Report to Congressional 

Requesters 

United States Government Accountability Office

GAO 

MILITARY 

PERSONNEL 

Army Needs to Better 

Enforce Requirements 

and Improve Record 

Keeping for Soldiers 

Whose Medical 

Conditions May Call 

for Significant Duty 

Limitations 

June 2008 

GAO-08-546 
What GAO Found

United States Government Accountability Office

Why GAO Did This Study

Highlights

Accountability Integrity Reliability

June 2008

MILITARY PERSONNEL

Army Needs to Better Enforce Requirements and 

Improve Record Keeping for Soldiers Whose Medical 

Highlights of GAO-08-546, a report to Conditions May Call for Significant Duty Limitations

congressional requesters 

The increasing need for warfighters 

for the Global War on Terrorism 

has meant longer and multiple

deployments for soldiers. Medical 

readiness is essential to their 

performing needed duties, and an

impairment that limits a soldier’s 

capacities represents risk to the

soldier, the unit, and the mission. 

Asked to review the Army’s

compliance with its guidance, GAO

examined the extent to which the 

Army is (1) adhering to its medical 

and deployment requirements

regarding decisions to send

soldiers with medical conditions to 

Iraq and Afghanistan, and (2) 

deploying soldiers with medical 

conditions requiring duty

limitations, and assigning them to

duties suitable for their limitations. 

GAO reviewed Army guidance, and 

medical records for those 

preparing to deploy between April 

2006 and March 2007; interviewed 

Army officials and commanders at

Forts Benning, Stewart, and Drum,

selected for their high deployment

rates; and surveyed deployed 

soldiers with medical limitations. 

What GAO Recommends

The Army needs to take specific 

measures, such as developing an 

enforcement mechanism to ensure

timely performance of medical 

board evaluations and enhancing 

soldiers’ and their families’ access 

to an ombudsman, to help 

safeguard soldiers with medical 

conditions from being deployed

and assigned to duties unsuitable 

to their medical limitations. In 

written comments on a draft of the

report, DOD concurred with GAO’s 

recommendations. 

Army guidance allows commanders to deploy soldiers with medical 

conditions requiring duty limitations, subject to certain requirements, but the 

Army lacks enforcement mechanisms to ensure that all requirements are met,

and medical record keeping problems obstruct the Army’s visibility over these 

soldiers’ conditions. A soldier diagnosed with an impairment must be given a 

physical profile form designating numerically the severity of the condition 

and, if designated 3 or higher (more severe), must be evaluated by a medical 

board. Commanders must then determine proper duty assignments based on 

soldiers’ profile and commanders’ staffing needs. From a random projectable 

sample, GAO estimates that 3 percent of soldiers from Forts Benning, Stewart, 

and Drum who had designations of 3 did not receive required board 

evaluations prior to being deployed to Iraq or Afghanistan for the period 

studied. In some cases, soldiers were not evaluated because commanders 

lacked timely access to profiles; in other cases, commanders did not take 

timely actions. The Army also had problems with retention and completeness 

of profiles; although guidance requires that approved profiles be retained in 

soldiers’ medical records, 213 profiles were missing from the sample of 685 

records reviewed. The Army was not consistent in assigning numerical 

designations reflecting soldiers’ abilities to perform functional activities. GAO 

estimates from a random projectable sample that 7 percent of soldiers from 

these three installations had profiles indicating their inability to perform 

certain functional activities, yet carrying numerical designators below 3. While 

medical providers can “upgrade” numerical designations discretionarily based 

on knowledge of soldiers’ conditions, the upgrades can mask limitations and 

cause commanders to deploy soldiers without needed board evaluations. 

While GAO found no evidence of widespread revision in profile designations, 

some soldiers interviewed or surveyed disagreed with their designations yet 

were reluctant to express concerns for fear of prejudicial treatment. The Army

has instituted a program to provide ombudsmen to whom soldiers can bring 

medical concerns, but it is targeted at returning soldiers and is not well 

publicized as a resource for all soldiers with medical conditions. Without 

timely board evaluations and retention of profile information for deploying 

soldiers with medical conditions, the Army lacks full visibility and 

commanders must make medical readiness, deployment, and duty assignment

decisions without being fully informed of soldiers’ medical limitations. 

GAO estimates that about 10 percent of soldiers with medical conditions that 

could require duty limitations were deployed from the three installations, but 

survey response was too limited to enable GAO to project the extent to which 

they were assigned to suitable duties. Along with interviews, however, 

responses suggest that both soldiers and commanders believe soldiers are 

generally assigned to duties that accommodate their medical conditions. 

Occasional exceptions have occurred when a profile did not reflect all 

necessary medical information or a soldier’s special skill was difficult to 

replace. Officials said soldiers sometimes understate their conditions to be 

deployed with their units, or overstate them to avoid deployment. 

To view the full product, including the scope 

and methodology, click on GAO-08-546. 

For more information, contact Brenda S. 

Farrell, (202) 512-3604 or farrellb@gao.gov
Contents 

Letter 1

Results in Brief 5

Background 8

Army Is Not Meeting All Requirements for Deploying Soldiers with 

Medical Conditions and Has Unresolved Problems with Medical 

Record Keeping 14

Army Requirements for Deploying Soldiers with Medical 

Conditions Are Not Always Being Met 15

Soldiers’ Medical Records Are Not Always Complete and Do Not 

Always Retain Profiles, and Numerical Designations Are Not 

Consistently Determined 19

One In 10 Soldiers in the Projectable Sample Who Has a Medical 

Condition Has Deployed, but We Were Unable to Determine 

Duty Suitability 25

Some Deploying Soldiers Have Medical Conditions 25

Extent to Which Commanders Assigned Soldiers to Duties Suitable 

to Their Medical Conditions Cannot Be Determined 29

Conclusions 31

Recommendations for Executive Action 32

Agency Comments and Our Evaluation 32

Appendix I Scope and Methodology 35

Appendix II Army Physical Profile (DA Form 3349) 40 

Appendix III PULHES Definitions 42 

Appendix IV Army Physical Profile Codes 43 

Appendix V Department of Defense Pre-Deployment Health

Assessment (DD Form 2795) 46 

Page i GAO-08-546 Medical Condition of Deployed Soldiers
Appendix VI Comments from the Department of Defense 48

Appendix VII GAO Contact and Staff Acknowledgments 53

Related GAO Products 54

Tables 

Table 1: Number of Soldiers in the Sample with Permanent 

Physical Profile Designations of 3 Who Did Not Receive

Pre-Deployment Evaluation by MMRB or MEB 18

Table 2: Numbers and Percentages of Medical Conditions That May 

Require Significant Duty Limitations, by Physical Profile 

Category, across Profiles of Deployed Soldiers in the 

Sample 28

Table 3: Soldier Sample Universe, Target Sample Sizes, and 

Number of Records Reviewed at Each Visited Installation 37

Figures 

Figure 1: Estimated Percentage of Soldiers with Physical Profile 

Designations of Permanent 3 Who Deployed and 

Percentage of Soldiers Who Did Not Receive PreDeployment Evaluation by MMRB or MEB 17

Figure 2: Estimated Percentage of Soldiers Unable to Perform 

Functional Activities Yet Designated as 2 in Their Profiles 21

Figure 3: Comparison of Estimated Percentages of Soldiers with 

Profiles Who May Require Significant Duty Limitations 

against Those Who Do Not 26

Figure 4: Comparison of Estimated Percentages of Soldiers Having 

Medical Conditions That May Require Significant Duty 

Limitations Who Deployed against Those Who Did Not 27

Page ii GAO-08-546 Medical Condition of Deployed Soldiers
Abbreviations 

AHLTA Armed Forces Health Longitudinal Technology Application 

DOD Department of Defense 

MEB Medical Evaluation Board 

MEDPROS Army Medical Protection System 

MMRB Military Occupational Specialty Medical Retention Board 

MOS Military Occupational Specialty 

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Page iii GAO-08-546 Medical Condition of Deployed Soldiers
United States Government Accountability Office

Washington, DC 20548 

June 10, 2008 

The Honorable Ike Skelton 

Chairman 

Committee on Armed Services 

House of Representatives 

The Honorable Susan A. Davis 

Chairwoman

Subcommittee on Military Personnel

Committee on Armed Services 

House of Representatives 

The Honorable Vic Snyder 

Member of Congress 

House of Representatives 

From fiscal years 2004 through 2007, the average number of active and 

reserve servicemembers deployed by the Department of Defense (DOD) 

has increased about 19 percent, from 216,000 to 256,000 servicemembers, 

in support of Operation Iraqi Freedom and the Global War on Terrorism. 

The Army has been the major source of servicemembers supporting 

continued operations, and the increasing need for able warfighters has 

meant longer and multiple deployments for its soldiers. Serving in the 

armed forces requires the medical readiness necessary to plan and execute 

duties to meet operational goals. Any medical or psychological condition 

that limits the ability of a servicemember to execute his or her duties 

represents a risk to the servicemember, the unit, and the accomplishment 

of the mission. Military commanders, medical providers, and 

servicemembers share the responsibility for medical readiness as an 

integrated effort to ensure that servicemembers are ready to fight in 

support of ongoing operations. 

Whenever a soldier is diagnosed with a medical condition, Army guidance 

requires that medical providers document the soldier’s limitations in his or 

her medical record with a permanent or temporary physical profile,1

 1

See appendix II for a copy of the physical profile form DA 3349. 

