United States Government Accountability Office

Washington, DC 20548 

September 6, 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

Subject: Defense Health Care: DOD Has Established a Chiropractic 

i

 

 Benef t for Active Duty Personnel 

The Floyd D. Spence National Defense Authorization Act for Fiscal Year 2001 (NDAA 

2001) directed the Department of Defense (DOD) to develop and implement a plan to 

make a chiropractic benefit available to all active duty personnel in the U.S. armed 

forces.1 The practice of chiropractic focuses on the relationship between structure 

(primarily, the spine) and function (as coordinated by the nervous system) and how 

that relationship affects the preservation and restoration of health. In August 2001, 

DOD submitted to Congress an implementation plan that described how it planned to

develop a chiropractic benefit within the military health system. The plan addressed 

patient eligibility, access to care, the location of chiropractic clinics, projected costs, 

staffing, and the marketing and monitoring of the benefit. 

The NDAA 2001 directed DOD to develop the implementation plan in consultation 

with the Oversight Advisory Committee (OAC), which was established by the 

National Defense Authorization Act for Fiscal Year 1995 (NDAA 1995). The OAC was 

directed by the NDAA 1995 to oversee a 3-year DOD chiropractic demonstration 

project at no fewer than 10 military treatment facilities (MTF).2The NDAA 1995 

directed that the OAC include the Assistant Secretary of Defense for Health Affairs; 

the Surgeons General of the Army, the Air Force, and the Navy; and at least four 

representatives of the chiropractic profession; and also directed that we serve as a 

1

Pub. L. No. 106-398, App. A, § 702, 114 Stat. 1654, 1654A-173-174 (2000). 2

An MTF is a military hospital or clinic on or near a military base. 

 GAO-05-890R DOD’s Chiropractic Health Care Program
member of the OAC.

3

 As a member of the OAC, we attended meetings of the OAC and 

provided technical input and advice. 

The NDAA 2001 also mandated that we monitor the development and implementation 

of DOD’s chiropractic health care plan. As agreed with the committees of jurisdiction,

we reviewed the implementation of DOD’s chiropractic benefit.4

 

To review the implementation of DOD’s chiropractic benefit, we examined relevant 

legislation, statutes, and reports containing congressional directives to DOD for 

establishing and enhancing the chiropractic benefit as well as those directing earlier 

chiropractic demonstration projects. We reviewed DOD’s February 2000 Final 

Chiropractic Health Care Demons ration Program Report and DOD’s August 2001 

Report on Chiropractic Health Care Implementation Plan (implementation plan). We 

also reviewed pertinent DOD policies and procedures, and communications between

the services and the TRICARE Management Activity (TMA), the office responsible for 

ensuring that DOD’s health policy is implemented. We collected workload, staffing, 

and financial data from fiscal year 2002 through fiscal 2004 from each of the MTFs 

that have established chiropractic clinics. Although we did not independently verify 

the data that we collected, we queried representatives from each of the services to 

review the systems used for collecting and maintaining the data. We determined that 

the data were adequate for our purpose. We interviewed officials from the TMA, the 

Offices of the Surgeons General of the Air Force, Army, and Navy; and officials and 

chiropractors from five MTFs that have chiropractic clinics. We also interviewed an 

official from Cherokee Nation, a company that contracts chiropractors to work in 

chiropractic clinics for the Army and Air Force. We conducted our review according 

to generally accepted government auditing standards from October 2004 through 

August 2005. 

t

 

Results in Brief 

To implement its chiropractic benefit, DOD has opened chiropractic clinics at 42 of

its 238 MTFs, worldwide, and does not plan to add any additional clinics at this time. 

All of DOD’s 1.8 million active-duty personnel are eligible for the benefit. The 42 

chiropractic clinics are located in the United States in areas with a high number of 

active-duty personnel. Approximately 969,000, or 54 percent, of active-duty personnel 

reside in the areas served by the MTFs with chiropractic clinics. To support the 

benefit, DOD provides annual allotments from its health care budget. In fiscal year 

2004, the allotment increased to $11 million. An additional $203,000 was provided by 

the MTFs with chiropractic clinics in fiscal year 2004. DOD generally adhered to the 

priorities specified in its implementation plan in selecting the sites for the 42 clinics 

and in determining the clinics’ staffing levels. DOD has not completed other actions 

described in the implementation plan. For example, DOD’s implementation plan 

3

Pub. L. No. 103-337, § 731, 108 Stat. 2663, 2809 (1994) (NDAA 1995). 4

We did not evaluate the development of DOD’s implementation plan because of our previous role as a 

member of the OAC in accordance with NDAA 1995. In our role, we participated in developing DOD’s 

implementation plan by providing the OAC with a member. To maintain compliance with the 

independence requirements of generally accepted government auditing standards, we are unable to

evaluate the development of that same plan. 

