Military Health Care: Information on Use of and Access to Toxic Exposure Records

Summary

What GAO Found The Individual Longitudinal Exposure Record (ILER) is a web application that links service members’ and veterans’ military toxic exposures and related information from Department of Defense (DOD) and Department of Veterans Affairs (VA) databases. DOD and VA intend ILER to be a multi-purpose tool to support clinicians in providing diagnoses and treatment decisions, researchers in conducting health surveillance and epidemiological research, and Veterans Benefit Administration (VBA) claims benefits staff in processing disability claims. Use of the ILER web application among DOD and VA staff increased after the Honoring our PACT Act of 2022 (PACT Act) was enacted in August 2022. This act expanded eligibility for VA health care and disability benefits to veterans who experienced certain toxic exposures during their military service. The increase in ILER use after the PACT Act’s enactment was driven largely by VBA staff. VBA staff have also been the largest group of users since enactment. Percentage of Individual Longitudinal Exposure Record (ILER) Account Logins, by Agency as Identified by Staff During Account Registration, September 2022 Through January 2026 In March 2026, service members gained the ability to access the ILER web application and add self-reported updates to their record. ILER officials said they plan to also provide service members with a way to request corrections by September 2026. For veterans, officials said they plan to provide access to ILER and a way to request corrections by October 2026. ILER officials and officials from eight stakeholder organizations said some potential benefits of service member and veteran access to their ILER information include increased transparency and knowledge. For example, service members and veterans may be able to have more informed conversations with clinicians about diagnoses and risks of future health effects. Those officials said one of the potential challenges includes frustration if service members and veterans see missing or incomplete records. ILER officials are providing information about ILER’s capabilities and limitations in education and outreach efforts to help mitigate this challenge. Why GAO Did This Study Military service members and veterans may experience adverse health outcomes associated with toxic exposures experienced during military service. For example, those who deployed to Afghanistan and Iraq after September 11th have reported health concerns from toxic exposures, particularly to smoke and harmful emissions produced by open-air burn pits. In April 2026, VA estimated that about 48 percent of veterans who have been screened since 2022 (approximately 3.2 million of 6.8 million total veterans screened) had at least one potential toxic exposure during military service. DOD and VA launched ILER in 2019 as a tool to compile information on individuals’ service-related toxic exposures and health assessments from several databases. Staff can use ILER to process disability claims, provide health care, and conduct research. The National Defense Authorization Act for Fiscal Year 2022 includes a provision for GAO to review ILER. This report describes available information on the use of ILER by DOD and VA staff and service members’ and veterans’ access to their ILER record. GAO analyzed data on ILER use among DOD and VA staff from October 2019 through January 2026; reviewed related documents and interviewed officials managing ILER; and interviewed stakeholder organizations, including six military and veterans service organizations and two toxic exposure non-profit organizations. GAO selected these organizations as they represent service members or veterans and have knowledge or expertise related to military toxic exposures. For more information, contact Alyssa M. Hundrup at hundrupa@gao.gov.