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entitled 'Military Personnel: Top Management Attention Is Needed to 
Address Long-standing Problems with Determining Medical and Physical 
Fitness of the Reserve Force' which was released on October 27, 2005. 

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Report to Congressional Committees: 

United States Government Accountability Office: 

GAO: 

October 2005: 

Military Personnel: 

Top Management Attention Is Needed to Address Long-standing Problems 
with Determining Medical and Physical Fitness of the Reserve Force: 

GAO-06-105: 

GAO Highlights: 

Highlights of GAO-06-105, a report to congressional committees: 

Why GAO Did This Study: 

The Department of Defense’s (DOD) operations in time of war or national 
emergency depend on sizeable reserve force involvement and DOD expects 
future use of the reserve force to remain high. Operational readiness 
depends on healthy and fit personnel. Long-standing problems have been 
identified with reserve members not being in proper medical or physical 
condition. Drilling members in the reserve force by law are required to 
have a medical exam every 5 years and an annual certificate of their 
medical status. Also, DOD policies require an annual dental exam and an 
annual evaluation of physical fitness. Compliance with these routine 
requirements is the first step in determining who is fit for duty. 
Public Law 108-375 required GAO to study DOD's management of the health 
status of reserve members activated for Operations Enduring Freedom and 
Iraqi Freedom. GAO assessed DOD’s (1) ability to determine reserve 
force compliance with routine exams, and (2) visibility over reserve 
members’ health status after they are called to duty and the care, if 
any, provided to those deployed with preexisting conditions. 

What GAO Found: 

DOD is unable to determine the extent to which the reserve force 
complied with routine examinations due to lack of complete or reliable 
data. Although each reserve component employs a tracking system capable 
of monitoring compliance with medical exams, only one component has 
taken the necessary quality assurance steps to ensure the reliability 
of its data. While the Office of the Under Secretary of Defense for 
Personnel and Readiness has the responsibility for overseeing medical 
and physical fitness policy and processes, it has not established a 
management control framework and executed a plan to oversee compliance 
with routine examinations. Specifically, this office has not enforced 
holding all responsible levels accountable, ensuring that all 
requirements are being met, and that complete and reliable data are 
being entered into the appropriate tracking system. For example, this 
office has not enforced its own requirement for the services to report 
on the components’ physical fitness status. Without complete and 
reliable data, DOD is not in a sound position to provide the Secretary 
of Defense or Congress assurances that the reserve force is medically 
and physically fit when called to active duty. 

DOD has only limited visibility over the health status of reserve 
members after they are called to duty and is unable to determine the 
extent of care provided to those members deployed with preexisting 
medical conditions despite the existence of various sources of medical 
information. The components collect various types of medical data, but 
vary in their ability to systematically identify, track, and report 
information on those with temporary and permanent conditions that may 
limit deployability. In addition, medical information is captured on 
predeployment forms for all members and entered into a DOD-wide 
centralized database. GAO has previously reported that the database has 
missing and incomplete health data, and DOD is working to correct this 
through its quality assurance program. GAO found during this review 
that DOD has continued to make progress entering the data from the 
forms into the database, but the data are still incomplete and the 
reasons why members are determined medically nondeployable are not 
captured in a way that is easily discernable. While the Under Secretary 
of Defense continues to have responsibility for overseeing the medical 
and physical fitness of reserve members after they are called to duty, 
the combatant commanders, under the Joint Chief of Staff, have this 
responsibility for the theater. DOD is unable to determine the care 
provided to those deployed with preexisting medical conditions because 
DOD has not determined what preexisting conditions may be allowed into 
a specific theater and, thus, does not know what conditions to track. 
Evidence GAO developed suggests that members are deployed into theater 
with preexisting conditions, such as diabetes, heart problems, and 
cancer. The impact of those who are not medically and physically fit 
for duty could be significant for future deployments as the pool of 
reserve members from which to fill requirements is dwindling and those 
who have deployed are not in as good health as they were before 
deployment. 

What GAO Recommends: 

GAO is making a number of recommendations to improve DOD’s management 
of the health status of reserve members. In commenting on a draft of 
this report, DOD did not concur with two of our six recommendations. 

www.gao.gov/cgi-bin/getrpt?GAO-06-105. 

To view the full product, including the scope and methodology, click on 
the link above. For more information, contact Derek B. Stewart, (202) 
512-5559, stewartd@gao.gov. 

[End of section] 

Contents: 

Letter: 

Results in Brief: 

Background: 

Lack of DOD Oversight Hinders DOD's Ability to Determine Reserve 
Components' Compliance with Routine Medical and Physical Fitness 
Examination Requirements, but Indications of Noncompliance Exist: 

DOD Lacks Visibility over the Health Status of Reserve Components after 
Being Called to Active Duty and the Extent to which Members with 
Preexisting Conditions Required Care during Deployment: 

Conclusions: 

Recommendations for Executive Action: 

Agency Comments and Our Evaluation: 

Appendix I: Scope and Methodology: 

Appendix II: Comments from the Department of Defense: 

Appendix III: GAO Contact and Staff Acknowledgments: 

Related GAO Products: 

Tables: 

Table 1: Service Decisions Concerning Reserve Components' 
Deployability, November 2001 through June 2005: 

Table 2: Service Decisions Concerning Active Components' Deployability, 
November 2001 through June 2005: 

Table 3: Total Predeployment Referral Rate by Reserve Component, 
November 2001 through June 2005: 

Table 4: Total Predeployment Referral Rate by Active Component, 
November 2001 through June 2005: 

Table 5: Rate of Servicemembers Health Status as Recorded on Pre-and 
Postdeployment Forms for Active and Reserve Components from November 
2001 through June 2005: 

Figures: 

Figure 1: Rate of Medical Referrals by Type for Active and Reserve 
Components from November 2001 through June 2005: 

Figure 2: Medical Conditions of Army National Guard and Army Reserve 
Members in a Medical Holdover Status as of August 11, 2005: 

Abbreviations: 

AFAA: Air Force Audit Agency: 

AFFMS: Air Force Fitness Management System: 

AMSA: Army Medical Surveillance Activity: 

ANG: Air National Guard: 

APFT: Army Physical Fitness Test: 

CENTCOM: U.S. Central Command: 

DIMHRS: Defense Integrated Military Human Resources System: 

DNBI: Disease Nonbattle Injury: 

DOD: Department of Defense: 

GAO: Government Accountability Office: 

HCP: Health Care Provider: 

IMR: Individual Medical Readiness: 

JMeWS: Joint Medical Work Station: 

JMROC: Joint Medical Readiness Oversight Committee: 

JPTA: Joint Patient Tracking Application: 

MEDPROS: Medical Protection System: 

MND-TM: Medical Nondeployable Tracking Module: 

MODS: Medical Operational Data System: 

MORDT: Mobilization Operational Readiness Deployment Test: 

MRRS: Medical Readiness Reporting System: 

NDAA: National Defense Authorization Act: 

OSD: Office of the Secretary of Defense: 

OUSD/P&R: Office of the Under Secretary of Defense for Personnel and 
Readiness: 

PHA: Preventive Health Assessment: 

PHAM: Periodic Health Assessment Monitor: 

PIMR: Preventive Health Assessment and Individual Medical Readiness: 

PRIMS: Physical Readiness Information Management System: 

RCPHA: Reserve Component Periodic Health Assessment: 

TRAC2ES: TRANSCOM Regulating Command and Control Evacuation System: 

TRANSCOM: U.S. Transportation Command: 

United States Government Accountability Office: 

Washington, DC 20548: 

October 27, 2005: 

The Honorable John Warner: 
Chairman: 
The Honorable Carl Levin: 
Ranking Minority Member: 
Committee on Armed Services: 
United States Senate: 

The Honorable Duncan L. Hunter: 
Chairman: 
The Honorable Ike Skelton: 
Ranking Minority Member: 
Committee on Armed Services: 
House of Representatives: 

The Department of Defense's (DOD) operations in time of war or national 
emergency are currently dependent upon sizeable National Guard and 
Reserve involvement and DOD expects future use of the reserve force to 
remain high. DOD policy acknowledges the importance that reserve 
component[Footnote 1] members are medically and physically fit[Footnote 
2] for deployment[Footnote 3] when called to active duty. As of June 
2005, more than 323,000 reserve component members had deployed in 
support of Operation Enduring Freedom and Operation Iraqi 
Freedom,[Footnote 4] which is almost three times the number of reserve 
component members deployed in support of Operations Desert Shield and 
Desert Storm. Reserve forces played a vital role in Operations Desert 
Shield and Desert Storm. However, problems were revealed with reserve 
component members not being in proper medical or physical condition for 
these deployments. Some members could not deploy to the Persian Gulf, 
and others had difficulty performing their missions while there. In an 
effort to help obviate similar problems in the future, Congress passed 
legislation during the 1990s to help monitor and track the health 
status of deployed members of the Armed Forces, including reserve 
component members.[Footnote 5] 

Public Law 108-375, the Ronald W. Reagan National Defense Authorization 
Act for Fiscal Year 2005, requires GAO to study DOD's management of the 
health status of reserve component members ordered to active duty in 
support of Operation Enduring Freedom and Operation Iraqi Freedom. 
Specifically, GAO assessed: (1) DOD's ability to determine the reserve 
components' compliance with routine medical and physical fitness 
examinations, and (2) DOD's visibility over reserve components' health 
status after they are called to duty and the care, if any, provided to 
those deployed with preexisting conditions. 

To address our first objective, we reviewed federal statutes and Office 
of the Secretary of Defense (OSD) applicable directives and 
instructions to identify and understand the roles and responsibilities 
of the offices within DOD for management of the health status of the 
reserve components. We discussed these statutes and guidance with 
senior officials in the Office of the Under Secretary of Defense for 
Personnel and Readiness. We discussed service policies for medical and 
physical fitness with military officials within the service surgeon 
general offices and officials responsible for physical fitness in the 
service personnel and operations functions. We also analyzed reserve 
component regulations and policies and discussed these with responsible 
reserve component officials. We took steps to assess the reliability of 
these reserve component compliance data and we discuss the results of 
our assessment in the report. We also visited several unit-level 
commands in all six reserve components. In addition, we conducted a 
limited medical and personnel file review and group discussions at an 
Army National Guard unit in the Mid-Atlantic and an Army Reserve unit 
in the Mid-west for the purposes of understanding some of the issues 
confronting the Army components in terms of compliance. 

To address our second objective, we interviewed reserve component 
headquarters officials and active component officials responsible for 
mobilizing the reserve components and observed an Army mobilization of 
Army National Guard and Army Reserve members at Fort Bliss, Texas to 
obtain information on processes used to screen members for their 
medical deployability. We obtained and analyzed data provided on 
medical deployability from DOD's centralized database on pre-and 
postdeployment health assessments, maintained at the Army Medical 
Surveillance Activity (AMSA) and discussed available data with AMSA 
officials. We also obtained and analyzed data on Army reserve component 
members held at mobilization stations for medical reasons and discussed 
these data with officials from the Office of the Assistant Secretary of 
the Army for Manpower and Reserve Affairs and the Army Office of the 
Surgeon General. Based on our review of the AMSA database we used, we 
determined that the data from it were reliable for the purposes of this 
report. To address the extent of medical care provided in theater for 
preexisting medical conditions, we reviewed the Joint Chiefs of Staff 
policy for Deployment Health Surveillance and Readiness and information 
provided by the U.S. Central Command (CENTCOM) Surgeon General office 
regarding medical deployment criteria for Operation Enduring Freedom 
and Operation Iraqi Freedom and discussed these policies with the 
appropriate DOD officials. We met with medical officials who served in 
theater and discussed situations they witnessed related to reserve 
members who had deployed with preexisting conditions. We conducted our 
review from October 2004 through September 2005 in accordance with 
generally accepted government auditing standards. A more thorough 
description of our scope and methodology is provided in appendix I. 

Results in Brief: 

DOD is unable to determine the extent to which the reserve components 
comply with routine medical and physical fitness examination 
requirements due to a lack of OSD guidance and oversight, and 
incomplete or unreliable compliance data supplied by the components. 
Although the Office of the Under Secretary of Defense for Personnel and 
Readiness (OUSD/P&R) has the responsibility for overseeing medical and 
physical fitness policy and processes, this office has not established 
a management control framework and executed a plan to oversee 
compliance with routine examinations. For example, OUSD/P&R has not 
provided guidance to the reserve components regarding requirements for 
the 5-year medical examination and an annual medical certificate. Thus, 
each reserve component has developed its own implementing policies with 
differences in scope, frequency, and administration of the medical 
examination. Lack of OSD guidance makes oversight difficult because 
uniform criteria against which to measure compliance do not exist. 
DOD's ability to determine the extent of compliance has been hindered 
because OSD does not track reserve components' compliance with routine 
medical examinations. In addition, the data reported at the reserve 
component level have been incomplete and unreliable for purposes of 
determining compliance with routine medical and physical fitness 
examination requirements, and responsibility for compliance has not 
been enforced. For example, although each reserve component employs a 
tracking system capable of monitoring compliance with medical 
examinations, only one reserve component--the Navy Reserve--has taken 
the necessary quality assurance steps to ensure the reliability of its 
data on compliance. 

Further, DOD has not enforced its own requirement for the services to 
report on the status of the reserve and active components' physical 
fitness. No reserve component has a tracking system that can report 
complete and reliable data on compliance with physical fitness 
examinations on a componentwide basis. Moreover, although the reserve 
components place the responsibility for tracking compliance with 
medical and physical fitness examinations on the unit commander, the 
reserve components do not always hold the unit commanders accountable 
and the unit commanders do not always enforce the compliance of their 
members. OUSD/P&R has not enforced holding all responsible levels 
accountable, ensuring that all requirements are being met, and complete 
and reliable data are being entered into the appropriate tracking 
system. Despite DOD's inability to determine the extent of reserve 
component compliance with routine medical and physical fitness 
examinations, we found indications of noncompliance. For example, a 
limited review of medical files at one Army National Guard and one Army 
Reserve location, data from a Navy report, test results of two units in 
a Marine Corps battalion, and data from a review conducted by the Air 
Force Audit Agency indicate some noncompliance at all components with 
routine examination requirements. OSD's lack of oversight could 
negatively impact operational readiness for future deployments as the 
number of needed personnel may not be medically and physically fit when 
called to active duty. 

DOD has limited visibility over the health status of reserve component 
members after they are called to duty and is unable to determine the 
extent of care provided to those members deployed with preexisting 
medical conditions despite the existence of various sources of medical 
information. For example, the reserve components all collect various 
types of medical data, but vary in their ability to systematically 
identify, track, and report information on members with both temporary 
and permanent conditions that limit medical deployability. In addition, 
medical information is captured on predeployment forms for all reserve 
members and entered into a DOD-wide centralized database, but the data 
are incomplete and the reasons why members were found nondeployable are 
not captured in a way that is easily discernable. Furthermore, DOD is 
unable to determine the care provided to those deployed with 
preexisting medical conditions because DOD has not determined what 
preexisting conditions may be allowed into a specific theater of 
operations and therefore does not know what conditions to track. The 
medical deployment criteria specific to Operations Iraqi Freedom and 
Enduring Freedom are still evolving, and although DOD has a number of 
systems for tracking medical conditions in theater, the current 
databases do not capture data on known preexisting conditions. 
Developing and updating specific medical criteria for a theater of 
operations are the responsibilities of the combatant command. In the 
absence of specific theater guidance, the services relied on their own 
deployment criteria. For the Army, specific deployment medical criteria 
did not exist until February 2005. Evidence we developed suggests that 
reserve members did deploy with preexisting medical conditions that 
could not be adequately addressed in theater, such as diabetes, heart 
problems, and cancer. The impact on operations of those determined 
nondeployable or those deployed with mission-limiting medical 
conditions is unknown. However, the impact could be significant for 
future deployments as the pool of Guard and Reserve members from which 
to fill requirements is dwindling and those who have deployed are not 
in as good health as they were before deployment. 

We are making several recommendations in this report. For DOD to have 
visibility over the reserve components' compliance with routine 
examinations, we recommend that DOD establish a management control 
framework and execute a plan for improving oversight and take steps to 
enforce the service reporting requirement on the status of their 
members' physical fitness. To improve DOD's visibility over reserve 
component members' health status after they are called to duty, we 
recommend that DOD oversee the development of the reserve components' 
tracking systems to identify and track members' temporary and permanent 
medical conditions that limit deployability and modify the 
predeployment forms to better capture the reasons for nondeployment and 
medical referrals. To help prevent the deployment of members with 
preexisting medical conditions that could adversely affect the mission 
and strain resources in theater, we recommend that DOD develop medical 
criteria for specific theaters and explore using existing tracking 
systems to track those with treatable preexisting medical conditions. 

In written comments on a draft of this report, DOD did not concur with 
our first and fourth recommendation, partially concurred with our fifth 
recommendation, and concurred with our second, third and sixth 
recommendations. DOD did not concur with our first recommendation that 
it establish a management control framework and execute a plan for 
issuing guidance, establishing quality assurance for data reliability, 
and tracking compliance with routine medical examinations. DOD did not 
state that it disagreed with our findings; however, DOD stated that it 
had initiatives underway that addressed our recommendation. We disagree 
with DOD's conclusion because, based on our review, we do not believe 
that DOD's initiatives are far enough along to dismiss further action, 
and we continue to believe that our recommendation has merit. DOD 
concurred with our second recommendation that DOD take steps to enforce 
the services' reporting requirement on the status of their members' 
physical fitness. During our review none of the reports had been 
submitted to the Principal Deputy as required. We raised concerns in 
this report about the data reliability of the tracking systems for 
physical fitness. Just as we found with routine medical examinations, 
we also found that DOD lacked quality assurance of the data on 
compliance with physical fitness examinations in its tracking systems. 
We note that the responsible office for physical fitness oversight, the 
Office of Morale, Welfare, and Recreation, does not participate on the 
Joint Medical Readiness Oversight Committee that is directed to oversee 
improvements in medical readiness, nor are we aware of any DOD plans to 
include improvements in the oversight of physical fitness in its 
comprehensive medical readiness plan. Therefore, we have expanded our 
first recommendation to include routine physical fitness examinations 
in the actions to be addressed. 

DOD concurred with our recommendation that DOD oversee the development 
of the reserve components' tracking systems to identify and track 
members' temporary and permanent medical conditions that limit 
deployability. DOD did not concur with our recommendation that DOD 
modify the medical predeployment form to better capture reasons for 
nondeployment and medical referrals. DOD stated that the best sources 
of accurate information about what medical reasons kept service members 
from deploying are the permanent medical records. We continue to 
believe our recommendation has merit because DOD has no way to 
systematically analyze the information to determine why servicemembers 
are medically nondeployable. DOD partially concurred with our 
recommendation that DOD determine what preexisting medical conditions 
should be allowed into a specific theater of operations, especially 
during the initial stages of operations, and take steps to consistently 
utilize these criteria for determining medical deployability. DOD also 
noted that due to the ever-changing nature of a theater of operations 
and the inexact nature of medicine, a list of nondeployable preexisting 
conditions will never be fully comprehensive or fully enforceable. We 
agree that a list of nondeployable preexisting medical conditions can 
never be fully comprehensive; however, we still believe DOD could 
establish a list of what preexisting medical conditions should be 
allowed into specific theaters of operations, especially during the 
initial stages of operations, so that in future deployments DOD would 
not experience situations such as those that occurred with members 
being deployed into Iraq who clearly had preexisting conditions that 
should have prevented their deployment. DOD concurred with our 
recommendation that DOD explore using existing tracking systems to 
track those who have treatable preexisting medical conditions in 
theater. DOD noted that refinements to medical tracking system are 
ongoing. We wish to note that before DOD's tracking systems can be used 
to track those who have treatable preexisting medical conditions in 
theater, DOD must determine what preexisting medical conditions should 
be allowed into a specific theater of operations as called for in our 
fifth recommendation. 