Page 1 GAO-08-546 Medical Condition of Deployed Soldiers
describing the soldier’s medical condition and physical capability. These 

medical providers, who serve as the profiling officers, must also assign a 

numerical designation reflecting the extent of any limitation on a scale

from 1 to 4, such that a designation of 1 indicates that a soldier has a high

level of medical fitness, while a designation of 4 signifies a drastically 

limited ability to perform military duties due to one or more medical 

conditions or defects.2

 A designation of 3 indicates that a soldier has one 

or more medical conditions that may require significant duty limitations, 

and the soldier should receive duty assignments that are commensurate 

with his or her limitations. Once soldiers receive a permanent profile 

indicating that they have a permanent or chronic medical condition that 

may require significant limitations in assignment, Army guidance generally 

requires further evaluation of the soldiers’ ability to perform duties in their 

current job assignments. Moreover, DOD guidance requires soldiers to be 

evaluated for medical readiness prior to deployment. 

In prior reports, we have highlighted long-standing issues with the medical 

deployability of servicemembers.3

 Specifically, we have found continuing

problems with the completion of pre- and post-deployment health 

assessments. We also reported in October 2005 that we found reserve 

component servicemembers were deploying with preexisting medical 

conditions, and we provided various recommendations for more guidance 

and better visibility over servicemembers with medical conditions in 

theater.4

 DOD has taken action based on these recommendations, such as 

establishing tracking and reporting of key force health protection and 

quality assurance elements such as immunizations and pre- and postdeployment health assessments. 

 2

See appendix III for descriptions of the physical profile numerical designations and 

categories. 

3

GAO, Defense Health Care: Comprehensive Oversight Framework Needed to Help Ensure 

Effective Implementation of a Deployment Health Quality Assurance Program, GAO-07-

831 (Washington, D.C.: June 22, 2007); Defense Health Care: Quality Assurance Process

Needed to Improve Force Health Protection and Surveillance, GAO-03-1041 (Washington,

D.C.: Sept. 19, 2003); and 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). See the Related GAO Products section for more GAO reports pertaining to 

medical deployability. 

4

GAO, Military Personnel: Top Management Attention Is Needed to Address Longstanding Problems with Determining Medical and Physical Fitness of the Reserve Force, 

GAO-06-105 (Washington. D.C.: Oct. 27, 2005). 

Page 2 GAO-08-546 Medical Condition of Deployed Soldiers
From March through October 2007, the Army Office of the Inspector 

General conducted an inquiry at Fort Benning based on media allegations

that soldiers were deployed with significant medical limitations. Army 

Inspector General officials interviewed the soldiers named in the news 

articles, numerous medical providers, and unit leaders to obtain their 

testimonies regarding their pre-deployment medical reviews. The 

Inspector General officials reviewed the standards for completing physical 

profiles, the compliance with these standards, commanders’ decisions or 

actions that were based on these profiles, and whether any reprisals may 

have occurred against soldiers with regard to complaints and concluded

that the Army followed standards in all but one instance where a soldier’s 

profile was changed without proper authority and the soldier deployed. 

The soldier was reevaluated in theater and redeployed to Fort Benning. 

They found no instances of reprisal. According to an Inspector General 

official, further investigation of one medical provider led to no findings of 

wrongdoing. The report recommended that the Army direct (1) a special 

inspection of medical fitness procedures, which is ongoing; (2) leaders and 

soldiers to review and follow Army standards for documenting and 

assessing medical limitations; and (3) the Army Surgeon General to revise

the physical profile form to include a Privacy Act statement, instructions 

for using the physical profile form, and definitions of key terms. 

The Chairs of the House Armed Services Committee and the Military 

Personnel Subcommittee requested that we review the Army’s compliance 

with guidance on the deployment of soldiers with medical conditions.5

 As 

agreed with congressional staff, we examined: 

1. the extent to which the Army is adhering to its medical and

deployment requirements regarding decisions to send soldiers with 

medical limitations to Iraq and Afghanistan; and

2. the extent to which the Army is deploying soldiers with medical 

conditions requiring duty limitations to Iraq and Afghanistan, and 

whether it is assigning them to duties suitable to their limitations. 

To address the extent to which the Army is adhering to its medical and

deployment requirements regarding decisions to send soldiers with 

medical limitations to Iraq and Afghanistan, we reviewed Army guidance

regarding documentation of soldiers’ medical limitations prior to 

 5

Representative Vic Snyder was Chair of the Subcommittee on Military Personnel at the 

time of the request. 

Page 3 GAO-08-546 Medical Condition of Deployed Soldiers
deployment and conditions under which soldiers with medical conditions 

are considered deployable. We selected three Army installations—Fort 

Benning and Fort Stewart in Georgia, and Fort Drum in New York—that 

met one or both of the following two factors: (1) these installations had a 

large number of active component soldiers deployed from each 

installation to Iraq or Afghanistan between April 1, 2006, and March 31, 

2007; or (2) these installations had initial allegations of soldiers being 

deployed with significant medical limitations from these installations. For 

these locations, we prepared a random, projectable sample of active

component soldiers preparing for deployment who indicated that they may 

be under a profile. We reviewed medical records of soldiers in this sample 

and identified a subset of the soldiers who had received profiles 

documenting medical conditions that may require significant duty 

limitations prior to preparing to deployment.6

 We interviewed medical 

providers, personnel officials, Army commanders, and soldiers to identify 

and evaluate the installation’s procedures for documenting medical 

limitations in physical profiles and the training provided at each 

installation. We did not review documentation of medical limitations other 

than the physical profiles. To determine the extent to which the Army is 

deploying soldiers with medical conditions requiring duty limitations to 

Iraq and Afghanistan, and whether it is assigning them to duties suitable to

their limitations, we compared the medical data on the subset of soldiers 

who had significant medical limitations from April 2001 to March 2007 

with the soldiers’ deployment data from Forts Benning, Stewart, and 

Drum. From this analysis, we identified the number of soldiers who had a 

profile in effect at the time of their deployment from each installation. We

reviewed Army processes for tracking soldiers while deployed. We 

interviewed Army officials and commanders about any procedures in 

place to ensure that soldiers are assigned within their limitations. We also

surveyed 66 active component Army soldiers deployed with medical 

conditions to Iraq and Afghanistan and received responses from 24 of 

them, for a response rate of about 36 percent. While we cannot project the 

results of the surveys to all soldiers with medical conditions across the 

Army deployed to Iraq and Afghanistan, we present the information we 

obtained to illustrate these issues. 

 6

GAO has reported in the past that military health records are often incomplete and do not 

contain all necessary documentation. GAO, Defense Health Care: DOD Needs to Improve 

Force Health Protection and Surveillance Processes, GAO-04-158T (Washington, D.C.: 

Oct. 16, 2003); and Gulf War Illnesses: Research, Clinical Monitoring, and Medical 

Surveillance, GAO/T-NSIAD-98-88, (Washington, D.C.: Feb. 5, 1998). Our analysis for this 

report is considered to be baseline data and cannot be considered comprehensive. 

Page 4 GAO-08-546 Medical Condition of Deployed Soldiers
For a complete discussion of our scope and methodology, see appendix I.

We conducted this performance audit from April 2007 through April 2008 

in accordance with generally accepted government auditing standards. 

Those standards require that we plan and perform the audit to obtain 

sufficient, appropriate evidence to provide a reasonable basis for our 

findings and conclusions based on our audit objectives. We believe that 

the evidence obtained provides a reasonable basis for our findings and 

conclusions based on our audit objectives. 

Commanders may deploy soldiers who have medical conditions that may 

require significant limitations in duty assignment, subject to certain 

requirements; however, the Army lacks enforcement mechanisms to 

ensure that all requirements are met, and various other problems exist 

with regard to record keeping of physical profiles. Based on a random 

projectable sample of soldiers preparing to deploy during April 2006 

through March 2007, we estimate that 3 percent7

 of soldiers from Fort 

Benning, Fort Stewart, and Fort Drum who met the criteria for higher 

evaluation by a medical board did not receive needed evaluations prior to 

being deployed to Iraq or Afghanistan. Army guidance requires a soldier 

diagnosed with a limiting medical condition to be given a physical profile 

indicating the severity of the limitation, and in certain cases, to be 

reviewed by a Military Occupational Specialty Medical Retention Board 

(MMRB) or a Medical Evaluation Board (MEB). Commanders, with the 

assistance of personnel management officers, are responsible for 

determining proper duty assignments for soldiers based on their 

knowledge of the soldiers’ physical profiles and assignment limitations, 

and soldier’s job duties. According to personnel officials, in some cases 

soldiers do not receive needed board evaluations prior to deployment 

because medical officials did not distribute profiles to commanders in a 

timely way, or because commanders did not take needed action prior to 

the soldiers’ deployments. Without performing required medical board 

evaluations, the Army lacks a systematic method for ensuring that 

commanders recognize all cases of medical limitations and assign soldiers 

to duty assignments that suitably accommodate them. Additionally, the 

Army continues to have problems with the completeness and retention of 

physical profiles, and it has been inconsistent in its designations of 

Results in Brief 

 7

All percentage estimates of soldiers at these installations are based on random samples 

and are subject to sampling error. For this estimate, we are 95 percent confident that

between 1 percent and 4 percent of soldiers from these installations did not receive 

required evaluations prior to deployment. 

Page 5 GAO-08-546 Medical Condition of Deployed Soldiers
soldiers’ abilities to perform certain functional activities. Once physical

profiles are prepared, signed, and approved as needed, Army guidance

requires that the physical profiles be retained in soldiers’ medical records. 

At Forts Benning, Stewart, and Drum, we found that 213 physical profiles 

were missing from the 685 medical records of soldiers with medical 

conditions that may require significant limitations. Of the physical profiles 

retained in the sample of these medical records, we determined that 20

profiles were not complete, for example, they lacked necessary approval 

signatures. We found that each installation uses its own process for 

retaining physical profiles, leading to inconsistencies in retention across 

Army installations. The Army intends for all physical profiles to be 

processed and retained in its official electronic medical record system, in 

an effort to correct inconsistencies in profile procedures; however, steps 

have not been taken to implement this change and current plans do not 

ensure that information will be entered and distributed in a timely manner. 