2 GAO-05-890R DOD’s Chiropractic Health Care Program 
stated that a marketing and promotion program, which would include pamphlets and 

other materials, would be necessary to make active-duty personnel aware of the 

benefit. However, DOD did not provide active-duty personnel with such materials as 

specified in the plan. Instead, DOD relied on each MTF to determine whether and

how to promote the benefit. The implementation plan also called for close monitoring 

of the benefit to determine whether the benefit meets current needs, but DOD 

officials said that they had not monitored whether the benefit meets current or future 

demand from active-duty personnel. 

In commenting on a draft of this report, DOD generally agreed with our findings. 

DOD noted that oversight of the chiropractic clinics is provided at the service level, 

which involves frequent communication with TMA regarding medical care, budget, 

and legislative issues that affect the chiropractic program across the military health 

system. 

Background 

Military health care is provided by TRICARE, DOD’s health provider network. 

TRICARE covers about 9.1 million beneficiaries, including active-duty and retired 

members of the armed services and their families. The military health system’s

primary mission is to maintain the health of 1.8 million military personnel engaged in 

active duty.5

 Costing about $17.8 billion in fiscal year 2004, TRICARE is financed 

through DOD’s Defense Health Program (DHP) budget. The services administer 

TRICARE through their respective MTFs and other providers. Worldwide, DOD has

238 MTFs. The Surgeon General of each service has authority over the MTFs for that 

branch of the service. 

Congress has directed that DOD consider implementing a chiropractic benefit in the 

military health system since the 1980s. The Department of Defense Authorization Act 

of 1985 mandated that DOD conduct a demonstration project to evaluate the costeffectiveness of incorporating chiropractic services for active-duty service members, 

retirees, and their dependents, as part of the Civilian Health and Medical Program of 

the Uniformed Services (CHAMPUS) benefit, the military health system in place prior 

to TRICARE.6 In August 1993, DOD prepared a report to Congress on the CHAMPUS 

Chiropractic Demonstration Project. The report stated that after a 2-year 

demonstration project conducted in two states, DOD did not favor establishing a 

permanent benefit because other types of care had higher priority for the DHP’s

limited funds. 

In the NDAA 1995, Congress directed the Secretary of Defense to establish another 

demonstration program at no fewer than 10 sites for 3 years to evaluate the feasibility 

and advisability of expanding DOD’s health system to include the chiropractic 

 5

In addition to members of the armed forces, “active-duty personnel” also include members of the

Coast Guard, the Commissioned Corps of the National Oceanic and Atmospheric Administration, and

the Public Health Service. Members of the Reserves and National Guard are also eligible for care in the 

military health system when they are in active-duty status for over 30 days. 6

Pub. L. No. 98-525, § 632(b), 98 Stat. 2492, 2543 (1984). 

3 GAO-05-890R DOD’s Chiropractic Health Care Program 
benefit.

7

 The NDAA 1995 also directed the Secretary to convene the OAC to, among 

other things, submit to Congress a plan for evaluating the program. The Secretary, 

with assistance from the OAC, was required to produce a final report at the 

conclusion of the demonstration period. The National Defense Authorization Act for 

Fiscal Year 1998 directed that the demonstration be increased to include at least 

three additional clinics in the MTFs that were not already designated to participate in 

the program, and it also extended the program for 2 more years, to conclude at the 

end of fiscal year 1999.8

DOD issued its Final Chiropractic Health Care Demons ration Program Report in 

February 2000. The report concluded that it was feasible to integrate chiropractic 

care services into DOD’s health system because chiropractic services complemented 

traditional medical care for patients with back pain but that it was not advisable to do

so because of the additional costs entailed. The report stated that chiropractic care 

posed an additional cost because it did not fully offset the costs of traditional, 

nonchiropractic, medical care. DOD estimated that the anticipated total cost of 

making chiropractic care available to all TRICARE beneficiaries could reach 

$70 million annually.

t

 

9

 The report also stated that because of fiscal limitations within 

the military health system, full implementation of the chiropractic benefit would 

necessitate reducing or eliminating other existing medical programs. 