Background: 

As required by law,[Footnote 6] each reserve component is to make 
available qualified personnel for active duty in the armed forces in 
time of war or national emergency and at such other times as national 
security requires. With this requirement comes the responsibility that 
each reserve component provides personnel who are medically and 
physically fit for active duty. As noted in DOD guidance,[Footnote 7] 
fitness specifically includes the ability to accomplish the task and 
duties unique to a particular operation, and ability to tolerate the 
environmental and operational conditions of the deployed location, 
including wear of protective equipment. 

Reserve Components and Routine Medical and Physical Fitness 
Examinations: 

DOD reserve components include the Army Reserve, the Army National 
Guard, the Air Force Reserve, the Air National Guard, the Navy Reserve, 
and the Marine Corps Reserve. Reserve forces consist of three 
categories: the Ready Reserve, the Standby Reserve, and the Retired 
Reserve. The Ready Reserve had approximately 1.1 million National Guard 
and Reserve members at the end of fiscal year 2004, and its members 
were the only reservists who were subject to involuntary mobilization 
under the partial mobilization authorized by President Bush following 
the attacks of September 11, 2001. Within the Ready Reserve, there are 
three subcategories: the Selected Reserve, the Individual Ready 
Reserve, and the Inactive National Guard. Members of all three 
subcategories are subject to a mobilization under a partial 
mobilization but routine medical and physical fitness policies apply 
primarily to the Selected Reserve, consisting of about 850,000 members 
at the end of fiscal year 2004.[Footnote 8] 

DOD administers medical examinations to military personnel for various 
reasons at different intervals. These include examinations at 
accession, mobilization,[Footnote 9] for special duty assignments, and 
at separation and retirement. The examinations that are required 
routinely for Selected Reserve members to ensure ongoing medical and 
physical fitness include two that are prescribed by federal statute and 
the second two prescribed by DOD regulations and policy. Compliance 
with these routine requirements is the first step toward determining 
who is fit for duty. 

Federal statute[Footnote 10] prescribes that each member of the 
Selected Reserve[Footnote 11] who is not on active duty is required to: 

* be examined as to the member's physical (medical) fitness every 5 
years, or more often as the respective Secretary considers necessary; 
and: 

* complete an annual certificate of medical condition. 

DOD policy prescribes that each member of the Selected Reserve: 

* receive an annual dental examination; and: 

* be evaluated annually for physical fitness for duty, to include an 
assessment of aerobic capacity, muscular strength, muscular endurance, 
and desirable fat composition. 

Reserve Components Differ in Approaches to Mobilize and Medically 
Screen Members for Deployment: 

Within the constraints of the existing mobilization 
authorities[Footnote 12] and DOD guidance, the services have 
flexibility as to how, where, and when they conduct mobilization 
processing. As a result, the services differ in how they mobilize and 
consequently medically screen members upon notification that a unit or 
individual will be called to active duty. The Army and Navy use 
centralized approaches, mobilizing their reserve component forces at a 
limited number of locations. The Army uses 15 primary sites that it 
labels "power projection platforms" and 12 secondary sites called 
"power support platforms." The Navy has 15 geographically dispersed 
Navy Mobilization Processing Sites but is currently using only 5 of 
these sites because of the relatively small numbers of personnel who 
are mobilizing. 

By contrast, the Air Force uses a decentralized approach, mobilizing 
its reserve component members at their home stations--135 for the Air 
Force Reserve and 90 for the Air National Guard--where all medical 
screening is performed. The Marine Corps uses a hybrid approach. It has 
five Mobilization Processing Centers to centrally mobilize individual 
reservists and is currently using three of these centers. However, the 
Marine Corps uses a decentralized approach to mobilize its units. 
Selected Marine Corps Reserve units do most of their mobilization 
processing at their home stations, including medical screening, and 
then report to their gaining commands. 

Roles and Responsibilities for Developing and Implementing Examination 
Requirements: 

Within the Office of the Under Secretary of Defense for Personnel and 
Readiness, the Office of the Assistant Secretary of Health Affairs is 
responsible for developing medical policies and processes; the 
Principle Deputy to the Under Secretary oversees the Office of Morale, 
Welfare, and Recreation for developing physical fitness policies; and 
the Office of the Assistant Secretary for Reserve Affairs serves in an 
advisory capacity to the Under Secretary to determine how the reserve 
components can better implement these requirements. Each service's 
Assistant Secretary for Manpower and Reserve Affairs provides force 
management policy for both the active and reserve components. It is 
then the responsibility of each National Guard and Reserve Command--the 
Chief, Army Reserve, the Director of the Army National Guard, the Chief 
of the Navy Reserve (Commander of Navy Reserve Forces and Commander of 
Marine Corps Reserve Forces), Chief of the Air Force Reserve, and the 
Director of the Air National Guard--that the policies for medical and 
physical fitness examinations are properly implemented for their 
respective commands. Each National Guard and Reserve unit commander is 
responsible for ensuring that the members under his or her command are 
provided routine medical and physical examinations in a timely manner, 
and for identifying and processing members who are not medically 
qualified or physically fit for active duty. The reserve component 
member is responsible for meeting scheduled medical examination 
requirements, obtaining any recommended follow-up medical and dental 
care from his or her personal (civilian) medical provider, and 
truthfully reporting any changes in his or her medical or dental 
condition to military unit commanders and military medical personnel. 
Upon mobilization, responsibility for the medical and physical fitness 
of the reserve component members transfers to the active duty 
counterparts. 

Problems Identified with Medical Deployability during Operations Desert 
Shield and Desert Storm: 

Several studies identified medical issues with the reserve component 
members called to duty for Operations Desert Storm and Desert Shield. A 
1991 Army Inspector General report[Footnote 13] estimated that as many 
as 8,000 reserve component personnel were found to be medically 
nondeployable upon arrival at mobilization stations. Even though all 
but 1,100 eventually deployed, the nondeployable soldiers disrupted the 
mobilization process because units had to undergo extensive efforts to 
replace nondeployable reserve members with those who could be deployed. 
The report also noted that some soldiers who had coronary bypass 
surgery, cancer, and amputations had not been identified at their home 
stations and reported to their mobilization station. In 1991, we 
reported[Footnote 14] that medical screenings conducted at mobilization 
stations identified numerous problems that impaired soldiers' ability 
to deploy, including ulcers, chronic asthma, spinal arthritis, 
hepatitis, seizures, and diabetes. In 1992, we reported[Footnote 15] 
that because many medical personnel were found nondeployable for 
various reasons, including medical reasons, many units deployed with 
medical personnel shortages and were not fully mission capable upon 
arrival in the Persian Gulf. For example, two reserve component 
surgeons--one who was unable to stand for more than 30 minutes and 
another who had Parkinson's disease--reported for duty but were unable 
to deploy due to their conditions. A 1992 Sixth U.S. Army Inspector 
General report[Footnote 16] stated that many soldiers deployed to 
Southwest Asia had to return to the United States because of medical 
conditions that had not been previously diagnosed. This report noted 
that home unit commanders were not identifying soldiers with severe 
medical problems, some permanent, to determine if they were medically 
fit to perform their duties and job assignments before deploying. 

In 1994,[Footnote 17] we did a comprehensive review of the medical and 
physical fitness policies for reserve component members serving in 
Operations Desert Storm and Desert Shield and found that at one Army 
mobilization station nearly 4 percent of the reserve component members 
reporting for duty had serious medical conditions including cancer and 
heart disease. One soldier had double kidney failure, one had muscular 
dystrophy, and another had a gunshot wound to the head. We found that 
DOD medical policy, which permits the services to retain nondeployable 
reservists, was inconsistent with a military strategy that requires 
forces to be capable of responding quickly to unexpected military 
contingencies anywhere in the world and we recommended that DOD revise 
its policy that allows members not to be worldwide deployable, but DOD 
disagreed and did not take action. We also found that DOD was not aware 
of the physical fitness problems because the services were not 
reporting fitness information as DOD required and GAO recommended that 
DOD revise its directive to require services to report on their 
members' physical fitness status. DOD concurred with our 
recommendations and agreed to take actions. Other related GAO products 
are found at the end of this report. 

DOD's System to Assess Active and Reserve Component Members' Health 
Status Prior to Deployments: 

Section 1074f of Title 10, United States Code requires that the 
Secretary of Defense establish a system to assess the medical condition 
of members of the armed forces (including members of the reserve 
components) who are deployed outside of the United States or its 
territories or possessions as part of a contingency operation or combat 
operation. It further requires that records be maintained in a 
centralized location to improve future access to records, and that the 
secretary establish a quality assurance program to evaluate the success 
of the system in ensuring that members receive pre-and postdeployment 
medical examinations and that record-keeping requirements are met. 

DOD policy requires that the services collect pre-and postdeployment 
health information from their members, and submit copies of the forms 
that are used to collect this information to the Army Medical 
Surveillance Activity (AMSA).[Footnote 18] Initially, deployment health 
assessments were required for all active and reserve component 
personnel who were on troop movements resulting from deployment orders 
of 30 continuous days or greater to land-based locations outside the 
United States that did not have permanent U.S. military treatment 
facilities. However, on October 25, 2001, the Assistant Secretary of 
Defense for Health Affairs updated DOD's policy and required deployment-
related health assessments for all reserve component personnel called 
to active duty for 30 days or more. The policy specifically stated that 
the assessments were to be done "whether or not the personnel were 
deploying outside the United States." Both assessments use a 
questionnaire designed to help military healthcare providers in 
identifying health problems and providing needed medical care. The 
predeployment health assessment is generally administered at the 
service mobilization site or unit home station before deployment. 

On February 1, 2002, the Chairman of the Joint Chiefs of Staff issued 
updated deployment health surveillance procedures. Among other things, 
these procedures specified that active and reserve component personnel 
must complete or revalidate the health assessment within 30 days prior 
to deployment. The procedures also stated that the original completed 
health assessment forms were to be placed in the military member's 
permanent medical record and a copy "immediately forwarded to AMSA." 

Both forms include demographic information about the servicemember, 
member-provided information about the member's general health, and 
information about referrals that are issued when service medical 
providers review the health assessments. The predeployment assessment 
also includes a final medical disposition that shows whether the member 
was deployable or not. 

In September 2003,[Footnote 19] we reported that DOD did not maintain a 
complete, centralized database of the active Army and Air Force 
components' member health assessments and immunizations. Following our 
2003 review, DOD established a deployment health quality assurance 
program to improve data collection and accuracy. The department's first 
annual report documenting issues relating to deployment health 
assessments was issued in May 2005. 

In September 2004,[Footnote 20] we reported similar findings for the 
reserve component members. We reported that DOD's ability to 
effectively manage the health status of its reserve component members 
is limited because its centralized database has missing and incomplete 
health records and it has not maintained full visibility over reserve 
component members with medical problems. For example, the Marine Corps 
did not send predeployment health assessments to DOD's database as 
required, due to unclear guidance and a lack of compliance monitoring. 
The Air Force has visibility of involuntarily mobilized members with 
health problems, but lacks visibility of members with health problems 
who are on voluntary orders. As a result, some Air Force reserve 
component personnel had medical problems that had not been resolved for 
up to 18 months, but the full extent of this problem was unknown since 
the Air Force did not have a mechanism for tracking members who are on 
voluntary duty orders with medical problems. We made several 
recommendations regarding improvements in this area and DOD generally 
concurred with our recommendations and agreed to take actions. 

Recent DOD Efforts in Response to the 2005 National Defense 
Authorization Act: 

Section 731 of the Ronald W. Reagan National Defense Authorization Act 
for Fiscal Year 2005 (NDAA) requires the Secretary of Defense to 
develop and implement a comprehensive plan to improve medical readiness 
of members of the Armed Services by focusing on areas such as health 
status, health surveillance, and accountability for medical readiness. 
The mandate also required that the Secretary of Defense establish a 
Joint Medical Readiness Oversight Committee (JMROC) with a specified 
membership to oversee the development and implementation of a 
comprehensive medical readiness plan.[Footnote 21] 

In response to the act, the first meeting of the JMROC was held in 
February 2005 during this review. The committee is chaired by the Under 
Secretary of Defense for Personnel and Readiness and membership 
includes the Assistant Secretaries of Defense for Reserve Affairs and 
Health Affairs, the Joint Staff Surgeon, the Chief of the National 
Guard Bureau, Army Reserve, Navy Reserve, Air Force Reserve and the 
Commander of the Marine Corps Reserve, as well as the Vice Chiefs of 
Staff of the Army, Vice Chief of Navy Operations, the Vice Chief of 
Staff of the Air Force and the Assistant Commandant of the Marine Corps 
as well as their respective Surgeon Generals and Assistant Secretaries 
for Manpower and Reserve Affairs, and a representative of the 
Department of Veterans Affairs. 

A draft copy of the Comprehensive Medical Readiness Plan which 
addresses all defense medical issues identified in the act was signed 
by the Under Secretary of Defense for Personnel and Readiness on June 
23, 2005. Officials from the Force Health Protection Directorate in the 
OSD Office of Health Affairs--which is providing the staff for drafting 
and overseeing this effort--stated that financial and legislative 
constraints, which may limit the implementation of the plan, will have 
to be identified and addressed, and indicators for measuring progress 
will have to be developed before the plan is finalized. 

Among other things, the draft plan specifies that DOD: 

(l) institutionalize the Individual Medical Readiness[Footnote 22] 
(IMR) reporting process by developing a DOD instruction for the IMR and 
requires that this information be provided to commanders to assist them 
in improving the health status of members of their units; 

(2) expand and improve the pre-and postdeployment assessment process by 
refining the predeployment survey to improve consistency with the 
postdeployment survey and develop periodic postdeployment health 
reassessments; 

(3) develop a policy defining the circumstances under which treatment 
for medical conditions may be provided in theater and circumstances 
under which medical conditions are to be resolved prior to deployment; 
and: 

(4) review the results of this GAO study. 

Lack of DOD Oversight Hinders DOD's Ability to Determine Reserve 
Components' Compliance with Routine Medical and Physical Fitness 
Examination Requirements, but Indications of Noncompliance Exist: 

DOD is unable to determine the extent to which the reserve components 
are in compliance with routine medical and physical fitness examination 
requirements primarily due to a lack of OSD guidance, oversight, and 
incomplete or unreliable compliance data supplied by the components. 
Although the Office of the Under Secretary of Defense for Personnel and 
Readiness (OSD/P&R) has the responsibility for overseeing medical and 
physical fitness policy and processes, this office has not established 
a management control framework and executed a plan to oversee 
compliance with routine examinations. For example, OSD/P&R has not 
provided guidance to the reserve components regarding requirements for 
the 5-year medical examination and an annual medical certificate. Thus, 
in the absence of OSD guidance, each reserve component has developed 
its own implementing policies, resulting in differences in scope, 
frequency, and administration making it difficult because uniform 
criteria against which to measure compliance do not exist; however, OSD 
has provided consistent guidance for dental and physical fitness 
examinations. DOD's ability to determine the extent of compliance has 
been hindered because OSD does not oversee reserve component members' 
compliance with the routine physical fitness or medical examination 
requirements. Furthermore, the data reported at the reserve component 
level have been incomplete and unreliable for purposes of determining 
compliance with routine medical and physical fitness examinations, and 
responsibility for compliance has not been enforced. We found 
indications of noncompliance during our site visits and reviews of 
existing audit reports and investigations. OSD's lack of oversight 
could negatively impact operational readiness for future deployments, 
as the number of needed personnel may not be medically and physically 
fit for active duty. 

Lack of OSD Guidance Contributes to Variations in Examination Policies 
among the Components: 

Although OSD/P&R has the responsibility for overseeing medical and 
physical fitness policy and processes, this office has not established 
a management control framework and executed a plan that includes 
issuing guidance to the reserve components on compliance with the 
requirements for the 5-year medical examination and an annual medical 
certificate. For example, the statutory requirement for the 5-year 
medical examination has not been defined by OSD, leaving each reserve 
component to develop implementing guidance, resulting in differences in 
scope, frequency, and administration of the examination among the 
components. In addition, there has not been any OSD implementing 
guidance regarding the statutory requirement for an annual medical 
certificate, and so different guidance has been developed by the 
surgeons' general offices responsible for each of the six reserve 
components. Lack of OSD guidance makes oversight difficult to determine 
because the uniform criteria against which to measure the components' 
compliance do not exist. OSD, through the Office of the Assistant 
Secretary of Defense for Health Affairs, has established a consistent 
requirement and implementation policy for an annual dental examination. 
OSD has also established a consistent requirement for a physical 
fitness examination, although the specific content of the physical 
fitness examination varies among the components and it is not 
coordinated with the medical examinations. 

5-Year Medical Examination Requirements Vary among the Components: 

The requirement for a routine medical examination has been in effect 
for all active and reserve components since at least 1960.[Footnote 23] 
Yet, as of September 2005, OSD has not developed a plan or provided 
direction to the components on how to implement this 
requirement.[Footnote 24] In the absence of OSD guidance, the surgeons 
general responsible for the four services and six reserve components 
have each developed their own separate implementing guidance for the 
current requirement[Footnote 25] for a 5-year medical examination, 
resulting in differences in scope, frequency, and administration among 
the components as illustrated below. 

Routine medical examinations include assessments in six areas: physical 
capacity or stamina, upper extremities, hearing and ears, lower 
extremities, eyes/vision, and psychiatric.[Footnote 26] For Army active 
and reserve component members older than age 40, there are additional 
age-specific screenings such as prostate examination, a prostate- 
specific antigen test, and a fasting lipid profile that includes 
testing for total cholesterol, low-density lipoproteins, and high- 
density lipoproteins. The Department of the Navy conducts routine 
medical examinations on all Navy and Marine Corps active component and 
reserve members that include height and weight measurements, blood 
pressure testing, urinalysis, serology, and mental issues. Those being 
examined are also questioned about their past and present medical 
history, including serious illnesses, injuries, chronic conditions, and 
operations. The Air Force reserve components' medical examination for 
nonflyers has been significantly reduced to minimize lost training time 
due to annual medical requirements. The scope of the current testing 
exam requirement is essentially limited to brief skin exams for scars 
and cancer and limited laboratory blood work, and excludes EKGs, 
cholesterol, lipid panels, depth perception, glaucoma, and mammograms. 
One question asked on the questionnaire addresses mental status and 
whether the member has a history of anxiety or depression. 

In addition to the differing scope, the different implementing guidance 
across the services has resulted in variations among the services in 
the frequency and administration of the 5-year medical examinations. 
For example, Army guidelines require that Selected Reserve members 
complete a medical examination once every 5 years. During our review, 
the Navy and Marine Corps personnel were examined at slightly different 
intervals: every 5 years through age 50, every 2 years through age 60, 
and annually after age 60. The Air Force is even more different, in 
that it no longer requires a traditional medical examination physical 
be completed every 5 years for nonflyers.[Footnote 27] Instead, members 
are required to complete an annual Preventive Health Assessment (PHA), 
the answers to which--combined with the member's age, gender, health 
risk factors, medical history, and occupations--will determine the 
types of screening and laboratory tests required and if the member 
needs to be seen by a military health care provider. At a minimum, 
however, Air Force reserve component members are required to have a 
visit with a military health care provider, or Periodic Health 
Assessment Monitor (PHAM),[Footnote 28] at least once every 3 years, 
while Air National Guard members are required to visit a Health Care 
Provider (HCP)[Footnote 29] at least once every 5 years. Thus, 
differences exist between the two Air Force reserve components. 

Annual Certification of Members Medical Condition Varies among 
Components: 

In the absence of any implementing guidance from OSD, guidance for the 
annual certification of medical condition has been developed by the 
surgeon general's offices responsible for each of the six reserve 
components. Like the 5-year medical examination, the annual certificate 
of medical condition is prescribed by statute[Footnote 30] which states 
that "each member of the Selected Reserve who is not on active duty 
shall execute and submit annually to the Secretary concerned a 
certificate of physical condition." This requirement has been in law 
since at least 1960 and is especially important for the reserve 
components, since they are not seen by military health care providers 
as often as the active duty. 