Moreover, from the random projectable sample of soldiers preparing to 

deploy, we estimate that about 7 percent8

 of soldiers from Forts Benning, 

Stewart, and Drum had medical records that indicated they could not 

perform certain functional activities and yet were not designated 

accordingly. While Army medical providers have some flexibility to 

upgrade soldiers’ numerical designations to indicate less severe medical 

conditions based on knowledge of the soldiers’ medical conditions, these 

discretionary upgrades can mask soldiers’ limitations and cause 

commanders to deploy soldiers without needed medical board 

evaluations. While we found no evidence of widespread revision in profile 

designations, some soldiers told us that they disagreed with the numerical

designations they were assigned yet were reluctant to bring their concerns

to their commanders for fear of prejudicial treatment. The Army has 

instituted an ombudsman program to provide a point of contact to whom 

soldiers and family members can bring their concerns, but the program is 

targeted at returning rather than deploying injured soldiers, and it is not 

well publicized as a resource for active duty soldiers with medical 

conditions. 

From our random projectable sample of soldiers preparing for deployment 

between April 2006 and March 2007, we estimate that about 10 percent9

 of 

soldiers from Forts Benning, Stewart, and Drum who have medical 

conditions that could require significant limitations in duty assignments 

 8

The 95 percent confidence interval for this estimate is from 5 to 10 percent of soldiers. 

9

The 95 percent confidence interval for this estimate is from 7 to 12 percent of soldiers. 

Page 6 GAO-08-546 Medical Condition of Deployed Soldiers
were deployed to Iraq and Afghanistan, but we were unable to determine 

whether those soldiers were assigned to duties suitable to their medical

conditions. We were told that soldiers, at times, understate their 

conditions or negotiate with medical providers in order to be deployed 

with their units or to remain in the Army; conversely, in some cases 

soldiers have overstated their medical conditions in order to avoid 

deployment. We estimate that about 86 percent of soldiers from the three 

installations did not have profiles indicating medical conditions that could 

require significant limitations. Of the estimated 14 percent who had such 

medical conditions, approximately two-thirds were deployed. Most of the 

deploying soldiers whose medical records indicated a potential 

requirement for significant duty limitations had conditions such as 

herniated discs, various forms of back pain, or chronic knee pain. We 

could not determine the extent to which the Army assigned soldiers with 

medical conditions to duties that were suitable to their limitations because

of the limited response to our survey. However, our limited survey 

responses and interviews with soldiers and commanders revealed that 

most respondents in both surveys and interviews believed soldiers were 

generally assigned to duties that were suitable to their limitations. We 

spoke with commanders at Forts Benning, Stewart, and Drum, and they 

reported that they were aware of the medical conditions of the soldiers 

with whom they had deployed and always took these conditions into 

account when assigning duties. Most soldiers whom we interviewed or 

who responded to our survey revealed that they were able to accomplish 

most of their duties. For example, one soldier who had back pain limiting 

his ability to carry all necessary combat equipment reported that he had 

discussed this problem with his commander while in theater, and the 

commander had reassigned him to duties that did not require wearing all 

his equipment. Commanders we interviewed noted that they occasionally

required their soldiers to perform duties potentially exceeding the soldiers’ 

medical limitations, in some cases because a soldier’s physical profile did

not reflect all necessary medical information, or in other cases because the 

soldier had special skills that were difficult to replace. 

We are recommending that the Army take several actions; first, to help 

ensure that soldiers with medical conditions are appropriately evaluated 

and assigned to suitable duties while deployed, and second, to help ensure

that active duty soldiers and their families have access to a point of 

contact to whom they can bring concerns regarding recognition of their 

medical limitations prior to and during deployment. In commenting on a 

draft of this report, DOD concurred with our recommendations; we 

summarize these comments and provide our response in our Agency 

Comments section. 

Page 7 GAO-08-546 Medical Condition of Deployed Soldiers
Various pieces of DOD guidance provide overall direction and require the 

services to define medical deployment standards to ensure that 

servicemembers deploying to a theater of operations are in optimal 

health.10 DOD allows the military services to deploy servicemembers who 

do not meet the services’ medical standards under certain conditions. For 

example, a service is required to obtain a waiver from the Combatant 

Command Surgeon if the service wishes to deploy a servicemember who 

does not meet deployment standards and can receive medical treatment at 

deployed locations that will render them fit for duty.11 DOD guidance 

requires the services to continue to employ measures that ensure 

servicemembers are medically and psychologically fit for worldwide 

deployability, taking into account additional guidance provided by the 

combatant commander on theater-specific medical limitations. The 

Assistant Secretary of Defense for Health Affairs is planning to release 

new guidance that provides more guidelines on medical conditions that, in

general, should preclude servicemembers from being deployed. Because 

DOD has not determined the issue date and has not yet implemented this 

new guidance, we were not able to evaluate its effect during our review. 

Background 

The Offices of the Surgeon General of each military service have 

established procedures to evaluate the health conditions of their 

servicemembers according to service-specific medical standards.12 Our 

prior work has shown that the Army, Air Force, Navy, and Marine Corps 

all have different methods of assessing their servicemembers’ medical 

readiness prior to deployment and documenting any medical conditions 

 10Under Secretary of Defense for Personnel and Readiness, Department of Defense 

Instruction 6490.03, Deployment Health (Aug. 11, 2006); Under Secretary of Defense for 

Personnel and Readiness, Memorandum, Policy Guidance for Medical Deferral Pending 

Deployment to Theaters of Operation (Feb. 9, 2006); Under Secretary of Defense for 

Personnel and Readiness, Department of Defense Instruction 6025.19, Individual Medical 

Readiness (IMR) (Jan. 3, 2006); Under Secretary of Defense for Personnel and Readiness, 

Department of Defense Instruction 6200.05, Force Health Protection Quality Assurance 

Program (Feb. 16, 2007); Assistant Secretary of Defense, Memorandum, Policy for 

Department of Defense Deployment Health Quality Assurance Program (Jan. 9, 2004); 

U.S. Central Command, Individual Protection and Individual/Unit Deployment Policy, PPG 

Modification 8 (July 2007). 

11In our review, we did not find that soldiers in our sample who had deployed were 

considered not deployable due to their medical condition and thus, we did not find

instances of waivers in order to deploy soldiers in our sample. 

12U.S. Army Regulation 40-501, Standards of Medical Fitness (Jan. 18, 2007); U.S. Air Force 

Instruction 10-203, Duty Limiting Conditions (Oct. 25, 2007); and U.S. Navy Manual of the 

Medical Department NAVMED p-117 (Aug. 12, 2005). 

Page 8 GAO-08-546 Medical Condition of Deployed Soldiers
and limitations. The Army’s guidance, similar to the other services’ 

guidance, allows the commander to have the ultimate authority to deploy

servicemembers and make proper duty assignments, if certain procedures 

are followed, while taking into account the medical provider’s assessment 

of a servicemember’s medical condition and duty limitations. 

Army Guidance The Army Office of the Surgeon General and Army Deputy Chief of Staff 

(G-1) provide guidance on soldiers’ medical readiness. Regarding medical 

matters, the Army Office of the Surgeon General heads the Army Medical 

Command, which provides guidance to Army medical treatment facilities. 

Medical Evaluation Boards (MEB) of soldiers are conducted at medical 

treatment facilities at Army installations. Regarding command matters, the 

Army Manpower and Reserve Affairs Office works with the Army Deputy 

Chief of Staff G-1 to provide guidance to human resource directorates at 

each installation. The Deputy Chief of Staff G-1 has overall responsibility 

for the Physical Performance Evaluation System which involves an 

administrative screening board known as the Military Occupational 

Specialty Medical Retention Board (MMRB). 

Army Regulation 40-501 requires that the Army document physical and

mental conditions that may limit a soldier’s ability to perform his or her 

duties on the physical profile form. Using the physical profile, Army 

medical providers, who serve as profiling officers, provide 

recommendations on a soldier’s medical limitations in order to assist the 

commander in properly assigning the soldier to duties that contribute to 

the unit’s mission. A profiling officer creates a physical profile that 

documents any limitations found during a medical examination, and 

identifies whether the medical limitation is temporary, in which case a 

short-term condition can be improved by further treatment, or permanent, 

in which case a chronic condition will not improve with medical treatment 

at that point in time. The profiling officer classifies the medical limitations 

under six categories: 

Physical Profiles 

• physical capacity 

• upper extremities 

• lower extremities 

• hearing 

• eyes 

• psychiatric 

These categories are often abbreviated as the “PULHES” factors (see 

app. III for further detail). The medical limitations in physical profiles are 

Page 9 GAO-08-546 Medical Condition of Deployed Soldiers
also given a numerical designation from 1 to 4 to reflect the different levels

of functional capability and severity of impairment. Soldiers with physical 

profiles designated by the number 1 are considered to have a high level of

medical fitness; a 2 indicates that a soldier has some medical condition or

physical defect that may require some activity limitations; a 3 under one or 

more of the factors indicates that the soldier has a medical condition or 

physical defect that may require significant limitations in duty assignment; 

and soldiers designated by the number 4 must have their military duties 

drastically limited.13 Profiling officers must also specify whether the 

soldier can perform certain functional activities comprising the minimum 

requirements needed in order to be medically qualified for worldwide 

deployment.

Profiling officers should evaluate a soldier who has a temporary profile at 

least once every 3 months to determine whether the soldier’s medical 

condition has improved or, if not, whether an extension of up to 12 months 

is needed. If an extension is needed beyond 12 months, a temporary 

profile should be changed to a permanent profile. Permanent and 

temporary profiles normally require the signature of only the profiling 

officer. Both the signatures of the profiling officer and a higher level 

medical provider, who is designated the approving authority, are required

when a permanent profile number is designated at 3 or 4, or when a 

permanent profile designation has been changed from a 3 to a 2. 

