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entitled 'DOD Civilian Personnel: Greater Oversight and Quality 
Assurance Needed to Ensure Force Health Protection and Surveillance for 
Those Deployed' which was released on September 29, 2006. 

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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: 

DOD Civilian Personnel: 

GAO-06-1085: 

GAO Highlights: 

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

Why GAO Did This Study: 

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 Found: 

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. 

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. 

[Hyperlink, http://www.gao.gov/cgi-bin/getrpt?GAO-06-1085]. 

To view the full product, including the scope and methodology, click on 
the link above. For more information, contact Valerie Melvin at (202) 
512-6304 or melvinv@gao.gov. 

[End of Section] 

Contents: 

Letter: 

Results in Brief: 

Background: 

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 and Implemented Medical Treatment Policies Which 
Provide for the Care of Its Deployed Federal Civilians: 

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

Conclusions: 

Recommendation for Executive Action: 

Agency Comments and Our Evaluation: 

Appendix I: Scope and Methodology: 

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

Appendix III: Comments from the Department of Defense: 

Appendix IV: GAO Contact and Staff Acknowledgments: 

Tables: 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Figures: 

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

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: 

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: 

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.[Footnote 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.[Footnote 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. 

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.[Footnote 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)[Footnote 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.[Footnote 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. 

To determine the extent to which DOD and the selected components had 
established medical treatment policies for deployed federal civilian 
personnel who required treatment for injuries, illnesses, and diseases, 
we analyzed DOD policies and guidance related to defense health care 
and discussed these with senior DOD and service surgeon general 
officials. To assess the implementation of the policies, we requested 
all of the workers' compensation claims that had been filed under the 
Federal Employees' Compensation Act[Footnote 6] by DOD federal 
civilians who had deployed to Afghanistan and Iraq. However, our actual 
review of claims filed by DOD federal civilian personnel was limited to 
those who had deployed to Iraq because the responsible DOD officials 
were unable to identify the specific claims that had been filed by 
those federal civilians who had deployed to Afghanistan. We selected 
and reviewed a non-probability sample of workers' compensation claims 
to reflect a range of casualties, including injuries, physical and 
mental illnesses, and diseases. The scope of our review did not extend 
to the Department of Labor's claims review process, which covers the 
workers' compensation claims process. 

To determine the types of and differences in special pays and benefits 
provided to DOD federal civilian and military personnel who deploy in 
support of contingency operations in Afghanistan and Iraq, we examined 
the major provisions for special pays and disability and death benefits 
for civilian and military personnel, relying primarily on statutes, 
Department of State regulations, and DOD guidance. To illustrate how 
special pays affected overall compensation provided to DOD federal 
civilian and military personnel, we modeled scenarios for both groups 
based on similar circumstances, such as pay grades, length of 
deployment, and special pays. With regard to disability benefits, we 
compared benefits provided to DOD federal civilians for line-of-duty 
injuries with benefits provided to military personnel for service- 
connected injuries, focusing on three main categories of disability: 
(1) temporary disability, (2) permanent partial disability, and (3) 
permanent total disability. With regard to death benefits, we primarily 
reviewed statutes governing both cash and noncash government-provided 
benefits. In this report, we do not take a position regarding the 
adequacy or appropriateness of the special pays and benefits provided 
to DOD federal civilian and military personnel. 

We performed our review from March 2006 through August 2006 in 
accordance with generally accepted government auditing standards. For 
more detailed information on our scope and methodology, see appendix I. 

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 compensation[Footnote 7] and disability 
retirement;[Footnote 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.[Footnote 9] 

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 documentation[Footnote 10] 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. 

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.[Footnote 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. 

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

Location: Army: Fort Benning CONUS Replacement Center[A]; 
Number of federal civilian deployment records reviewed: 578; 
Number (and percent) with no documentation in either records or data 
files: 2 (0.3). 

Location: Army: Fort Bliss CONUS Replacement Center[A]; 
Number of federal civilian deployment records reviewed: 2,977[B]; 
Number (and percent) with no documentation in either records or data 
files: 0 (0.0)[B]. 

Location: Army: U.S. Army Corps of Engineers Transatlantic Programs 
Center; 
Number of federal civilian deployment records reviewed: 127; 
Number (and percent) with no documentation in either records or data 
files: 2 (1.6). 

Location: Army: Total; 
Number of federal civilian deployment records reviewed: 3,682; 
Number (and percent) with no documentation in either records or data 
files: 4. 

Location: Navy: Naval Air Depot Cherry Point; 
Number of federal civilian deployment records reviewed: 52; 
Number (and percent) with no documentation in either records or data 
files: 19 (36.5). 

Location: Navy: Total; 
Number of federal civilian deployment records reviewed: 52; 
Number (and percent) with no documentation in either records or data 
files: 19. 

Location: Air Force: Andrews Air Force Base; 
Number of federal civilian deployment records reviewed: 10; 
Number (and percent) with no documentation in either records or data 
files: 9 (90.0). 

Location: Air Force: Hill Air Force Base; 
Number of federal civilian deployment records reviewed: 8; 
Number (and percent) with no documentation in either records or data 
files: 5 (62.5). 

Location: Air Force: Hurlburt Field; 
Number of federal civilian deployment records reviewed: 12; 
Number (and percent) with no documentation in either records or data 
files: 11 (91.7). 

Location: Air Force: Wright-Patterson Air Force Base; 
Number of federal civilian deployment records reviewed: 7; 
Number (and percent) with no documentation in either records or data 
files: 4 (57.1). 

Location: Air Force: Total; 
Number of federal civilian deployment records reviewed: 37; 
Number (and percent) with no documentation in either records or data 
files: 29. 

Location: Grand Total; 
Number of federal civilian deployment records reviewed: 3,771[C]; 
Number (and percent) with no documentation in either records or data 
files: 52. 

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

² Note: CONUS refers to the continental United States. 

[A] DCMA 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. 

[B] Although 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. 

[C] Deployed 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. 

[End of table] 

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.[Footnote 
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. 

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

Location: Army: Fort Benning CONUS Replacement Center[A]; 
Number of federal civilian deployment records reviewed: 578; 
Number (and percent) missing only one immunization: 246 (42.6); 
Number (and percent) missing two or more immunizations: 195 (33.7). 

Location: Army: Fort Bliss CONUS Replacement Center[A]; 
Number of federal civilian deployment records reviewed: 2,977[B]; 
Number (and percent) missing only one immunization: 0 (0.0); 
Number (and percent) missing two or more immunizations: 2,977 (100.0). 

Location: Army: U.S. Army Corps of Engineers Transatlantic Programs 
Center; 
Number of federal civilian deployment records reviewed: 127; 
Number (and percent) missing only one immunization: 25 (19.7); 
Number (and percent) missing two or more immunizations: 85 (66.9). 

Location: Army: Total; 
Number of federal civilian deployment records reviewed: 3,682; 
Number (and percent) missing only one immunization: 271; 
Number (and percent) missing two or more immunizations: 3,257. 

Location: Navy: Naval Air Depot Cherry Point; 
Number of federal civilian deployment records reviewed: 52; 
Number (and percent) missing only one immunization: 8 (15.4); 
Number (and percent) missing two or more immunizations: 39 (75.0). 