The different guidance from each of the services has resulted in 
differing definitions from each service as to what is involved in the 
annual medical certificate. For example, Department of Army regulations 
require that all members of the Army Reserve and Army National Guard 
certify their medical condition annually on a two-page certification 
form, where members report physician and dentist visits since their 
last examination, describe current medical or dental problems, and 
disclose any medications they are currently taking. Navy and Marine 
Corps Selected Reserve members complete an Annual Certificate of 
Physical Condition that provides information including the location of 
their health and dental records, the dates and purpose or type of their 
last complete physical and dental examinations, and the date of their 
last HIV blood test among others. Reservists are also expected to 
disclose any injury, illness, or disease that occurred within the last 
12 months and resulted in hospitalization, or caused them to be absent 
from work, school, or duty for more than 3 consecutive days; if they 
have been under a physician's care or taken prescription medications 
during the past 12 months; and any physical defects, family issues, or 
mental problems that would prevent them from being mobilized. The Air 
Force has combined this annual requirement into its PHA screening 
process. Within the Air Force Reserve, the PHA process involves all 
members initially completing a Reserve Component Health Risk 
Assessment, which was formerly known as the Annual Medical Certificate. 
In the Air National Guard, the PHA involves all the members initially 
completing an annual Health History Questions/Interval History, which 
was formerly known as the Annual Medical Certificate. 

Dental Examination Requirements Are Consistent among Components: 

The annual dental examination is a consistent requirement across the 
reserve components that was established by DOD policy and provided 
consistent standards for active duty and Selected Reserve members to 
improve dental readiness.[Footnote 31] In 1998, the Office of the 
Assistant Secretary of Defense for Health Affairs, under the Under 
Secretary of Defense for Personnel and Readiness, directed that all 
active duty and Selected Reserve members obtain an annual dental 
examination so that DOD would have a clear picture of members' dental 
readiness and fitness for duty.[Footnote 32] Although the 1998 
directive required all services to provide implementation plans for 
completing all dental examinations by 2001, Health Affairs recognized 
that the services were having difficulty identifying both the 
mechanisms for compliance and the tracking system for documentation, 
and extended the goal of 90 percent compliance until February 2004. A 
year and half later, DOD still does not have complete and reliable 
information on all reserve components' compliance. 

According to Army regulation, all soldiers within the Army National 
Guard are required to have a dental examination on an annual 
basis.[Footnote 33] The current annual dental examination requires an 
assessment of the current state of oral health; risk for future dental 
disease, including periodontal assessment; and oral cancer screening. 
Prior to early 2004, the Army reserve components were still conducting 
only a dental screening.[Footnote 34] In March 2000, the Navy issued 
instructions requiring Navy and Marine Corps reservists to undergo an 
annual dental examination. Currently, both the Air Force Reserve and 
Air National Guard require annual dental examinations in line with 
DOD's requirement. The Air Force Reserve made this a requirement in 
January 2003, but the Air National Guard did not make it a requirement 
until September 2004. Prior to these times, the required dental exam 
interval was once every 3 years for the Air Force Reserve and once 
every 5 years for the Air National Guard. 

Physical Fitness Examination Requirements Consistent among the 
Components, but Content Varies and It Is Not Coordinated with Medical 
Examination Requirements: 

Although the specific content of the physical fitness examination 
varies among the components, the requirement for at least an annual 
physical fitness examination is consistent across the components 
because it was established by DOD policy which is to be monitored by 
the Principal Deputy Under Secretary of Defense for Personnel and 
Readiness, Office of Morale, Welfare, and Recreation.[Footnote 35] 
Specifically, the policy requires that all military services and 
reserve components develop and use physical fitness tests that evaluate 
aerobic capacity (e.g., a timed run), muscular strength, and muscular 
endurance (e.g., push-ups, pull-ups, sit-ups), and that all service 
members be formally evaluated and tested for the record at least 
annually (unless they are under a medical waiver). 

The specific content of the physical fitness examination varies among 
the components because different physical abilities are needed to meet 
the services' different missions. The Army Physical Fitness Test (APFT) 
is a performance test that indicates a member's ability to perform 
physically and handle his or her own body weight. The APFT is required 
annually for the Army National Guard. As of October 2004, the Chief of 
the Army Reserve required Army reservists to be tested twice a year, as 
are their active component counterparts. The APFT consists of 2 minutes 
of push-ups, 2 minutes of sit-ups, and a 2-mile run (the same test is 
administered to both the active and reserve component). The number of 
push-ups and sit-ups and the 2-mile run time are based on the soldier's 
age range and sex (the physical fitness test required to enter the Army 
has the same requirements for all ages, but different requirements for 
gender). All Navy personnel, regardless of age and component (active or 
reserve), are required to participate semiannually in a Physical 
Fitness Assessment that includes a Body Composition Assessment and 
Physical Readiness Test unless medically prohibited from doing so. Body 
composition is assessed by an initial weight and height screening or an 
approved circumference technique to estimate body fat percentage. 
Testing includes a series of physical events designed to evaluate an 
individual's flexibility through a sit-reach activity, muscular 
strength and endurance through curl-ups and push-ups, and aerobic 
capacity through a 1.5-mile run/walk, or 500-yard or 450-meter swim. 
Individuals who fail either the Body Composition Assessment or the 
Physical Readiness Test or both are considered to have failed the 
entire assessment. The Marine Corps has also developed a Body 
Composition Program and Physical Fitness Test to assess each Marine's 
fitness level. Active component Marines are tested semiannually while 
Marine Corps Reservists are tested annually. Body composition standards 
are health-and performance-based limits for body weight and body fat. 
Physical fitness testing includes pull-ups for males, flexed-arm hang 
for females, a timed abdominal crunch event, and a timed 3-mile run. 
These events are designed to test the strength and stamina of the upper 
body, midsection, and lower body, as well as the cardiovascular system. 
The Air Force fitness program requires an annual physical assessment to 
motivate all members to participate in a year-round physical 
conditioning program, including proper aerobic conditioning, 
strength/flexibility training, and healthy eating. Fitness assessment 
results are based on a composite score calculated from results of an 
aerobic assessment (1.5-mile run), muscular fitness assessment (push-
ups and crunches), and body composition measurement (abdominal 
circumference measurement). 

Although DOD has directed the military physical fitness programs to 
complement the health promotion program within OSD's Office of Health 
Affairs and senior medical officials have told us that medical and 
physical fitness go "hand-in-hand," physical fitness policies are not 
coordinated with medical fitness policies at the OSD, service, reserve 
component, or unit levels. Furthermore, DOD did not consider physical 
fitness a factor for determining the medical deployability of reserve 
component members prior to deployment to Iraq and Afghanistan, even 
though we reported in 1994[Footnote 36] that several Army reports on 
Operations Desert Shield and Desert Storm noted fitness-related 
problems that hindered wartime operations. For example, one report 
noted that poor fitness contributed to the deaths by heart attack of 
eight reserve component personnel deployed to the Persian Gulf. 

OSD Does Not Oversee Compliance with Routine Medical and Physical 
Fitness Examinations: 

OSD does not have a plan to oversee reserve components' compliance with 
the routine medical or physical fitness examinations, which hinders 
DOD's ability to determine the extent of compliance. For example, OSD 
does not track reserve component members' compliance with routine 
medical examinations. In addition, OSD does not enforce its own 
directive requiring the services to report on their members' compliance 
with physical fitness examinations. 

OSD Does Not Track Compliance with Routine Medical Examinations: 

Although OSD's Office of Health Affairs has begun to track medical 
readiness indicators, it does not have a plan to track compliance with 
routine medical examinations and does not attempt to track compliance 
with physical fitness examinations. OSD's Office of Health Affairs has 
initiated a process requiring that all reserve components report 
quarterly the percentage of their members who are in compliance with 
the following six indicators of medical readiness: dental class I or 
II; immunizations; medical readiness laboratory tests, such as 
providing a blood sample; no deployment-limiting conditions; periodic 
health assessment; and medical equipment, such as eyeglass inserts for 
face masks. This process continues to evolve as the Office of Health 
Affairs wrestles with inconsistencies in requirements among the reserve 
components, especially in regard to the periodic health assessment 
since each reserve component implements the requirement for a periodic 
5-year medical examination differently.[Footnote 37] Without 
centralized oversight and management for tracking compliance, DOD's 
ability to determine the extent of compliance with routine medical 
examinations may be impeded. 

OSD Has Not Enforced Its Directive Requiring the Services to Report on 
Compliance with Physical Fitness Exams: 

OSD has not enforced its own directive requiring the reserve and active 
components to report on their members' compliance with physical fitness 
examinations by March 2005. Although DOD policy states that physical 
fitness is a vital element of combat readiness and is essential to the 
general health and well-being of military personnel, OSD and the 
reserve components have been lax in reporting compliance with physical 
fitness examination requirements and do not fully utilize available 
systems that could report physical fitness status on a servicewide 
basis. DOD established a reporting requirement for physical fitness in 
November 2002, in response to recommendations from our prior reports; 
however, it has not enforced compliance with this new requirement. 

The new physical fitness policy requires that each military service 
establish and maintain a data repository that provides baseline 
statistics and a tracking mechanism that monitors physical fitness and 
body fat for both the active and reserve components. The policy was 
developed over the course of many years. In response to a 
recommendation in our 1994 report,[Footnote 38] the Under Secretary of 
Defense for Personnel and Readiness stated that revised DOD 
guidance[Footnote 39] would "require the services to provide an annual 
report assessing their physical fitness and health promotion programs, 
to include a brief summary on how physically fit and healthy they view 
their military members, both active and reserve components." Not only 
did the original directive fail to require the services to submit an 
annual report on the status of servicemembers' physical fitness, but 
senior military officials in the office responsible for developing 
these directives told us that no service ever submitted a status report 
on their physical fitness programs as required by the revised 
directive. In 1998, we again reported that DOD's oversight of the 
physical fitness program was inadequate and that DOD had not enforced 
the annual reporting requirement.[Footnote 40] Officials in the Office 
of Morale, Welfare, and Recreation stated that in response to our 
report, DOD guidance was again revised in November 2002, to require the 
services to report annually to the Principal Deputy Under Secretary of 
Defense for Personnel and Readiness[Footnote 41] on a number of very 
specific physical fitness statistics, including the number of personnel 
tested, the number of personnel who failed the test, and the number 
placed in remedial training programs. The first report was due to the 
Principal Deputy Under Secretary of Defense for Personnel and Readiness 
by the military services by March 31, 2005. However, during our review 
we were told by officials in the Office of Morale, Welfare, and 
Recreation that none of the reports had been submitted to the Principal 
Deputy as required. The Air Force, Navy, and Marine Corps were 
developing their information during this review. The Army had until 
March 2007 to report because, according to a signed memorandum by the 
Principal Deputy Under Secretary of Defense for Personnel and 
Readiness, the Army is taking steps to report this information as part 
of the Defense Integrated Military Human Resources System (DIMHRS). 
Until this reporting requirement is enforced, DOD's ability to 
determine compliance with the physical fitness examinations may 
continue to be hindered. 

Reporting of Compliance at Reserve Component Level Is Hindered by 
Incomplete and Unreliable Data and Lack of Enforcement: 

Incomplete and unreliable data at the reserve component level regarding 
compliance with routine medical and physical fitness examinations have 
hindered DOD's ability to determine the extent of the reserve 
components' compliance with the examination requirements. Each reserve 
component employs a tracking system capable of monitoring compliance 
with medical examinations, but only one reserve component--the Navy 
Reserve--has data that are reliable for determining compliance with 
routine medical examinations. Furthermore, even though DOD policy calls 
for each military service to establish and maintain a physical fitness 
data repository, no reserve component has demonstrated that its 
tracking system can report complete and reliable compliance data on 
physical fitness. Although the reserve components place the 
responsibility for tracking compliance with medical and physical 
fitness examinations on the unit commander, the reserve components do 
not always hold the unit commanders accountable and the unit commanders 
do not always enforce the compliance of their members. No centralized 
oversight exists to hold all levels accountable, thus ensuring that all 
requirements are being met. 

Most Reserve Component Data on Compliance with Routine Medical 
Examinations Are Unreliable: 

All of the reserve components are now employing systems that can track 
compliance with medical examinations, but only one reserve component-- 
the Navy Reserve--has taken the necessary quality assurance steps to 
ensure the reliability of its data on compliance with routine medical 
examinations. In contrast, we found that the data captured by the 
systems used by the Army and the Air Force were unreliable for 
determining compliance with routine medical examinations. We did not 
assess the reliability of the data used by the Marine Corps because it 
is in the process of implementing and testing the use of the Navy's 
system. 

Assessing data for their reliability includes quality assurance steps 
to consider the completeness and currency of the data, i.e., 
determining whether there are assurances that all members are included 
and the information is up to date; quality control measures, such as 
conducting periodic testing of the data against medical records, to 
ensure the accuracy and reliability of the data; and examining who is 
using the data and for what purposes, and how reliable the user thinks 
the data are. We found that the Navy Reserve had taken such quality 
assurance steps. For example, the Navy has directed its Readiness 
Commands to conduct routine inspections to verify medical data accuracy 
in the Navy Reserve's Medical Readiness Reporting System (MRRS) and 
required reserve units to review 10 percent of their medical records 
for accuracy after each drill weekend. In addition, Navy Reserve units 
are also required to keep the Commander, Navy Reserve Forces Command 
informed about medical and dental compliance on a biweekly basis. 

In contrast, we found that the compliance data on routine medical 
examinations captured by the Army Medical Protection System (MEDPROS) 
were unreliable for the purposes of determining compliance with routine 
medical examinations. MEDPROS was developed in 1998 to track anthrax 
compliance and has since matured to meet current mobilization 
requirements. All Army components--active, reserve, and guard--are 
required to enter members' medical compliance data into MEDPROS. We 
found the data captured by this system are unreliable for monitoring 
compliance with routine requirements for several reasons, including 
missing data, failure to include data for all Army units, and lack of 
quality assurance assessments on data content being performed to test 
the data's reliability. Until quality control measures are instituted, 
the Army will not be able to reliably use MEDPROS to track compliance 
with the requirements for the 5-year medical examination, the annual 
medical certificate, and the annual dental examination. 

We also found that the Air National Guard's Preventive Health 
Assessment and Individual Medical Readiness (PIMR) system and the Air 
Force Reserve's Reserve Component Periodic Health Assessment (RCPHA) 
system were unreliable for the purposes of determining compliance with 
routine medical examinations. We found that neither system produces 
data that are reliable for the purposes of determining compliance with 
routine medical examinations because: (1) both the Air Force Audit 
Agency and Air Force Inspection Agency have reported discrepancies in 
their review of medical records and the data from these systems, and 
(2) there is a high reliance on unit commands to test and verify the 
reliability of the data. In addition, during our site reviews, we found 
medical staff at several commands having difficulty entering large 
backlogs of medical data, which raised concerns about the timeliness of 
the data. Often, this backlog took several weeks to resolve and 
required the assistance of full-time reservists. However, according to 
program managers and database administrators, the quality of the data, 
in terms of their completeness and accuracy, ranges from quite good to 
exceptional when subjected to internal system software checks. Until 
resources necessary to input and verify the data in a timely manner are 
provided, the Air Force will not be able to rely on PIMR and RCHPA data 
to determine compliance with routine medical examination requirements. 

We did not assess the reliability of the data used by the Marine Corps 
because it is in the process of implementing and testing the use of 
Navy's system. According to a Marine Corps official, once the new 
system is fully implemented, the Marine Corps will have the same 
oversight capability over medical compliance that the Navy Reserve 
currently has. 

Reserve Components Are Unable to Report Complete and Reliable Data on 
Compliance with Routine Physical Fitness Examinations on a 
Componentwide Basis: 

Even though DOD policy calls for each military service to establish and 
maintain a physical fitness data repository, no reserve component has a 
tracking system that can report complete and reliable data on 
compliance with physical fitness examinations on a componentwide basis. 
In fact, the Army Reserve, the Army National Guard, and the Marine 
Corps Reserve do not have systems that are designed to track compliance 
with physical fitness examinations on a componentwide basis. 

The Navy Reserve, the Air National Guard, and Air Force Reserve each 
have systems that can track compliance with physical fitness 
examinations on a componentwide basis. The Navy Reserve system, 
however, may not be producing reliable data at this time. Further, we 
have concerns regarding the reliability of the data produced by the Air 
National Guard and the Air Force Reserve because such data are not 
reviewed or validated on a regular basis. 

The Army does not report physical fitness on a componentwide basis. 
According to a Department of Army memo, dated April 19, 2004, and 
confirmed through our discussions with Army and OSD officials, physical 
fitness and body composition data will eventually be tracked in DIMHRS, 
in which the Army is the first component to participate. Until DIMHRS 
is used, the Army will be unable to report complete and reliable data 
on componentwide compliance with the physical fitness examination 
requirements. According to Army Reserve officials, physical fitness 
data can be tracked in the regional level application software 
database, but the information may not be updated by the units in a 
timely or consistent manner. This information is then updated in the 
Total Army Personnel database, which updates the Individual Training 
and Readiness System. In the Army National Guard, the states may use 
the personnel database to record the scores and dates of physical 
fitness examinations, but not consistently. The Army's first report on 
the status of its physical fitness compliance for all its components 
will be due March 31, 2007, because the Office of the Under Secretary 
of Defense for Personnel and Readiness granted the Army a 2-year 
extension for its requirement to report on the physical fitness status 
of all members (active, reserve, and guard). The data in this report, 
if complete and reliable, could enable DOD to determine the Army's 
compliance with the physical fitness examination requirement. According 
to the 2004 Department of the Army Memo, if DIMHRS is not on line by 
September 2006, the Army will manually report these data. 

Compliance with physical fitness examination requirements is tracked at 
headquarters level for the Navy Reserve, but we found that the Navy is 
unable to report complete and reliable compliance data. The Navy 
requires all commands to report their physical fitness assessment data, 
including physical readiness test results, through the Physical 
Readiness Information Management System (PRIMS). However, we found the 
data generated by this system to be unreliable because, according to a 
Navy Official, there are about 2,000 duplicate records that need to be 
purged and about 25 percent of the Body Composition Assessment scores 
have not been reported by unit commanders. Until internal controls are 
established to eliminate duplication and ensure completeness of data, 
the Navy will be unable to report complete and reliable data on 
componentwide compliance with the physical fitness examination 
requirement. The Navy submitted its annual report on physical fitness, 
due March 31, 2005, to DOD 3 months late, on July 8, 2005. According to 
a DOD official, the Navy did not request an extension or provide an 
explanation for the late submission. Because the data in this report 
came from the PRIMS system that we found to be unreliable, we do not 
believe that DOD can reliably use the information in the report to 
determine the Navy's compliance with the physical fitness examination 
requirement. 

The Marine Corps is unable to report complete and reliable data on 
compliance with the physical fitness examination because, in contrast 
to the Navy, the Marine Corps does not have a dedicated physical 
fitness reporting system. Instead, the Marine Corps requires unit 
commanding officers to record physical fitness scores in unit diaries, 
personnel records, and the Marine Corps Total Force System, a Marine 
Corps-wide personnel system. Units that input data into this system are 
responsible for reviewing the data and certifying that they are 
correct. However, a Marine Corps official indicated that the data are 
assumed to be correct when transmitted to higher commands, but no steps 
are taken to verify accuracy of the data. As of August 2005, the Marine 
Corps had provided DOD with a draft report addressing calendar year 
2004 physical fitness scores. According to a DOD official, the Marine 
Corps did not request an extension or provide an explanation for the 
late draft submission. Further, as of September 2005, the Marine Corps 
had not responded to our official request for the annual physical 
fitness report. Without an ongoing quality assurance program to 
consistently and continuously ensure the completeness and reliability 
of the data in the Marine Corps Total Force System, we did not rely on 
the data in the draft Marine Corps Physical Fitness Report provided to 
DOD. 