In the NDAA 2001, Congress directed DOD to develop a plan to provide the 

chiropractic benefit for all active-duty members of the military.10 In August 2001, DOD 

issued its implementation plan, which served as an operational framework for DOD 

in implementing its chiropractic benefit. Enclosure I lists selected legislation directed 

toward establishing and increasing the availability of DOD’s chiropractic benefit. 

DOD Has Made the Chiropractic Benefit Available at 42 MTFs in the United

States

To implement its chiropractic benefit, DOD has opened chiropractic clinics in 42 of

its 238 MTFs. DOD does not currently plan to open additional clinics, but DOD 

officials said they continue to assess additional need for the benefit. The benefit is

provided for active-duty personnel at the MTFs with chiropractic clinics, all of which 

are located in the United States. The locations for clinics were selected because they 

are in areas that have a high number of active-duty personnel. Approximately 969,000, 

or 54 percent, of active-duty personnel, reside in the areas served by the MTFs with 

chiropractic clinics. DOD allocated $11 million to the benefit in fiscal year 2004, and 

an additional $203,000 was provided by the MTFs with chiropractic clinics. DOD 

generally followed its implementation plan in locating and staffing its chiropractic 

clinics, but it did not actively promote or closely monitor the benefit as described in 

the plan. 

7

Pub. L. No. 103-337, § 731, 108 Stat. 2663, 2809 (1994). 8

Pub. L. No. 105-85, § 739(a), (b), 111 Stat. 1629, 1815 (1997). 9

We did not adjust the $70 million figure to 2005 dollars. The figure is taken from DOD’s February 2000 

report and is in 2000 dollars. 10Congress did not direct that DOD’s plan include the provision of the benefit to military retirees and 

dependents. 

4 GAO-05-890R DOD’s Chiropractic Health Care Program 
DOD Has Opened Clinics at 42 MTFs and Does Not Plan to Open More 

DOD has opened chiropractic clinics for active-duty members of the uniformed

services at 42 of DOD’s 238 MTFs and does not plan to open additional clinics. The 

NDAA 2001 mandated that DOD create a plan to fully implement the chiropractic 

benefit; DOD responded by developing and submitting an implementation plan in 

August 2001 and began implementing the program in October of that same year. By 

fiscal year 2003, DOD had opened 31 chiropractic clinics. In a committee report for 

the National Defense Authorization Act for Fiscal Year 2004, the Senate Committee 

on Armed Services directed that DOD provide the benefit at no fewer than 45 sites by

the end of fiscal year 2004.11 DOD officials said they have fulfilled the requirements of 

the law and do not have immediate plans to add any additional clinics. They also said 

they will continue to assess additional need for the benefit. 

The chiropractic clinics have been opened at the MTFs in the United States with large 

active-duty populations. As of June 2005, the Army had opened the most chiropractic 

clinics with 17, the Air Force had opened 14, and the Navy had opened 11. Each of the 

42 chiropractic clinics accepts active-duty patients from the other services. Figure 1 

shows the locations of the MTFs that have chiropractic clinics.12

 

 11S. Rep. No. 108-46 at 331-332 (2003). 12On May 13, 2005, DOD made recommendations for base realignments and closures. Thirty-six bases 

that have MTFs with chiropractic clinics would be affected if these recommendations are 

implemented; 16 would be realigned and 20 would gain additional staff or functions. DOD defines 

“realignment” as any action that both reduces and relocates functions and civilian personnel positions. 

DOD has not determined how this would affect the chiropractic program. 

5 GAO-05-890R DOD’s Chiropractic Health Care Program 
Figure 1: Location of DOD’s 42 Chiropractic Clinics (August 2005) 

Source: GAO. 

Air Force

Army

Navy





























































































 









Note: Specific locations are listed in enc. II.