Location: Navy: Total; 
Number of federal civilian deployment records reviewed: 52; 
Number (and percent) missing only one immunization: 8; 
Number (and percent) missing two or more immunizations: 39. 

Location: Air Force: Andrews Air Force Base; 
Number of federal civilian deployment records reviewed: 10; 
Number (and percent) missing only one immunization: 2 (20.0); 
Number (and percent) missing two or more immunizations: 7 (70.0). 

Location: Air Force: Hill Air Force Base; 
Number of federal civilian deployment records reviewed: 8; 
Number (and percent) missing only one immunization: 0 (0.0); 
Number (and percent) missing two or more immunizations: 3 (37.5). 

Location: Air Force: Hurlburt Field; 
Number of federal civilian deployment records reviewed: 12; 
Number (and percent) missing only one immunization: 3 (25.0); 
Number (and percent) missing two or more immunizations: 3 (25.0). 

Location: Air Force: Wright-Patterson Air Force Base; 
Number of federal civilian deployment records reviewed: 7; 
Number (and percent) missing only one immunization: 1 (14.3); 
Number (and percent) missing two or more immunizations: 4 (57.1). 

Location: Air Force: Total; 
Number of federal civilian deployment records reviewed: 37; 
Number (and percent) missing only one immunization: 6; 
Number (and percent) missing two or more immunizations: 17. 

Location: Grand Total; 
Number of federal civilian deployment records reviewed: 3,771[C]; 
Number (and percent) missing only one immunization: 285; 
Number (and percent) missing two or more immunizations: 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. 

[A] DCMA 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. 

[B] Although 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. 

[C] Deployed 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. 

[End of table] 

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.[Footnote 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. 

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

Location: Army: Fort Benning CONUS Replacement Center[A]; 
Number of federal civilian deployment records reviewed: 578; 
Number (and percent) missing tuberculosis screening: 2 (0.3); 
Number (and percent) missing HIV screening: 12 (2.1). 

Location: Army: Fort Bliss CONUS Replacement Center[A]; 
Number of federal civilian deployment records reviewed: 2,977[B]; 
Number (and percent) missing tuberculosis screening: 3 (0.1); 
Number (and percent) missing HIV screening: 2 (0.1). 

Location: Army: U.S. Army Corps of Engineers Transatlantic Programs 
Center; 
Number of federal civilian deployment records reviewed: 127; 
Number (and percent) missing tuberculosis screening: 28 (22.0); 
Number (and percent) missing HIV screening: 2 (1.6). 

Location: Army: Total; 
Number of federal civilian deployment records reviewed: 3,682; 
Number (and percent) missing tuberculosis screening: 33; 
Number (and percent) missing HIV screening: 16. 

Location: Navy: Naval Air Depot Cherry Point; 
Number of federal civilian deployment records reviewed: 52; 
Number (and percent) missing tuberculosis screening: 10 (19.2); 
Number (and percent) missing HIV screening: 10 (19.2). 

Location: Navy: Total; 
Number of federal civilian deployment records reviewed: 52; 
Number (and percent) missing tuberculosis screening: 10; 
Number (and percent) missing HIV screening: 10. 

Location: Air Force: Andrews Air Force Base; 
Number of federal civilian deployment records reviewed: 10; 
Number (and percent) missing tuberculosis screening: 6 (60.0); 
Number (and percent) missing HIV screening: 0 (0.0). 

Location: Air Force: Hill Air Force Base; 
Number of federal civilian deployment records reviewed: 8; 
Number (and percent) missing tuberculosis screening: 5 (62.5); 
Number (and percent) missing HIV screening: 0 (0.0). 

Location: Air Force: Hurlburt Field; 
Number of federal civilian deployment records reviewed: 12; 
Number (and percent) missing tuberculosis screening: 1 (8.3); 
Number (and percent) missing HIV screening: 8 (66.7). 

Location: Air Force: USAF Wright-Patterson; 
Number of federal civilian deployment records reviewed: 7; 
Number (and percent) missing tuberculosis screening: 0 (0.0); 
Number (and percent) missing HIV screening: 1 (14.3). 

Location: Air Force: Total; 
Number of federal civilian deployment records reviewed: 37; 
Number (and percent) missing tuberculosis screening: 12; 
Number (and percent) missing HIV screening: 9. 

Location: Grand Total; 
Number of federal civilian deployment records reviewed: 3,771[C]; 
Number (and percent) missing tuberculosis screening: 55; 
Number (and percent) missing HIV screening: 35. 

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

Note: CONUS refers to the continental United States. 

[A] DCMA 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. 

[B] Although 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. 

[C] Deployed 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. 

[End of Table] 

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.[Footnote 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. 

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

Location: Army: Fort Benning CONUS Replacement Center[A]; 
Number of federal civilian deployment records reviewed: 578; 
Number (and percent) with no documentation in records or data files: 
502 (86.9). 

Location: Army: Fort Bliss CONUS Replacement Center[A]; 
Number of federal civilian deployment records reviewed: 2,977[B]; 
Number (and percent) with no documentation in records or data files: 
2,977 (100.0). 

Location: Army: U.S. Army Corps of Engineers Transatlantic Programs 
Center; 
Number of federal civilian deployment records reviewed: 127; 
Number (and percent) with no documentation in records or data files: 3 
(2.4). 

Location: Army: Total; 
Number of federal civilian deployment records reviewed: 3,682; 
Number (and percent) with no documentation in records or data files: 
3,482. 

Location: Navy: Naval Air Depot Cherry Point; 
Number of federal civilian deployment records reviewed: 52; 
Number (and percent) with no documentation in records or data files: 15 
(28.8). 

Location: Navy: Total; 
Number of federal civilian deployment records reviewed: 52; 
Number (and percent) with no documentation in records or data files: 
15. 

Location: Air Force: Andrews Air Force Base; 
Number of federal civilian deployment records reviewed: 10; 
Number (and percent) with no documentation in records or data files: 9 
(90.0). 

Location: Air Force: Hill Air Force Base; 
Number of federal civilian deployment records reviewed: 8; 
Number (and percent) with no documentation in records or data files: 6 
(75.0). 

Location: Air Force: Hurlburt Field; 
Number of federal civilian deployment records reviewed: 12; 
Number (and percent) with no documentation in records or data files: 10 
(83.3). 

Location: Air Force: Wright-Patterson Air Force Base; 
Number of federal civilian deployment records reviewed: 7; 
Number (and percent) with no documentation in records or data files: 3 
(42.9). 

Location: Air Force: Total; 
Number of federal civilian deployment records reviewed: 37; 
Number (and percent) with no documentation in records or data files: 
28. 

Location: Grand Total; 
Number of federal civilian deployment records reviewed: 3,771[C]; 
Number (and percent) with no documentation in records or data files: 
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. 

[A] DCMA 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. 

[B] Although 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. 

[C] Deployed 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. 

[End of table] 

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.[Footnote 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.[Footnote 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. 

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.[Footnote 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. 

In a September 2003 report[Footnote 18] on the Army's and the Air 
Force's compliance with force health protection policy for 
servicemembers, we noted that neither of the military services had 
fully complied with DOD's force health protection and surveillance 
policies for many active duty servicemembers, including the policies 
requiring that servicemembers be assessed before and after deploying 
overseas and receive certain immunizations. We further noted that DOD, 
at that time, did not have an effective quality assurance program to 
provide oversight of, and ensure compliance with, the department's 
force health protection and surveillance requirements, and that the 
lack of such a system was a major cause of the high rate of 
noncompliance that we identified at the units we visited. In response 
to a legislative mandate[Footnote 19] 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. 