According to profiling officers, during the preparation of the physical 

profile and medical evaluation of the soldier, the profiling officer may 

communicate with the commander of the soldier for the purpose of better

identifying the soldier’s medical limitations. All permanent physical 

profiles are coded to designate any assignment limitations, including 

whether a soldier has been reviewed by an MMRB or a Physical Evaluation 

Board.14 Once the physical profile is signed by profiling officer, and 

approved by the designated approving authority as needed, Army 

regulation 40-501 requires that the completed physical profile should be 

retained in the soldier’s medical record and copies of it should be 

 13During our review at the three installations, we only reviewed one physical profile 

designated at level 4. It was a temporary profile and the soldier did not deploy with it in

effect. 

14Currently, no code exists for soldiers reviewed by an MEB who were not also reviewed by 

a subsequent Physical Evaluation Board. The Army plans to correct this oversight in the

next revision of Army regulation 40-501. See appendix IV for full description of profile 

codes from AR 40-501. 

Page 10 GAO-08-546 Medical Condition of Deployed Soldiers
distributed to the unit commander and the soldier. For permanent physical 

profiles, one more copy is distributed to the military personnel office. 

Army medical records comprise both hard copy documents and an 

electronic system called the Armed Forces Health Longitudinal 

Technology Application (AHLTA), the official system for retaining 

soldiers’ medical documentation. AHLTA is used DOD-wide and gives 

medical providers access to soldiers’ medical information, including 

medical evaluation history, prescriptions, diagnostic tests, and physical 

profile information. The Army also tracks soldiers’ medical readiness 

information through the Army Medical Protection System (MEDPROS), in 

order to allow commanders to have access to soldiers’ medical 

information that might affect readiness, but this system retains limited 

information only on permanent physical profiles and does not supply any 

detailed description of medical limitations or incapacity to perform 

functional activities. 

Because physical profiles merely represent medical recommendations 

made by the profiling officer to a soldier’s commander, physical profile 

designations do not automatically determine whether a soldier is 

deployable or not. Three Army regulations require higher levels of review 

for soldiers with a numerical designation of at least a 3 in order to assist 

commanders in properly assigning soldiers to duties suitable to their 

medical limitations.15 Army guidance states that once soldiers receive a 

permanent profile designation of at least a 3, they are not deployable for 

the duration of the MMRB or MEB until the board is concluded.16

MMRB and MEB Evaluations 

If a soldier receives a permanent profile of at least a 3, the profiling officer

and approving authority must provide an initial determination of whether 

the soldier meets Army medical standards or not.17 If they believe that a 

soldier meets medical standards, Army regulation 600-60 requires that the 

soldier be reviewed by an MMRB to determine whether the soldier is able

to complete the duties in his or her job assignment or needs to be 

reassigned to a job that accommodates his or her limitations. The MMRB 

 15Army Regulation 40-501; Army Regulation 600-60, Physical Performance Evaluation 

System (June 25, 2002); Army Regulation 40-400, Patient Administration (Feb. 6, 2008). 

16Army Regulation 600-60 (June 25, 2002). 

17Army Regulation 40-501, chapter 3, lists certain diseases or medical conditions that could

severely limit a soldier’s ability to perform his or her duties, such as heart disease, cirrhosis 

of the liver, chronic asthma, and epilepsy. 

Page 11 GAO-08-546 Medical Condition of Deployed Soldiers
consists of five voting members, including a medical provider, a senior 

commander, and when reasonably available, soldiers of the same branch 

or specialty as the soldier being evaluated as well as non-voting members 

including a personnel advisor, a recorder, and anyone else to ensure a fair 

hearing. Once the personnel office receives the permanent profile from the 

medical administrative office and convenes an MMRB, the recorder will 

assemble the soldier’s personnel records and medical records. The 

commander will prepare an evaluation of the impact of the profile 

limitations on the soldier’s ability to perform the full range of duties in the 

soldier’s job assignment, known as a Military Occupational Specialty 

(MOS). During the MMRB, the personnel advisor will summarize the 

details of the soldier’s current MOS and common duties, and the medical 

provider will brief the MMRB on the soldier’s physical profile. The soldier 

will also present facts or call witnesses relevant to his or her physical 

performance, current MOS retention, or MOS reclassification preference. 

The MMRB can recommend either that (1) the soldier remain in the Army 

under his or her current military occupational specialty or specialty code,

(2) the soldier be placed in probationary status for up to 6 months to 

improve the condition of a disease or injury, (3) the soldier be reclassified 

into another occupational specialty, or (4) the soldier be referred to the 

MEB for medical disqualification processing. 

Active component Army soldiers should appear before an MMRB within 60 

days of the date the physical profile is signed by the medical provider who 

is designated the approval authority. Army regulation 600-60 requires that 

personnel officials responsible for convening the MMRB maintain 

statistics on each case in order to assess whether or not MMRB 

evaluations are convened within the 60-day time limit. As of March 2008, 

officials now are required to report the statistics to the Deputy Chief of 

Staff of the Army. 

Alternatively, if a profiling officer and the approving authority believe that

a soldier with a permanent profile designation of at least a 3 does not meet 

medical standards, Army regulation 40-501 requires that the soldier should 

be reviewed by an MEB to fully ascertain the soldier’s medical condition 

and limitations. From the MEB results, a subsequent Physical Evaluation 

Page 12 GAO-08-546 Medical Condition of Deployed Soldiers
Board determines whether the soldier is to be retained in the Army or not, 

and the applicable disability rating.18

There are two ways in which an MEB is initiated: by referral from the 

medical provider designated as the approving authority or by referral from 

an MMRB. When an MEB is referred by an approving authority, the 

soldier’s physical profile is distributed to the Physical Evaluation Board 

liaison officer at the medical treatment facility, who is responsible for the 

case management of the soldier. A medical provider reexamines the 

servicemember and reviews his or her medical history, including prior test 

results, diagnoses, and treatments. The medical provider will then 

complete a narrative summary to document the nature and degree of 

severity of the soldier’s condition. The commander also provides a letter 

describing how the soldier’s medical condition affects job performance 

and deployability status. Also provided is a summary of the soldier’s chief 

complaint, stated in the soldier’s own words. MEBs are composed of two 

or more physicians, one being a senior medical provider with detailed

knowledge of Army medical standards and procedures, and other 

members having familiarity with these matters. MEB evaluations must be 

completed within 90 days of approval of the physical profile, or of the date 

when the MMRB referral is received by the liaison officer. The MEB could 

result in several outcomes, including: (1) the soldier is returned to duty,

with a profile marked that he or she meets medical retention standards; or 

(2) the soldier is referred to a Physical Evaluation Board to determine 

whether he or she has lost the ability to perform assigned duties because 

of a medical condition and thus is unfit for duty, or the soldier is fit for 

duty and thus is retained in the Army. 

An Army memorandum requires that the liaison officers track certain 

statistics and use an electronic database system to ensure that MEB 

evaluations are completed within 90 days.19 This information is reported 

quarterly to the Deputy Under Secretary of Defense for Military Personnel 

Policy. 

 18The MEB and Physical Evaluation Board processes are together called the Physical 

Disability Evaluation System, but because a soldier is not evaluated by a Physical 

Evaluation Board without first going through an MEB, we refer to this in the report as the 

MEB process.

19Chief of Staff of the United States Army, Memorandum, Metrics and Continuous Process 

Improvements for Medical Evaluation Board (MEB) and Physical Evaluation Board 

(PEB) Processing (Sept. 26, 2007). 

Page 13 GAO-08-546 Medical Condition of Deployed Soldiers
According to a DOD instruction,20 within 60 days prior to deployment, 

soldiers complete a pre-deployment health assessment form21 to reflect 

soldiers’ medical readiness with respect to immunizations, dental, 

hearing/eye exams, and medical limitations on physical profiles. If a 

soldier indicates on the pre-deployment health assessment form that he or 

she is on a profile, or light duty, or undergoing a medical board, the soldier 

is referred to a medical care provider for reevaluation and verification of 

the medical limitations under the physical profile. If a soldier does not 

meet the medical requirements under the pre-deployment health 

assessment, the soldier is classified as not deployable, until the soldier 

receives further treatment. Moreover, if a soldier is also undergoing an 

MMRB or MEB, the soldier is considered not deployable until the 

evaluation is completed and the soldier is found fit for duty. The predeployment health assessment is updated to indicate that the soldier is 

deployable once he or she receives treatment or undergoes a board 

screening and is found fit for duty. 

Pre-deployment Health 

Assessments 

Under Army regulation 40-501, Army commanders have the ultimate 

authority to deploy soldiers, but commanders are required to recognize 

soldiers’ limiting conditions and assign them duties consistent with their 

limiting conditions, with the assistance of personnel management officers 

from Army Forces Command and Human Resources Command. 

The Army allows commanders to deploy soldiers who have medical 

conditions that may require significant limitations in duty assignment as 

long as they meet requirements in the guidance, including board 

evaluations, suitable duty assignments, and available medical treatment in 

deployed locations, if needed; however, the Army is not meeting all 

requirements to ensure board evaluations are conducted within prescribed 

time frames, and various problems exist with regard to physical profile 

record keeping. Army requirements for deploying soldiers with medical 

conditions are not always being met; commanders are not always aware of 

medical limitations in a timely way, and in the sample review, we found 

that commanders are not always adhering to guidance to ensure that 

soldiers are not being deployed to Iraq or Afghanistan prior to having 

needed MMRB or in some cases MEB evaluations. Furthermore, the Army 

continues to have problems with retention and completeness of its 

Army Is Not Meeting 

All Requirements for 

Deploying Soldiers 

with Medical 

Conditions and Has 

Unresolved Problems 

with Medical Record 

Keeping 

 20Department of Defense Instruction 6490.03 (Aug. 11, 2006).