Fifty-Four Percent of Active-Duty Personnel Are Served by the MTFs with

Chiropractic Clinics

Approximately 969,000, or 54 percent, of active-duty personnel, reside in the areas 

served by the MTFs with chiropractic clinics. (See table 1.) However, DOD officials 

said that the chiropractic benefit is available to all active-duty personnel because they 

can be referred by their primary care manager to a chiropractor located in one of 

DOD’s 42 chiropractic clinics. DOD officials said that personnel residing in remote 

and overseas locations or in locations that are not near an MTF with a chiropractic 

clinic can travel, if necessary, to receive the benefit. According to DOD data, 19 

percent of active-duty personnel currently reside in remote or overseas areas. DOD 

6 GAO-05-890R DOD’s Chiropractic Health Care Program 
defines a remote area as an area in the United States in which an active-duty member 

resides and works more than 50 miles from an MTF. An additional 28 percent of 

active-duty personnel reside in areas of the U.S. served by MTFs that do not have 

chiropractic clinics. Currently, there is no provision for active-duty personnel to

receive chiropractic services in the civilian or purchased-care sector. 

Table 1: Proximity of Active Duty Personnel to Chiropractic Clinics (August 2005) 

Location of active-duty personnel Active-duty population 

Percent of active-duty 

population 

Residing In areas served by a chiropractic clinic 969,000 54 

Residing in locations not served by a chiropractic clinic

Living overseas 246,000 14

Living in remote areas 88,000 5

Living in areas of the United States served by 

MTFs with no chiropractic clinic 497,000 28

831,000 46 

Total 1,800,000 100 

Sources: TMA and the Offices of the Surgeons General of the Air Force, Army, and Navy, DOD. 

DOD’s Allotments for the Benefit Have Increased

Since 2002 the chiropractic benefit has been directly funded from the DHP with an 

annual allotment for each of the services. DOD’s annual allotment to the chiropractic 

benefit has grown over time to $11 million in fiscal year 2004. Table 2 shows the 

annual DHP allotments for the chiropractic benefit for fiscal years 2002 through 2004 

as well as the number of clinics in operation by each service for the same period. 

Table 2: Annual DHP Allotments Directly for the Chiropractic Program and Number of Clinics,

by Service, Fiscal Years 2002-2004 

Dollars in millions 

Fiscal year

2002 2003 2004

Service 

DHP 

allotment 

Number of 

clinics 

DHP 

allotment 

Number of 

clinics 

DHP

allotment 

Number of 

clinics 

Air Force $1.8 4 $1.7 8 $2.7 14 

Army 2.3 5 4.4 13 4.3 17

Navy 1.8 5 3.6 10 4 11

Total $6.0 14 $9.8 31 $11 42

Source: DOD. 

Notes: DHP allotments are in millions of dollars. Totals may not add because of rounding.

Most MTFs provide additional financial support for their respective chiropractic 

clinics from their own resources. Twenty-six of the 42 MTFs that have chiropractic 

clinics have provided additional financial support from funds that the MTFs have 

received for their general use to cover supplies or incidental items. The amount of

funding provided by MTFs for their respective clinics has varied from one MTF to

another. Table 3 shows the amount of MTF funds provided for chiropractic clinics, as

well as the number of clinics in operation, by service for fiscal years 2002 through 

2004. 

7 GAO-05-890R DOD’s Chiropractic Health Care Program 
Table 3: MTF Funds Provided for Chiropractic Clinics and Number of Clinics, by Service,

Fiscal Years 2002-2004 

Fiscal year

2002 2003 2004

Service MTF funds 

Number of 

clinics MTF funds 

Number of 

clinics MTF funds 

Number of 

clinics 

Air Force $10,571 4 $40,642 8 $94,932 14 

Army 25,768 5 54,012 13 44,222 17 

Navy 111,317 5 60,914 10 63,674 11

Total $147,656 14 $155,568 31 $202,828 42

Sources: Offices of the Surgeons General of the Air Force, Army, and Navy. 

Note: Funds contributed by MTFs were in addition to the DHP allotments provided to the services.