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.[Footnote 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: 

[See PDF for image] 

Source: Assistant Secretary of Defense for Health Affairs. 

[End of figure] 

Specifically, medical treatment during a military contingency begins 
with level one care, which consists of basic first aid and emergency 
care at a unit in the theater of operation. The treatment then moves to 
a second level of care, where, at an Aid station, injured or ill 
personnel are examined and evaluated to determine their priority for 
continued movement outside of the theater of operation and to the next 
(third) level of care. At the third level, injured or ill personnel are 
treated in a medical installation staffed and equipped for 
resuscitation, surgery, and postoperative care. Finally, at the fourth 
level of care, which occurs far from the theater of operation, injured 
or ill personnel are treated in a hospital staffed and equipped for 
definitive care. Injured or ill DOD federal civilians deployed in 
support of contingency operations in Afghanistan and Iraq who require 
level four medical care are transported to DOD's Regional Medical 
Center in Landstuhl, Germany. 

Injured or ill DOD federal civilians who cannot be returned to duty in 
theater are evacuated to the United States for continuation of medical 
care. In these cases (or where previously deployed federal civilians 
later identify injuries or diseases and subsequently request medical 
treatment), DOD's policy provides for its federal civilians who require 
treatment for deployment-related injuries or occupational illnesses to 
receive medical care through either the military's medical treatment 
facilities or civilian facilities. The policy stipulates that federal 
civilians who are injured or become ill as a result of their deployment 
must file a Federal Employees' Compensation Act (FECA) claim[Footnote 
21] 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. 

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: 

[See PDF for image] 

Source: GAO analysis. 

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

[End of figure] 

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: Premium pay; 
Civilian personnel: Overtime, night differential, Sunday/holiday work, 
compensatory time off; 
Military personnel: No equivalent. 

Type of special pay: Post differential (Civilian); 
Hardship duty pay (Military); 
Civilian personnel: 35 percent of basic pay; 
Military personnel: $100 per month. 

Type of special pay: Danger pay (Civilian); 
Hostile fire pay/imminent danger pay (Military); 
Civilian personnel: 35 percent of basic pay; 
Military personnel: $225 per month. 

Type of special pay: Family separation allowance; 
Civilian personnel: No equivalent; 
Military personnel: $250 per month. 

Type of special pay: Combat zone tax exclusion; 
Civilian personnel: No equivalent; 
Military personnel: For enlisted personnel, all compensation is tax-
free; 
officers are capped at $6,724.50 per month. 

Type of special pay: Savings deposit program; 
Civilian personnel: No equivalent; 
Military personnel: 10 percent interest on savings deposits up to 
$10,000. 

Source: GAO analysis of military and federal data. 

[End of table] 

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: 

Types of Compensation: Base pay; 
Comparison 1: Civilian (GS-11): $61,510; 
Comparison 1: Military (O-3): $54,036; 
Comparison 2: Civilian (GS-13): $87,664; 
Comparison 2: Military (O-5): $79,567; 
Comparison 3: Civilian (GS-15): $121,856; 
Comparison 3: Military (O-6): $98,575. 

Types of Compensation: Basic allowance for subsistence (BAS)[A]; 
Comparison 1: Civilian (GS-11): 0; 
Comparison 1: Military (O-3): 2,250; 
Comparison 2: Civilian (GS-13): 0; 
Comparison 2: Military (O- 5): 2,250; 
Comparison 3: Civilian (GS-15): 0; 
Comparison 3: Military (O-6): 2,250. 

Types of Compensation: Basic allowance for housing (BAH)[A]; 
Comparison 1: Civilian (GS-11): 0; 
Comparison 1: Military (O-3): 26,784; 
Comparison 2: Civilian (GS-13): 0; 
Comparison 2: Military (O-5): 31,644; 
Comparison 3: Civilian (GS-15): 0; 
Comparison 3: Military (O-6): 31,908. 

Types of Compensation: 30 hours overtime (per week); 
Comparison 1: Civilian (GS-11): 55,396; 
Comparison 1: Military (O-3): 0; 
Comparison 2: Civilian (GS-13): 65,520; 
Comparison 2: Military (O-5): 0; 
Comparison 3: Civilian (GS-15): 91,088; 
Comparison 3: Military (O-6): 0. 

Types of Compensation: Post differential/hardship duty pay[B]; 
Comparison 1: Civilian (GS-11): 21,529; 
Comparison 1: Military (O-3): 1,200; 
Comparison 2: Civilian (GS-13): 30,682; 
Comparison 2: Military (O-5): 1,200; 
Comparison 3: Civilian (GS-15): 42,650; 
Comparison 3: Military (O-6): 1,200. 

Types of Compensation: Danger pay/ hostile fire/imminent danger pay[ 
B]; 
Comparison 1: Civilian (GS-11): 21,529; 
Comparison 1: Military (O- 3): 2,700; 
Comparison 2: Civilian (GS-13): 30,682; 
Comparison 2: Military (O-5): 2,700; 
Comparison 3: Civilian (GS-15): 42,650; 
Comparison 3: Military (O-6): 2,700. 

Types of Compensation: Family separation allowance[A]; 
Comparison 1: Civilian (GS-11): 0; 
Comparison 1: Military (O-3): 3,000; 
Comparison 2: Civilian (GS-13): 0; 
Comparison 2: Military (O-5): 3,000; 
Comparison 3: Civilian (GS-15): 0; 
Comparison 3: Military (O- 6): 3,000. 

Types of Compensation: Gross Pay; 
Comparison 1: Civilian (GS-11): 159,963; 
Comparison 1: Military (O-3): 89,970; 
Comparison 2: Civilian (GS-13): 183,500[C]; 
Comparison 2: Military (O-5): 120,361; 
Comparison 3: Civilian (GS-15): 183,500[C]; 
Comparison 3: Military (O-6): 139,633. 

Types of Compensation: TSP contribution[D]; 
Comparison 1: Civilian (GS- 11): 15,000; 
Comparison 1: Military (O-3): 4,498; 
Comparison 2: Civilian (GS-13): 15,000; 
Comparison 2: Military (O-5): 6,018; 
Comparison 3: Civilian (GS-15): 15,000; 
Comparison 3: Military (O-6): 6,982. 

Types of Compensation: Combat zone tax exclusion[E]; 
Comparison 1: Civilian (GS-11): 0; 
Comparison 1: Military (O-3): 56,736; 
Comparison 2: Civilian (GS-13): 0; 
Comparison 2: Military (O-5): 80,694; 
Comparison 3: Civilian (GS-15): 0; 
Comparison 3: Military (O-6): 80,694. 

Types of Compensation: Military tax exclusion[F]; 
Comparison 1: Civilian (GS-11): 0; 
Comparison 1: Military (O-3): 32,034; 
Comparison 2: Civilian (GS-13): 0; 
Comparison 2: Military (O-5): 36,894; 
Comparison 3: Civilian (GS-15): 0; 
Comparison 3: Military (O-6): 37,158. 