21See appendix V for a copy of the pre-deployment assessment form DD 2795.

Page 14 GAO-08-546 Medical Condition of Deployed Soldiers
physical profiles, as well as a lack of consistency in designations with 

regard to soldiers’ abilities to perform functional activities. While we did 

not find widespread revision of profiles prior to deployment, we found 

that soldiers were concerned about how the Army was addressing their 

medical problems prior to deployment. While commanders may recognize 

medical limitations on a case by case basis, without performing required 

medical board evaluations, the Army lacks a method for ensuring that all 

such cases are appropriately recognized. 

While Army guidance allows commanders to deploy soldiers with medical 

conditions that may require significant limitations in duty assignments, 

subject to certain requirements, we found that commanders are not always 

aware of soldiers’ medical limitations when making deployment decisions, 

and they do not always adhere to these requirements. Army guidance 

requires that whenever a new physical profile is created, copies of 

physical profile documentation, once authorized by the approving medical 

authority, should be added to a soldier’s medical record and given to the 

soldier, his or her commander, and the command’s personnel office.22

Army guidance stipulates that soldiers with a permanent profile containing 

a numerical designation of a 3 or 4 who meet Army medical retention 

standards should be evaluated by an MMRB within 60 days of receiving the 

approved physical profile, to determine whether the soldier is able to 

complete all the duties in his or her current job assignment or should 

alternatively be reassigned to a job that accommodates his or her medical 

limitation(s).23 Alternatively, a soldier with a permanent profile of a 3 or 4 

who is believed by a profiling officer not to meet medical standards must 

be evaluated by an MEB within 90 days to determine whether that soldier 

should be retained in the Army.24 Moreover, within 60 days prior to 

deployment, DOD guidance requires the Army to review soldiers for 

medical readiness.25 During this pre-deployment assessment, soldiers who 

report having a physical profile must be referred to a medical provider, 

which according to medical providers may result in an updated 

confirmation of their numerical designation. If a soldier receives a new 

profile indicating a medical condition that may require significant 

Army Requirements 

for Deploying Soldiers 

with Medical 

Conditions Are Not 

Always Being Met 

 22Army Regulation 40-501 (Jan. 18, 2007). 

23Army Regulation 600-60 (June 25, 2002). 

24Army Regulation 40-400 (Feb. 6, 2008). 

25DOD Instruction 6490.03 (Aug. 11, 2006). 

Page 15 GAO-08-546 Medical Condition of Deployed Soldiers
limitations in assignment, Army guidance categorizes the soldier as not 

deployable until he or she is reviewed by an MMRB or in some cases 

MEB.26 Commanders, with the assistance of personnel management 

officers, are responsible for determining proper duty assignments for 

soldiers based on their knowledge of soldiers’ physical profiles, 

assignment limitations, and the need for accomplishing necessary duties 

within the soldiers’ MOS. Commanders may also consider the availability 

of medical treatment at deployed locations when determining the 

deployability of soldiers with physical profiles. 

At Forts Benning, Stewart, and Drum, we found that commanders are not 

always adhering to requirements in Army guidance to ensure that needed 

board evaluations are performed. After reviewing 685 medical records and 

the deployment information of soldiers who were preparing for 

deployment in the statistically valid sample, we estimate that 6 percent of 

soldiers from Forts Benning, Stewart, and Drum were deployed with 

designations of permanent 3 in their physical profiles—signifying to a

commander that they have medical conditions that may require significant 

limitations.27 These soldiers should have been reviewed prior to 

deployment by a MMRB, or MEB as needed, in accordance with Army 

regulations.28 Further, we estimate that about 3 percent of the soldiers 

from Forts Benning, Stewart, and Drum had profiles that indicated that 

they met medical retention standards and required an MMRB, or may not 

meet standards and required an MEB, but were deployed without having

been reviewed by an MMRB or MEB.29 Figure 1 summarizes percentages 

(and confidence intervals) of soldiers with profile designations of 

permanent 3 who deployed from Forts Benning, Stewart, and Drum, and 

the percentage of those soldiers who did not receive evaluation by an 

MMRB or MEB prior to deployment.

 26Army Regulation 600-60 (June 25, 2002). 

27The 95 percent confidence interval for this estimate is from 4 to 8 percent of soldiers. 

28Although the Army may obtain a waiver in order to deploy soldiers that do not meet

medical fitness standards if medical treatment is available in theater according to DOD 

guidance, we did not find evidence of any waivers. 

29The 95 percent confidence interval for this estimate is from 1 percent to 4 percent of 

soldiers.

Page 16 GAO-08-546 Medical Condition of Deployed Soldiers
Figure 1: Estimated Percentage of Soldiers with Physical Profile Designations of 

Permanent 3 Who Deployed and Percentage of Soldiers Who Did Not Receive PreDeployment Evaluation by MMRB or MEB 

0

5

10

15

20

25

30

35

40

45

50

0

5

10

15

20

25

30

35

40

45

50

Total

Ft. Drum

Ft. Stewart

Ft. Benning

(n=189)

(n=259)

(n=237)

(n=685)

Percentage

Source: GAO analysis of DOD data.

Installation

Soldiers who deployed with a permanent 3 profile

Soldiers that deployed with a permanent 3 profile not reviewed by MEB or MMRB

Equals 95 percent confidence interval, upper and lower bounds for each estimate

In our sample, we found that of the 42 soldiers who had profile 

designations of permanent 3, 17 soldiers did not receive needed board 

evaluations prior to their deployment. Although we could project this as a 

percentage of the soldiers from Forts Benning, Stewart, and Drum, we did 

not project this as a percentage of the 42 soldiers who had profile 

designations of a permanent 3 because the size of this subgroup in the 

sample is not sufficient to report a reliable confidence interval for a 

population estimate. Table 1 shows the number of soldiers in the sample 

with permanent physical designations of 3 who did not receive predeployment evaluations by MMRB or MEB. 

Page 17 GAO-08-546 Medical Condition of Deployed Soldiers
Table 1: Number of Soldiers in the Sample with Permanent Physical Profile 

Designations of 3 Who Did Not Receive Pre-Deployment Evaluation by MMRB or

MEB 

Army 

installation 

Number of soldiers who 

deployed with permanent 

profiles of 3

Number of deployed soldiers 

with permanent profiles of 3 

not reviewed by MMRB or MEB

Fort Benning 11 5

Fort Stewart 16 7

Fort Drum 15 5

 Total 42 17

Source: GAO analysis of DOD data. 

Notes: The size of this subgroup in the sample is not sufficient to report a reliable confidence interval 

for a population estimate. Therefore, we did not project this subgroup to the population of Forts 

Benning Stewart, and Drum. MEB evaluations are conducted in cases where retention is in question. 

These needed evaluations may not be occurring because each of the three 

installations lacked an enforcement mechanism to ensure all procedures 

are followed. According to medical providers, commanders, and personnel 

officials, in some cases soldiers do not receive their MMRB or MEB 

evaluations because profiles were not distributed by the approving 

authority or medical administrative office in time to inform commanders 

of the existence of the profiles. In other cases, according to personnel 

officials, commanders were given notice of the profiles but did not take 

needed action on time, but we were not able to determine why this 

occurred. 

Moreover, we found that while Army personnel officials at the three 

installations we visited were maintaining proper data on MEB evaluations, 

they were not maintaining required statistics on the performance of MMRB 

evaluations. Army guidance requires that medical and personnel officials 

have to maintain certain statistics in order to know whether MEB or 

MMRB evaluations are conducted within set time frames.30 Personnel 

officials told us that they kept informal data on each MMRB case in 

separate files, such as the date of the approved profile, the date it was 

received, and the date of the MMRB. However, this information was not 

summarized as would be needed in order to calculate the period of time 

that elapsed between the stages of MMRB evaluations. Prior to February 

 30Army regulation 600-60 (June 25, 2002); Chief of Staff of the United States Army, 

Memorandum (Sept. 26, 2007). 

Page 18 GAO-08-546 Medical Condition of Deployed Soldiers
2008, the Army did not require that these statistics be reported to anyone. 

The Army revised its regulation 600-60 to require the reporting of quarterly 

statistics to the Deputy Chief of Staff of the Army beginning in March 2008. 

That change may lead to better oversight of the timeliness of the MMRB, 

but we were not able to assess the impact of this recent change during this 

review. 

Without performing all required medical board evaluations or tracking the 

timeliness of board evaluations, the Army lacks a systematic method for 

confirming that commanders recognize all cases of medical limitations and 

assign soldiers to duty assignments that suitably accommodate them. 

Medical records are intended to provide a soldier’s history of medical 

treatment and limitations, and Army regulation 40-501 requires that once 

physical profiles are prepared and signed, the profiles should be kept in a 

soldier’s medical record. These completed profiles include the numerical 

designation, a description of medical limitations, the signature of the 

profiling officer and approving authority, as needed, and the dates of the 

signatures. Medical records comprise both the hard copy and electronic 

versions of medical information. Commanders use physical profiles to 

assess soldiers’ physical ability to perform their duties. 

When we compared records in the official electronic medical system, 

AHLTA, and hard copy records with those in an electronic medical 

readiness system, MEDPROS, we found that 213 physical profiles were 

missing from the 685 medical records of soldiers in the sample who had a 

medical condition that may require significant limitations at Forts 

Benning, Stewart, and Drum. Further, of the physical profiles that were 

retained in the sample of medical records of soldiers with medical 

conditions that may require significant limitations, we found that 20 were 

not complete. Specifically, both hardcopy and electronic medical records 

lacked profiles with the appropriate signatures and dates of final approval. 

