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

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.

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.

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.

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.