Types of Compensation: Adjusted gross income[G]; 
Comparison 1: Civilian (GS-11): 144,963; 
Comparison 1: Military (O-3): 0; 
Comparison 2: Civilian (GS-13): 168,500; 
Comparison 2: Military (O-5): 0; 
Comparison 3: Civilian (GS-15): 168,500; 
Comparison 3: Military (O-6): 14,799. 

Types of Compensation: Federal taxes due[H]; 
Comparison 1: Civilian (GS-11): 23,687; 
Comparison 1: Military (O-3): 0; 
Comparison 2: Civilian (GS-13): 30,528; 
Comparison 2: Military (O-5): 0; 
Comparison 3: Civilian (GS-15): 30,528; 
Comparison 3: Military (O-6): - 4,970. 

Types of Compensation: Income After Taxes; 
Comparison 1: Civilian (GS- 11): $136,276; 
Comparison 1: Military (O-3): $89,970; 
Comparison 2: Civilian (GS-13): $152,972; 
Comparison 2: Military (O-5): $120,361; 
Comparison 3: Civilian (GS-15): $152,972; 
Comparison 3: Military (O-6): $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. 

[A] Not taxable for military personnel. 

[B] Post 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. 

[C] Although total compensation for the calendar year is capped at 
$200,000, Title 5 § 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. 

[D] Assumes $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. 

[E] The combat zone tax exclusion is authorized by 26 U.S.C. § 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. 

[F] Includes nontaxable family separation allowance, BAS, and BAH. 

[G] Adjusted Gross income minus TSP, combat zone tax exclusion, and 
other military tax exclusions. 

[H] Computed using commercial tax preparation software. 

[End of table] 

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

Types of Compensation: Base pay; 
Comparison 1: Civilian (GS-11): $61,510; 
Comparison 1: Military (O-3): $54,036; 
Comparison 2: Civilian (GS-13): $87,664; 
Comparison 2: Military (O-5): $79,567; 
Comparison 3: Civilian (GS-15): $121,856; 
Comparison 3: Military (O-6): $98,575. 

Types of Compensation: Basic allowance for subsistence (BAS)[A]; 
Comparison 1: Civilian (GS-11): 0; 
Comparison 1: Military (O-3): 2,250; 
Comparison 2: Civilian (GS-13): 0; 
Comparison 2: Military (O- 5): 2,250; 
Comparison 3: Civilian (GS-15): 0; 
Comparison 3: Military (O-6): 2,250. 

Types of Compensation: Basic allowance for housing (BAH)[A]; 
Comparison 1: Civilian (GS-11): 0; 
Comparison 1: Military (O-3): 26,784; 
Comparison 2: Civilian (GS-13): 0; 
Comparison 2: Military (O-5): 31,644; 
Comparison 3: Civilian (GS-15): 0; 
Comparison 3: Military (O-6): 31,908. 

Types of Compensation: 30 hours overtime (per week); 
Comparison 1: Civilian (GS-11): 27,698; 
Comparison 1: Military (O-3): 0; 
Comparison 2: Civilian (GS-13): 32,760; 
Comparison 2: Military (O-5): 0; 
Comparison 3: Civilian (GS-15): 45,544; 
Comparison 3: Military (O-6): 0. 

Types of Compensation: Post differential/hardship duty pay[B]; 
Comparison 1: Civilian (GS-11): 10,764; 
Comparison 1: Military (O-3): 600; 
Comparison 2: Civilian (GS-13): 15,341; 
Comparison 2: Military (O-5): 600; 
Comparison 3: Civilian (GS-15): 21,325; 
Comparison 3: Military (O-6): 600. 

Types of Compensation: Danger pay/ hostile fire/imminent danger pay[ 
B]; 
Comparison 1: Civilian (GS-11): 10,764; 
Comparison 1: Military (O- 3): 1,350; 
Comparison 2: Civilian (GS-13): 15,341; 
Comparison 2: Military (O-5): 1,350; 
Comparison 3: Civilian (GS-15): 21,325; 
Comparison 3: Military (O-6): 1,350. 

Types of Compensation: Family separation allowance[A]; 
Comparison 1: Civilian (GS-11): 0; 
Comparison 1: Military (O-3): 1,500; 
Comparison 2: Civilian (GS-13): 0; 
Comparison 2: Military (O-5): 1,500; 
Comparison 3: Civilian (GS-15): 0; 
Comparison 3: Military (O- 6): 1,500. 

Types of Compensation: Gross Pay; 
Comparison 1: Civilian (GS-11): 110,736; 
Comparison 1: Military (O-3): 86,520; 
Comparison 2: Civilian (GS-13): 151,106; 
Comparison 2: Military (O-5): 116,911; 
Comparison 3: Civilian (GS-15): 183,500[C]; 
Comparison 3: Military (O-6): 136,183. 

Types of Compensation: TSP contribution[D]; 
Comparison 1: Civilian (GS- 11): 15,000; 
Comparison 1: Military (O-3): 4,326; 
Comparison 2: Civilian (GS-13): 15,000; 
Comparison 2: Military (O-5): 5,846; 
Comparison 3: Civilian (GS-15): 15,000; 
Comparison 3: Military (O-6): 6,809. 

Types of Compensation: Combat zone tax exclusion[E]; 
Comparison 1: Civilian (GS-11): 0; 
Comparison 1: Military (O-3): 28,368; 
Comparison 2: Civilian (GS-13): 0; 
Comparison 2: Military (O-5): 40,347; 
Comparison 3: Civilian (GS-15): 0; 
Comparison 3: Military (O-6): 40,347. 

Types of Compensation: Military tax exclusion[F]; 
Comparison 1: Civilian (GS-11): 0; 
Comparison 1: Military (O-3): 30,534; 
Comparison 2: Civilian (GS-13): 0; 
Comparison 2: Military (O-5): 35,394; 
Comparison 3: Civilian (GS-15): 0; 
Comparison 3: Military (O-6): 35,658. 

Types of Compensation: Adjusted gross income[G]; 
Comparison 1: Civilian (GS-11): 95,736; 
Comparison 1: Military (O-3): 23,292; 
Comparison 2: Civilian (GS-13): 136,106; 
Comparison 2: Military (O-5): 35,324; 
Comparison 3: Civilian (GS-15): 168,500; 
Comparison 3: Military (O-6): 53,369. 

Types of Compensation: Federal taxes due[H]; 
Comparison 1: Civilian (GS-11): 9,561; 
Comparison 1: Military (O-3): -4,790; 
Comparison 2: Civilian (GS-13): 21,007; 
Comparison 2: Military (O-5): - 1,155; 
Comparison 3: Civilian (GS-15): 30,528; 
Comparison 3: Military (O-6): 1,856. 

Types of Compensation: Income After Taxes; 
Comparison 1: Civilian (GS- 11): $101,175; 
Comparison 1: Military (O-3): $91,310; 
Comparison 2: Civilian (GS-13): $130,099; 
Comparison 2: Military (O-5): $118,066; 
Comparison 3: Civilian (GS-15): $152,972; 
Comparison 3: Military (O-6): $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. 

[A] Not taxable for military personnel. 

[B] Post 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. 

[C] Although total compensation for the calendar year is capped at 
$200,000, Title 5 § 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. 

[D] Assumes $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. 

[E] The combat zone tax exclusion is authorized by 26 U.S.C. § 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. 

[F] Includes nontaxable family separation allowance, BAS, and BAH. 