Soldiers’ Medical 

Records Are Not 

Always Complete and 

Do Not Always Retain 

Profiles, and 

Numerical 

Designations Are Not 

Consistently 

Determined 

These problems may be occurring because each installation uses its own 

informal process for approving and distributing completed physical 

profiles to the soldier, commander, and medical record. For example, at 

Forts Benning and Stewart, a profiling officer would consult with the 

soldier and his commander in creating the profile, and if the physical 

profile were permanent and designated a 3 or 4, the medical provider who 

created the profile would provide it to the approving medical provider. 

The approving medical provider would then provide it to personnel 

officials in order to initiate an MMRB or to the liaison officer to initiate an 

Page 19 GAO-08-546 Medical Condition of Deployed Soldiers
MEB, if needed, and would also provide it to the medical administrative 

office, to be retained in the medical record. Officials did not strictly adhere

to time frames during this process, and personnel officials expressed 

doubt to us as to whether they received all physical profiles. Medical and 

command officials at Fort Drum stated that their process was also 

informal and they did not strictly adhere to timeframes, but they retained

hard copies of all permanent physical profiles separate from the soldiers’ 

medical records at the liaison officer’s administrative office. Without a 

systematic method for approving and distributing profiles, current 

informal processes have led to inconsistencies in retention of the physical

profiles in the medical record. The electronic personnel system also 

contains medical information, and we found that it is not being routinely 

updated. As a result, communication to commanders about physical 

limitations in many cases comes from the soldiers themselves, rather than

the medical record system or personnel system. 

Army officials intend to require that all physical profiles be processed and

retained in the AHLTA electronic medical system; however, steps have not

been taken to implement the system change. The system change will 

require that physical profiles be approved and routed electronically to

commanders, medical providers, and the personnel offices to initiate MEB 

and MMRB proceedings. This change is intended to correct the limited 

visibility over profile information and inconsistencies in profile 

procedures, similar to the issues we have found in this review at Forts 

Benning, Stewart, and Drum. However, Army officials told us they have 

not finalized plans for actions needed and associated milestones to 

implement these changes. Moreover, current plans do not ensure that the

information will be entered and distributed in a timely manner, as officials

who convene the MMRB or MEB do not have authority to compel timely 

system input by commanders and medical providers. 

Finally, the Army is not consistent in its use of numerical designations in 

profiles to reflect a soldier’s ability to perform certain functional activities. 

Army guidance states that when soldiers are not able to meet certain 

requirements they are given a numerical designation of at least 3, and this

designation should result, in most instances, in a review of their cases by 

an MMRB or MEB. When profiling officers prepare physical profiles 

carrying a designation of 2, these profiles do not generally receive further 

review, until the soldier indicates he or she is under a physical profile at 

the pre-deployment assessment. Based on our random projectable sample 

of soldiers preparing to deploy between April 2006 and March 2007, we 

estimate that about 7 percent of the soldiers who were preparing for 

deployment at Forts Benning, Stewart, and Drum had physical profiles in 

Page 20 GAO-08-546 Medical Condition of Deployed Soldiers
their medical record showing the inability to perform functional activities

yet were not designated with a score of at least 3.31 Figure 2 shows the 

estimated percentage (and confidence intervals) of soldiers by Army 

installation who had profiles that indicated that they were unable to 

perform certain functional activities, yet the profiles had a designation 

of 2. 

Figure 2: Estimated Percentage of Soldiers Unable to Perform Functional Activities

Yet Designated as 2 in Their Profiles 

0

5

10

15

20

25

30

35

40

45

50

0

5

10

15

20

25

30

35

40

45

50

Total

Ft. Drum

Ft. Stewart

Ft. Benning

(n=189)

(n=259)

(n=237) 

(n=685)

Percentage

Source: GAO review of Army records.

Installation

Soldiers with profile designations of 2, unable to perform functional activities

Equals 95 percent confidence interval, upper and lower bounds for each estimate

The physical profile form defines performance of functional activities 

according to whether the soldier is: (1) able to carry and fire his or her 

individually assigned weapon; (2) able to move a fighting load of 48 

pounds for at least 2 miles; (3) able to wear his or her protective mask and

all chemical defense equipment; (4) able to construct an individual fighting

 31The 95 percent confidence interval for this estimate is from 5 to 10 percent of soldiers. 

Page 21 GAO-08-546 Medical Condition of Deployed Soldiers
position; (5) able to perform 3-5 second rushes under direct or indirect 

fire; and (6) healthy, without any medical condition that prevents 

deployment. Army regulation 40-501 allows for some flexibility in the 

medical provider’s designation of numerical designation in a soldier’s 

profile, and according to medical providers, they may upgrade

designations based on their knowledge of the soldier’s medical condition 

and the soldier’s capacity to handle medical limitations. However, 

discretionary upgrades can mask a soldier’s limitations such that a 

commander might deploy the soldier without benefit of MMRB evaluation

and may place the soldier in duties unsuitable to his or her limitations. 

We did not find widespread revision of profiles by profiling officers or 

approving authorities prior to deployment. Only 1 percent of the physical

profiles we reviewed were changed from a permanent 3 to 2 within a few 

months prior to the soldier’s deploying. Upgrades in numerical 

designations are generally annotated by remarks in the descriptive text 

included in a soldier’s profile, and they must include a second approving 

medical provider’s signature. However, informal discussions between 

soldier and medical provider can result in a change in the profile 

designation that may not be noted in the profile. In one case, we found 

that a soldier’s profile was changed from a 3 to a 2 without meaningful 

annotation, and lacking the requisite second approving signature. This 

soldier reported to us that she had not undergone a new medical diagnosis 

prior to the profile upgrade; however, she also had told her medical 

provider that she did not want to go through an MMRB or MEB and 

thereby risk being removed from the Army. According to Army officials, 

soldiers’ medical conditions may have improved for various reasons, such 

as undergoing surgery or additional physical therapy. 

Although we found no evidence of widespread revision in numerical 

designations, in our surveys to deployed soldiers or our interviews with 

Army personnel officials and family members of deployed soldiers, some 

soldiers or family members expressed concerns to us that they were 

uninformed about how the Army was addressing their medical problems 

prior to deployment, and they knew of no venue to resolve their 

complaints. In surveys, two additional soldiers also stated that they did not 

feel they had been correctly graded in their physical profile designations, 

but were reluctant to discuss the matter with their commanding officers 

for fear of prejudicial treatment. One soldier stated that her physical 

profile had been changed without further physical examination. The other 

soldier noted that her physical profile designation was upgraded even 

though a medical provider had added more limitations after examining 

her, and she did not agree that the profile expressed all the limitations 

Page 22 GAO-08-546 Medical Condition of Deployed Soldiers
caused by her back, knee, and shoulder ailments. We reviewed the 

documentation in the physical profiles of these soldiers and the profiles 

contained requisite approving signatures, dates, and descriptions of 

limitations. However, our analysis did not evaluate the medical providers’

diagnoses of the medical conditions, because we are not qualified to 

evaluate the providers’ medical judgment. Moreover, we would not be able

to determine from the documentation if the soldier did not agree with the 

profile, whether the profile was changed without further physical 

examination, or whether the medical provider or the soldier fully 

communicated all of the issues involved. 

Army personnel officials told us that they were unable to assist soldiers 

bringing complaints about not being evaluated by a medical board when 

the soldiers received a new permanent profile prior to their deployment, 

because the officials do not have access to soldiers’ medical information 

and do not have the authority to enforce time frames. These officials had

also been contacted by soldiers’ family members who were concerned that 

the soldiers would be deployed and their conditions would worsen at 

deployed locations. An Army personnel official told us that soldiers 

sometimes questioned whether they were to be evaluated by a board prior 

to deployment, but by the time this official received the physical profile to

initiate an MMRB, the soldiers had already been deployed. Because the 

officials do not have access to all medical information, they would not be 

able to verify whether soldiers’ profiles were approved. These situations 

may be occurring because physical profiles are not being distributed in a 

timely manner. Also, because Army personnel officials do not have the 

authority to enforce time frames, they could not compel commanders to 

provide timely input for the approval of the profile or compel designated 

approving authorities to distribute the approved profiles. Thus, although

Army personnel officials may believe that physical profiles are not being 

delivered in a timely manner, they do not have the ability to resolve these 

soldiers’ complaints. 

Issues regarding proper medical evaluation of soldiers prior to deployment 

could be resolved by having a designated point of contact to whom 

soldiers and family members can bring their concerns. Such a point person 

would require access to the soldier’s medical information and the ability to 

resolve any problems and questions about a soldier’s medical readiness. 

This person would also need to work independently of the operations 

commander in order to prevent bias or coercion by the commander in 

resolving soldier issues. 

Page 23 GAO-08-546 Medical Condition of Deployed Soldiers
In September 2007, the Army Medical Command created a program to 

designate an ombudsman, or point of contact, available for each 

installation to whom soldiers can bring concerns on issues such as health

care, pay, physical disability processing, and transition to the Veterans 

Administration. The Army memorandum32 establishing this program states 

that ombudsmen will resolve complaints, assist in obtaining accurate 

information, and act as advocates specifically for soldiers assigned to the 

Warrior Transition Unit and their families. According to ombudsmen at 

Forts Benning, Stewart, and Drum, they may also provide support for any 

soldier or family member of a soldier who needs assistance, through walkins or through the Army Wounded Soldier and Family Hotline. In 

accordance with the memorandum, the ombudsman will be independent

from commanders at the installation, and will work closely with the 

Medical Assistance Group, which is part of the Army Medical Command 

under the Army Surgeon General’s leadership at Fort Sam Houston, Texas. 

However, the ombudsman program is not broadly publicized as a resource 

for active duty soldiers with medical conditions or their family members. 

