Department of Defense Rejects GAO Recommendation Regarding "Sexual Assault Victimization" in the Military

    On January 23, news broke that outgoing Defense Secretary Leon Panetta had issued a directive that the military's ban on women in combat would be lifted.  The New York Times reported that his decision was in response to unanimous agreement among the Joint Chiefs of Staff as expressed in a letter to Panetta:

Mr. Panetta’s decision came after he received a Jan. 9 letter from Gen. Martin E. Dempsey, the chairman of the Joint Chiefs of Staff, who stated in strong terms that the armed service chiefs all agreed that “the time has come to rescind the direct combat exclusion rule for women and to eliminate all unnecessary gender-based barriers to service.”

     The Times article said it was unclear why the Joint Chiefs decided to act now after years of discussion, although there is speculation that recent threats of legal action may have played a role.  However, a Government Accountability Office report issued on January 29 raises some questions about the timing of such a monumental change in policy.

    I first reported the GAO report in a January 31 blog post at The Weekly Standard where I addressed the fiscal impact of allowing women in combat positions.  However, the broader focus of the report is spelled out in its title: "DOD Has Taken Steps to Meet the Health Needs of Deployed Servicewomen, but Actions Are Needed to Enhance Care for Sexual Assault Victims." An explanation of the special focus on sexual assault victims appears early in the report [emphasis added]:

The roles for women in the military have been expanding and evolving, particularly since the Persian Gulf War more than 2 decades ago. Formerly, servicewomen served primarily in supportive roles in overseas U.S. military operations. Today, servicewomen are integral to combat support and counterinsurgency operations, and they serve in many roles they previously did not hold. In late 2011, for example, women began serving aboard Navy submarines. In early 2012, the Department of Defense (DOD) announced that changes to its assignment policies would result in more than 14,000 additional positions being opened to women, including positions in select direct ground combat units. Further, while sexual assault victimization is not unique to women, the presence of women in new roles suggests that continued vigilance with respect to this issue is needed. Given the expanding and evolving role of women in the military, the health and wellness of servicewomen plays an important role in overall military readiness. 

    According to the National Defense Authorization Act for 2012, this report was originally due by December 31, 2012.  As mentioned above, the report was released on January 29, but given that the paragraph above does not mention the lifting of the women in combat ban, the GAO report was apparently finalized prior to Panetta's announcement. This policy change, much more far reaching that even the change opening "14,000 additional positions" in early 2012, exponentially increases the need for "continued vigilance" regarding "sexual assault victimization" that the GAO calls for.  Therefore, the timing of the announcement lifting the ban and the DOD's reaction to the GAO report recommendations is curious.

    The GAO made two recommendations at the conclusion of its inquiry regarding "sexual assault victimization":

To enhance the medical and mental health care for servicewomen who are victims of sexual assault, GAO recommends that DOD (1) develop department-level guidance on the provision of care to victims of sexual assault; and (2) take steps to improve first responders' compliance with the department's requirements for annual refresher training. DOD did not concur with the first recommendation, but cited steps it is taking that appear consistent with the recommendation. DOD concurred with the second recommendation.

     In this short summary of the DOD's reaction to the draft report, which the DOD reviewed before the GAO prepared and issued the final version on January 29, the GAO notes that the DOD "did not concur with the first recommendation, but cited steps it is taking that appear consistent with the recommendation." This summary sounds sanguine about the steps the DOD is taking to conform to the GAO's first recommendation, but it fails to convey the lengths to which the DOD appears to have gone to avoid concurring and to avoid fully cooperating with the GAO staff conducting the review.  Here is the full paragraph from the body of the report discussing the DOD's recommendations.  It is quite lengthy, but I have taken the liberty of highlighting all the references to the DOD's reticence to fully engage the GAO:

In written comments on a draft of this report, DOD stated in its cover letter that, overall, the department did not concur with the report's findings and conclusions. However, DOD's cover letter did not provide an explanation for this comment. In an enclosure to its letter, DOD stated that it did not concur with our first recommendation that the Assistant Secretary of Defense for Health Affairs develop and implement department-level guidance on the provision of medical and mental health care to victims of sexual assault that would specify health care providers' responsibilities to respond to and care for sexual assault victims, whether in the United States or in deployed environments. DOD's justification of its assessment, however, did not make clear why the department did not concur. Instead, DOD provided examples of steps it has been taking that may help to address the findings in this report. Specifically, DOD stated that, while the second version of DOD Instruction 6495.02, entitled "Sexual Assault Prevention and Response (SAPR) Program Procedures" has been in coordination for nearly 2 years and is not yet published, the revised instruction will be comprehensive and will contain two medical enclosures. According to DOD, the first medical enclosure will address health care provider procedures and direct the Surgeons General of the military services to carry out responsibilities related to the
coordination, evaluation, and implementation of care, while the second medical enclosure will address health care providers' responsibilities related to Sexual Assault Forensic Examination kits. During the course of this review, we met with DOD officials who had knowledge of and were involved in the instruction's revision, but these officials did not discuss or share their draft revisions with us when we presented our findings to them. We cannot verify, therefore, whether the enclosures referenced in DOD's comments will address our recommendation. However, we plan to review the instruction when DOD finalizes it to determine whether it meets the intent of our recommendation. Finally, DOD stated that the department meets its oversight responsibilities with regard to sexual assault response through training in graduate medical education and through monitoring and oversight of the process that governs credentialing and privileging of providers.  However, it is not clear why this statement is applicable to our recommendation. We did not address these points in the finding that led to this recommendation, and our recommendation is focused on the need for additional guidance. 

    The DOD's lack of transparency and full cooperation with the GAO has certainly compromised the effectiveness of this report at the precise time when a huge policy change regarding women is emerging. Not only, as the GAO indicates above, will this require further follow up by the GAO, but it has prevented Congress from having complete information on an important aspect of the issue at a time when Congress must decide whether or not to act.  As the GAO report said:

Given the expanding and evolving role of women in the military, the health and wellness of servicewomen plays an important role in overall military readiness. 

    Implementing this policy change, unless Congress intervenes, will be the first order of business for Chuck Hagel or whoever ends up being confirmed as the next Secretary of Defense. And given the importance of the military readiness of the United States, the Department of Defense owes the GAO, Congress and the American people full disclosure when it comes to how it plans to handle one of the most significant changes to the armed forces in our lifetime.


Note: A version of this article first appeared on February 6, 2013 at The Weekly Standard.

Government Report: Women in Combat to Cost Money

Note: This article was originally published at The Weekly Standard.

    Ever since outgoing Defense Secretary Leon Panetta announced a week ago that the U.S. military would lift its ban on women in combat roles, the debate, which has been simmering for decades, boiled up again. Much of the argument has centered on cultural, social, and morale-related effects that such a change would bring about, though other practical issues have been raised as well. However, a Government Accountability Office (GAO) report released just this week may bring some other considerations to the fore, among them, the financial impact.

    According to the introduction to the GAO report, the National Defense Authorization Act For Fiscal Year 2012 charged the GAO with conducting “a review of the female-specific health care services provided by DOD to female servicemembers...”  Though not directly addressed by the GAO, the report raises a perhaps unanticipated consequence of lifting the ban on women in combat. With an increasing number of women in combat units, as well as presumably an overall increase in women enlisting in the service now that more positions will be open to them, there may be a corresponding increase in health-related costs. For example, the report says:

DOD has put in place policies and guidance that include female-specific aspects to help address the health care needs of servicewomen during deployment. Also, as part of pre-deployment preparations, servicewomen are screened for potentially deployment-limiting conditions, such as pregnancy, and DOD officials and health care providers with whom GAO met noted that such screening helps ensure that many female-specific health care needs are addressed prior to deployment.

    The “female-specific aspects” of health care are self-evident, but for confirmation, one need look no further than the Affordable Care Act with its 145 uses of the word “women” versus one use of “men.” Although women already serve in many areas of the military, the full (or near-full) integration will certainly impact the amount of “female-specific ” medical equipment, supplies, and expertise needed by each branch of the service to meet the increased demand. Examination rooms may need to be retooled and medics may need further training. Additionally, the “potentially deployment-limiting conditions, such as pregnancy” can be screened for, but will still affect associated costs, not to mention the readiness of units destined for combat, in a way that is not present with male-only units. The report implies this when it says:

Given the expanding and evolving role of women in the military, the health and wellness of servicewomen plays an important role in overall military readiness.

    The exact cost of women in combat is not revealed in the GAO report.

    But at a time when the defense budget is under increasing scrutiny, and with the threat of sequestration slashing the budget further, the likely increased healthcare costs associated with the lifting of the ban should be taken into account.

    Higher costs may not be the most important aspect of the policy change, but neither can they be ignored. The higher percentage of the defense budget that must be devoted to routine healthcare, the lower the percentage that is available for areas more directly related to keeping the U.S. military the best equipped, best trained fighting force in the world, ready at a moment’s notice to deploy whenever and wherever needed.