[G] Adjusted Gross income minus TSP, combat zone tax exclusion, and 
other military tax exclusions. 

[H] Computed using commercial tax preparation software. 

[End of table] 

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 compensation[Footnote 22] 
and disability retirement.[Footnote 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. 

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.[Footnote 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,[Footnote 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. 

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 review[Footnote 26] 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.[Footnote 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. 

Our April 2006 review of disability benefits[Footnote 28] 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,[Footnote 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. 

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.[Footnote 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. 

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: Social Security; 
Civilian personnel: Lump sum: $255; 
Military personnel: Lump sum: $255. 

Selected types of survivor benefits: Death gratuity; 
Civilian personnel: Up to $10,000; 
Military personnel: $100,000. 

Selected types of survivor benefits: Burial expenses; 
Civilian personnel: Up to $800, plus $200 for costs associated with 
terminating employee status; 
Military personnel: Up to $7,700. 

Selected types of survivor benefits: Life insurance; 
Civilian personnel: Basic pay, rounded to the nearest thousand, plus 
$2,000; 
Military personnel: Servicemembers' Group Life Insurance up to 
$400,000. 

Selected types of survivor benefits: Retirement plan; 
Civilian personnel: Basic death benefit of $24,866.19 (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; 
Military personnel: No equivalent. 

Source: GAO analysis of federal data. 

[End of table] 

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: Social Security; 
Civilian personnel: Recurring payment based on earnings in covered 
employment; 
Military personnel: Recurring payment based on earnings in covered 
employment. 

Type of recurring survivor benefit: Survivor benefit plan; 
Civilian personnel: No equivalent; 
Military personnel: 55 percent of the military member's monthly 
retirement pay, offset by Dependency Indemnity Compensation. 

Type of recurring survivor benefit: Dependency and indemnity 
compensation; 
Civilian personnel: No equivalent; 
Military personnel: $1,033 per month plus $257 per month for each 
dependent child, plus an additional $250 for the first 2 years for 
dependent children. 

Type of recurring survivor benefit: Workers' compensation (only if the 
death occurs while in the line of duty); 
Civilian personnel: Up to 75 percent of employee's monthly salary[A]; 
Military personnel: No equivalent. 

Type of recurring survivor benefit: Retirement plan (included if DOD 
contributes to the survivor benefit); 
Civilian personnel: 50 percent of monthly retirement payment if the 
employee had 10 years of service[A]; 
Military personnel: No equivalent. 

Source: GAO analysis of federal data. 

[A] The 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. 

[End of table] 

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: Continuation of health insurance coverage; 
Civilian personnel: Survivors may continue to participate in the 
Federal Employees' Health Benefits Program at the same cost as a 
federal employee if, prior to employee's death, these individuals were 
covered as family members under the plan; 
Military personnel: Surviving family members of the deceased 
servicemember remain eligible for health care benefits under TRICARE[A] 
at active duty dependent rates for a 3-year period, after which they 
are eligible for retiree dependent rates. 

Noncash Benefit: Education benefits for spouse, children, or both; 
Civilian personnel: No equivalent; 
Military personnel: Surviving spouse and children are eligible for up 
to 45 months of education benefits. 

Noncash Benefit: Military-specific; 
Civilian personnel: No equivalent; 
Military personnel: 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. 

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

[End of table] 

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 [Hyperlink, 
http://www.gao.gov]. 

Should you or your staff have any questions about this report, please 
contact me at (202) 512-6304 or by e-mail at melvinv@gao.gov. Contact 
points for our Offices of Congressional Relations and Public Affairs 
may be found on the last page of this report. Key contributors to this 
report are listed in appendix IV. 

Signed by: 

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: 

[End of section] 

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.[Footnote 31] 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. 

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

DOD component locations: Army: Fort Benning CONUS Replacement Center, 
Georgia[A]; 
Number of DOD federal civilian deployment records reviewed: 238. 

DOD component locations: Army: Fort Bliss CONUS Replacement Center, 
Texas[A]; 
Number of DOD federal civilian deployment records reviewed: 2,977[B]. 

DOD component locations: Army: U.S. Army Corps of Engineers 
Transatlantic Programs Center, Virginia; 
Number of DOD federal civilian deployment records reviewed: 127. 

DOD component locations: Navy: Naval Air Depot, Cherry Point, North 
Carolina; 
Number of DOD federal civilian deployment records reviewed: 52.  

DOD component locations: Air Force: Andrews Air Force Base, Maryland; 
Number of DOD federal civilian deployment records reviewed: 10. 

DOD component locations: Air Force: Hill Air Force Base, Utah; 
Number of DOD federal civilian deployment records reviewed: 8. 

DOD component locations: Air Force: Hurlburt Field, Florida; 
Number of DOD federal civilian deployment records reviewed: 12. 

DOD component locations: Air Force: Wright-Patterson Air Force Base, 
Ohio; 
Number of DOD federal civilian deployment records reviewed: 7. 

DOD component locations: Total; 
Number of DOD federal civilian deployment records reviewed: 3,431. 

Source: GAO. 

Note: CONUS refers to the continental United States. 

[A] DCMA 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. 

[B] Although 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. 

[End of table] 

In total, we reviewed 3,431 hard copy and automated records for federal 
civilian personnel who deployed to Afghanistan and Iraq. Specifically, 
we reviewed hard copies of deployment records for 454 (out of a 
reported 822) federal civilian personnel at seven component locations 
and automated deployment records for 2,977 (out of the reported 2,977) 
federal civilian personnel at the other location where all deployment 
records were being maintained electronically. The results of deployment 
record reviews, however, could not be projected beyond the samples to 
all DOD federal civilians who had deployed during this time frame. To 
facilitate our review of federal civilian deployment records at the 
selected component locations, we developed a data collection instrument 
to review and collect deployment health information from each 
individual civilian's deployment record. 

For federal civilians in our review at each location, we reviewed 
deployment records for documentation that the following force health 
protection and surveillance policy requirements were met: 

* Pre-and post-deployment health assessments; 

* Tuberculosis screening test (within 1 year of deployment); 

* Human Immunodeficiency Virus (HIV) screening test; 

* Pre-deployment immunizations: 

- hepatitis A (first and second course); 

- influenza (within 1 year of deployment); 

- tetanus-diphtheria (within 10 years of deployment); 

- typhoid; and: 

- smallpox (within 5 years of deployment): 

After our review of hard copy deployment records, we requested each 
component's medical personnel to reexamine those hard copy deployment 
records that were missing required health documentation, and we 
adjusted our results where documentation was subsequently provided. We 
also requested and queried other documentation from information systems 
used by the components to capture deployment and related health 
information, making adjustments to our results where documentation was 
found in the systems. These data sources included the Army's Medical 
Protection System (MEDPROS), the Army's medical database (MedBase), the 
Air Force's Preventive Health Assessment and Individual Medical 
Readiness (PIMR) system and its Comprehensive Immunization Tracking 
Application (CITA), DOD's Defense Enrollment Eligibility Reporting 
System (DEERS), which is used by the Navy, and the Army Medical 
Surveillance Activity's Defense Medical Surveillance System (DMSS). 