DOD Generally Followed Its Implementation Plan in Establishing the Benefit

DOD generally followed its implementation plan in selecting sites and determining 

staffing levels for the chiropractic clinics that were opened after the conclusion of the 

demonstration project but did not complete other actions described in the 

implementation plan. In determining locations for chiropractic clinics, DOD noted in

its implementation plan that chiropractic care would continue at the 13 MTFs that 

had chiropractic clinics established for the demonstration project. For each service, 

the implementation plan included a list of MTFs considered for receiving chiropractic 

clinics, prioritized by projected demand on the basis of the size of the active duty 

population served by the MTFs. Decisions about opening chiropractic clinics at

particular MTFs also were based upon criteria reflecting specific aspects of the areas 

served by the MTFs. DOD officials said that, in addition to the criteria used to 

develop the lists, other factors that were considered included the (1) proximity of 

other MTFs offering chiropractic services, (2) availability of space at the MTF, and 

(3) plans for future construction at the MTF. The implementation plan provided the 

services with guidance on the order for opening the clinics. However, DOD gave the 

services discretion in deciding which clinics to open on the basis of all of the factors.

The locations of the clinics suggest that DOD generally opened clinics at the MTFs in 

the order in which they appear on the list in its implementation plan. (See enc. II.) 

The Army opened clinics at 17 of the first 18 MTFs appearing on the list, the Navy 

opened clinics at 11 of the first 12, and the Air Force opened clinics at 14 of the first 

25. Officials from the Surgeons General’s offices said that the lack of available space 

at an MTF was the most common reason that an MTF on the list would not have 

received a clinic but said that the services carefully evaluated each site on the list. 

DOD officials said they also generally followed the criteria stated in the 

implementation plan for staffing the clinics. According to DOD’s implementation

plan, staffing levels at each clinic would be based on the number of active-duty 

personnel and historical MTF workloads. DOD assumed that a single chiropractor 

with one assistant could treat approximately 1,000 patients and handle 4,200 visits a 

year from these patients. At the end of fiscal year 2004, DOD had staffed its 42 clinics 

with 58 chiropractors. Most of the clinics are staffed with a single chiropractor. 

DOD’s chiropractors are civilian contractors. The Army and Air Force use a thirdparty firm to hire their chiropractic contractors, while the Navy hires its entire 

chiropractic staff through the Navy Medical Logistics Command. Table 4 shows the 

8 GAO-05-890R DOD’s Chiropractic Health Care Program 
number of chiropractors staffed in DOD chiropractic clinics, by service, since fiscal 

year 2002. 

Table 4: Number of Chiropractors Staffed in DOD Chiropractic Clinics, by Service, Fiscal Years 2002-

2004 

Fiscal year

Service 2002 2003 2004

Air Force 11 14 18 

Army 13 19 21

Navy 9 18 19

Total 33 51 58

Sources: Offices of the Surgeons General of the Air Force, Army, and Navy. 

The implementation plan anticipated that staffing requirements would be recomputed 

according to demand as the chiropractic program matured and data were collected to 

evaluate the benefit. However, DOD has not conducted a formal assessment of 

staffing needs since October 2001, when the benefit was first established. Instead, 

service representatives said they have staffed clinics on the basis of input from the 

MTFs about how they are handling their workload and said that they communicate as

needed with the MTF officials to assess the status of the chiropractic clinics and 

solve any staffing issues that might arise. 

DOD has not completed other actions described in the implementation plan. For 

example, DOD’s implementation plan stated that a marketing and promotional 

program would be necessary to make personnel aware of the benefit, as well as to

inform their physicians, case managers, and commanders about the benefit. Such a 

program was to include promotional materials such as handouts, posters, generic 

news items for post or base papers, or other similar materials. However, DOD’s 

promotional activities have been limited. For example, DOD officials said that DOD 

had not provided materials for promoting the chiropractic benefit to the services but

had instead left it to the services to promote the benefit. Service representatives said 

that they had not produced promotional materials about the chiropractic benefit and 

did not monitor the MTFs’ promotional efforts. The MTF staff we interviewed said 

that they had not produced materials to promote the chiropractic benefit. We found 

that only 10 of the 42 MTFs with chiropractic clinics included the chiropractic benefit

on their Web site. In addition, although the implementation plan stated that DOD 

would monitor the program to determine whether the benefit meets current needs

and to identify future demand, DOD officials told us that they have not conducted 

such monitoring. 

Agency Comments 

We requested comments on a draft of this report from DOD. DOD provided written

comments that are reprinted in enclosure III. In its comments, DOD generally 

concurred with our findings, noting that oversight of the chiropractic clinics is 

provided at the service level, which involves frequent communication with TMA 

regarding medical care, budget, and legislative issues that affect the chiropractic 

program across the military health system. We incorporated technical comments 

provided by DOD as appropriate. 