We were not able to fully evaluate how effectively the ombudsman 

program would be able to resolve the issues brought by deploying soldiers 

as opposed to soldiers in the Warrior Transition Unit and their family 

members, as the ombudsman program has only recently been

implemented. It was not fully implemented at the time of our review at 

Forts Benning, Stewart, and Drum. Ensuring that soldiers who are not part 

of the Warrior Transition Unit and their family members are aware of and 

have access to the ombudsman program may help to alleviate some of 

these concerns brought forth by deploying soldiers. 

As a result of the various medical record deficiencies and discretionary 

profile revisions discussed, commanders’ visibility over their soldiers’ 

potential medical conditions cannot be ensured. Furthermore, without a 

well-publicized ombudsman program, soldiers preparing for deployment 

cannot be assured of having the opportunity to air and resolve their 

medical concerns. 

 32Army Office of the Surgeon General/Army Medical Command Policy Memorandum, 

Ombudsman Program in Support of Warriors in Transition (Sept. 6, 2007). 

Page 24 GAO-08-546 Medical Condition of Deployed Soldiers
Based our review of medical records from Forts Benning, Stewart, and 

Drum, we estimate that about 10 percent of active duty soldiers with 

profiles indicating medical conditions that could require significant 

limitations in duty assignments were deployed to Iraq and Afghanistan. 

Although Army guidance allows for the deployment of soldiers with 

medical conditions, it requires commanders to assign soldiers to duties 

that are suitable to their limitations. Because of the low response rate to 

our survey, we were unable to determine the extent to which these 

soldiers were in fact assigned duties suitable to their medical conditions. 

From the limited responses to our survey and from interviews with 

soldiers, most reported that they were able to accomplish most of their 

duties, although they were sometimes required to perform duties 

exceeding their medical limitations. 

We reviewed 685 medical records taken from a random projectable sample

of active component soldiers who were preparing for deployment between 

April 2006 and March 2007 from Forts Benning and Stewart, in Georgia, 

and Fort Drum, in New York. From these installations, we estimate that 86 

percent of soldiers, did not have profiles indicating medical conditions 

that could require significant limitations in duty assignments.33 We 

estimate that 14 percent of soldiers preparing to deploy from Forts 

Benning, Stewart, and Drum had profiles indicating conditions that could 

require significant limitations: specifically, soldiers with physical profile 

designations of 3 or 4, or who indicated that they could not perform 

certain functional activities.34 Figure 3 shows the total number of records 

reviewed and the estimated percentage (and confidence intervals) of 

soldiers who had medical impairments that could require significant 

limitations by installation from Forts Benning, Stewart, and Drum. 

One In 10 Soldiers in 

the Projectable 

Sample Who Has a 

Medical Condition 

Has Deployed, but We

Were Unable to

Determine Duty 

Suitability 

Some Deploying 

Soldiers Have Medical 

Conditions 

 33The 95 percent confidence interval for this estimate is from 84 to 88 percent of soldiers. 

34The 95 percent confidence interval for this estimate is from 12 to 16 percent of soldiers. 

Page 25 GAO-08-546 Medical Condition of Deployed Soldiers
Figure 3: Comparison of Estimated Percentages of Soldiers with Profiles Who May 

Require Significant Duty Limitations against Those Who Do Not 

0

10

20

30

40

50

60

70

80

90

100

0

10

20

30

40

50

60

70

80

90

100

Total

Ft. Drum

Ft. Stewart

Ft. Benning

(n=189)

(n=259)

(n=237)

(n=685)

Percentage

Source: GAO review of Army records.

Installation

Soldiers who do not have medical conditions that may require significant duty limitations

Soldiers who have medical conditions that may require significant duty limitations

Equals 95 percent confidence interval, upper and lower bounds for each estimate

As shown in figure 4, of the estimated 14 percent of soldiers preparing to 

deploy from Forts Benning, Stewart, and Drum who had medical 

conditions that could require significant limitations in duty assignment, 

approximately two-thirds—about an estimated 10 percent of the total 

number of soldiers35—were deployed to Iraq or Afghanistan. These 

soldiers with medical conditions included soldiers having a physical 

profile designation of at least a 3, or indicating that they could not perform 

certain functional activities. The remaining estimated 4 percent of soldiers 

 35The 95 percent confidence interval for this estimate is from 7 to 12 percent of soldiers. 

Page 26 GAO-08-546 Medical Condition of Deployed Soldiers
with medical conditions that could require significant limitations did not 

deploy.36

Figure 4: Comparison of Estimated Percentages of Soldiers Having Medical 

Conditions That May Require Significant Duty Limitations Who Deployed against 

Those Who Did Not 

0

5

10

15

20

25

30

35

40

45

50

0

5

10

15

20

25

30

35

40

45

50

Total

Ft. Drum

Ft. Stewart

Ft. Benning

(n=189)

(n=259)

(n=237)

(n=685)

Percentage

Source: GAO review of Army records.

Installation

Soldiers with medical conditions that may require significant medical limitations who did not deploy

Soldiers with medical conditions that may require significant medical limitations who were deployed

Equals 95 percent confidence interval, upper and lower bounds for each estimate

Soldiers in the sample who deployed with medical conditions that could 

require significant limitations had conditions such as herniated discs, back 

pain, chronic knee pain, type 2 diabetes, or mild asthma. A soldier might 

have a physical profile that indicates multiple medical limitations that fall 

under different categories.37 Table 2 shows that of the 66 deployed soldiers

 36The 95 percent confidence interval for this estimate is from 3 to 6 percent of soldiers. 

37See appendix III for descriptions of the physical profile categories. 

Page 27 GAO-08-546 Medical Condition of Deployed Soldiers
who had medical conditions that could require significant limitations, 

55 percent deployed with defects of the lower extremities (under the “L” 

category). For example, one soldier’s physical profile showed chronic hip 

pain that restricted physical training pace and limited the soldier to lifting 

no more than 48 pounds. Medical conditions of the eyes and psychiatric 

conditions had the lowest rates of occurrence. While we did not review 

documentation of medical limitations other than the soldiers’ physical 

profiles, according to Army medical officials, mental health conditions are 

not generally documented in physical profiles unless the conditions 

limited a soldier’s ability to accomplish his or her duty. Commanders were 

also notified of a soldier’s mental condition by medical providers if 

commanders requested the mental health evaluation of the soldier. 

Table 2: Numbers and Percentages of Medical Conditions That May Require 

Significant Duty Limitations, by Physical Profile Category, across Profiles of

Deployed Soldiers in the Sample 

Category of medical

conditions in physical

profiles

Number of medical 

conditions

Percentage of medical 

conditions

“P” Physical Capacity 15 23%

“U” Upper Extremities 7 11%

“L” Lower Extremities 36 55%

“H” Hearing and Ears 10 15%

“E” Eyes 3 5%

“S” Psychiatric 2 3%

Source: GAO review of Army soldiers’ medical records. 

Note: The 73 total occurrences of medical limitations in the sample were indicated in the physical 

profiles of 66 soldiers with medical conditions that may require significant limitations who were 

deployed to Iraq and Afghanistan. The percentages of occurrences do not equal 100 percent because

some soldiers have a medical condition that may require significant limitations in more than one 

category. 

Page 28 GAO-08-546 Medical Condition of Deployed Soldiers
We were unable to determine the extent to which deployed soldiers in the 

sample with medical conditions were assigned duties suitable to their 

limitations. While Army guidance requires commanders to assign soldiers 

to duties that are suitable to their medical conditions, it does not require 

that they track the assignments of their soldiers to duties that

accommodate their limitations. In order to determine the extent to which

they had been assigned to duties suitable for those conditions, we 

surveyed by e-mail a sample of deployed soldiers with medical conditions.

In our survey, we asked these soldiers for information on their ability to 

perform the duties to which they were assigned. However, we did not get a 

sufficiently high response rate to enable us to project findings from the 

survey respondents. We sent the survey to 66 soldiers, but received

responses from only 24. Of the 24 soldiers who responded, 19 reported 

that they were able to complete most or all of their duties, and 22 of the 24

said they wanted to deploy with their units. None said that they could 

perform only a few or none of their duties. However, 5 of the soldiers we 

surveyed indicated that they were able to perform only some of their 

duties. 

Extent to Which 

Commanders 

Assigned Soldiers to 

Duties Suitable to 

Their Medical 

Conditions Cannot Be

Determined 

Survey responses indicated that some soldiers had experienced job 

reassignments to accommodate the limitations of their medical conditions. 

For example, one soldier had a shoulder injury that limited his ability to 

wear all of his body armor. When his unit was deployed to Iraq, he was 

assigned to duties in Kuwait so that he would not have to wear all of his 

body armor. Another soldier with a hearing deficit had his occupational 

category changed from infantry to supply specialist to protect him from 

exposure to loud noise. One soldier had degenerative disc disease, with 

lower back and leg pain, and his commander reassigned him from being 

leader of his unit to base security to accommodate his medical condition 

by limiting the time he had to wear his equipment. However, three of our 

survey respondents reported that their duties or occupational categories 

were not changed, although they believed they should have been. For 

example, one soldier often fell asleep during guard duty because his sleep 

apnea treatment was impaired by the irregularity of electric power 

availability, which he needed to support his continuous positive airway 

pressure machine. 

Although we were unable to speak with the commanders of the particular 

soldiers surveyed in the sample, we spoke with other commanders at Forts 

Benning, Stewart, and Drum to help explain these survey responses. These 

commanders reported that they were aware of the medical conditions of 

the soldiers with whom they had deployed and that they always 

considered these conditions in their duty assignments. Army commanders 

Page 29 GAO-08-546 Medical Condition of Deployed Soldiers
told us that soldiers with medical impairments may on occasion be 

required to perform job duties exceeding their limitations because they

have special skills that are hard to replace using other personnel. 