At the Army's Fort Benning, we created a sampling frame (i.e., total 
population) of records for 606 federal civilian deployments between 
June 1, 2003, and September 30, 2005. Our study population was limited 
to DOD federal civilians who deployed to Afghanistan or Iraq. We then 
drew a stratified random sample of 288 deployment records and 
stratified the sample to isolate potential duplicate deployment records 
for the same federal civilian. We found two duplicate records and 
removed them from both the population and sample, as shown in table 12. 
We also removed another 14 deployment records from our sample because 
those DOD federal civilians had been deployed to locations other than 
Afghanistan or Iraq, and were not eligible for the duty population. In 
addition, we removed another 13 deployment records that were originally 
selected as potential replacement records; however, we found that those 
replacements were not needed. Ultimately, we identified 238 in-scope 
responses, for a weighted response rate of 87 percent. Each sampled 
record was subsequently weighted in the analysis to represent all DOD 
federal civilians deployed to Afghanistan or Iraq. The disposition of 
the federal civilian deployment records we reviewed at Fort Benning are 
summarized in the following table: 

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

Stratum description: Stratum 1: Records with potential duplicates; 
Total population size: 2; 
Total sample size: 2; 
Number of respondents: 2. 

Stratum description: Stratum 2: Records without potential duplicates; 
Total population size: 604; 
Total sample size: 286; 
Number of respondents: 236. 

Stratum description: Total; 
Total population size: 606; 
Total sample size: 288; 
Number of respondents: 238. 

Source: GAO. 

[End of table] 

Our probability sample is only one of a large number of samples that we 
might have drawn. Because each sample could have provided different 
estimates, we express our confidence in the precision of our particular 
sample's results as a 95 percent confidence interval. This is the 
interval that would contain the actual population value for 95 percent 
of the Fort Benning, Ga., samples we could have drawn. All percentage 
estimates from our sample have margins of error (that is, widths of 
confidence intervals) of plus or minus 5 percentage points or less, at 
the 95 percent confidence level, unless otherwise noted. 

We took steps to assess the reliability of DOD federal civilian 
deployment and health data for the purposes of this review, including 
consideration of issues such as the completeness of the data from the 
respective information systems' program managers and administrators. We 
also examined whether the data were subjected to quality control 
measures such as periodic testing of the data against deployment 
records to ensure the accuracy and reliability of the data. In 
addition, we reviewed existing documentation related to the data 
sources and interviewed knowledgeable agency officials about the data. 
We did not find these deployment and health data to be sufficiently 
reliable for (1) identifying the universe of DOD federal civilian 
deployments or (2) use as the sole source for reviewing the health and 
immunization information for all DOD federal civilian deployments, but 
we found the information systems to be sufficiently reliable when used 
as one of several sources in our review of deployment records. In those 
instances where we did not find a deployment health assessment or 
immunization in either the deployment records or in the electronic data 
systems, we concluded that the health assessment or immunization was 
not documented. 

To determine the extent to which DOD has established and the components 
have implemented medical treatment policies for DOD federal civilians 
who deployed in support of contingency operations, we examined 
pertinent medical treatment policies for DOD federal civilian employees 
who required treatment for injuries and diseases sustained while 
supporting contingency operations. In addition, we obtained workers' 
compensation claims filed by DOD federal civilian personnel with the 
Department of Labor's Office of Workers' Compensation Programs(OWCP) 
showing those civilians who sustained injuries and diseases during 
deployment. We selected and reviewed a non-probability sample of claims 
to assess the components' processes and procedures for implementing 
DOD's medical treatment policies across a range of civilian casualties 
including injuries, physical and mental illnesses, and diseases. The 
scope of our review did not extend to the Department of Labor's claims 
review process. 

To identify special pays and benefits provided to DOD federal civilians 
who deployed in support of contingency operations and to assess the 
extent that special pays and benefits differ from those provided to 
deployed active duty military personnel, we examined major statutory 
provisions for special pays, disability and death benefits for federal 
civilians and military personnel, including relevant chapters of Title 
5 of the U.S. Code governing federal civilian personnel management; 
relevant chapters of Title 10 of the U.S. Code governing armed forces 
personnel management; Section 112 of Title 26 of the U.S. Code 
governing combat zone tax exemption; relevant chapters of Title 37 of 
the U.S. Code governing pay and allowances for the uniformed services; 
relevant chapters of Title 38 of the U.S. Code governing veterans' 
benefits; relevant provisions of applicable public laws governing 
military and civilian pay and benefits; applicable directives and 
instructions related to active duty military and DOD federal civilian 
benefits and entitlements; DOD financial management regulations; 
Department of State regulations; and prior GAO reports. In addition, we 
discussed the statutes and guidance with cognizant officials of the 
Office of the Under Secretary of Defense for Personnel and Readiness, 
military services' headquarters, and the Defense Contract Management 
Agency involved with the administration of active duty and federal 
civilian personnel entitlements. We did not perform a comprehensive 
review of all compensation--comprised of a myriad of pays and benefits-
-offered to active duty military and federal civilian personnel in 
general. Our analysis focused on selected elements of compensation such 
as special pays (e.g., hostile fire/imminent danger pay). Also, we did 
not make direct analytical comparisons between compensation and 
benefits offered by DOD to deployed federal civilian and military 
personnel because such comparisons must account for the demands of the 
military service, such as involuntary relocation, frequent and lengthy 
separations from family, and liability for combat. 

After reviewing documents and interviewing officials, we then compiled 
and analyzed the information on the types and amounts of special pays 
and benefits available to active duty military and DOD federal civilian 
personnel who deployed to Afghanistan or Iraq. We interviewed DOD 
officials to discuss the basis for any differences in compensation. In 
addition, to illustrate how special pays affect overall compensation 
provided to DOD federal civilian and military personnel, we modeled 
scenarios for both groups using similar circumstances, such as length 
of deployment, pay grades, special pays (e.g., post differential pay, 
danger pay, overtime pay, family separation allowance, basic allowance 
for housing, basic allowance for subsistence), and duty location. 
Through discussions with senior DOD officials, we made an assumption 
that deployed DOD federal civilians worked 30 hours of overtime per 
week. For deployed DOD federal civilians, we subtracted a contribution 
of $15,000 to the Thrift Savings Plan (TSP) to obtain the adjusted 
gross income. We assumed that DOD federal civilians, temporarily at a 
higher tax bracket, would take maximum advantage of the opportunity to 
defer taxes. We assumed that the military personnel would contribute a 
smaller percentage of pay, 5 percent of gross income, to TSP. We made 
this assumption because much of the military pay was not subject to 
federal taxes, which removes the incentive to contribute to TSP, and 
because unlike for federal workers, military TSP does not have a 
matching component. For military personnel, we also deducted the amount 
of pay not subject to taxes due to the combat zone exclusion, family 
separation allowance, basic allowance for subsistence, and basic 
allowance for housing. Using these assumptions, we generated an 
adjusted gross income and used that as input into a commercial tax 
program, Turbo Tax, to obtain federal taxes owed. We assumed that both 
DOD federal civilian and military personnel were married, filing 
jointly, with a spouse that earned no income. We assumed that the 
family had two children and qualified for two child tax credits, and 
the Earned Income Tax Credit, if at that income level. This resulted in 
four exemptions and a standard deduction of $10,000 in 2005. For 
purposes of validation, we repeated this exercise using an alternate 
tax program, Tax Cut, and obtained identical results. 

We conducted our review from March 2006 to August 2006 in accordance 
with generally accepted government auditing standards. 

