The need for having better exposure data has been recognized repeatedly in numerous external reviews of Department of Defense (DoD) and Department of Veterans Affairs (VA) activities regarding Service member health protection and veteran health care and disability determination (GAO, 1999, 2000a,b, 2005a,b, 2006; IOM, 1996a, 1999b, 2000c).
Detailed health status data collected throughout a Service member’s active duty and veteran experience, coupled with individual exposure data collected during that period, would provide the data needed to make better decisions about an individual’s likelihood of service-related disease causation and thus minimize the need for presumptions. As the Institute of Medicine (IOM) noted in 1996,
The DoD, the branches of the armed services, and the DVA should continue to work together to develop, fund, and staff medical information systems that include a single, uniform, continuous, and retrievable electronic medical record for each [S]ervice member. The uniform record should include each relevant health item (including baseline personal risk factors, every inpatient and outpatient medical contact, and all health-related interventions), allow linkage to exposure and other data sets, and have the capability to incorporate relevant medical data from beyond DoD and DVA institutions (e.g., U.S. Public Health Service facilities, civilian medical providers, and other health-care institutions)…. (IOM, 1996a, p. 10)
DoD and VA have been working together since 1998 to improve sharing of medical information for active-duty military personnel and veterans. The agencies have developed a short-term plan to improve their existing health information systems and a long-term plan to create a modern health information system based on computable data. However, as GAO points out, DoD and VA lack a detailed project management plan to guide their efforts (GAO, 2007).
In 1997, President Clinton issued a directive to DoD and VA “to create a new Force Health Protection Program. Every soldier, sailor, airman, and Marine will have a comprehensive, life-long medical record of all illnesses and injuries they suffer, the care and inoculations they receive, and their exposure to different hazards. These records will help us prevent illness and identify and cure those that occur” (DoD, 2006a, p. 2).
Also in 1997, coincident with the presidential directive described above, DoD issued an instruction describing the “Implementation and Application of Joint Medical Surveillance for Deployments.” This document defined initial expectations for more detailed medical surveillance and exposure assessment data collection systems for both deployment and in-garrison or nondeployment settings. This plan laid the groundwork for systems that would “eventually be capable of linking deployment and nondeployment