Publicly released: May 22, 2019
Objective
This is one of two reports evaluating operations and management of Military Cemeteries under the control of the Military Departments. It is a follow-up evaluation to our previous report, DODIG-2013-098, “Assessment of U.S. Military Cemeteries,” June 28, 2013, (Revised May 20, 2019).
This report evaluates the operations and management of 16 of the 38 Military Cemeteries. Specifically, we:
- evaluated gravesite accountability and the system of record used to schedule, plan, account for, and accurately document the burials in the cemetery;
- reviewed the status and implementation of the DoD, Army, Navy, and Air Force cemetery regulations;
- reviewed contracted support for Military Cemeteries; and
- verified completion of actions taken by the Military Services in response to recommendations from the previous DoD Office of Inspector General report.
A second, companion report to this one, DODIG-2019-083, “Operations and Management of Arlington and Soldiers’ and Airmen’s Home National Military Cemeteries,” May 20, 2019, evaluates the operations and management at the Army National Military Cemeteries, consisting of the Arlington National Cemetery and the Soldiers’ and Airmen’s Home National Cemetery.
Background
The Assistant Secretary of Defense (Manpower and Reserve Affairs), within the office of the Under Secretary of Defense for Personnel and Readiness, is assigned overall responsibility for burial accountability and care and maintenance of all DoD Military Cemeteries.
The Army, Navy, and Air Force manage day-to-day activities at the 38 cemeteries established to honor veterans and fallen service members. The Army manages 28 cemeteries: the two Army national cemeteries (Arlington National Cemetery and Soldiers’ and Airmen’s Home National Cemetery), and 26 additional cemeteries on or near Army installations. The Navy and Air Force are responsible for five cemeteries each.
During this evaluation, we visited 16 Military Cemeteries managed by the Army (11), Navy (2), and Air Force (3).
Findings
In this evaluation we concluded that gravesite accountability existed if:
- the names of people buried in the cemetery exist within the cemetery’s system of record,
- burial locations for individuals listed in the database corresponded to that person’s gravesite, and,
- visitors with the correct name or location of an individual could find that person’s memorial or burial site.
We determined that 5 of the 16 Military Cemeteries we visited did not have full gravesite accountability. At those 5 cemeteries, we found 15 gravesite accountability errors in our collective sample of 3,376 gravesites. We found that Cemetery Responsible Officials, in some instances, did not:
- ensure proper placement of gravesite markers or verify that information on the markers corresponded to burial records,
- update their cemetery system of record after each burial, or
- verify that gravesite locations were correct in their system of record.
A lack of complete gravesite accountability could prevent family members, or other interested persons, from finding specific gravesites. Furthermore, new burials could be initiated on occupied sites, resulting in unintentionally disturbing remains.
We also identified 108 discrepancies across 14 of the 16 cemeteries we visited. Discrepancies are instances in which one or more data elements were inconsistent among the database of record, supporting documentation, and the gravesite marker. None of the discrepancies had an impact on gravesite accountability.
We determined that almost 100 of these discrepancies were a result of data inconsistencies between the information on the grave marker and in the database of record. For example, the date of birth on a decedent’s marker read October 1, 1866, while records showed September 9, 1865.
We also found that Service regulations and guidelines governing cemetery administration, operations, maintenance, and inspections were inconsistent across the Services. The inconsistent policies occurred because there is no DoD-wide policy governing the operation and management of Military Cemeteries. Consequently, the Services operated their cemeteries using various standards and practices for records management, inspections, maintenance, and training. Our evaluation determined that these inconsistencies can potentially compromise gravesite accountability.
Our evaluation identified no areas of concern regarding contracted services for military cemeteries under the control of Military Departments. Cemetery officials and contracting officer representatives coordinated the development of contract performance work statements supporting cemeteries, and monitoring contractor performance.
In addition, we reviewed the status of 16 open recommendations from the previous DoD Office of Inspector General report on Military Cemeteries. Fifteen of the recommendations remain open due to a continued lack of DoD-level policy. We therefore make additional, consolidated recommendations on these open issues in Recommendations B.1 and B.2 in this report.
The remaining open recommendation stated that commanders of U.S. Navy installations responsible for Military Cemeteries should conduct a 100-percent record-to-grave verification. Based on the discrepancies in burial data identified during this project, we reissued this recommendation to the Under Secretary of Defense for Personnel and Readiness and broadened it to include all Military Cemeteries.
Recommendations
We recommend that the Under Secretary of Defense for Personnel and Readiness:
- develop standardized training for Cemetery Representative Officers, including procedures on how to record burials and how to order headstones from the Department of Veteran’s Affairs;
- develop and publish business rules to standardize the method for adjudicating data discrepancies and inaccuracies; and
- conduct a census of Military Cemeteries by applying the business rules referred to in the previous recommendation and direct a conversion to full use of digital records.
We recommend that the Under Secretary of Defense for Personnel and Readiness, in coordination with the Under Secretary of Defense for Acquisition and Sustainment publish a comprehensive instruction that provides guidance on operation of the Military Cemeteries, including management, accountability, and inspections.
We also recommend that, once the DoD issues its instruction, the Secretaries of the Army, Navy, and Air Force each update their cemetery regulations accordingly.
Management Comments and Our Response
The Deputy Assistant Secretary of Defense (Military Community and Family Policy), responding for the Under Secretary of Defense for Personnel and Readiness, agreed with our recommendations related to standardizing training for cemetery officials, establishing business rules for adjudicating data discrepancies, and completing an accountability census of all cemeteries and the digitization of all records. The Deputy Assistant Secretary of Defense stated that the draft DoD Instruction for DoD cemeteries, intended for publication, designates the Department of the Army as the lead component for the establishment of uniform standards and measures, and for the establishment, operation, and management of the interment and accountability system of record for all DoD cemeteries. The Deputy Assistance Secretary of Defense also detailed previous efforts to scan burial records, collect data, capture geospatial data, photograph markers, and establish digital records for all gravesites. Additionally, the Deputy Assistant Secretary of Defense explained ongoing efforts with the Army Analytics Group to upload the digital gravesite data gathered into the Army National Military Cemeteries (ANMC) Research Tool.
The draft DoD Instruction for DoD cemeteries meets the intent of our recommendations related to training, business rules, and overall operations at the Military Cemeteries. Therefore, these recommendations are resolved but remain open. The Deputy Assistant Secretary of Defense’s efforts to digitize burial records and leverage the ANMC Research Tool meets the intent of our recommendation regarding a census of Military Cemeteries through the application of business rules. Therefore this recommendation is resolved, but remains open. We will close these recommendations once the Deputy Assistant Secretary of Defense (Military Community and Family Policy) publishes the draft DoD Instruction for DoD Cemeteries, uploads the digitized burial records into the ANMC Research Tool, and ensures access by Navy and Air Force cemetery officials.
The ANMC Executive Director stated that the other Services are already leveraging the Army’s training, business rules, and systems. The Executive Director recommended that DoD adopt the Army’s programs as DoD standards. We believe that the response from the Deputy Assistant Secretary of Defense (Military Community and Family Policy), regarding the intent to designate the Department of the Army as the lead component for the establishment of uniform standards and training addresses the Executive Director’s comments.
The Army, Navy, and Air Force agreed with the recommendation to update their cemetery regulations once the Deputy Assistant Secretary of Defense (Military Community and Family Policy) publishes overarching guidance that standardizes cemetery operations across the Services.
This report is a result of Project No. D2018-D00SPO-0019.000