Although both the Air Force Reserve and Air National Guard each have a 
dedicated system to track the physical fitness status of their members, 
we found quality assurance procedures lacking, possibly leading to 
incomplete and unreliable data with which to track physical fitness 
compliance. The Air Force Reserve's software system Program--the Air 
Force Fitness Management System (AFFMS)--only tracks fitness program 
results on a current basis and only retains data entered from 2004 
forward. However, quality assurance procedures are not followed. For 
example, there are delays in entering data; compliance of individual 
units is only reviewed if there is a question; and headquarters does 
not routinely assess members' currency. This program relies on a 
fitness program manager within each unit command to monitor program 
metrics. According to an AFFMS system official, the only true way of 
determining the reliability of the data in this system is to compare 
these data with the data in the respective member's personnel files, 
and this has not been done. The Air National Guard (ANG) tracking 
system for compliance with physical fitness examinations is ANG's 
Fitness Age and was first implemented in late 2003, although many ANG 
units lagged in their use of Fitness Age until after April 2004. ANG's 
Fitness Age database only reflects calendar year information as of a 
specific point in time, and does not track or measure performance based 
on a running 12-month period. The ANG Fitness Program requires an 
assessment on all ANG members once per calendar year. According to ANG 
officials, most physical fitness testing is performed within the last 
few months of the calendar year. Because the data are cumulative, the 
only time that physical fitness information can be assessed for all 
members taking the test is at the end of the calendar year. In other 
words, most reservists would appear out of compliance until they take 
their annual exam even though they are probably still within their 1- 
year window for testing. Furthermore, information on the number of 
reservists not tested at all or who are overdue is not captured by the 
ANG Fitness Age database. According to an ANG official, the 
responsibility for managing the physical fitness program rests with the 
respective ANG installation's command. The respective ANG installations 
(unit commands) have visibility over their respective "overdue" 
members. However, ANG headquarters lacks sufficient oversight to assess 
compliance. Without ongoing quality assurance programs to consistently 
and continuously ensure the completeness and reliability of the data in 
the Air National Guard and Air Force Reserve systems, we did not rely 
on the data in these systems. 

Accountability to Comply with Routine Medical and Physical Fitness 
Examination Is Not Always Enforced: 

In general, throughout the reserve components, the individual members 
are responsible for maintaining their physical and medical fitness and 
the unit commanders are responsible for ensuring members' compliance 
with medical and physical fitness examinations; however, the reserve 
components do not always hold the unit commanders accountable and the 
unit commanders do not always enforce the members' compliance. 
Accountability for compliance is fragmented at various levels of 
command. No centralized oversight exists to hold all levels accountable 
ensuring that all requirements are being met. Individual members are 
responsible for attending all scheduled examinations and assessments, 
seeking timely medical advice when necessary, reporting changes in 
their medical health on the annual medical certificate, and 
successfully completing the requirements of the physical fitness 
examinations. False statements may result in reassignment, discharge, 
or other disciplinary action. Unit commanders are responsible for 
implementing any administrative and command provisions for 
examinations, informing members of the examination requirements, 
establishing training programs for physical fitness, taking actions 
against reserve members who fail to comply with the requirements, and 
reporting the current medical and dental status of reservists through 
the applicable tracking systems, and they are ultimately responsible 
for the accuracy of medical and physical fitness information relied on 
by higher commands. However, reserve components do not always hold the 
unit commanders accountable for these responsibilities and the unit 
commanders we interviewed expressed concern about the many competing 
responsibilities they have, such as meeting training requirements, and 
how they must prioritize the use of their limited resources. One unit 
commander also expressed concern about enforcing medical and physical 
fitness policies if it meant losing a "good soldier" who otherwise 
performs his duties well. Without oversight and accountability at the 
OSD and respective service and reserve component levels, unit 
commanders may not have the incentive or resources to fully enforce the 
medical and physical fitness examination requirements and compliance 
may suffer. 

Indications of Noncompliance with Medical and Physical Fitness 
Examination Requirements Exist: 

Although DOD can not determine the extent of reserve components' 
compliance with routine medical and physical fitness examinations, we 
found indications of noncompliance during our site visits and in our 
reviews of existing audit reports and investigations. For example, a 
limited review of medical files at one Army National Guard and one Army 
Reserve location, data from a Navy report, test results of two units in 
a Marine Corps battalion, and data from a review conducted by the Air 
Force Audit Agency indicate some noncompliance at all components with 
the routine medical examination, annual medical certificate, annual 
dental examination, and annual physical fitness examination. 

Indications of Noncompliance with 5-Year Medical Examination and Annual 
Medical Certificate Exist at All Components: 

A review of available medical files at one Army National Guard and one 
Army Reserve location, data from a Navy report, test results of two 
units in a Marine Corps battalion, and data from a review conducted by 
the Air Force Audit Agency indicate some noncompliance with the routine 
medical examination and the annual medical certificate at all 
components. For example, in April 2005 we conducted a review of 39 
medical files at an Army National Guard unit that was deployed to Iraq 
in 2003 for 1 year. We found that 13 members were not in compliance 
with the routine medical examination at the time of our review. 
Further, while 36 members were in compliance with the annual medical 
certificate at the time of our review, only 3 members were in 
compliance with the annual medical certificate prior to the unit being 
alerted of their most recent mobilization date for deploying to Iraq. 
According to the commander of this unit, there are a number of actions 
that need to be accomplished during weekend drills, and with limited 
time and resources available, completing routine medical requirements 
is low on the long list of priorities. In addition, during June 2005, 
we reviewed 175 medical files of an Army Reserve unit that deployed to 
Afghanistan in 2003 for 10-month deployment. We found that all but 2 
members were in compliance with the 5-year medical examination. While 
150 members were in compliance with the annual medical certificate at 
the time of our review, not a single member was in compliance with the 
annual medical certificate prior to the unit receiving alert orders of 
their mobilization. Furthermore, many of the soldiers that we spoke 
with during our review stated that they were unfamiliar with the annual 
medical certificate. In addition, a February 2005 Army Inspector 
General Report noted that virtually all reserve component leaders they 
contacted during their review expressed frustration with their 
inability to maintain the medical deployability status of their 
soldiers using the annual medical certificate process.[Footnote 42] 
Leaders noted the certificate only reflects what a soldier is willing 
to share. Often the only medical personnel available to review and sign 
the certificate is a unit medic, who can do little more than ask if the 
data are correct. 

In July 2005, the Navy reported that 96.8 percent of reserve members 
had completed the routine 5-year medical examination and 94 percent of 
reserve members had completed the annual medical certificate. These 
high rates are due, in part, to the high priority placed on medical and 
dental compliance throughout the Navy Reserve. 

Although the Marine Corps Reserve does not currently have componentwide 
automated information on medical compliance, it does conduct a periodic 
site inspection called the Mobilization Operational Readiness 
Deployment Test (MORDT). We reviewed the results of the MORDT at two 
units of a Selected Reserve Battalion that had been mobilized. The 
first unit test results we reviewed indicated that 98 percent of the 
reservists had completed a routine physical examination within 5 years, 
and 90 percent had submitted annual health certifications. The second 
unit test results also indicated that 98 percent of the reservists had 
completed a routine annual physical within 5 years, and 88 percent had 
submitted annual health certifications. According to Marine Corps 
Reserve officials, all Marine Corps Selected Reserve units are 
subjected to an unannounced test prior to mobilization to ensure the 
unit can deploy. 

The Air Force Audit Agency (AFAA) recently concluded its review of the 
Service's Individual Deployment Process, during which it found 
significant problems with the Guard's and Reserve's medical records. 
Ten Air National Guard and Air Force Reserve installations included in 
a sample of 20 installations designed to be able to produce estimates 
for all Air Force personnel who were eligible to be deployed during the 
90-day window between June 1, 2004, and August 31, 2004, were in 
compliance with medical requirements such as, but not limited to, 
annual medical assessments and dental examinations. The AFAA reviewed 
the medical records and associated documentation for accuracy and 
completeness. Based on AFAA's review and analysis of 14,121 eligible 
Guard and Reserve members combined, about 13 percent[Footnote 43] were 
found to have medical discrepancies in their medical records. At 2 of 
the unit commands included in AFAA's review that we also visited in our 
review, command officials said that they agreed with the AFAA's 
findings and were taking corrective action. 

Indications of Noncompliance with Dental Examinations Exist at All 
Reserve Components: 

Indications of noncompliance with the dental examination requirement 
were also present at all the reserve components. For example, as 
previously noted, in April 2005, we conducted a review of 39 medical 
files of an Army National Guard unit; of these, 33 were not in 
compliance with the annual dental examination at the time of our 
review. Furthermore, 32 members were not in compliance with the annual 
dental examination prior to alert. In June 2005, we visited an Army 
Reserve unit to conduct a review of 175 medical files. Although only 13 
members were not in compliance with the annual dental examination at 
the time of our review, over 130 members were not in compliance with 
the dental examination prior to alert. 

Other evidence indicates that compliance with dental requirements has 
been a particular matter of concern for the Army reserve components. 
According to a February 2005 Army Inspector General Report,[Footnote 
44] there are examples of reserve component service members with 
multiple tooth extractions at nearly every mobilization station. 
Furthermore, in cases where members presented dental records during 
mobilization, often the only entries are dated to the members' basic 
training and initial exams and procedures. We found a stark example of 
what happens during mobilization when a member's dental status is 
allowed to remain below Class I or II. In one unit we visited, we 
interviewed a member who had 30 teeth extracted prior to deployment. 
According to the member, although dental screenings were conducted 
annually, indicating that he was a dental class III he took no follow- 
up action to correct his dental problems because he had no dental 
insurance and correcting the problem was not a priority. At the time 
this servicemember was being mobilized, a Department of the Army memo 
dated December 6, 2002, stated that soldiers assigned to designated 
units scheduled to deploy within 75 days of mobilization and identified 
as being within dental class III or IV have necessary dental treatment 
initiated to bring them up to dental classification II, the deployment 
standard. 

Although we did not review individual medical and dental records at 
Navy and Marine Corps Reserve sites we visited, we did review specific 
reports to assess whether these components monitored members' dental 
status. We found that the Navy Reserve compliance appears to be 
improving. For example, in early July 2005, the Navy reported that 88.6 
percent of selected reservists were in a Dental Class I or II category, 
an increase over the 69 percent reported in the Dental Class I or II 
category in December 2002. We also reviewed MORDT results for two 
Marine Corps units during a site visit to a Marine Corps Reserve 
Battalion that had been mobilized. We found that test results for the 
first unit indicated that 85 percent were categorized as Dental Class I 
or II while 77 percent in the second unit were categorized as Dental 
Class I or II. 

Analysis provided by the AFAA from its review, mentioned earlier, 
indicated that about 13 percent[Footnote 45] of the Air National Guard 
and Air Reserve members who were eligible to be deployed between June 
1, 2004, and August 31, 2004, were found to have discrepancies in their 
dental records. In addition to the AFAA review, in 2004 the Air Force 
Inspection Agency conducted health services inspections and found 
discrepancies in dental readiness classifications in 49 percent of the 
37 installations reviewed. 

Indications of Noncompliance with Physical Fitness Examination 
Requirement Exist at All Reserve Components: 

As with the other examination requirements, we also found indications 
of noncompliance with the physical fitness examination requirement at 
all six components. 

During our review in April 2005 we also reviewed 29 physical fitness 
files of the Army National Guard unit that deployed to Iraq. Of the 29 
physical fitness files we reviewed, only 18 members showed compliance 
with the physical fitness examination requirement during 2004. Of these 
18 members, 11 passed the physical fitness test and 7 failed. According 
to the unit commander, some soldiers possess skills that are greatly 
needed for unit continuity and strength and usually outweigh the 
ramifications of having to separate the member due to physical fitness 
test failures. We also conducted a review in June 2005 of 227 physical 
fitness files of the Army Reserve unit that deployed to Afghanistan. Of 
the 227 physical fitness files we reviewed, only 117 members showed 
evidence of compliance with the physical fitness examination 
requirement during 2005. Of these 117 members, 89 passed the physical 
fitness test and 16 failed.[Footnote 46] In group discussions held at 
this time, members stated that there were no repercussions for failing 
the physical fitness test. As previously reported in our 1994 
report,[Footnote 47] we also found that physical fitness scores had 
been inappropriately changed and servicemembers were not discharged 
even after repeated test failures, primarily because commanders placed 
more emphasis on maintaining unit strength. 

While visiting a Navy Reserve Activity, we obtained a single unit's 
physical fitness test results to ensure data were properly maintained 
in the Physical Readiness Information Management System. However, when 
we asked the Navy Personnel Command to provide a copy of the required 
physical fitness report, we learned the report would be submitted to 
OSD late. According to a Navy official, the Navy had identified over 
2,000 duplicate record entries and estimated that nearly 25 percent of 
the body fat scores were missing from the data totals. In its report to 
OSD, the Navy reported that it had not mandated separation processing 
for individuals who failed the physical fitness test since May 2001. 

During a visit to a Marine Corps Reserve Center, we also obtained 
information that indicated individual Marine Corps reservists' physical 
fitness scores were recorded in the Marine Corps Total Force System. 
Subsequent to our visit, however, we learned that the Marine Corps also 
provided an unofficial "draft" physical fitness report to the OSD after 
the deadline. In order to review Marine Corps physical fitness 
statistical data, we requested a copy of the report on April 6, 2005. 
As of October 2005, the Marine Corps had not responded to our request. 

The Air Force did not meet OSD's required due date in submitting its 
first annual report on its assessment of the physical fitness, body 
fat, and health promotion program for the active service, the Air 
National Guard, and the Air Force Reserve. The Air Force did not submit 
its annual report until May 4, 2005. Based on the data provided by the 
Air Force for the Air National Guard and the Air Force Reserve, only 83 
percent of the force members were tested, with 13.2 percent of those 
tested falling into the poor category. However, the Air Force's 
assessment of one of its reserve component's statistical data may not 
be entirely correct. In its reported statistical information of the 
numbers of members tested, those members testing in the poor category 
are higher than those numbers directly reported by the Air National 
Guard to the Air Force Medical Support Agency, which consolidated the 
respective components' data and in turn submitted the overall report to 
the Assistant Secretary of Defense for Force Management Policy. In 
addition, as discussed earlier, we were unable to determine that the 
data used from the Air National Guard and Air Force Reserve databases 
that generated these data are reliable. 

DOD Lacks Visibility over the Health Status of Reserve Components after 
Being Called to Active Duty and the Extent to which Members with 
Preexisting Conditions Required Care during Deployment: 

DOD does not have complete visibility over the health status of reserve 
component members after they are called to duty and is unable to 
determine the extent of care provided to those members deployed with 
preexisting medical conditions. Despite the existence of various 
sources of medical information, DOD has incomplete visibility over 
members' health status when called to active duty, primarily because 
the reserve components vary in their ability to systematically 
identify, track, and report members' medical deployability and the DOD- 
wide centralized database cannot provide complete information--both of 
which hinder DOD's ability to accurately determine what forces remain 
for future deployments. In addition, DOD is unable to determine the 
extent to which reserve component members received care for preexisting 
medical conditions while deployed; however, evidence suggests that 
reserve component members did deploy with preexisting medical 
conditions that could not be adequately addressed in theater and that 
some of these conditions may have stressed in-theater medical 
capabilities. 

Visibility over Health Status of Reserve Members after They Are Called 
to Active Duty Is Limited: 

Although DOD has some visibility over reserve component members after 
they are called to active duty or mobilized, this visibility is limited 
despite several potential sources of information. For example, the 
reserve components vary in their ability to systematically identify, 
track, and report information about members' medical deployability, 
which limits DOD's visibility over the health status of members. In 
addition, although medical information is captured on predeployment 
forms for all reserve component members and entered into a DOD-wide 
centralized database during mobilization, some data are still missing 
and information regarding the reasons why members were found 
nondeployable is not captured in a way that can be easily searched 
through the database. Moreover, medical referral data captured on the 
predeployment forms provide some insight into the care that members may 
have required during mobilization, but this care is not always related 
to why a member was determined to be medically nondeployable. Some data 
on the medical reasons why Army Guard and Reserve members were not 
deployed after being activated can be obtained from an analysis of the 
Army's medical holdover database, but this information is insufficient 
to provide DOD with visibility over members' health status since it is 
only gathered on the numbers of Army reserve components held prior to 
deployment and this population is diminishing due to positive changes 
in Army's medical holdover policy. DOD's limited visibility over 
reserve component members' health status when they are called to active 
duty could affect planning for future deployments because the pool of 
available Guard and Reserve component members from which to fill 
requirements for certain skills and grades is dwindling, and members' 
health status is deteriorating following deployments. 

Reserve Components Vary in Ability to Identify, Track, and Report 
Medical Nondeployable Members: 

The reserve components vary in their ability to systematically 
identify, track, and report members' medical deployability, and only 
three reserve components--the Navy Reserve, the Air Force Reserve, and 
Air National Guard--can currently identify and track members with both 
temporary and permanent conditions that limit medical deployability. 
This limited visibility over reserve component members' medical 
deployability status hinders DOD's ability to identify the pool of 
available Guard and Reserve members who are available for deployment. 

The Navy Reserve uses the Medical Readiness Reporting System (MRRS) to 
track and report the status of reservists classified as Temporarily Not 
Physically Qualified for duty because of an illness, injury, or other 
medical condition that should be resolved within 6 months. This system 
is also used to track and report the status of reservists, classified 
as Not Physically Qualified for duty, with more serious medical 
conditions such as cancer or heart disease that will not be resolved in 
6 months and may lead to a medical review or board retention decision. 
As the Marine Corps Reserve continues to fully implement the Navy's 
Medical Readiness Reporting System, it too will have these same 
capabilities. Both the Air National Guard and the Air Force Reserve's 
medical tracking systems--PIMR and RCPHA, respectively--can identify 
and track members with specific medical conditions that limit 
deployment; however, neither system can distinguish between temporary 
and permanent limitations. In addition, the Air Force has a system 
called Military Personnel Data System that captures information on all 
medical profiles and can report specific queries on specific categories 
such as temporary and permanent conditions. Although the Army tracks 
active, guard, and reserve members with medical profiles that limit 
deployment through their medical tracking system, MEDPROS, the active 
Army and Army Reserve do not presently track members with temporary 
medical conditions that render them nondeployable. However, the Army 
National Guard is in the process of implementing a system, called the 
Medical Non-Deployable Tracking Module (MND-TM), that will track its 
members who have a temporary or permanent medical condition that 
renders them nondeployable. Army National Guard officials expect all 
states to use this system for its members by July 2007. Until all six 
reserve components are able to systematically identify and track 
members' medical deployability status, DOD will not have the most 
accurate information to centrally manage estimating the remaining 
available pool of guard and reserve members for future deployments. 

Centralized DOD-wide Database Provides Some Visibility over Health 
Status During Mobilization, but Data Could Be Further Improved: 

DOD has some visibility over reserve component members' medical status 
during mobilization through the centralized DOD-wide database operated 
by the Army Medical Surveillance Activity (AMSA). All active and 
reserve component members are required to complete a medical 
predeployment form to document the member's medical deployability 
status, which is then forwarded to AMSA for entry into the database. 
Thus, information can be obtained from the centralized database on 
reserve and active component members who were determined nondeployable 
during mobilization due to medical reasons. The member also completes a 
health assessment form after deployment. However, we have noted in 
previous reports that the centralized database has missing and 
incomplete forms. In our last report issued in September 2004,[Footnote 
48] we found that for the required forms from reserve component members 
(1) not all of the forms had reached AMSA, (2) only some of the forms 
that had reached AMSA had been entered into the database, and (3) not 
all of the forms contained complete information, thus limiting 
analysis. 

We also noted that while the components were not in complete compliance 
with the requirement to submit pre-and postdeployment assessments, the 
number of assessments had grown significantly. During this review, we 
found that DOD has continued to make progress toward collecting the pre-
and postdeployment forms. According to AMSA officials, the database 
contained about 140,000 assessments at the end of 1999, grew to about 1 
million assessments by May 2003, almost doubled at 1,960,125 by June 
2004, and was at 2,241,177 by June 2005. 

Further, DOD has established a centralized deployment health quality 
assurance program to improve data collection and accuracy.[Footnote 49] 
Each service has also developed a deployment health quality assurance 
program. The department's first annual report, documenting, among other 
things, issues relating to predeployment health assessments, was issued 
in May 2005. The DOD quality assurance program includes (1) periodic 
site visits jointly conducted with staff from the Office of the 
Assistant Secretary for Health Affairs and staff from the military 
services to assess compliance with the deployment health requirements, 
(2) periodic reports from the services on their quality assurance 
programs, and (3) periodic reports from AMSA on health assessment data 
maintained in the centralized database. The report noted that 
centralized management of quality assurance had improved accountability 
of the preassessment forms on the part of the services. 