[End of section] 

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. 

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

DOD Personnel: Civilian; 
Payment calculation for temporary partial and temporary total 
disability: Continuation of pay up to 45 days, followed by a recurring 
payment for wage loss (based on a percentage of salary, up to a cap); 
* 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; 
* 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; 
Maximum monthly payment cap in 2006: $6,608 per month without 
dependents; 
$7,435 per month with dependents. 

DOD Personnel: Military; 
Payment calculation for temporary partial and temporary total 
disability: Continuation of pay for generally no longer than a year, 
followed by recurring VA disability compensation payments; 
A servicemember's disability rating ranging from 0 to 100 percent, in 
10 percent increments.[A]; 
Maximum monthly payment cap in 2006: Each disability rating level 
corresponds to an annually fixed monthly VA payment amount. During 
2006, amounts ranged from $112 to $2,393 per month; 
"Add-ons" to basic payments; 
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. 

[A] Unlike 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. 

[End of table] 

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: 

Compensation payments; 
Civilian personnel: 
* Payment calculation; 
* 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.[A]; 
Maximum period of time payments can be provided; 
Payments provided for the remainder of life, as long as the impairment 
persists; 
Schedule award; 
Schedule of payments are based on the specific type of impairment. For 
example, up to 312 weeks (6 years) compensation due to the loss of an 
arm, or the loss (or loss of use) of any other important external or 
internal organ of the body; 
Military personnel: Payment calculation; 
* VA basic payment amounts established annually for disability ratings 
ranging from 10 percent to 90 percent. During 2006, amounts ranged from 
$112 to $1,436 per month.[ A]; 
"Add-ons" to basic payments; 
If the disability rating is 30 percent or more, the individual is 
entitled to additional VA 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; 
Special monthly VA compensation payments up to $4,176, depending on the 
specific type and degree of impairment; 
Maximum period of time payments can be provided; 
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. 

[End of table] 

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. 

[End of section] 

Appendix III: Comments from the Department of Defense: 

Under Secretary Of Defense: 
4000 Defense Pentagon: 
Washington, D.C. 20301-4000: 

Sep 20 2006: 

Personnel And Readiness: 

Ms. Valerie C. Melvin: 
Acting Director, Defense Capabilities and Management: 
U.S. Government Accountability Office: 
441 G Street, N. W. 
Washington, DC 20548: 

Dear Ms. Melvin: 

This is the Department of Defense (DoD) response to the Government 
Accountability Office (GAO) draft report, GAO-06-1085, "DOD Civilian 
Personnel: Greater Oversight and Quality Assurance Needed to Ensure 
Force Health Protection and Surveillance for Those Deployed," dated 
September 1, 2006 (GAO Code 350829). We appreciate the GAO's efforts to 
comply with the broad review requirements established by Senate Armed 
Services Committee. The GAO's observations with respect to DoD policies 
regarding deployment of civilians confirm that the Department has come 
a long way since its 1994 review (GAO report, GAO/NSIAD-95-5, "DoD 
Force Mix Issues: Greater Reliance on Civilians in Support Roles Could 
Provide Significant Benefits," dated October 19, 1994, GAO Code 
391217). The draft report's findings provide reassurance that DoD 
policies are now in place that resolve GAO's previous concerns. 

The draft GAO report provides the following recommendation: "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 Under 
Secretary of Defense (Personnel and Readiness) to establish an 
oversight and quality assurance mechanism to ensure that all Components 
fully comply with its requirements" (Page 36/GAO draft report). In 
arriving at this recommendation, GAO observed that in a number of 
cases, DoD was unable to produce documentation confirming that deployed 
civilians received necessary immunizations, or pre-or post-medical 
assessments. 

DoD partially concurs. In reviewing the draft report, DoD activities, 
particularly the Army Corps of Engineers, Transatlantic Programs 
Center, determined that for many of the records studied by GAO, 
documentation did exist, thus raising reservations about GAO's 
findings. For example, many immunizations were, in fact, documented in 
nurse's notes, or were not required at the time of deployment and 
should not have been reported as "missing". While we question the 
accuracy of the GAO's findings with respect to medical documentation, 
we acknowledge the necessity for all deployed civilians to receive 
required immunizations and medical assessments. Further, confirmation 
documentation must be available in every instance. We intend to take 
the steps outlined below to determine appropriate implementation of the 
recommendation. 

We are already aware of the challenges to assuring that all deploying 
military and civilian personnel receive necessary force health 
protection services. We have written and coordinated a new DoD 
Instruction that establishes a comprehensive DoD force health 
protection quality assurance program, with an expected publication 
before the end of 2006. With this Instruction, the current DoD 
deployment health quality assurance program will be expanded to 
encompass the full breadth of health surveillance activities, and apply 
to DoD civilian and DoD contractor personnel accompanying deployed 
military forces as well as all military personnel. Initially, the 
expanded program will focus on process issues to ensure that deployed 
federal civilians receive the same pre-and post-deployment assessments 
as military Service members (for example, that deployment health 
assessment documents are completed, that necessary immunizations are 
obtained, that serum samples are collected and sent to the designated 
central repository, and that education and risk communication is 
provided). Additionally, proposed revisions to DoD Directives and 
Instructions that specifically address planning, preparation, and 
utilization of DoD civilians in support of contingencies and 
emergencies include new accountability obligations, to include annual 
assessments for compliance with pre-and post-deployment medical 
assessment requirements. In June 2006, as an interim measure, we 
established a requirement for Components to document in the Defense 
Civilian Personnel Data System the deployment of civilian employees who 
are assigned to contingency operations overseas. We anticipate that 
enhanced capabilities of the Defense Integrated Military Human 
Resources System (DIMHRS) will ultimately provide DoD with 
comprehensive, centralized data regarding its deployed personnel. 

In addition, we intend to further expand our force health protection 
quality assurance program to focus on the clinical quality of care. Our 
civilians have several options for health care (for example, through 
the Federal Employees Health Benefits Program or in appropriate 
circumstances, space available in DoD medical treatment facilities). 
DoD has neither direct access to civilian medical records nor influence 
over how care is provided in the private sector. Accordingly, we intend 
to form a multi-functional working group under the direction of the 
Office of the Under Secretary of Defense for Personnel and Readiness, 
to address and propose integrated solutions to implementing these 
provisions of the expanded quality assurance program. 

The draft report reflects substantial research and review of 
information and data provided by numerous sources and many DoD 
activities. Of particular note is the draft report's discussion of the 
special pays and benefits provided to DoD civilians and military 
personnel. GAO does not take a position regarding the adequacy or 
appropriateness of these benefits and compensation; however, the 
selection and presentation of the associated data could easily mislead 
the reader into drawing erroneous conclusions. Moreover, the 
comparisons do 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, military commissary and 
exchange privileges. We strongly suggest that GAO amend the report to 
place its comparison of pay and benefits in appropriate context. 
Therefore, we request that you clearly acknowledge the fundamental 
differences between the military and civilian systems within the 
introduction of the aforementioned discussion. We offer the following 
concepts for consideration. 

