Health Quality
Assurance Program, GAO-07-831 (Washington, D.C.: June 22, 2007).

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

In our 2006 report, we found that DOD had 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.^17 DOD's military health system
provides four levels of medical care to personnel who are injured or
become ill while deployed, as shown in figure 1.

Figure 1: Overview of the Levels of DOD Medical Care Provided While
Deployed

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.

^17DOD 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.

In our 2006 report, we found that 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 FECA claim^18 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, as noted in our report, 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
employees 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.

^18The Federal Employees' Compensation Act, 5 U.S.C. SS 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)^19 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, 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.

DOD Provides Special Pays and Benefits to Deployed DOD Federal Civilian and
Military Personnel, but the Types and Amounts Differ

Our 2006 report found that 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. It should be
noted that while DOD federal civilian and military personnel are key
elements (components) of the Total Force, each is governed by a distinctly
different system. Both groups receive special pays, but the types and
amounts differ. DOD federal civilian personnel also receive different
types and amounts of disability benefits, depending on specific program
provisions and individual circumstances. In 2003, we designated federal
disability programs as a high-risk area because of continuing challenges
with modernizing those programs.^20 Importantly, our work examining
federal disability programs has found that the major disability programs
are neither well aligned with the 21st century environment nor positioned
to provide meaningful and timely support. 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.

^19Our actual review of claims filed by DOD federal civilians 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.

^20GAO, High-Risk Series: An Update, GAO-07-310 (Washington, D.C.: January
2007), 83-84.

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 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
government-provided disability benefits--disability compensation^21 and
disability retirement.^22 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. In 2003, we designated
federal disability programs as a high-risk area because of continuing
challenges with modernizing those programs. Importantly, our work
examining federal disability programs has found that the major disability
programs are neither well aligned with the 21st century environment nor
positioned to provide meaningful and timely support.^23

  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, as shown in table
6. 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.

^21Under 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.

^22Disability 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.

^23GAO-07-310.

^24Payment 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.

Table 6: 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.

  Permanent Partial Disability Benefits

When a partial disability is determined to be permanent, DOD federal
civilian and military personnel can to continue to receive recurring
compensation payments, as shown in table 7. 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.

Table 7: 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.

aUnder 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,
or 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.

  Permanent Total Disability Benefits

When an injury is severe enough to be deemed permanent and total,^25 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 similar to those for
permanent partial disability. DOD federal civilians with permanent
disabilities receive a schedule award based on the specific type of
impairment. In addition, DOD federal civilian personnel may be eligible
for an additional attendant allowance--up to $1,500 per month during
2006--if such care is needed. Military personnel receive special monthly
VA compensation payments for particularly severe injuries, such as
amputations, blindness, or other loss of use of organs and extremities.
The payments are designed to account for attendant care or other special
needs deriving from the disability. In 2003, we designated federal
disability programs as a high-risk area because of continuing challenges
with modernizing those programs. Our work examining federal disability
programs found that the major disability programs are neither well aligned
with the 21st century environment nor positioned to provide meaningful and
timely support.^26

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
civilian and military personnel also receive noncash benefits, which
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.

^25Permanent total disability generally means that an individual is unable
to maintain gainful employment.

^26GAO-07-310.

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.

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    salary^a                                            
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 service^a                                  

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.

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 TRICARE^a  
                          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.

Concluding Observations

DOD currently has important policies in place that relate to the
deployment of its federal civilians. Moreover, DOD's issuance of its new
instruction on force health quality assurance further indicates that DOD
is taking steps in the right direction. If the department follows through
with its efforts, we believe it will strengthen its force health
protection and surveillance oversight for the Total Force.

Mr. Chairman and Members of the Subcommittee, this concludes my prepared
statement. I would be happy to answer any questions you may have.

Contacts and Acknowledgments

If you or your staffs have any questions about this testimony, please
contact Brenda S. Farrell at (202) 512-3604 or [22][email protected] .
Contact points for our Offices of Congressional Relations and Public
Affairs may be found on the last page of this statement. Key contributors
to this testimony include Sandra B. Burrell, Assistant Director; Julie C.
Matta; and John S. Townes.

(351099)

To view the full product, including the scope
and methodology, click on [23]GAO-07-1235T .

For more information, contact Brenda S. Farrell at (202) 512-3604 or
[email protected].

Highlights of [24]GAO-07-1235T , a testimony before the Subcommittee on
Oversight and Investigations, Committee on Armed Services, House of
Representatives

September 18, 2007

DOD CIVILIAN PERSONNEL

Medical Policies for Deployed DOD Federal Civilians and Associated
Compensation 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. GAO was
asked to discuss DOD's (1) force health protection and surveillance
policies, (2) medical treatment policies that cover federal civilians
while they are deployed to support contingency operations in Afghanistan
and Iraq, and

(3) differences in special pays and benefits provided to DOD's deployed
federal civilian and military personnel.

For this statement, GAO primarily drew on its September 2006 report that
addressed these objectives. For its report, GAO analyzed over 3,400
deployment-related records at eight component locations for deployed
federal civilians and policies related to defense health care, reviewed
claims filed under the Federal Employees' Compensation Act (FECA); and
examined major provisions of special pays and disability and death
benefits provided to DOD's deployed federal civilians and military
personnel.

[25]What GAO Recommends

GAO recommended that DOD establish an oversight and quality assurance
mechanism to ensure that all components fully comply with its
requirements. In 2007, DOD issued a new force health protection and
surveillance policy that if effectively implemented will establish such a
mechanism.

In 2006, GAO reported that DOD had established force health protection and
surveillance policies to assess and reduce or prevent health risks for its
deployed federal civilians, but it lacked procedures to ensure
implementation. GAO's review of over 3,400 deployment records found that
components lacked documentation that some federal civilians who deployed
to Afghanistan and Iraq had received, among other things, required pre-
and post-deployment health assessments and immunizations. Also, DOD lacked
centralized data to readily identify its deployed civilians and their
movement in theater, thus hindering its efforts to assess the overall
effectiveness of its force health protection and surveillance
capabilities. GAO noted that until DOD establishes a mechanism to
strengthen its oversight of this area, it would not be effectively
positioned to ensure compliance with its policies, or the health care of
deployed federal civilians.

GAO also reported that DOD had 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
under the DOD military health system. GAO reviewed a sample of seven
workers' compensation claims (out of a universe of 83) filed under FECA 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
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.

GAO reported that 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 government-provided disability
benefits; however, the type and amount of the benefits vary, and some are
unique to each group. Importantly, continuing challenges with modernizing
federal disability programs have been the basis for GAO's designation of
this as a high-risk area since 2003. In addition, while the 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 civilians almost always receive
lower noncash benefits than military personnel. GAO does not take a
position on the adequacy or appropriateness of the special pays and
benefits provided to DOD federal civilian and military personnel. Any
deliberations on this topic should include an examination of how such
changes would affect ensuring adequate and appropriate benefits for those
who serve their country, as well as the long-term fiscal well-being of the
nation.

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References

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  21. http://www.gao.gov/cgi-bin/getrpt?GAO-03-1041
  22. mailto:[email protected]
  23. http://www.gao.gov/cgi-bin/getrpt?GAO-07-1235T
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