For this review, we obtained predeployment information from AMSA 
officials based on over 1 million active and reserve component 
predeployment health assessment forms collected between November 2001 
and June 2005. More than 5 percent of the reserve component and more 
than 6 percent of the active component predeployment health assessment 
forms did not record the servicemember's deployability status. Of the 
approximately 94 percent of forms that were complete, nearly the same 
percent of reserve component and active component members were found 
medically deployable, 94 percent of the reserve component members 
compared to 96 percent of the active component members. Unfortunately, 
the forms do not always capture information regarding the reasons why 
members were found medically nondeployable or do not capture that 
information in a systematic way. For example, although the form has an 
entry for a narrative explanation to explain why a member is medically 
nondeployable, an AMSA official informed us that these explanations are 
often incomplete or not decipherable, and can not be easily 
categorized. Furthermore, although the forms do provide space for the 
member's deployment destination, this information is not always filled 
in because, according to AMSA officials, deployment destination is 
often not known by the member or is classified. Therefore, the data 
presented here are for all worldwide deployments, including the United 
States, and could change after the initial deployment, thus preventing 
an analysis by operation. 

As seen in table 1, the total nondeployable rate for all six reserve 
components was more than 5 percent, while table 2 shows the total 
nondeployable rate for the active component was almost 4 percent. While 
the Army Reserve had the highest percentage of nondeployable 
servicemembers among the reserve components, at about 9 percent, the 
active Army had the highest percentage of nondeployable servicemembers 
among the active components, at almost 6 percent. According to medical 
officials, some of these nondeployable personnel, such as those who had 
suffered multiple heart attacks, should have been discharged prior to 
the time that they received their mobilization orders. Others had 
temporary conditions, such as broken bones and pregnancies, that did 
not warrant medical discharges but made the servicemember nondeployable 
at the time of the assessment. 

Table 1: Service Decisions Concerning Reserve Components' 
Deployability, November 2001 through June 2005: 

Reserve Components: Army Reserve; 
Deployable: 100,286; 
Nondeployable: 9,842; 
Deployable or nondeployable answer missing on form: 5,578; 
Percentage with missing answer: 4.82; 
Total number of predeployment health assessments completed: 115,707; 
Percentage nondeployable: 8.51. 

Reserve Components: Army National Guard; 
Deployable: 181,160; 
Nondeployable: 10,959; 
Deployable or nondeployable answer missing on form: 6,584; 
Percentage with missing answer: 3.31; 
Total number of predeployment health assessments completed: 198,703; 
Percentage nondeployable: 5.52. 

Reserve Components: Navy Reserve; 
Deployable: 8,597; 
Nondeployable: 99; 
Deployable or nondeployable answer missing on form: 1,445; 
Percentage with missing answer: 14.25; 
Total number of predeployment health assessments completed: 10,141; 
Percentage nondeployable: .98. 

Reserve Components: Air Force Reserve; 
Deployable: 13,164; 
Nondeployable: 156; 
Deployable or nondeployable answer missing on form: 2,341; 
Percentage with missing answer: 14.95; 
Total number of predeployment health assessments completed: 15,661; 
Percentage nondeployable: 1.00. 

Reserve Components: Air National Guard; 
Deployable: 35,025; 
Nondeployable: 243; 
Deployable or nondeployable answer missing on form: 3,335; 
Percentage with missing answer: 8.64; 
Total number of predeployment health assessments completed: 38,603; 
Percentage nondeployable: .63. 

Reserve Components: Marine Corps Reserve; 
Deployable: 3,886; 
Nondeployable: 31; 
Deployable or nondeployable answer missing on form: 763; 
Percentage with missing answer: 16.30; 
Total number of predeployment health assessments completed: 4,684; 
Percentage nondeployable: .66. 

Total; 
Deployable: 342,118; 
Nondeployable: 21,330; 
Deployable or nondeployable answer missing on form: 20,046; 
Percentage with missing answer: 5.23; 
Total number of predeployment health assessments completed: 383,499; 
Percentage nondeployable: 5.56. 

Source: GAO analysis of AMSA data. 

[End of table] 

Table 2: Service Decisions Concerning Active Components' Deployability, 
November 2001 through June 2005: 

Active Components: Army; 
Deployable: 347,057; 
Nondeployable: 21,018; 
Deployable or nondeployable answer missing on form: 19,451; 
Percentage with missing answer: 5.02; 
Total number of predeployment health assessments completed: 387,528; 
Percentage nondeployable: 5.42. 

Active Components: Navy; 
Deployable: 20,190; 
Nondeployable: 109; 
Deployable or nondeployable answer missing on form: 1,627; 
Percentage with missing answer: 7.42; 
Total number of predeployment health assessments completed: 21,928; 
Percentage nondeployable: 0.50. 

Active Components: Air Force; 
Deployable: 150,045; 
Nondeployable: 1,477; 
Deployable or nondeployable answer missing on form: 14,544; 
Percentage with missing answer: 8.76; 
Total number of predeployment health assessments completed: 166,066; 
Percentage nondeployable: 0.90. 

Active Components: Marine Corps; 
Deployable: 47,318; 
Nondeployable: 166; 
Deployable or nondeployable answer missing on form: 4,191; 
Percentage with missing answer: 8.11; 
Total number of predeployment health assessments completed: 51,678; 
Percentage nondeployable: 0.32. 

Active Components: Total; 
Deployable: 564,610; 
Nondeployable: 22,770; 
Deployable or nondeployable answer missing on form: 39,813; 
Percentage with missing answer: 6.35; 
Total number of predeployment health assessments completed: 627,200; 
Percentage nondeployable: 3.63. 

Source: GAO analysis of AMSA data. 

[End of table] 

Medical Referral Data Provide Insight on Care Provided during 
Mobilization: 

The predeployment health assessment forms capture information on 
specific medical referrals given to members by the reviewing health 
care official during mobilization, which is useful in gaining some 
insight into the care that members may have required during 
mobilization. These data are not as helpful in determining why a member 
was not medically deployable since they are not always related to why a 
member was determined to be nondeployable. According to a senior OSD 
official, although any indicated referral may be related to a 
disposition of nondeployable, this is not always the case. Three common 
scenarios illustrate this relationship: (1) a member is found to be 
clearly nondeployable from a medical standpoint, and no referral is 
made; (2) a member is referred for further evaluation for a condition 
for which deployability is questionable, in which case there is a 
direct relation between the referral and the determination of 
deployable or nondeployable; or (3) a member is found to be deployable, 
but has a minor medical issue for which the health provider provides a 
referral for treatment. According to a senior OSD official, the last 
scenario is a fairly uncommon reason for a referral. Examples might 
include a referral for a routine preventive test, such as a Pap test in 
a gynecological clinic. The Pap test is a desired preventive medical 
test, but depending on the date and result of the last Pap exam and the 
individual's personal history and risk factors, it is not always 
necessary to perform one prior to deployment. 

More than 50,000 referrals were made on the predeployment health 
assessments from November 2001 through June 2005 for both the active 
and reserve components. As shown in table 3, of the 21,000 forms with 
referrals for reserve component members, the referral rate averaged 
more than 5 percent. As shown in table 4, of the 24,633 forms with 
referrals for their active duty counterparts, the referral rate was 
about 4 percent. Within the reserve components, the Army Reserve had 
the highest referral rate at nearly 8 percent, while the Air National 
Guard and Air Force Reserve had the lowest rates, both at less than 1 
percent. 

Table 3: Total Predeployment Referral Rate by Reserve Component, 
November 2001 through June 2005: 

Reserve component: Army National Guard; 
Total number of predeployment events with referrals: 11,609; 
Total predeployment referral rate: 5.84. 

Reserve component: Army Reserve; 
Total number of predeployment events with referrals: 8,750; 
Total predeployment referral rate: 7.56. 

Reserve component: Air National Guard; 
Total number of predeployment events with referrals: 201; 
Total predeployment referral rate: 0.52. 

Reserve component: Air Force Reserve; 
Total number of predeployment events with referrals: 145; 
Total predeployment referral rate: 0.93. 

Reserve component: Navy Reserve; 
Total number of predeployment events with referrals: 211; 
Total predeployment referral rate: 2.08. 

Reserve component: Marine Corps Reserve; 
Total number of predeployment events with referrals: 84; 
Total predeployment referral rate: 1.79. 

Reserve component: Total; 
Total number of predeployment events with referrals: 21,000; 
Total predeployment referral rate: 5.48. 

Source: GAO analysis of AMSA data. 

[End of table] 

Table 4: Total Predeployment Referral Rate by Active Component, 
November 2001 through June 2005: 

Active component: Army; 
Total number of predeployment events with referrals: 20,312; 
Total predeployment referral rate: 5.24. 

Active component: Air Force; 
Total number of predeployment events with referrals: 3,047; 
Total predeployment referral rate: 1.83. 

Active component: Navy; 
Total number of predeployment events with referrals: 572; 
Total predeployment referral rate: 2.61. 

Active component: Marine Corps; 
Total number of predeployment events with referrals: 702; 
Total predeployment referral rate: 1.36. 

Active component: Total; 
Total number of predeployment events with referrals: 24,633; 
Total predeployment referral rate: 3.93. 

Source: GAO analysis of AMSA data. 

Note: Predeployment Health Assessment forms may contain no referrals, 
one referral, or multiple referrals per completed form. 

[End of table] 

There are 18 categories of referrals that can be checked on the 
predeployment form, of which 1 is "other" and does not provide any 
further detail. As seen in figure 1, the top 3 medical referrals for 
the reserve components were "other," "dental," and "eye," whereas the 
top 3 referrals for active components were "other," "dental," and 
"orthopedics." The rate of medical referrals for the reserve components 
was almost 40 percent and for the active components was almost 50 
percent. 

Figure 1: Rate of Medical Referrals by Type for Active and Reserve 
Components from November 2001 through June 2005: 

[See PDF for image] 

[End of figure] 

Although the AMSA referral data do provide some insight into the 
medical care required during mobilization, the referral data are not 
detailed enough to determine the type of medical referral or determine 
the reason for nondeployment. 

Army Medical Holdover Database Provides Data on Activated Members Who 
Were Not Deployed Due to Medical Problems: 

The Army's medical holdover database, a module within the Medical 
Operational Data System (MODS), does provide DOD with a snapshot of 
data about the number of Army National Guard and Reserve members who 
were not deployed after being called to active duty because of medical 
problems and the medical reasons why they were not deployed after being 
activated. Although all of the services may keep reserve component 
members on active duty if they incur an injury in the line of duty 
following deployment, only the Army has held reserve component members 
in need of medical care at military treatment facilities prior to 
deployment. These servicemembers are referred to as the medical 
holdover population. Because of the large numbers of activated Army 
National Guard and Army Reserve members placed in medical holdover by 
the Army in the early part of Operation Iraqi Freedom, the Army Office 
of the Surgeon General created a module in an existing database to 
track them. We examined the Army medical holdover data to obtain 
information about the possible reasons why servicemembers were found to 
be medically nondeployable. However, the data cannot provide complete 
visibility over members' health status because the population receiving 
medical care from the Army prior to deployment is diminishing due to 
changes in Army's medical holdover policy. Further, until January 2005, 
MODS was not used consistently by all case managers[Footnote 50] 
responsible for servicemembers in medical holdover. 

Between December 2002 and October 2003, 4,850 activated Army reserve 
component members were found medically nondeployable and kept on active 
duty until their medical problems had been resolved and they were 
returned to full duty or until they had been referred to a medical 
board and discharged from the Army. In October 2003, the Army changed 
its policy to allow the demobilization of personnel who were found to 
be nondeployable within the first 25 days of activation. In accordance 
with this policy, reserve component servicemembers identified in the 
first 25 days as having a medical condition that renders the individual 
nondeployable may be released from active duty immediately. As a result 
of this policy change, the Army was able to demobilize reserve 
component members who were found to be nondeployable within the first 
25 days of their mobilization. The change also reduced the inflow of 
reserve component members on active duty with medical problems who were 
identified during the predeployment health assessment process. As of 
August 11, 2005,[Footnote 51] only 860 reserve component 
members[Footnote 52] were in a medical holdover status as a result of a 
medical condition found prior to deployment. 

As shown in figure 2, the most common medical condition that has 
prevented a reserve component member from deployment[Footnote 53] is 
orthopedic in nature--accounting for 56 percent of the 860 Army 
National Guard and Army Reserve members who were found medically 
nondeployable and placed in a medical holdover status--followed by 
internal medicine at 16 percent, and neurological problems at 8 
percent. 

Figure 2: Medical Conditions of Army National Guard and Army Reserve 
Members in a Medical Holdover Status as of August 11, 2005: 

[See PDF for image] 

[End of figure] 

Despite the more specific information about medical status that can be 
obtained by reviewing these medical holdover data, the data are fairly 
new and limited to those held at medical treatment centers. 

Lack of Visibility over Reserve Component Members' Health Status Could 
Affect Planning for Future Deployments: 

Although senior military officials at various levels of command told us 
that the health status of reserve component members did not affect 
deployment schedules, the extent to which unit commanders have had to 
find replacement members to fill in for members who were medically 
unqualified upon alert, the reasons why, and how, or if, this impacted 
planning of operations in Iraq and Afghanistan are unknown. However, 
DOD's lack of visibility over reserve component members' health status 
when they are called to active duty could affect planning for future 
deployments as the demand for troops for the Global War on Terrorism 
continues. 

The Army has had to transfer reserve component personnel from 
nonmobilized units to mobilized units to meet mission requirements. For 
example, the Army Inspector General reported in February 2005 that with 
increasing frequency, Army units identified for alert and mobilization 
had previously provided members to other units. The report noted that 
frequently more than half of a deploying unit's personnel had been 
transferred into the unit to meet personnel requirements. This "ripple 
effect" is occurring across the Army reserve force, and each subsequent 
mobilization requires more and more personnel transfers to meet 
personnel requirements. The need for these personnel transfers is 
largely due to an outdated Cold War strategy that planned to use the 
reserve forces as a later deploying force and therefore did not give 
them full resources. As more units are used for this "cross-leveling", 
it becomes even more important that the Army have good visibility over 
the health status of the remaining reserve component members. 

In addition, as shown in table 5, the health status has declined for 
active and reserve components after returning from deployment as shown 
by data from the pre-and postdeployment health assessments. The Army 
National Guard and Army Reserve had the highest percentage of 
servicemembers indicating their health as fair to poor on the 
postdeployment health assessment. 

Table 5: Rate of Servicemembers' Health Status as Recorded on Pre-and 
Postdeployment Forms for Active and Reserve Components from November 
2001 through June 2005: 

Reserve component: 

Military component: Army Reserve; 
Predeployment: good to excellent: 95.77; 
Postdeployment: good to excellent: 87.05; 
Predeployment: fair to poor: 2.70; 
Postdeployment: fair to poor: 12.30. 

Military component: Army National Guard; 
Predeployment: good to excellent: 96.57; 
Postdeployment: good to excellent: 89.07; 
Predeployment: fair to poor: 2.27; 
Postdeployment: fair to poor: 10.31. 

Military component: Marine Corps Reserve; 
Predeployment: good to excellent: 98.36; 
Postdeployment: good to excellent: 89.90; 
Predeployment: fair to poor: 0.99; 
Postdeployment: fair to poor: 8.95. 

Military component: Air National Guard; 
Predeployment: good to excellent: 99.13; 
Postdeployment: good to excellent: 97.43; 
Predeployment: fair to poor: 0.42; 
Postdeployment: fair to poor: 1.73. 

Military component: Air Force Reserve; 
Predeployment: good to excellent: 99.00; 
Postdeployment: good to excellent: 96.49; 
Predeployment: fair to poor: 0.40; 
Postdeployment: fair to poor: 2.16. 

Military component: Navy Reserve; 
Predeployment: good to excellent: 98.60; 
Postdeployment: good to excellent: 93.67; 
Predeployment: fair to poor: 0.64; 
Postdeployment: fair to poor: 5.08. 

Active component: 

Military component: Army; 
Predeployment: good to excellent: 95.00; 
Postdeployment: good to excellent: 90.53; 
Predeployment: fair to poor: 3.44; 
Postdeployment: fair to poor: 8.32. 

Military component: Marine Corps; 
Predeployment: good to excellent: 97.51; 
Postdeployment: good to excellent: 93.49; 
Predeployment: fair to poor: 1.74; 
Postdeployment: fair to poor: 5.59. 

Military component: Air Force; 
Predeployment: good to excellent: 98.82; 
Postdeployment: good to excellent: 97.73; 
Predeployment: fair to poor: 0.86; 
Postdeployment: fair to poor: 1.73. 

Military component: Navy; 
Predeployment: good to excellent: 96.88; 
Postdeployment: good to excellent: 94.27; 
Predeployment: fair to poor: 2.55; 
Postdeployment: fair to poor: 5.08. 

Source: GAO analysis of AMSA data. 

[End of table] 

As the pace of operations for the reserve forces continues to be high 
and the health status of returning members is diminished, it becomes 
even more important that DOD has good visibility over the availability 
of remaining units. Improved visibility and tracking of the health 
status and medical deployability of these members is a key component in 
the calculation of the members available for planning future 
deployments. 

Extent to which Members with Preexisting Medical Conditions Required 
Treatment during Deployment Cannot Be Determined: 

DOD cannot determine the extent to which reserve component members 
received care for preexisting medical conditions while deployed in 
theater[Footnote 54] because DOD has not determined what preexisting 
medical conditions may be allowed into specific theaters of operations. 
The purpose of examining members and properly screening them at the 
mobilization stations is to help ensure that members are medically and 
physically fit to deploy and do not have any condition that would 
adversely affect the mission. As noted in DOD guidance,[Footnote 55] 
fitness specifically includes the ability to accomplish the task and 
duties unique to a particular operation, and the ability to tolerate 
the environmental and operational conditions of the deployed location. 
Specific medical deployment criteria for proper screening are essential 
for determining preexisting medical conditions that can not be 
adequately addressed in theater and could stress in theater medical 
capabilities. While evidence suggests that members did deploy with 
preexisting conditions, the total impact of this is unknown. 

While Specific Deployment Criteria for Operations Enduring Freedom and 
Iraqi Freedom Continue to Evolve, Tracking of Known Preexisting 
Conditions Has Not Begun: 

Developing and updating medical criteria for a specific theater of 
operations are the responsibilities of the combatant commands--for 
Operation Enduring Freedom and Operation Iraqi Freedom this is U.S. 
Central Command (CENTCOM). The CENTCOM medical deployment criteria have 
been evolving over the course of these operations. CENTCOM has updated 
this guidance six times throughout these operations to include more 
specific guidance to the theater of operations; the last update was 
issued in January 2005. During the initial mobilizations for these 
operations, the services were dependent on CENTCOM general deployment 
criteria issued in May 2001, which did not identify medical conditions 
that would render a member medically unfit for these operations. In the 
absence of specific guidance early on during the operations, the 
services relied upon their own medical deployment criteria. For the 
Army, specific criteria did not exist until February 2005.[Footnote 56] 

The original CENTCOM deployment criteria made a general statement that 
all personnel must be assessed and determined to be medically and 
psychologically fit for worldwide deployment to a combat theater and 
that the in-theater health infrastructure provides only limited medical 
care. Not until May 2004 did CENTCOM update its deployment criteria to 
include more specific guidance. This updated guidance stated that 
servicemembers who have existing medical conditions may deploy if all 
of the following conditions were met: (1) an unexpected worsening of 
the condition is not likely to have a medically grave outcome; (2) the 
condition is stable; and (3) any required ongoing health care or 
medications must be immediately available in theater in the military 
health system, and have no special handling, storage, or other 
requirements, such as electrical power. The criteria provided a list of 
conditions that may preclude medical clearance for DOD civilians and 
contractors (including current heart failure, history of heat stroke, 
and uncontrolled hypertension); however, according to CENTCOM 
officials, this list of conditions did not apply to servicemembers 
because they were already covered by service-specific guidelines. The 
most recent CENTCOM deployment criteria applicable to all 
servicemembers and DOD civilians and contractors were issued in January 
2005, and update theater-specific immunization requirements and provide 
more detailed guidance on contact lens wear, among other things. As 
these policies are developed, the combatant command is to provide them 
to the services, which are then responsible for determining how they 
implement the screening requirements in terms of screening their 
deploying forces, including activated reservists. 