- - - - - 

9 GAO-05-890R DOD’s Chiropractic Health Care Program 
We are sending copies of this report to the Secretary of Defense, appropriate

congressional committees, and other interested parties. Copies will also be made 

available to others upon request. In addition, this report is available at no charge on

GAO’s Web site at http://www.gao.gov. If you or your staff have any questions 

regarding this report, please contact me at (202) 512-7101 or crossem@gao.gov. 

Contact points for our Offices of Congressional Relations and Public Affairs may be 

found on the last page of this report. Contributions were made by Tom Conahan, 

Assistant Director; Martin Gahart; Cathleen Hamann, and Carolina Morgan. 

Marcia Crosse 

Director, Health Care 

Enclosures – 3 

10 GAO-05-890R DOD’s Chiropractic Health Care Program 
Enclosure I Enclosure I

Selected Laws Pertaining to Development of DOD’s Chiropractic Benefit

Law Description 

Department of Defense 

Authorization Act, 1985, 

Pub. L. No. 98-525 § 632(b),

98 Stat. 2492, 2543 (1984). 

Directed the Secretary of Defense to conduct demonstration projects to 

determine the cost-effectiveness of a chiropractic benefit for CHAMPUSeligible beneficiaries. 

National Defense 

Authorization Act for Fiscal 

Year 1995, Pub. L. No. 103-

337, § 731, 108 Stat. 2663, 

2809 (1994). 

Required that the Secretary of Defense establish a 3-year chiropractic

demonstration program at no less than 10 military treatment facilities to 

evaluate the feasibility and advisability of providing chiropractic care through 

the medical care facilities of the Armed Forces. Provided for establishment of 

an Oversight Advisory Committee (OAC) to assist and advise in the 

development and conduct of the demonstration program.

National Defense 

Authorization Act for Fiscal 

Year 1998, Pub. L. No. 105-

85, § 739(a), (b), 111 Stat. 

1629, 1815 (1997). 

Extended the demonstration program for 2 years through fiscal year 1999.

Mandated the expansion of the chiropractic health care demonstration 

program to at least three additional treatment facilities. 

Floyd D. Spence National 

Defense Authorization Act 

for Fiscal Year 2001, Pub. L.

No. 106-398, § 702, 114 

Stat. 1654, App. A 1654A173-174 (2000). 

Required the development and implementation of a plan to provide a 

permanent chiropractic care benefit for all active-duty personnel to be phased

in over a 5-year period, beginning October 1, 2001. Required that GAO

monitor the development and implementation of the chiropractic plan.a

National Defense 

Authorization Act for Fiscal 

Year 2004, Pub. L. No. 108-

136, § 711, 117 Stat. 1392, 

1530 (2003). 

Required the Secretary of Defense to accelerate the implementation of the 

plan to provide a chiropractic benefit for active-duty personnel, with the goal of 

completing the implementation of the plan by October 1, 2005, rather than the 

original deadline of October 1, 2006. 

Source: GAO. 

Note: CHAMPUS = Civilian Health and Medical Program of the Uniformed Services.

a

We did not evaluate the development of DOD’s implementation plan because of our previous role as a member of the OAC in

accordance with NDAA 1995. In our role, we participated in developing DOD’s implementation plan by providing the OAC with

a member. To maintain compliance with the independence requirements of generally accepted government auditing standards,

we are unable to evaluate the development of that same plan.

