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: Published: Oct 27, 2005. Publicly Released: Oct 27, 2005.

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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.

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.

Recommendations for Executive Action

  1. Status: Closed - Implemented

    Comments: DOD partially concurred with this recommendation stating that certain medical conditions should clearly render a member nondeployable and have made strides to define these conditions. DOD also noted that due to the ever-changing nature of the theater of operations and the inexact nature of medicine, a list of nondeployable preexisting conditions will never be fully comprehensive or enforceable. We believe DOD should make more of an effort to develop a list of what preexisting conditions should not be allowed into specific theaters of operations so that future deployments would not experience situations such as those that occurred with members being deployed into Iraq who clearly had pre-existing conditions that would prevent deployment. Following the release of GAO's report, USCENTCOM's Individual Protection and Individual/Unit Deployment Policy was amended to include an expanded list of medical conditions that usually preclude medical clearance for deployment. Further, it is noted in this policy that medical clearance to deploy for persons with any of the conditions noted should be granted only after consultation with the theater medical authority who can determine if adequate treatment facilities and specialist support is available at the duty station.

    Recommendation: 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, the Secretary of Defense should 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.

    Agency Affected: Department of Defense

  2. Status: Closed - Not Implemented

    Comments: DOD did not concur with our recommendation that DOD modify the medical pre-deployment form to better capture reasons for nondeployment and medical referrals, stating that the medical records are the best source of this information. Although this may be the case, DOD has no way to systematically analyze this information. Furthermore, the pre-deployment form already has an entry for reason nondeployable but because it is narrative it is often not decipherable, incomplete and cannot be easily categorized. Although DOD noted that the referral data is captured electronically and categorized using a list of common referral categories, we found that the top medical referral category was "other" and therefore the form does not provide any meaningful insight into the reasons why almost 40 percent of the active components and 50 percent of the reserve components required a medical referral prior to deployment. DOD, in the DAMIS report, noted that the current Post-Deployment Health Assessment form includes a sufficient list of categories to facilitate monitoring of trends in referral patterns, access to specialty care, untimeliness of follow-up, and eventual diagnoses and outcomes. DOD therefore, noted that a second equally detailed assessment as part of the pre-deployment health assessment process would be unnecessarily disruptive.

    Recommendation: To improve DOD's visibility over reserve components' health status after they are called to duty, the Secretary of Defense should 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.

    Agency Affected: Department of Defense

  3. Status: Closed - Implemented

    Comments: DOD concurred with our recommendation. DOD stated that it is already actively adapting existing systems (particularly the Army Guard system)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 limit an individual's deployability. However, the overall effectiveness will continue to be limited by a lack of access to civilian medical records of reserve component members. DOD asserts that its 2005 Comprehensive Medical Readiness Plan addresses the goal of improving medical readiness and enhancing servicemember health status tracking before, during, and after military operations. Specifically, DOD states that its plan addressed the provisions in the FY 2005 NDAA in that it identified 10 objectives and 22 related action items. DOD notes that as of September 20, 2007, 20 of the action items were complete. The Joint Medical Readiness Oversight Committee (JMROC) expanded the plan to include readiness actions mandated by the NDAAs for FYs 2006 and 2007, and DOD notes that 14 of the 16 action items are complete. DODIG updated the DAMIS report on 5/7/2010 by noting that DOD's actions to address this recommendation were completed on 3/25/2010. Specifically, DODIG noted that the Comprehensive Medical Readiness Plan, annual report to Congress on the plan, and the establishment of the Joint Medical Readiness Oversight Committee are requirements of the FY 2005 NDAA, Section 735. DODIG adds that reports of the progress plan have been provided to Congress, and the plan has been updated with additional actions. Further, DODIG noted that as a result of a RAND study, recommendations were made and were published.

    Recommendation: To improve DOD's visibility over reserve components' health status after they are called to duty, the Secretary of Defense should 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.

    Agency Affected: Department of Defense

  4. Status: Closed - Implemented

    Comments: Although DOD concurred with this recommendation, we expanded our first recommendation to include physical fitness examinations in the actions to be addressed because we found that the reserve components were unable to report complete and reliable data on compliance with routine physical fitness examinations and lacked quality assurance of the data. Furthermore, the responsible office for the physical fitness oversight is the Office of Morale, Welfare and Recreation which does not participate in the Joint Medical Readiness Oversight Committee mentioned in the first recommendation. During our review, the reserve components had submitted information but we question its reliability based on the above circumstances. According to DODIG, as of March 31, 2005, the Air Force, Navy, and Marine Corps have annually provided USD P&R with reports that include their respective assessments of their military servicemembers' physical fitness, body fat results, and health promotion programs. The Army, citing a need to wait for DIMHRS to become operational, was granted multiple reporting waivers--the latest extension being until March 2012. However, DIMHRS has since become a defunct system and it is unclear whether Army has or will begin reporting this data prior to the March 2012 deadline.

    Recommendation: To have visibility over reserve components' compliance with routine medical and physical fitness examinations, the Secretary of Defense should 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.

    Agency Affected: Department of Defense

  5. Status: Closed - Implemented

    Comments: In January 2006, DOD published Instruction 6025.19 on "Individual Medical Readiness" (IMR)--portions of which address GAO's recommendation that it establish a management control framework. Specifically, the instruction implements policy, assigns responsibilities, and prescribes procedures to improve medical readiness through monitoring and reporting. Additionally, the instruction addresses GAO's recommendation to establish quality assurance for data reliability in that it assigns responsibility to the Assistant Secretary of Defense for Health Affairs for ensuring that Quality Assurance/Quality Control programs are in place, defining measurable medical elements for all military services, consolidating IMR data and issuing DOD-wide IMR reports, and requiring that military department-specific electronic data systems can interface. Further, DOD developed and implemented Instruction 6200.05 on Feb. 16, 2007, which establishes DOD Force Health Protection/Quality Assurance Program requirements. Finally, DOD's efforts addresses GAO's recommendation to track compliance with routine medical and physical fitness exams in that DOD now requires the military departments to use their respective electronic data collection systems to capture, track, and report each member's IMR currency, and requiring quarterly IMR reports that summarize the IMR status of active and selected reserve members of the Armed Forces.

    Recommendation: To have visibility over reserve components' compliance with routine medical and physical fitness examinations, the Secretary of Defense should 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.

    Agency Affected: Department of Defense

  6. Status: Closed - Not Implemented

    Comments: DOD concurred with our recommendation that DOD explore using 3 existing tracking systems to track members in theater with treatable preexisting conditions, e.g., to make sure that certain prescription drugs are made available. However, DOD must first figure out what conditions are allowed in theater (see recommendation #5 above). Attempted to identify status of this effort both through independent research as well as through working with DODIG. Neither produced any information to support a determination that this recommendation was implemented.

    Recommendation: 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, the Secretary of Defense should 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 Affected: Department of Defense

 

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