Because DOD has not determined what preexisting conditions may be 
allowed into a specific theater of operations, it has not known what 
preexisting conditions to track. As noted, the medical deployment 
criteria for the current theater of operations have been evolving, but 
specific medical deployment criteria have not been developed for other 
potential theaters of operation. However, some preexisting medical 
conditions may be common to all theaters of operation. DOD has not 
determined this. Further, although DOD has a number of systems for 
tracking medical conditions in theater, the current databases have not 
been modified to capture data on known preexisting conditions for this 
specific operation. For example, the Joint Medical Workstation (JMeWS) 
provides medical treatment status and medical surveillance information, 
as well as tracks and reports patient location within a theater of 
operations and during evacuation from frontline medical units to 
stateside medical treatment facilities. The U.S. Transportation Command 
(TRANSCOM) utilizes the TRANSCOM Regulating Command and Control 
Evacuation System (TRAC2ES) to document patient movements, such as 
medical evacuations. The Joint Patient Tracking Application (JPTA) was 
initially designed for use within Landstuhl Regional Medical Center in 
Germany as a way to manage Operations Enduring Freedom and Iraqi 
Freedom patients. In 2004, the services were directed by the Assistant 
Secretary of Defense for Health Affairs to implement JPTA at military 
treatment facilities in theater and the continental United States to 
improve patient tracking and management. The Disease Nonbattle Injury 
(DNBI) rates for the services in Operations Enduring Freedom and Iraqi 
Freedom are tracked in the DNBI database by the Air Force Institute for 
Operational Health. We did not evaluate these systems since they do not 
distinguish care provided for preexisting medical conditions. 

Evidence Suggests that Reserve Component Members Have Been Deployed 
into Theater with Preexisting Medical Conditions: 

Although DOD does not systematically develop or report information 
about the extent of care that was provided in theater to reserve 
component members for preexisting medical conditions,[Footnote 57] 
senior military medical officials who served in theater have provided 
examples of reserve component members who were deployed with 
preexisting medical conditions that could not be adequately addressed 
in theater. Some officials told us that such treatments strained in 
theater medical capabilities and infrastructure. 

According to a senior military official in the surgeon's office of the 
commander in chief of the U.S. Central Command (CENTCOM), there were 
many instances of individuals, from all services, who deployed into the 
Iraq and Afghanistan theater of operations with conditions for which 
they should have been considered nondeployable. Also, medical officials 
from both the Army and Navy cited examples of conditions seen in 
theater that should have rendered members nondeployable. Among the 
examples cited were members with a history of heart attack, severe 
asthmatics (the desert conditions were not suitable for these members), 
severe hypertension, a woman 4 months into chemotherapy for breast 
cancer, and a man who had received a kidney transplant 2 weeks prior to 
deploying. Other examples included cases involving members deployed 
with sleep apnea requiring machines that are run by electricity, even 
though electricity was either unavailable or unpredictable. Another 
soldier, we were told, who arrived in theater was diabetic and required 
an insulin pump for treatment. We were also told of a number of 
psychiatric patients who were suffering from conditions such as bipolar 
disorder who should not have been in the desert because the medications 
that they were taking caused them to sweat profusely. One Air Force 
Reserve medical official who served in theater preparing members to be 
medically evacuated estimated that of the approximate 2,000 reservists 
she helped to evacuate, 10 percent being evacuated were due to 
preexisting conditions such as diabetes and heart problems, with the 
most common condition being diabetes. The commander of an Army Guard 
unit deployed to Iraq told us about a member who had deployed with a 
preexisting knee problem for which he had to be returned to the United 
States to correct. The issue was eventually resolved and the member was 
allowed to redeploy with his unit. 

According to a September 2004 Air National Guard Surgeon General 
memorandum,[Footnote 58] unacceptable dental health should preclude a 
member from deploying under any circumstances because dental resources 
do not exist in theater. However, the Air National Guard's Surgeon 
General has noted that dental emergencies are historically and 
currently the most common preventable reason for loss of manpower in 
the wartime theater.[Footnote 59] In addition, the Air Force's Air 
Surgeon Chief of Medical Services Directorate commented on January 17, 
2003, in response to a case involving an Air National Guard member who 
had been sent into theater with an obvious major preexisting dental 
condition, that it is unreasonable to expect deployed doctors and 
dentists to perform remedial procedures and provide care that should 
have been accomplished at home because it takes too much time away from 
treating injured and ill in theater, and it results in lost man hours 
for the gaining unit that it needs to accomplish its war-fighting 
requirements. In our small group discussions with Army National Guard, 
one servicemember said that he was told that he would receive dental 
care in theater, although this care was never provided. At one Air 
National Guard unit command we visited, officials informed us of a 
member who was mobilized and subsequently deployed with preexisting 
dental problems in late 2003, because (1) the dental condition was not 
disclosed by the member and (2) the unit command did not have a current 
dental exam in his medical records to prove otherwise. The member would 
not have been deployed had his true dental condition been initially 
identified, but he received substantial dental work while 
deployed.[Footnote 60] According to a unit command official, the member 
was subsequently returned to his unit command because his dental costs 
and related work downtime were excessive. 

Other Reasons Members May Have Arrived in Theater with Preexisting 
Conditions: 

In addition to a lack of specific guidance from CENTCOM to the services 
early in the operations, military medical officials told us other 
reasons why members may have arrived in theater with preexisting 
medical conditions. First, military officials stated that in some cases 
members did not disclose their preexisting medical conditions because 
they wanted to serve their country. A Navy official, for example, 
stated that a Navy officer with hypertension did not disclose his 
medical condition in order to deploy to Iraq to support Operation Iraqi 
Freedom. Because the officer's medical condition worsened in Iraq, the 
Navy had to return him to his home unit and find a replacement to fill 
his position. We were also told of members who arrived in theater with 
preexisting conditions with the expectation that they would be taken 
care of while they were there. For example, a senior medical official 
stated that one servicemember arrived in theater with one kidney and in 
need of dialysis, which was not available in theater. Early in 
operations several servicemembers with hernias were deployed with the 
expectation that the surgery would be conducted in theater. 

It is important to have up-to-date medical criteria specific to a 
theater of operations to alert members to changing condition in theater 
or new information on vaccinations, for example. Developing and 
updating medical criteria for a specific theater of operations is the 
responsibility of the commander in chief of the combatant command--in 
this case, CENTCOM. As these polices are completed and updated, the 
combatant command is to provide them to the services, who are then 
responsible for determining how they implement the requirements in 
terms of screening their deploying forces including activated 
reservists. 

Conclusions: 

The findings we present in this report are not new. In the aftermath of 
the first Persian Gulf War, a number of DOD and GAO studies were issued 
that identified problems with guard and reserve personnel being 
medically and physically fit for duty. DOD agreed with many of the 
studies' findings and recommendations but never developed a plan with 
goals, time frames, and measurable results to improve visibility over 
reserve component members' health status. At times, Congress has 
stepped in and directed DOD to make a number of improvements, 
especially for quality assurance and tracking of health assessment data 
collected before and after a member's deployment. Congress recently 
directed OSD to develop and implement a comprehensive plan to improve 
management of the health status of the reserve component. The 
importance of such a plan has become even more important in the current 
environment, where the pool of guard and reserve members with the right 
skills from which to fill requirements for DOD's overseas and domestic 
commitments is dwindling. 

Further, many of DOD's personnel policies, including its medical 
policies, are outdated, as they are based on Cold War strategy that 
allowed the reserve force more time to mobilize before deployment. Now 
the reserve force deploys with the active force and is expected to be 
medically and physically fit when called to duty. The lack of oversight 
of reserve members' health status, however, does not appear to be 
unique to the reserve component. Oversight, as seen in the area of 
enforcing DOD's reporting requirement on the status of physical fitness 
for both the active and reserve components, has not taken place. No 
repercussions exist if a service does not provide this report on time, 
nor are there any deadlines for the annual report to be submitted to 
OSD. 

OUSD/P&R has the authority to set medical and physical fitness policy 
and processes to oversee this area; however, OUSD/P&R has not taken 
action to exercise its authority to address these long-standing 
problems. 

Recommendations for Executive Action: 

As DOD proceeds to develop a comprehensive plan for improving 
management over the health status of the reserve components in response 
to the Ronald W. Reagan National Defense Authorization Act for Fiscal 
Year 2005, we recommend six actions. 

To have visibility over reserve components' compliance with routine 
medical and physical fitness examinations, we recommend that the 
Secretary of Defense: 

* direct the Under Secretary for Personnel and Readiness, in concert 
with the Assistant Secretary for Health Affairs and the Principal 
Deputy to the Under Secretary, to establish a management control 
framework and execute a plan for issuing guidance, establishing quality 
assurance for data reliability, and tracking compliance with routine 
medical and physical fitness examinations; and: 

* direct the Under Secretary for Personnel and Readiness, in concert 
with the Principle Deputy who oversees the Office of Morale, Welfare, 
and Recreation, to take steps to enforce the service reporting 
requirement on the status of members' physical fitness in conjunction 
with the actions taken in the first recommendation. 

To improve DOD's visibility over reserve components' health status 
after they are called to duty, we recommend that the Secretary of 
Defense: 

* direct the Under Secretary of Defense for Personnel and Readiness, in 
concert with the Assistant Secretary of Health Affairs, to also oversee 
the development of the reserve components' tracking systems to identify 
and track members' temporary and permanent medical conditions that 
limit deployability; and: 

* direct the Under Secretary of Defense for Personnel and Readiness, in 
concert with the Assistant Secretary of Health Affairs, to modify the 
medical predeployment forms to better capture reasons for nondeployment 
and medical referrals. 

To help prevent the deployment of reserve component members with 
preexisting medical conditions that could adversely affect the mission 
and strain resources in theater, and to provide visibility over those 
members deployed with preexisting conditions for which treatment can be 
provided in theater, we recommend that the Secretary of Defense: 

* direct the Chairman of the Joint Chief of Staff to determine what 
preexisting medical conditions should not be allowed into specific 
theaters of operations, especially during the initial stages of the 
operation, and to take steps to ensure that each service component 
consistently utilizes these as criteria for determining the medical 
deployability of its reserve component members during mobilization; 
and: 

* direct the Chairman of the Joint Chief of Staff, in concert with the 
service secretaries, to explore using existing tracking systems to 
track those who have treatable preexisting medical conditions in 
theater. 

Agency Comments and Our Evaluation: 

In written comments on a draft of this report, DOD did not concur with 
our first and fourth recommendations, partially concurred with our 
fifth recommendation, and concurred with our second, third, and sixth 
recommendations. DOD did not concur with our recommendation that it 
establish a management control framework and execute a plan for issuing 
guidance, establishing quality assurance for data reliability, and 
tracking compliance with routine medical examinations. DOD did not 
state that it disagreed with our findings; however, DOD stated that it 
had initiatives underway that addressed our recommendation. DOD further 
noted that because policies, programs, and instructions are already in 
place or in process, it did not see the need for any additional action. 
We disagree with DOD's conclusion because, based on our review, we do 
not believe that DOD's initiatives are far enough along to dismiss 
further action, and we continue to believe that our recommendation has 
merit. We agree that the initiatives DOD cited in its written comments 
are positive steps toward correcting the identified problems, but 
management and planning remain a concern. We have not seen enough 
evidence to agree that DOD has put in place a management control 
framework that will enforce holding all responsible levels accountable, 
ensuring that all routine medical requirements are being met, and that 
complete and reliable data are being entered into the appropriate 
tracking systems. As noted in our report, the problems with determining 
the health status of the reserve force were revealed during Operations 
Desert Shield and Desert Storm, and in the decade that has passed since 
then DOD has made little progress to correct the identified problems. 
As a result, in 2004, Congress directed DOD to establish a Joint 
Medical Readiness Oversight Committee to oversee the development and 
implementation of a comprehensive medical readiness plan. As also noted 
in our report, the committee held its first meeting in February 2005, 
and a plan to improve medical readiness was being developed during this 
review. We do not believe that a committee can be held accountable for 
ensuring that such actions take place. Ultimately, the Under Secretary 
of Defense for Personnel and Readiness, in concert with the Assistant 
Secretary for Health Affairs, are accountable for enforcing the 
requirements for routine medical examinations. 

Moreover, DOD stated that it has established a new quality assurance 
program that monitors electronic data with validation through medical 
record reviews of a wide range of force health protection measures. We 
did not find this to be true during our review. With the exception of 
the Navy Reserve, the reserve components do not monitor electronic data 
of routine medical examinations with validation through medical record 
reviews. Further, we found the data in the reserve components' tracking 
systems to be unreliable for purposes of determining compliance with 
routine medical examinations. As noted in our report, compliance with 
these routine medical examinations is the first step toward determining 
who is medically fit or ready for duty. DOD stated that its compliance- 
monitoring Individual Medical Readiness program regularly reports the 
overall medical readiness status for each servicemember. However, we 
found that the Individual Medical Readiness program's outcomes are 
derived from data in the reserve components' tracking systems, which we 
have found to be unreliable, with the exception of the Navy Reserve, 
for the purposes of determining compliance with routine medical 
examinations. DOD stated that its Individual Medical Readiness 
program's data are being incorporated into overall unit readiness 
status reports, providing visibility of reserve component medical 
readiness throughout the line command structure. We believe that until 
top management at DOD ensures that complete and reliable data on 
routine medical examinations are being entered into its tracking 
systems, DOD and Congress will continue to have a false picture of 
medical readiness for the reserve components. We believe that our first 
recommendation still has merit. 

DOD concurred with our recommendation that DOD take steps to enforce 
the services' reporting requirement on the status of their members' 
physical fitness. DOD stated that DOD instruction 1308.3, dated 
November 5, 2002, among other things, requires the active and reserve 
components to provide an annual report to the Principal Deputy of the 
OUSD/P&R not later than March 31. DOD stated that the Air Force, the 
Navy, and the Marine Corps have submitted their reports. DOD noted that 
exceptions to the reporting requirement for the Air Force and the Army 
had been approved. However, during our review we were told that none of 
the reports had been submitted to the Principal Deputy as required. We 
raised concerns in this report about the data reliability of the 
tracking systems for physical fitness. We found that the reserve 
components are unable to report complete and reliable data on 
compliance with routine physical fitness examinations on a 
componentwide basis due to incomplete and unreliable data. Just as we 
found with routine medical examinations, we also found that DOD lacked 
quality assurance of the data on compliance with physical fitness 
examinations in its tracking systems. We do not know what data 
reliability issues DOD will cite in its annual reports on physical 
fitness. We note that the responsible office for physical fitness 
oversight, the Office of Morale, Welfare, and Recreation, does not 
participate in the Joint Medical Readiness Oversight Committee that is 
directed to oversee improvements in medical readiness, nor are we aware 
of any DOD plans to include improvements in the oversight of physical 
fitness in its comprehensive medical readiness plan. Therefore, we have 
expanded our first recommendation to include routine physical fitness 
examinations in the actions to be addressed. 

DOD concurred with our recommendation that DOD oversee the development 
of the reserve components' tracking systems to identify and track 
members' temporary and permanent medical conditions that limit 
deployability. DOD stated that it is already actively adapting existing 
systems, and in some cases creating new ones, that can be used to track 
the medical status of active and reserve members, to include those 
known conditions that could limit an individual's deployability. DOD 
noted that it continues to pursue better integration between medical 
and personnel data systems to improve visibility regarding deployment- 
limiting medical conditions, whether temporary or permanent, but the 
overall effectiveness will continue to be limited by lack of access to 
civilian medical records of reserve component members. 

DOD did not concur with our recommendation that DOD modify the medical 
predeployment form to better capture reasons for nondeployment and 
medical referrals. DOD stated that the best sources of accurate 
information about what medical reasons kept service members from 
deploying are the permanent medical records. This may be the case, but 
we continue to believe our recommendation has merit because DOD has no 
way to systematically analyze the information to determine why 
servicemembers are medically nondeployable. Because the predeployment 
form is used to document whether a servicemember is deployable, this 
existing form could be modified to better capture the reasons for 
determining why a servicemember is determined nondeployable. Although 
the form has an entry for a narrative explanation to state why a member 
is medically nondeployable, AMSA officials informed us that these 
explanations are often not decipherable, incomplete, and can not be 
easily categorized. DOD also stated that the existing predeployment 
form already includes a list of the most common referral categories to 
simplify the documentation process for the health care provider. In 
addition, DOD also noted that data from the forms are captured 
electronically and are readily available to monitor for trends in 
referral patterns, among other things. We do not believe that any 
meaningful analysis for referrals can be determined from these forms 
because we found that the top medical referral category for the reserve 
and active components was "other". This heavy use of the category 
"other" does not provide any insight as to what medical care a member 
is receiving after being called to duty. Given that the rate of medical 
referrals for the reserve components was almost 40 percent and for the 
active components was almost 50 percent, we continue to believe that 
DOD should modify the predeployment form to better capture reasons for 
nondeployment and medical referrals. 

DOD partially concurred with our recommendation that DOD determine what 
preexisting medical conditions should be allowed into a specific 
theater of operations, especially during the initial stages of 
operations, and take steps to consistently utilize these criteria for 
determining medical deployability. DOD stated that certain conditions 
clearly should render a member nondeployable, and the services have 
made strides in defining these conditions and incorporating them into 
their applicable policies and procedures. But DOD also noted that due 
to the ever-changing nature of a theater of operations and the inexact 
nature of medicine, a list of nondeployable preexisting conditions will 
never be fully comprehensive or fully enforceable. We agree that a list 
of nondeployable preexisting medical conditions can never be fully 
comprehensive; however, we still believe DOD could establish a list of 
what preexisting medical conditions should be allowed into specific 
theaters of operations, especially during the initial stages of 
operations, so that in future deployments DOD would not experience 
situations such as those that occurred with members being deployed into 
Iraq who clearly had preexisting conditions that should have prevented 
their deployment. 

DOD concurred with our recommendation that DOD explore using existing 
tracking systems to track those who have treatable preexisting medical 
conditions in theater. DOD noted that refinements to medical tracking 
system are ongoing. We wish to note that before DOD's tracking systems 
can be used to track those who have treatable preexisting medical 
conditions in theater, DOD must determine what preexisting medical 
conditions should be allowed into a specific theater of operations as 
called for in our fifth recommendation. 

DOD noted in its overall comments that the reserve and active forces 
use many of the same reporting tools within each service and face the 
same basic challenges in ensuring data quality. DOD stated that where 
tracking systems are shared, the reserve components depend on the 
active components to develop and fund those systems, and that priority 
for deployment of large systems has historically been given to the 
active component. DOD also pointed out that our report indicates that 
the health status of members deteriorates with multiple deployments and 
that the data we used are self-reported and should be taken with great 
caution and in the proper context. We used the self-reported data from 
postdeployment health assessments to help demonstrate the importance of 
good visibility over the reserve forces. We noted that the demand for 
reserve personnel, especially within the Army components, continues, 
and the pool of reserve members used to fill requirements is dwindling. 
Further, the health status of returning reserve and guard members is 
not as good as it was before deployment as our analysis of the pre-and 
postdeployment health assessments showed. Therefore, it becomes even 
more important that DOD have good visibility over the health status of 
remaining reserve force to help determine what is left for future 
deployments. 

DOD's comments are reprinted in their entirety in appendix II. 

We are sending copies of this report to the Secretary of Defense; the 
Secretaries of the Army, the Navy, and the Air Force; the Commandant of 
the Marine Corps; the Chairman of the Joint Chiefs of Staff; and the 
Director, Office of Management and Budget. We will also make copies 
available to others upon request. In addition, the report will be 
available at no charge on the GAO Web site at http://www.gao.gov. 