It is difficult to compare the pay and benefits entitlements of 
civilian employees to the entitlements of military members with enough 
normalization to ensure the comparative analysis is not misinterpreted. 
DoD civilians and military members are key components of the Total 
Force, yet are governed by distinctly different systems. The precept of 
total service to protect and defend our country is the foundation of 
the military system, requiring worldwide mobility, availability for 
duty around the clock, and the expectation that members will engage in 
combat and other contingency situations. In contrast, DoD civilian 
employees are designated as noncombatants, and their deployment to 
contingency situations generally occurs on a voluntary basis. DoD 
civilians are governed by Federal employment and compensation statutes, 
and are expected to spend most of their careers in the United States or 
in non-hardship overseas postings. With these contrasts in mind, the 
civilian and military systems have been constructed to provide 
incentives that respond to the basic perspectives of civilian and 
military service, particularly when it comes to contingency deployment. 
For members of the military, long-term career prospects and a variety 
of life-long benefits function as key incentives for military service. 
In contrast, more immediate, short-term benefits serve as incentives to 
ensure the availability of a sufficient number of civilian employees 
with the needed skills to accomplish immediate contingency 
requirements. Recognizing this fundamental dichotomy is critical to any 
analysis that seeks to compare pay and benefits afforded to DoD 
civilian and military personnel. 

Finally, it is necessary to point out several technical corrections 
that GAO should make to the report prior to its issuance. 

* Page 4 of the draft report, middle paragraph, 3rD sentence: Revise 
sentence to read, "However, our actual review of claims filed by the 
DoD federal civilian personnel was limited to those who had deployed to 
Iraq because the Department of Labor did not assign a unique identifier 
for claims that had been filed by those federal civilians who had 
deployed to Afghanistan." Injury claim information is owned by the 
Department of Labor, Office of Workers Compensation (OWCP). 

* Page 12 of the draft report, Table 2, "DoD Federal Civilian 
Deployment Records Lacking Documentation of Required Immunizations" The 
number (and percent) of records missing two or more immunizations 
reported for the U.S. Army Corps of Engineers Transatlantic Program 
Center (TPC) is inaccurate. In the draft report, GAO identified 85 
records as missing at least two immunizations. TPC requested the 
specific documentation that GAO used to support its findings, as part 
of TPC's review of the draft report. In its response to TPC, GAO 
identified 69 records (54.3%) for this category, instead of 85 (66.9%). 
Thus, the correct number of records missing this documentation should 
be 69 (54.3%). 

* Page 23 of the draft report, Figure 2, "DoD Medical Treatment 
Processes for Federal Civilians Who Require Treatment for Deployment-
Related Injuries or Diseases After They Return to the United States" 
Revise Figure 2 to correctly reflect the procedures followed by DoD as 
follows: 

- Right column, 2nd box: Replace "specialist" with "physician selected 
by the employee". Treatment is not limited to that provided by a 
specialist. 

- Right column, 3'D box: Delete box entirely. Authorization of medical 
treatment in occupational disease cases is not a question of 
authorizing "further" medical treatment but of authorizing initial 
medical treatment. Unless OWCP approves the issuance of the medical 
authorization form (Form CA-16) in occupational disease cases, the only 
medical treatment that can be considered "authorized" is that rendered 
by the DoD medical treatment facility, and such authorizing flows from 
DoD, not OWCP. 

* Pages 26 to 28 of the draft report, Tables 6 and 7: Both of these 
tables erroneously reflect the basic pay for both civilian and military 
personnel, overtime payments, Federal taxes due, and tax relief 
amounts. The following specific examples illustrate the scope of the 
miscalculations and misinterpretations, and suggest the need for GAO to 
thoroughly review the tables and associated footnotes. 

- Both tables underestimate the years of service and corresponding 
basic pay for the military 05 and 06 comparisons. Most members have 16 
to 17 years of service upon promotion to 05, and 21 to 22 years of 
service upon promotion to 06. The use of 7 years of service 
underestimates the rate of base pay by $1,400 per month ($16,800 per 
year) for an 05, and $2,000 per month ($24,000 per year) for an O6. 

- All comparisons on both tables overstate overtime compensation. For 
example, the overtime rate corresponding to a GS-11 earning $61,510 per 
annum is $35.51 per hour. At this rate, 30 hours of overtime per week 
for a period of 1 year produces total overtime earnings of $55,395.60, 
instead of $55,588 as reflected Table 6. The adjusted overtime earnings 
affect the amounts reflected for gross pay and income after taxes. 
Similar miscalculations are evident for all of the civilian overtime 
comparisons. 

- Footnote c misstates the authorization provided to DoD to increase 
the premium pay cap, and should be revised to read: "Section 5307 of 
title 5, United States Code provides that employees may be paid 
compensation only to the extent that their total annual compensation 
does not cause the aggregate of total compensation (i.e., total 
compensation of all types, as defined in Subpart B of title 5, Code of 
Federal Regulations, including allowances, bonuses, awards, and 
differentials) 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. Thus, premium pay in excess of $183,500, up to 
$200,000, will be paid to such employees during the first pay period of 
2007. Deferred payments count towards employees' 2007 aggregate 
limitation." 

- Table 7 reflects base pay at an annual amount (i.e., 12 months) for 
all civilian and military comparisons, rather than for a period of 6 
months, which the table intends to illustrate. Similarly, the amounts 
reflected for gross pay, TSP contribution, adjusted gross income, 
Federal taxes due, and income after taxes should be computed to cover a 
period of 6 months, instead of 1 year. 

- Both tables omit hostile fire pay/imminent danger pay for military 
members assigned to Iraq or Afghanistan, which is $225 per month. 

- Both tables fail to recognize that military members can contribute 
their tax exempt pay up to $44,000 into the TSP, rather than the 
regular annual limit of $15,000. 

- Both tables overstate the value of the Combat Zone Tax Exemption 
(CZTE) for military members. The comparisons reflect the maximum amount 
of compensation that can be excluded under CZTE provisions from 
taxation, but in none of the comparisons is that amount of income 
actually earned. Further, the comparisons fail to acknowledge 
deductions military and civilian taxpayers would have (i.e., standard 
deductions, itemized deductions, other tax exemptions and tax credits, 
etc.) 

* Pages 29 - 36, and Appendix II on pages 46 and 47 of the draft 
report, "Disability and Survivor Benefits" These sections and Appendix 
II inappropriately mix discussion of Veterans Affairs (VA) and DoD 
benefits for military members without in any way distinguishing between 
the two. Further, the discussion presents incorrect information in many 
cases. For example, the first paragraph on page 30 states, "We found 
that compensation payments for military personnel were based on a 
disability rating, regardless of salary level." This statement is only 
true with regard to VA disability benefits. DoD disability payments do, 
in fact, take into account salary level. If a former member is entitled 
to both, there is an offsetting mechanism. 

DoD appreciates the opportunity to comment on the draft report. GAO may 
direct any questions to my action officer, Mr. Richard Nicholson, 703- 
571-9287. 

Sincerely, 

Signed by: 

David S. C. Chu: 

[End of section] 

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. 

FOOTNOTES 

[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). 

[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. 

[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. 

[7] 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. 

[8] Disability 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. 

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

[10] In 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. 

[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. 

[12] U.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. 

[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. 

[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. 

[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). 

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

[18] GAO-03-1041. 

[19] 10 U.S.C. § 1074f. 

[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. 

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

[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. 

[23] Disability 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. 

[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). 

[26] GAO-06-4. 

[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. 

[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. 

[31] 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. 

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