11 GAO-05-890R DOD’s Chiropractic Health Care Program
Enclosure II Enclosure II

Military Treatment Facilities Considered for Chiropractic Clinics, in Order 

of Projected Demand, by Service

Military treatment facilities as listed in implementation plan Date opened 

Air Force 

59th Medical Wing, Lackland Air Force Base (AFB), Tex.aSeptember 1998 

11th Medical Group, Bolling AFB, D.C. No clinic opened 

10th Medical Group, U.S. Air Force Academy, Colo. October 2002 

1st Medical Group, Langley AFB, Va. October 2002 

55th Medical Group, Offutt AFB, Nebr.a October 1995 

375th Medical Group, Scott AFB, Ill.a October 1995 

72nd Medical Group, Tinker AFB, Okla. February 2004 

96th Medical Group, Eglin AFB, Fla. October 2003 

6th Medical Group, MacDill AFB, Fla. No clinic opened 

74th Medical Group, Wright Patterson AFB, Ohio March 2004 

16th Medical Group, Hurlburt Field AFB, Fla. No clinic opened 

60th Medical Group, Travis AFB, Calif.aOctober 1995 

99th Medical Group, Nellis AFB, Nev. No clinic opened 

3rd Med Group, Elmendorf AFB, Alaska No clinic opened 

56th Medical Group, Luke AFB, Ariz. No clinic opened 

42nd Medical Group, Maxwell AFB, Ala. No clinic opened 

355 Medical Group, Davis Monthan AFB, Ariz. January 2004 

89th Medical Group, Andrews AFB, Md. October 2002 

12th Medical Group, Randolph AFB, Tex. No clinic opened 

78th Medical Group, Robins AFB, Ga. No clinic opened 

305th Medical Group, McGuire AFB, N.J. February 2004 

377th Medical Group, Kirtland AFB, N. Mex. No clinic opened 

43rd Medical Group Pope AFB, N.C. No clinic opened 

81st Medical Group, Keesler AFB, Miss. October 2002 

2nd Medical Group, Barksdale AFB, La. February 2004 

Army

Womack Army Medical Center, Fort Bragg, N.C. January 2003 

Darnall Army Community Hospital, Fort Hood, Tex. October 2002 

Martin Army Community Hospital, Fort Benning, Ga.

a October 1995 

Blanchfield Army Community Hospital, Fort Campbell, Ky. December 2003 

Walter Reed Army Medical Center, D.C.

a September 1998 

Kimbrough Ambulatory Care Center, Fort Meade, Md. October 2003 

Winn Army Community Hospital, Fort Stewart, Ga. May 2003 

Madigan Army Medical Center, Fort Lewis,Wash. April 2003 

Reynolds Army Community Hospital, Fort Sill, Okla.

a

September 1995 

Ireland Army Community Hospital, Fort Knox, Ky. July 2003 

Evans Army Community Hospital, Fort Carson, Colo.aSeptember 1995 

Tripler Army Medical Center, Fort Shafter, Hawaii May 2003 

General Leonard Wood Army Community Hospital, Fort Leonard Wood, Mo. October 2003 

Moncrief Army Community Hospital, Fort Jackson, S.C.

a

September 1995 

Eisenhower Army Medical Center, Fort Gordon, Ga. July 2003 

William Beaumont Army Medical Center, Fort Bliss, Tex. April 2003 

Dewitt Army Community Hospital, Fort Belvoir, Va. No clinic opened 

Guthrie Ambulatory Healthcare Clinic, Fort Drum, N.Y. January 2004 

Navy 

Naval Medical Center, Portsmouth, Va. January 2003 

Naval Medical Center, San Diego, Calif. September 2003 

Naval Hospital, Camp Pendleton, Calif.aOctober 1995 

Naval Hospital, Pensacola, Fla. September 2003 

National Naval Medical Center, Bethesda, Md.

a

August 1999 

12 GAO-05-890R DOD’s Chiropractic Health Care Program
Enclosure II Enclosure II

Naval Hospital, Camp Lejeune, N.C.

a

September 1995 

Naval Hospital, Jacksonville, Fla.aSeptember 1995 

Naval Hospital, Great Lakes, ll. October 2003 

Naval Medical Clinic, Pearl Harbor, Hawaii No clinic opened 

Naval Hospital, Bremerton, Wash. September 2002 

Naval Hospital, Cherry Point, N.C. January 2003 

Naval Hospital, Beaufort, S.C. October 2002 

Sources: Report on Chiropractic Health Care Implementation Plan (August 2001), and the Offices of the Surgeons General for the Air Force, Army, and Navy. 

Note: Military treatment facilities are arranged by projected demand based on population served by the Military Treatment

Facility, within service. 

a

Denotes clinics opened for the demonstration project, from fiscal year 1995 through fiscal 2000.

13 GAO-05-890R DOD’s Chiropractic Health Care Program 
Enclosure III Enclosure III 

Comments from the Department of Defense

14 GAO-05-890R DOD’s Chiropractic Health Care Program
Enclosure III Enclosure III 

(290253) 

15 GAO-05-890R DOD’s Chiropractic Health Care Program 
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