If you or your staff has any questions concerning this report, please 
contact me at (202) 512-5559 or stewartd@gao.gov. Contact points for 
our Offices of Congressional Relations and Public Affairs may be found 
on the last page of this report. GAO staff who made major contributions 
to this report are listed in appendix III. 

Derek B. Stewart: 
Director, Defense Capabilities and Management: 

[End of section] 

Appendix I: Scope and Methodology: 

To assess the Department of Defense's (DOD) ability to determine the 
reserve components' compliance with routine medical and physical 
fitness examinations, we reviewed federal statutes and Office of the 
Secretary of Defense (OSD) applicable directives and instructions to 
identify and understand the roles and responsibilities of the offices 
within DOD for management of the health status of the reserve 
components. We discussed these statutes and guidance with senior 
officials in the Office of the Under Secretary of Defense for Personnel 
and Readiness. We reviewed and discussed service policies and 
regulations for medical and physical fitness with military officials 
within the service surgeons' general offices and other service 
headquarters' officials responsible for physical fitness in the service 
personnel and operations functions. We also reviewed and discussed 
reserve component policies and guidance for medical and physical 
fitness examinations with officials within the reserve component 
surgeons' general offices and other reserve component officials 
responsible for physical fitness in the respective reserve component 
personnel and operations functions. We interviewed cognizant officials 
involved with policy development, administration, tracking, and 
reporting on compliance with medical and physical fitness examinations 
from the following offices or commands:[Footnote 61] 

Office of the Secretary of Defense: 

* Assistant Secretary of Defense for Health Affairs, Deployment Health 
Support Directorate; 

* Assistant Secretary of Defense for Reserve Affairs; and: 

* Principal Deputy Under Secretary of Defense for Personnel and 
Readiness, the Office of Morale, Welfare, and Recreation. 

Army: 

* Assistant Secretary of the Army, Manpower and Reserve Affairs; 

* U.S. Army Office of the Surgeon General and Commanding General, Army 
Medical Command; 

* U.S. Army Reserve Command, Fort McPherson, Georgia; 

* National Guard Bureau; 

* Army National Guard; 

* First U.S. Army, Fort Gillem, Georgia; 

* U.S. Army Forces Command, Fort McPherson, Georgia; 

* Army Fitness School, Ft. Benning, Georgia; 

* Fifth U.S. Army, Fort Sam Houston, Texas; 

* U.S. Army Medical Command, Fort Sam Houston, Texas; 

* U.S. Army Dental Command, Fort Sam Houston, Texas; 

* Army Audit Agency; and: 

* MEDPROS Program Office. 

Navy: 

* Assistant Secretary of the Navy, Manpower and Reserve Affairs; 

* Office of the Chief of Navy Operations; 

* Office of the Chief of Navy Reserve; 

* Bureau of Medicine and Surgery; 

* Commander Navy Reserve Forces Command, New Orleans, Louisiana; and: 

* Navy Personnel Command, Millington, Tennessee. 

Marine Corps: 

* U.S. Marine Corps Health Services, Headquarters; 

* U.S. Marine Corps Manpower and Reserve Affairs, Headquarters, 
Quantico, Virginia; and: 

* Marine Forces Reserve, Headquarters, New Orleans, Louisiana. 

Air Force: 

* Department of the Air Force, Headquarters; 

* Assistant Secretary of the Air Force for Manpower and Reserve 
Affairs; 

* Office of Air Force Reserve, Headquarters; 

* Air Force Reserve Command, Robins Air Force Base, Georgia; 

* National Guard Bureau; 

* Air National Guard, Headquarters; 

* Air National Guard Readiness Center; and: 

* Air Reserve Personnel Center, Denver, Colorado. 

We also conducted medical and physical fitness file reviews with an 
Army National Guard unit from the Mid-Atlantic region and an Army 
Reserve unit from the Mid-west region. We chose units that had deployed 
for Operations Enduring Freedom or Iraqi Freedom. During these visits 
we collected and analyzed information from available[Footnote 62] 
medical and personnel files to assess the reserve component members' 
compliance with routine medical and physical fitness examinations. We 
also documented difficulties the units had in ensuring that all members 
complied with medical and physical fitness examinations. Finally, 
during the site visits, we conducted group discussions with unit 
members regarding their experience with routine examination 
requirements. 

To gain a better understanding of how the components collect data about 
their members' compliance with routine medical and dental examinations 
and physical fitness assessments, we assessed the reliability of data 
produced by several services' databases. Assessing the reliability of 
the services' data included consideration of issues such as the 
completeness and currency of the data from the respective database 
system's program managers, administrators, and contractors; assurances 
that all members are included and the information is up to date; and 
examination of who is using the data and for what purposes, and the 
users' assessment of reliability. We also examined whether the data 
tracked through the services' systems was subjected to quality control 
measures, such as conducting periodic testing of the data against 
medical records, to ensure the accuracy and reliability of the data. In 
addition, we reviewed existing documentation related to the data 
sources and interviewed knowledgeable agency officials about the data. 
Overall, the reserve components' data we assessed regarding compliance 
with routine medical and dental examinations and fitness assessments 
did not accurately reflect the total population of service members, had 
limited data quality assurance, and were unreliable for the purposes of 
this report; however, we determined that the Navy Reserve's medical 
data were sufficiently reliable for our purposes. Data from the Navy 
Reserve's Medical Readiness Reporting System were found reliable 
because Readiness Commands conduct inspections that include examining 
the data for accuracy, Medical Department Representatives verify 10 
percent of the updated medical records after each weekend drill, and 
the data are reported to the Commander, Navy Reserve Forces Command 
biweekly. Further, we did not assess the reliability of the Marine 
Corps Reserve's medical data because the Marine Corps was in the 
process of changing from the Shipboard Automated Medical System, a 
stand-alone non-Web-based system, to the Navy Reserve's system. All 
reserve components' physical fitness data that we reviewed had missing 
or incomplete information, had limited data quality controls, or did 
not accurately reflect the total population of service members due to 
limited access to the database. Therefore, we determined the data to be 
unreliable for the purposes of assisting us in determining reserve 
component members' compliance with physical fitness examinations. 

To assess DOD's visibility over reserve components' health status after 
they are called to duty and the care, if any, provided to those 
deployed with preexisting conditions, we collected and analyzed 
information from a variety of sources throughout DOD. We interviewed 
officials at the six reserve component headquarters and officials 
responsible for mobilizing the reserve components. We also observed the 
mobilization of Army National Guard and Army Reserve members at Fort 
Bliss, Texas, to obtain information on their health status during this 
process. We obtained and analyzed data provided on medical 
deployability from the DOD-wide centralized database on pre-and 
postdeployment health assessments, maintained at the Army Medical 
Surveillance Activity, and discussed available data with these 
officials. We also obtained and analyzed data on Army servicemembers 
who were held at mobilization stations for medical reasons from the 
Army's medical holdover database (Medical Operational Data System). 
Based on our review of databases we used, we determined that the DOD- 
provided data were reliable for the purposes of this report. To address 
the extent of medical care provided in theater for preexisting medical 
conditions, we reviewed the Joint Chiefs of Staff procedures for 
Deployment Health Surveillance and Readiness and information provided 
by the U.S. Central Command Surgeon's General office regarding medical 
deployment criteria for Operations Enduring Freedom and Iraqi Freedom. 
We also collected and reviewed the services' medical instructions, 
memoranda, policies, and medical data. We reviewed several databases 
for relevance regarding collecting in theater medical data on 
preexisting conditions. Specifically, we obtained information and 
discussed the following databases: Joint Medical Workstation, the U.S. 
Transportation Command Regulating Command and Control Evacuation 
System, the Joint Patient Tracking Application, and the Air Force 
Institute for Operational Health Disease Nonbattle Injury database. 

However, we did not identify any databases used to collect information 
on members that may have had preexisting conditions when deployed. We 
also interviewed military medical officials who had served in theater 
to obtain information on preexisting conditions of reserve component 
members while deployed. In addition to those offices and commands 
previously listed, we discussed reserve component medical deployment 
policies, medical and physical fitness policies and instructions, and 
data regarding medical and physical fitness issues with responsible 
officials from: 

Department of Defense: 

* Joint Chiefs of Staff, J-4 (Logistics), Medical Readiness Division; 

* U.S. Transportation Command, Scott AFB, Illinois; 

* U.S. Central Command, MacDill, AFB, Florida; and: 

* Army Medical Surveillance Activity. 

Army: 

* U.S. Army Office of the Surgeon General and Commanding General, Army 
Medical Command; 

* U.S. Army Center for Health Promotion and Preventive Medicine-Europe; 

* Army Reserve Unit, Mid-west region; 

* Walter Reed Army Medical Center; and: 

* Soldier Readiness Processing, Medical Operations, Fort Bliss, Texas. 

Navy: 

* Navy Reserve Readiness Command Southwest, California; 

* Navy and Marine Corps Reserve Center, California; and: 

* Navy Branch Medical Clinic, Virginia. 

Marine Corps: 

* Marine Corps Mobilization Command, Kansas City, Missouri; and: 

* 4th Combat Engineer Battalion, Maryland. 

Air Force: 

* Air Force Institute for Operational Health; 

* 142nd Fighter Wing Air National Guard, Portland International 
Airport, Oregon; 

* 163rd Air Refueling Wing Air National Guard, March Air Reserve Base, 
California; 

* 349th Air Mobility Wing U.S. Air Force Reserve, Travis Air Force 
Base, California; and: 

* 452nd Air Mobility Wing U.S. Air Force Reserve, March Air Reserve 
Base, California. 

We reviewed Air Force audit and inspection reports. We interviewed 
officials with the Air Force Audit Agency regarding its report on the 
Air Force's Individual Deployment Process[Footnote 63] to obtain a 
better understanding of the report's scope and methodology to assess 
reserve components' compliance with medical and dental requirements. We 
assessed the reliability of the Air Force Audit Agency's analyses by 
(1) reviewing relevant documentation of their analyses, and (2) 
interviewing knowledgeable officials about the audit work and analyses. 
We determined the analyses were sufficiently reliable to use as one of 
the sources of evidence describing the extent of discrepancies in Air 
Force medical and dental records. We also reviewed the Air Force 
Inspection Agency's Health Services reports and its annual analysis 
reports for calendar year 2004.[Footnote 64] 

We also found DOD's Army Medical Surveillance Activity (AMSA) database 
and the Army's Medical Operational Data System (MODS) to be 
sufficiently reliable for the purposes of our report due to their data 
quality controls and currency. In addition, through our review of 
existing information about the systems and the resulting data and 
through discussions with cognizant agency officials, we found the data 
sufficiently reliable for the purposes of this report. 

We interviewed the Chief of AMSA. We discussed the information in the 
DOD-wide centralized health assessment database and obtained selected 
data from all the reserve and active component members' pre-and 
postdeployment health assessments that were completed from November 
2001 through June 2005. Assessments became mandatory for all mobilized 
reserve component members on October 25, 2001. The data we obtained 
contained predeployment health assessment records for 383,449 reserve 
component members and 627,200 for active members. We analyzed the data 
that we obtained to determine the categories of medical referrals and 
deployability status.[Footnote 65] We also analyzed data on the self- 
reported general health of the reserve component members and compared 
the data from predeployment assessments with the data from 
postdeployment assessments. All of our analyses compared data across 
the reserve components to look for differences or trends. 

Further, we reviewed the Army's medical holdover data in MODS and found 
them reliable for our reporting purposes. The Office of the Army 
Surgeon General uses MODS to monitor and track the medical holdover 
population. The intended use of this system is for the MEDCOM and other 
command elements to track active and reserve component servicemembers 
in outpatient medical treatment, while still on active duty status. 

We conducted our review from October 2004 through September 2005 in 
accordance with generally accepted government auditing standards. 

[End of section] 

Appendix II: Comments From the Department of Defense: 

ASSISTANT SECRETARY OF DEFENSE: 
RESERVE AFFAIRS: 
1500 DEFENSE PENTAGON: 
WASHINGTON, DC 20301-1500: 

OCT 13 2005: 

Mr. Derek B. Stewart: 
Director, Defense Capabilities and Management: 
U.S. Government Accountability Office: 
441 G Street, N.W.: 
Washington, DC 20548: 

Dear Mr. Stewart: 

This is the Department of Defense (DoD) response to the GAO draft 
report, "MILITARY PERSONNEL: Top Management Attention is Needed to 
Address Longstanding Problems with Determining Medical and Physical 
Fitness of the Reserve Force", dated September 29, 2005, (GAO Code 
350604/GAO-06-105). Written comments to each of the recommendations are 
attached. 

Should you have any questions reference this response, please direct 
them to my point of contact, COL Priscilla Berry, 703-693-8104, 
Priscilla.berry@osd.mil: 

We appreciate the opportunity to comment on the draft report. 

Sincerely, 

Signed by: 

T. F. Hall: 

Attachments: As stated: 

GAO DRAFT REPORT - DATED SEPTEMBER 29, 2005 GAO CODE 350604/GAO-06-105: 

"MILITARY PERSONNEL: Top Management Attention Is Needed to Address 
Longstanding Problems with Determining Medical and Physical Fitness of 
the Reserve Force" 

DEPARTMENT OF DEFENSE COMMENTS TO THE RECOMMENDATIONS: 

RECOMMENDATION 1: The GAO recommended that the Secretary of Defense 
direct the Under Secretary of Defense for Personnel and Readiness, in 
concert with the Assistant Secretary for Health Affairs, to establish a 
management control framework and execute a plan for issuing guidance, 
establishing quality assurance for data reliability, and tracking 
compliance with routine medical examinations. (Page 66/GAO Draft 
Report): 

DOD RESPONSE: Non-concur: 

The Department of Defense (DoD) remains committed to maximizing its 
visibility of medical readiness throughout the Reserve components (RC). 
New policies establishing a standardized management framework for a 
Force Health Protection Quality Assurance (FHP QA) program, and a 
compliance-monitoring program to measure Individual Medical Readiness 
(IMR), as called for in this recommendation, are already underway. 
Separate Department of Defense Instructions (DODI) establishing 
tracking and reporting policies for both programs are in the final 
phases of formal coordination. Because these policies, programs, and 
instructions are already in place or in process, we do not see the need 
for the Secretary of Defense to direct any additional action. 

The FHP QA program subsumes and expands upon DoD's Deployment Health QA 
program instituted in January 2004. The FHP QA program includes both 
DoD and Service level monitoring of electronic data with validation 
through medical records reviews of a wide range of force health 
protection measures. The IMR program monitors and reports regularly 
upon compliance with each of six critical IMR elements and the overall 
IMR status for each servicemember, at all levels, from unit to Service 
to DoD-wide. The IMR program will improve visibility and enhance 
reliability of Reserve component members' health status by replacing 
the existing every 5-year physical examination with an annual periodic 
health assessment (PHA). The IMR is also being incorporated into 
overall unit readiness status reports, providing visibility of RC 
medical readiness throughout the line command structure. Many of the 
components have already started implementing these program improvements 
and are seeing results. 

RECOMMENDATION 2: The GAO recommended that the Secretary of Defense 
direct the Under Secretary of Defense for Personnel and Readiness, in 
concert with the Principal Deputy who oversees the Office of Morale, 
Welfare, and Recreation, to take steps to enforce the Service reporting 
requirement on the status of their members' physical fitness. (Page 
66/GAO Draft Report): 

DOD RESPONSE: Concur: 

Department of Defense Instruction 1308.3, "DoD Physical Fitness and 
Body Fat Programs Procedures," November 5, 2002, which assigns 
responsibility to the Principal Deputy Under Secretary of Defense for 
Personnel and Readiness (formerly the Assistant Secretary of Defense 
for Force Management Policy), requires the DoD Components to: 1) 
establish a data repository for their Military Service Physical Fitness 
and Body Fat Program; 2) maintain a data repository that provides 
initial or baseline statistics and a tracking mechanism that monitors 
physical fitness and body fat results as specified in this Instruction; 
and 3) provide an annual report to the Under Secretary of Defense 
(Personnel and Readiness), not later than March 31, that assesses 
Service physical fitness, body fat and health promotion programs. These 
first reports were due March 31, 2005. The Air Force, Navy, and Marine 
Corps reports have been received. 

The Army requested a waiver to this reporting requirement until March 
31, 2007, when the Army expects to be able to imbed reporting of this 
data within the Defense Integrated Military Human Resources System 
(DIMHRS). If reporting through DIMHRS is not on line by September 2006, 
the Army agreed to submit a manual report until DIMHRS becomes viable 
for reporting this data. The Principal Deputy Under Secretary of 
Defense (Personnel and Readiness) approved this request. 

The Air Force Surgeon General requested two-year waiver to use 
abdominal circumference in lieu of the body fat measurement methodology 
described in DoDI 1308.3. The Principal Deputy Under Secretary of 
Defense (Personnel and Readiness) approved this request. At the end of 
this waiver period, March 31, 2006, the Air Force will provide a 
summary of findings and recommendations. 

RECOMMENDATION 3: The GAO recommended that the Secretary of Defense 
direct the Under Secretary of Defense for Personnel and Readiness, in 
concert with the Assistant Secretary for Health Affairs, to also 
oversee the development of the reserve components' tracking systems to 
identify and track members' temporary and permanent medical conditions 
that limit deployability. (Page 66/GAO Draft Report): 

DoD RESPONSE: Concur: 

The Assistant Secretary of Defense (Health Affairs) (ASD/HA), the 
Assistant Secretary of Defense (Reserve Affairs) (ASD/RA), and the 
Services are already actively adapting existing systems, and in some 
cases creating new ones, that can be used to track the medical status 
of Active and Reserve component members, to include those known 
conditions that could limit an individual's deployability. Many of 
these tools and systems are web-enabled to overcome IM/IT resource 
limitations common among RC units and to make it easier for RC members 
to provide medical information. Examples of these tools include the 
Health Assessment Review Tool (HART, used as part of the annual 
periodic health assessment), the DD Form 2900 (Post-deployment Health 
Reassessment questionnaire), Medical Protection System (MEDPROS, all 
Army components), Preventive Health Assessment and Individual Medical 
Readiness (PIMR, Active and Air National Guard), and the Medical 
Readiness Review System (MRRS, Navy and Marine Reserve Components). The 
DoD continues to pursue better integration between medical and 
personnel data systems to improve visibility regarding deployment- 
limiting medical conditions, whether temporary or permanent, but the 
overall effectiveness will continue to be limited by lack of access to 
civilian medical records of Reserve component members. 

Problems with the older processes that were meant to ensure medical 
readiness have been identified by Joint Forces Command (JFCOM) in its 
Lessons Learned Change Recommendation from Operation Iraqi Freedom. 
Currently, the Services are addressing these recommendations and are 
developing long-term strategic plans to improve RC medical readiness, 
to include making appropriate budgetary changes, as part of the 
Department's Comprehensive Medical Readiness Plan. Additionally, a RAND 
study to ascertain and describe those standards and systems used by the 
RC to track medical and dental readiness and the effectiveness of those 
systems is underway (sponsored by ASD/RA). 

RECOMMENDATION 4: The GAO recommended that the Secretary of Defense 
direct the Under Secretary of Defense for Personnel and Readiness, in 
concert with the Assistant Secretary for Health Affairs, to modify the 
medical pre-deployment forms to better capture reasons for non- 
deployment and medical referrals. (Page 66/GAO Draft Report): 

DoD RESPONSE: Non-concur: 

The Services are committed to improved reporting compliance which will 
enable better tracking of reasons for non-deployment of all members. 
The basic objective for the pre-deployment health assessments is, ".. a 
quick confirmation and documentation of a service member's health 
readiness and to determine if there is a need for a clinical evaluation 
before deployment.." as specified in an OSD(HA) 6 October 1998 policy 
memo. These forms do not substitute for a complete entry in the medical 
record that would include a detailed history, the results of any 
pertinent physical examination or ancillary testing (lab, radiography, 
etc.), assessment, and plan. The existing Pre-Deployment Health 
Assessment Form (DD Form 2795) already includes a list of the most 
common referral categories to simplify the documentation process for 
the healthcare provider. The data from the forms is captured 
electronically and is readily available to monitor for trends in 
referral patterns, access to specialty care, timeliness of follow-up, 
and eventual diagnoses and outcomes. The Department has focused 
primarily on this type of analysis in the post-deployment setting. With 
the new requirement for annual health assessments across the total 
force, the need for a second, equally detailed, assessment as part of 
the pre-deployment health assessment process is unnecessarily 
disruptive to the deployment process. 

