GAO: Defense lost track of 72,000 combat medical records

Government auditors said on Thursday that Defense Department officials could not account for more than 72,000 health questionnaires that were to have been completed by troops following their service in Iraq and Afghanistan.

The discovery "suggests either that not all of these service members filled out the questionnaire or that questionnaires were filled out, but were not incorporated into Defense's central repository," wrote Randall Williamson, director of health care at the Government Accountability Office in a report to Congress.

The records, known as post-deployment health reassessments, or PDHRA, are to be administered 90 to 180 days after service members return from deployment. Because mental health issues sometimes do not emerge until months after troops return from combat, the assessments are considered a vital tool in helping to identify deployment-related health issues.

Asked by the Senate Armed Services Committee to review the department's implementation of the PDHRA to active, reserve and separated service members, auditors last April sought the questionnaire records of troops who returned from Iraq or Afghanistan from Jan. 1, 2007, through May 31, 2008, after serving at least 30 days overseas. Of the roughly 319,000 service members who met that criteria, 74,000 were missing PDHRA records in Defense's central repository, which officials use as a key source of health surveillance information.

GAO then checked with the military services to see if their databases contained the missing questionnaires, which had not yet been electronically posted to the central database as required by policy. That check located about 7,000 of the missing questionnaires.

In September, GAO again queried Defense's central repository to update the April data for the same population of service members -- 15 months after the last service members would have returned from deployment. That query showed 72,000 missing questionnaires.

"DoD officials specifically cited the importance of this documentation for helping the quality assurance program ensure that service members have the opportunity to have their health concerns identified and addressed," Williamson wrote.

"Ensuring that reserve component service members fill out the PDHRA questionnaire may be particularly important, as some evidence suggests that these service members may be more likely to develop mental health conditions after returning from deployment when compared with their active component counterparts," he said.

The military services are responsible for administering PDHRA to active-duty personnel, and Defense contracts with Logistics Health Inc. to administer the questionnaire to troops in the Guard and Reserve. All troops are required to fill out only demographic information in the questionnaire, and they are encouraged to fill out sections regarding their physical and mental health.

Ellen Embrey, deputy assistant secretary of Defense for force health protection and readiness, said in a written response to the findings, "We must become more aggressive to ensure all eligible service members are correctly identified and offered the opportunity to complete the PDHRA, and that the resultant assessments are placed in the DoD central repository."

Defense officials said they would take steps to ensure service members who need to receive the PDHRA do so, and would brief commanders on the importance of compliance and requirements. They also pledged to resolve any problems with electronic transmission of questionnaires between the services and the department's central repository.