Self-reporting tools like the DD Form 2795 are living documents. To 
ensure consistency and validity, these documents undergo periodic 
review and evidence-based revision. The best sources of accurate 
information about what medical reasons kept service members from 
deploying are the permanent medical records. Without civilian medical 
records to aid in our insight, the annual assessments of Reserve 
component members become critically important. 

RECOMMENDATION 5: The GAO recommended that the Secretary of Defense 
direct the Chairman of the Joint Chief of Staff to determine what pre- 
existing medical conditions should not be allowed into specific 
theaters of operations, especially during the initial stages of the 
operation, and to take steps to ensure that each Service Component 
consistently utilizes these as criteria for determining the medical 
deployability of its reserve component members during mobilization. 
(Page 67/GAO Draft Report): 

DoD RESPONSE: Partially Concur: 

Clearly, certain pre-existing conditions should render a member non- 
deployable to austere theaters of operations where appropriate medical 
care is not readily available. The Services, especially the Army, have 
made strides in defining these conditions and incorporating them into 
their applicable policies and procedures. However, due to the ever- 
changing nature of a theater of operations and the inexact nature of 
medicine, a list of non-deployable pre-existing conditions will never 
be fully comprehensive or fully enforceable. As it is today, a 
commander will always have to make a decision regarding the 
deployability of each individual service member within their command, 
based upon the recommendation of the medical community, their knowledge 
of the conditions that will be encountered in theater, and the unique 
aspects of the individual's situation. 

RECOMMENDATION 6: The GAO recommended that the Secretary of Defense 
direct the Chairman of the Joint Chief of Staff, in concert with the 
Service Secretaries, to explore using existing tracking systems to 
track those who have treatable pre-existing medical conditions in 
theater. (Page 67/GAO Draft Report): 

DoD RESPONSE: Concur: 

Refinements to medical tracking systems are on-going, utilizing lessons-
learned with systems currently in place. Improvements in the 
documentation of medical conditions throughout the full continuum of 
military service, both active and reserve, will lead to better tracking 
and documentation of conditions that affect the health status of all 
military members. 

COMMENTS NOT RELATED TO RECOMMENDATIONS: 

Tracking compliance with routine medical examinations through 
electronic databases that contain reliable data is an important task 
for both the Active and the Reserve components, as both are held to the 
same standards of fitness and medical readiness. While, by design, this 
report did not focus on the health status of the Active forces, it is 
important to note that both Reserve and Active forces use many of the 
same reporting tools within each Service and face the same basic 
challenges in ensuring data quality. In situations where tracking 
systems are shared, the RC is typically dependent upon the Active 
component (AC) to develop and fund these systems. Priority for 
deployment of large systems, such as CHCSII, has historically been 
given to the AC. The RC has therefore been faced with developing 
component-specific programs or trying to accommodate data on their 
members in these department-wide systems. 

The GAO report indicates that the health status of members deteriorates 
with multiple deployments. This is based upon answers provided by 
members on their pre-deployment and post-deployment health assessments. 
That assumption was not validated with evaluations conducted by health 
care providers. It is understandable that members would report a 
decline in their overall health status immediately after deployment due 
to the multiple physical stressors and rigors of combat experienced 
during their time in a theater of operations. However, a study to 
determine if their perception of health status improves with time after 
returning from deployment has not been done. Thus, such assumptions 
should be taken with great caution and in the proper context. 

Differences in compliance between the Services often have to do with 
the geographically dispersed locations of their RC units. For example, 
Air Force RC medical units are typically located in the same location 
as the line units, thus giving them the ability to interact directly. 
Conversely, Army RC units are geographically dispersed, making it 
difficult for medical units to interact directly with non-medical 
units. In addition, the Air Force typically utilizes home-station 
mobilization, which means that the medical personnel conducting pre- 
deployment screenings are more likely to know the members they are 
screening and that the medical and command personnel have a greater 
opportunity to interact. 

[End of section] 

Appendix III: GAO Contact and Staff Acknowledgments: 

GAO Contact: 

Derek B. Stewart (202) 512-5559 or stewartd@gao.gov: 

Acknowledgments: 

In addition to the contact named above, Brenda S. Farrell, Assistant 
Director; James Bancroft, Larry Bridges, Renee S. Brown, Sara Hackley, 
Kenya Jones, Ron La Due Lake, Karen Kemper, Julia Matta, Jen Popovic, 
and Nicole Volchko. 

[End of section] 

Related GAO Products: 

Defense Health Care: Improvements Needed in Occupational and 
Environmental Health Surveillance during Deployment to Address 
Immediate and Longstanding Health Issues. GAO-05-632. Washington, D.C.: 
July 19, 2005. 

Reserve Forces: An Integrated Plan is Needed to Address Army Reserve 
Personnel and Equipment Shortages. GAO-05-660. Washington, D.C.: July 
12, 2005. 

Defense Health Care: Force Health Protection and Surveillance Policy 
Compliance Was Mixed, but Appears Better for Recent Deployments. GAO- 
05-120. Washington, D.C.: November 12, 2004. 

Military Personnel: DOD Needs to Address Long-term Reserve Force 
Availability and Related Mobilization and Demobilization Issues. GAO- 
04-1031. Washington, D.C.: September 15, 2004. 

Defense Health Care: DOD Needs to Improve Force Health Protection and 
Surveillance Processes. GAO-04-158T. Washington, D.C.: October 16, 
2003. 

Defense Health Care: Quality Assurance Process Needed to Improve Force 
Health Protection and Surveillance. GAO-03-1041. Washington, D.C.: 
September 19, 2003. 

Military Personnel: DOD Needs More Data to Address Financial and Health 
Care Issues Affecting Reservists. GAO-03-1004. Washington, D.C.: 
September 10, 2003. 

Military Personnel: DOD Actions Needed to Improve the Efficiency of 
Mobilizations for Reserve Forces. GAO-03-921. Washington, D.C.: August 
21, 2003. 

Defense Health Care: Army Has Not Consistently Assessed the Health 
Status of Early-Deploying Reservists. GAO-03-997T. Washington, D.C.: 
July 9, 2003. 

Defense Health Care: Army Needs to Assess the Health Status of All 
Early-Deploying Reservists. GAO-03-437. Washington, D.C.: April 15, 
2003. 

Defense Health Care: Most Reservists Have Civilian Health Coverage but 
More Assistance Is Needed When TRICARE is Used. GAO-02-829. Washington, 
D.C.: September 6, 2002. 

VA and Defense Health Care: Military Medical Surveillance Policies in 
Place, but Implementation Challenges Remain. GAO-02-478T. Washington, 
D.C.: February 27, 2002. 

Gender Issues: Improved Guidance and Oversight Are Needed to Ensure 
Validity and Equity of Fitness Standards. GAO/NSIAD-99-9. Washington, 
D.C.: November 17, 1998. 

Defense Health Care: Medical Surveillance Improved Since Gulf War, but 
Mixed Results in Bosnia. GAO/NSIAD-97-136. Washington, D.C.: May 13, 
1997. 

Reserve Forces: DOD Policies Do Not Ensure That Personnel Meet Medical 
and Physical Fitness Standards. GAO/NSIAD-94-36. Washington, D.C.: 
March 23, 1994. 

Operation Desert Storm: War Highlights Need to Address Problem of 
Nondeployable Personnel. GAO/NSIAD-92-208. Washington, D.C.: August 31, 
1992. 

Operation Desert Storm: Full Army Medical Capability Not Achieved. 
GAO/NSIAD-92-175. Washington, D.C.: August 18, 1992. 

National Guard: Peacetime Training Did Not Adequately Prepare Combat 
Brigades for Gulf War. GAO/NSIAD-91-263. Washington, D.C.: September 
24, 1991. 

FOOTNOTES 

[1] DOD's reserve components include the collective forces of the 
National Guard including the Army Guard and the Air Guard, as well as 
the forces from the Army Reserve, the Navy Reserve, the Marine Corps 
Reserve, the Air Force Reserve, and the Coast Guard Reserve. This 
report does not address the Coast Guard Reserve. 

[2] For the purposes of this report, medical fitness equates to 
compliance with routine or periodic medical (physical) examinations 
that identify the diseases and medical conditions that may prevent 
members from performing their military duties. Physical fitness equates 
to compliance with routine or periodic examinations that test a 
member's physical skills needed to perform the mission. 

[3] Deployment is a troop movement resulting from a Joint Chiefs of 
Staff and Unified Command Deployment Order for 30 continuous days or 
greater to a land-based location outside the United States. 

[4] Operation Enduring Freedom includes ongoing operations in 
Afghanistan and in certain other countries; Operation Iraqi Freedom 
includes ongoing operations in Iraq. 

[5] 10 U.S.C. § 1074f. 

[6] 10 U.S.C. § 10102. 

[7] Minimal Standards of Fitness for Deployment to the CENTCOM Area of 
Responsibility, January 2005. 

[8] The Selected Reserve's members include individual mobilization 
augmentees--individuals who train regularly, for pay, with active 
component units--as well as members who participate in regular training 
as members of National Guard or Reserve units. 

[9] Mobilization is the process of assembling and organizing personnel 
and equipment, activating or federalizing units and members of the 
National Guard or Reserves for active duty, and bringing the armed 
forces to a state of readiness for war or other national emergency. 

[10] 10 U.S.C. § 10206(a). 

[11] Prior to 2002, this statute applied to members of the Individual 
Ready Reserve and Inactive National Guard as well. Currently, the law 
requires that the Individual Ready Reserve be examined as to their 
medical fitness as a condition of military duty or promotion, or 
attendance at a military school or other career-related action. 10 
U.S.C. § 10206(b). 

[12] Most reserve members who were called to active duty for other than 
normal training after September 11, 2001, were mobilized under one of 
three legislative authorities: 10 U.S.C. § 12304, 12302, 12301(d). 

[13] Special Assessment of Operations Desert Shield/Storm Mobilization, 
Department of the Army, Inspector General, December 1991. 

[14] GAO, National Guard: Peacetime Training Did Not Adequately Prepare 
Combat Brigades for the Gulf War, GAO/NSIAD-91-263 (Washington, D.C.: 
Sept. 24, 1991). 

[15] GAO, Operation Desert Storm: Full Army Medical Capability Not 
Achieved, GAO/NSIAD-92-175 (Washington, D.C.: Aug. 18, 1992). 

[16] Sixth U.S. Army Inspector General Nondeployable Soldiers Special 
Inspection, August 1992. 

[17] GAO, Reserve Forces: DOD Policies Do Not Ensure That Personnel 
Meet Medical and Physical Fitness Standards, GAO/NSIAD-94-36 
(Washington, D.C.: Mar. 23, 1994). 

[18] AMSA operates the Defense Medical Surveillance System, which was 
established in 1997. 

[19] GAO, Defense Health Care: Quality Assurance Process Needed to 
Improve Force Health Protection and Surveillance, GAO-03-1041 
(Washington, D.C.: Sept. 19, 2003). 

[20] GAO, Military Personnel: DOD Needs to Address Long-term Reserve 
Force Availability and Related Mobilization and Demobilization Issues, 
GAO-04-1031 (Washington D.C.: Sept. 15, 2004). 

[21] The mandate directed that the Secretary establish the committee 
120 days after passage of the act, which was in October 2004. 

[22] OSD's Office of Health Affairs has begun a process requiring each 
active and reserve component to quarterly report the percentage of its 
members who are in compliance with six medical readiness elements: (1) 
dental class I or II; (2) immunizations; (3) medical readiness 
laboratory tests, such as DNA blood sample; (4) no deployment-limiting 
conditions; (5) periodic health assessment; and (6) medical equipment, 
such as eyeglass inserts for gas masks. 

[23] 10 U.S.C. § 10206 states that "each member of the Selected Reserve 
who is not on active duty shall be examined as to his physical fitness 
every five years, or more often as the Secretary concerned considers 
necessary." In 1993, the interval was changed from every 4 years to 
every 5 years. 

[24] In 2003, DOD asked the Armed Forces Epidemiological Board to 
review the appropriate methodology and interval for routine medical 
examinations to be applied similarly across all services. Based on the 
board's recommendations, the Assistant Secretary of Defense for Health 
Affairs is currently drafting a policy that would replace the 5-year 
medical examination with an annual periodic health assessment. Congress 
is currently considering changing the frequency requirement for a 
physical examination from every 5 years to annually as part of the 2006 
national defense authorization act. 

[25] In 1993, Congress mandated that these examinations be conducted at 
least once every 5 years. Prior to 1993, the requirement was once every 
4 years. 

[26] Members are given a (PUHLES) physical capacity or stamina, upper 
extremities, hearing, lower extremities, eyes, psychiatric score of 1 
to 4 for each of the six assessment areas. P1 represents a nonduty- 
limiting condition, meaning that the individual is fit for duty and 
possesses no physical or psychiatric impairments. P2 means a condition 
may exist; however, it is not duty-limiting. P3 or P4 means that the 
individual has a duty-limiting condition in one of the six assessment 
areas. P4 means the individual functions below the P3 level. A rating 
of either P3 or P4 puts the servicemember in a nondeployable status or 
may result in the changing of the reserve component member's job 
classification. 

[27] The Air Force Reserve and Air National Guard discontinued 
utilizing the "complete or comprehensive" long physical exams in July 
2001 and January 2003, respectively. However, annual physical exams for 
flying personnel continue to be conducted in both components. 

[28] A PHAM is a credentialed health care provider, and may be a 
physician, nurse practitioner, or physician's assistant. A PHAM 
performing examinations for flying personnel must be a flight surgeon. 

[29] An HCP is a credentialed health care provider, and may be a 
physician, nurse practitioner, or physician's assistant. An HCP 
performing flying personnel examinations must be a flight surgeon. 

[30] 10 U.S.C. § 10206(a)(2). 

[31] On December 19, 1996, the Assistant Secretary of Defense for 
Health Affairs issued DOD policy in Health Affairs Memo 97-020, 
standardizing dental classifications: Class I indicates no dental 
treatment or reevaluation required within the next 12 months; Class II 
indicates patients have the potential for dental emergencies with the 
next 12 months but it is not likely if certain treatments are obtained; 
Class III represents patients with oral conditions that if not treated 
are expected to result in dental emergencies within the next 12 months; 
and Class IV represents patients requiring a dental examination and 
whose dental classification is unknown. 

[32] On February 19, 1998, the Assistant Secretary of Defense for 
Health Affairs issued DOD policy, in Health Affairs Memo 98-021, 
requiring annual dental examinations and stipulating that personnel 
shall not deploy in Dental Class III or IV except under extreme 
circumstances. 

[33] While Army regulation, AR 40-501, only addresses an annual dental 
examination for the Army National Guard, according to the Army Dental 
Command and the Army Reserve, Army Reserve members adhere to the same 
dental standard. 

[34] The dental screening was more limited than the current dental 
examination. It included a mouth-mirror, and explorer or tongue 
depressor evaluation only. 

[35] DOD Directive 1308.1, "DOD Physical Fitness and Body Fat Program". 

[36] GAO, Reserve Forces: DOD Policies Do Not Ensure That Personnel 
Meet Medical and Physical Fitness Standards, GAO/NSIAD-94-36 
(Washington, D.C.: Mar. 23, 1994). 

[37] The Assistant Secretary of Defense for Health Affairs is currently 
drafting a policy intended to help standardize implementation of the 
medical examination requirements. 

[38] GAO, Reserve Forces: DOD Policies Do Not Ensure That Personnel 
Meet Medical and Physical Fitness Standards, GAO/NSIAD-94-36 
(Washington, D.C.: Mar. 23, 1994). 

[39] DOD Directive 1308.1. 

[40] GAO, Gender Issues: Improved Guidance and Oversight Are Needed to 
Ensure Validity and Equity of Fitness Standards, GAO/NSIAD-99-9 
(Washington, D.C.: Nov. 17, 1998). 

[41] This position was referred to as the Assistant Secretary of 
Defense (Force Management Policy) at the time the directive was revised 
in 2002. 

[42] Over 1,400 active and reserve component leaders, soldiers, and 
civilians in 35 locations in the United States were contacted by the 
Army Inspector General during its review. 

[43] We are 90 percent confident that the true percentage of medical 
discrepancies is within +/-6.1 percentage points of our estimate. 

[44] Department of the Army Inspector General Special Inspection of 
Army Mobilization/Demobilization in Support of Recent and Ongoing 
Operations, November 2003-June 2004, February 28, 2005. 

[45] We are 90 percent confident that the true percentage of medical 
discrepancies is within +/-6.1 percentage points of our estimate. 

[46] At the time of our review, 110 members did not have an APFT on 
file. In addition, there were service members who did not take a 
physical fitness test for the record during 2005, nor did they have a 
temporary or permanent profile when completing the physical fitness 
test. 

[47] GAO, Reserve Forces: DOD Policies Do Not Ensure That Personnel 
Meet Medical and Physical Fitness Standards, GAO/NSIAD-94-36 
(Washington, D.C.: Mar. 23, 1994). 

[48] GAO-04-1031. 

[49] This program was established following our 2003 review, GAO, 
Defense Health Care: Quality Assurance Process Needed to Improve Force 
Health Protection and Surveillance, GAO-03-1041 (Washington, D.C.: 
Sept. 19, 2003). 

[50] Draft regulation for the Medical Holdover Case Management Program 
states that a case manager is normally a registered nurse who is 
assigned to manage the medical care provided each medical holdover 
soldier. The case manager implements the case management process with a 
focus on clinical evaluation and outcomes. 

[51] As of August 11, 2005, the total number in medical holdover was 
4,866--860 of whom were placed there prior to deployment, and the 
remainder of whom were placed there due to a medical condition 
developed during deployment. 

[52] According to an Army official, 87 of these 860 have been in a 
medical holdover status for over a year due to complex medical 
conditions, such as cancer. 

[53] Conditions that could disqualify a reserve component servicemember 
from deployment and would cause the member to be released if identified 
medically nondeployable during the first 25 days of activation include 
temporary and permanent conditions that do not meet medical deployment 
standards as outlined in AR 40-501, Chapter 3. 

[54] For the purposes of this report, preexisting medical conditions 
refer to those medical conditions that were not identified during 
mobilization that may limit a member's ability to perform his or her 
mission and cannot be adequately addressed in theater. 

[55] Minimal Standards of Fitness for Deployment to the CENTCOM Area of 
Responsibility, January 2005. 

[56] Army Regulation 40-501 was updated to include standards for 
deployment in February 2005. 

[57] Although some systems exist to track various aspects of medical 
care provided in theater, we did not identify any system that tracks 
care provided to reserve component members for preexisting conditions. 

[58] This is based on Dental Class III or IV classification standards. 
This is a servicewide standard. 

[59] The Air National Guard issued the memorandum, via SG Log Letter 04-
026, on September 27, 2004. 

[60] From November 2003 through January 2004, the reservist incurred a 
total of 20 dental office and clinic visits and received two fillings, 
two extractions, four root canals, and three crowns, at a cost of about 
$5,200 to the military. 

[61] Unless otherwise noted, the officials listed in this appendix have 
their offices in the Pentagon or at locations in the Washington, D.C., 
metropolitan area. 

[62] We reviewed all available medical and physical fitness files 
during our visits to the units. Some files were not available because 
(1) members who had deployed with the unit had transferred to another 
unit or were no longer serving, (2) some files had been misplaced, and 
(3) some members were having a routine exam and their file was with 
them. 

[63] Air Force Audit Agency, Individual Deployment Process, Audit 
Report F2005-0005-FD3000 (June 13, 2005). 

[64] Air Force Inspection Agency, Health Services Inspection, ARC 
Inspection Results, ARC Element Results, Annual Analysis Calendar Year 
2004 (as of June 20, 2005). 

[65] The data represent deployment events. A deployment event is 
defined as a servicemember completing a pre-or postdeployment health 
assessment form with no recent history (within 6 months) of completing 
a separate pre-or postdeployment health assessment form. 

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