Commanders may also sometimes assign soldiers to duties exceeding their 

limitations because they are unaware of the extent of the limitations, as 

soldiers’ physical profiles may not reflect all of their medical information. 

Furthermore, according to both soldiers and senior medical officials 

whom we interviewed, soldiers may conceal the extent of their medical 

limitations or may negotiate with medical providers in order to remain 

with their units or in the Army. For example, one soldier did not agree 

with the upgrading of her physical profile designation, but also did not 

want to fully disclose her medical condition for fear of not meeting Army 

medical standards. Two soldiers stated that they agreed with their physical 

profile designation, which masks the severity of their limitations, and they

were deployed although their medical condition was progressively 

worsening while at deployed locations. In both these cases, the soldiers 

stated that they were nearing retirement and did not want to be discharged 

from the Army due to a medical board evaluation before they were eligible 

to receive their full retirement pensions, and they confirmed that their 

commanders accommodated their medical conditions. 

Conversely, Army officials have stated that soldiers may overstate their 

medical conditions in order to avoid deployment and they must take into 

account their other experiences with the soldiers’ limitations when 

evaluating their medical deployability. For example, one commander told 

us that one soldier brought up a foot injury to delay her deployment, 

although it was diagnosed by a medical provider outside the military and it 

was not in her military medical record. The commander allowed the 

soldier time to recuperate and allowed her to purchase a specific type of

boot to accommodate her injury. However, when the soldier did not 

purchase the boots in a timely manner in order to further delay her 

deployment, the commander found the boots at a nearby supply store and 

deployed the soldier into theater. 

Although we were not able to determine the extent to which Army 

commanders have assigned soldiers to duties that are suitable for their 

limitations, there may be soldiers who had proper evaluations performed 

prior to deployment yet still have concerns about the suitability of their 

assigned duties. Soldiers should have access to a program at deployed 

locations that is similar to the ombudsman program available at Army 

installations. The soldiers who have medical conditions that develop or 

worsen while at deployed locations and may not believe they are assigned

to appropriate duties should have access to a contact person who can 

Page 30 GAO-08-546 Medical Condition of Deployed Soldiers
address their concerns. This person should have access to the soldier’s 

medical information and the authority to resolve any problems, and he or 

she should work independently from the soldier’s commander. 

Long-standing issues regarding the medical deployability of

servicemembers have become increasingly important as the Global War on

Terrorism continues and large numbers of servicemembers are deployed. 

The Army is hampered by its lack of an enforcement mechanism from 

ensuring that soldiers’ MMRB or MEB evaluations are conducted within 

prescribed time frames and not delayed by the failure of commanders or 

medical providers to provide required information on time. Of the 

6 percent of soldiers from Forts Benning, Stewart, and Drum that we 

estimate were deployed with medical conditions that required further 

evaluation by a MMRB or MEB, we estimate that 3 percent of these 

soldiers did not receive these needed evaluations prior to deployment. 

Furthermore, the commanders and medical providers who must make 

medical readiness and deployment decisions about soldiers do not always

have full visibility over the soldiers’ medical limitations because physical

profile documentation is not always properly retained or complete. The 

Army intends to establish centralized electronic documentation and 

distribution of physical profiles to improve visibility, but it has not 

finalized plans for needed actions, associated milestones, and timeliness of 

the process. Without timely MMRB or MEB evaluations and the retention 

of complete physical profile information for deploying soldiers with 

medical conditions, commanders who assign duties can not be fully 

informed of soldiers’ medical limitations. We did not find widespread 

cases of improper duty assignments for deployed soldiers with medical 

conditions; however, the weaknesses in the Army procedures could permit 

this to occur. Although the Army ombudsman program may help alleviate 

concerns from soldiers and family members, they should be made aware 

of the program and the program should be made available for soldiers 

prior to and during deployment. Unless soldiers have been fully evaluated,

have an independent contact person to promote their concerns, and 

commanders have full knowledge of the soldiers’ limitations, the Army 

cannot safeguard soldiers with medical conditions from being deployed 

and assigned to duties unsuitable for their limitations. 

Conclusions 

Page 31 GAO-08-546 Medical Condition of Deployed Soldiers
To safeguard soldiers with significant medical limitations from being 

deployed and assigned to duties unsuitable for their limitations, we 

recommend that the Secretary of the Army: 

1. direct the Office of the Army Surgeon General and the Army Deputy 

Chief of Staff G-1 to collaboratively develop an enforcement 

mechanism to ensure that medical providers and commanders follow 

procedures so that soldiers whose permanent physical profiles 

indicate significant medical limitations are properly referred to and 

complete MEB and MMRB evaluation boards prior to deployment; 

2. direct the Office of the Army Surgeon General and the Army Deputy 

Chief of Staff G-1 to move forward with plans to electronically process 

and retain physical profiles, including specific actions and milestones, 

and to implement guidance to help ensure 

• the timely distribution of profiles to commanders and the military 

personnel office and 

• that the medical record keeping system include all information in the 

approved physical profiles, and that all profiles be retained in soldiers’ 

medical records; 

3. direct the Army Human Resources Command to disseminate 

information and provide soldiers and their families access to an 

independent ombudsman program prior to and during deployment to 

ensure that they are fully informed about this resource for addressing 

their concerns and to add independent oversight of Army medical and

deployment processes in the interests of the soldiers. 

DOD provided written comments on a draft of this report and concurred 

with each of our recommendations. In commenting on our first 

recommendation, DOD stated that our findings do not suggest the 

existence of a widespread problem throughout the Army, as the number of 

soldiers in our sample deployed without appearing before a medical 

evaluation board was 17; and furthermore, that survey and interview 

responses indicate that commanders appear to be assigning soldiers with 

medical limitations to suitable duties. However, we note that the 17

soldiers who deployed without receiving proper board evaluations 

represent a sizeable proportion of the 42 soldiers in our sample who 

should have received such a review prior to deployment. These 17 

soldiers, furthermore, can be projected from our sample to represent 

approximately 3 percent of the soldiers who were preparing for 

deployment at the three installations; we are providing further clarification 

Recommendations for 

Executive Action 

Agency Comments 

and Our Evaluation 

Page 32 GAO-08-546 Medical Condition of Deployed Soldiers
regarding this figure in the body of this report. Furthermore, as we have 

noted in our report, ad hoc measures to assign soldiers to suitable duties 

are not as reliable as an enforcement mechanism for ensuring that soldiers 

are so assigned. While we could not determine the number of soldiers who 

may have been assigned to unsuitable duties, as the Army does not track 

this information and our survey responses were limited, neither could we 

confirm that soldiers with medical limitations were consistently assigned 

to suitable duties. 

DOD noted that it had actions planned or underway to conduct a thorough 

inspection of the policies and procedures supporting a commander’s 

determination of soldier deployability, and to release new guidance 

regarding medical conditions that should preclude affected 

servicemembers from deployment, along with other initiatives, and we 

commend these efforts. 

In commenting on our second recommendation, DOD stated that the 

Office of the Army Surgeon General has identified and submitted 

requirements for the automation of physical profiles, beginning

development by the end of 2008, and we commend this planned initiative. 

We note that it is important for these plans to have specific actions and 

milestones, and for the Army to implement guidance to ensure timely 

distribution of profiles to commanders and military personnel officials 

through the automated system. 

In commenting on our third recommendation, DOD stated that two 

programs, the Army Ombudsman Program and the Wounded Soldier and 

Family Hotline, are available to assist all soldiers (and their families) 

whether preparing to deploy, deployed, or redeploying. However, we note 

that the Wounded Soldier and Family Hotline does not constitute a 

resource independent of the command. Although DOD states that 

retribution is not tolerated against those using the hotline, we maintain 

our view that soldiers should be able to turn to a resource independent of

the command. With regard to the Ombudsman Program, though it is 

independent of the command, we continue to assert our view that broad 

advertisement is needed for soldiers and their families to be made aware 

of this resource for those soldiers not only returning from deployment, but 

also prior to and during deployment.

The Army’s comments are reprinted in appendix VI. In addition, the Army 

provided technical comments, which we have incorporated as appropriate. 

Page 33 GAO-08-546 Medical Condition of Deployed Soldiers
We are sending copies of this report to interested congressional 

committees; the Secretary of Defense; the Secretaries of the Army, the 

Navy, and the Air Force; and the Commandant of the Marine Corps. 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 have any questions concerning this report, please 

contact me at (202) 512-3604 or farrellb@gao.gov. Contact points for our 

Offices of Congressional Relations and Public Affairs may be found on the 

last page of this report. Key contributors to this report are listed in 

appendix VII. 

Brenda S. Farrell, Director 

Defense Capabilities and Management 

Page 34 GAO-08-546 Medical Condition of Deployed Soldiers
Appendix I: Scope and Methodology 

Page 35 GAO-08-546 Medical Condition of Deployed Soldiers

Appendix I: Scope and Methodology 

To address the extent to which the Army is adhering to its medical and

deployment requirements regarding decisions to send soldiers with 

medical limitations to Iraq and Afghanistan, we reviewed relevant DOD 

and Army guidance related to medical standards and deployment 

procedures. We discussed the deployment of servicemembers with 

medical conditions with a variety of officials from the Office of the 

Assistant Secretary of Defense for Health Affairs, the Department of the 

Army, and the Office of the Army Surgeon General. As agreed with 

congressional staff, we also met with the Offices of the Air Force and Navy

Surgeons General as well as the Navy Bureau of Medicine and Surgery to 

gain an understanding of those services’ guidance on medical standards 

and deployment procedures. In December 2007, we provided a briefing to

congressional staff that included a discussion of these services’ guidance

regarding deployment of servicemembers with medical conditions. 

In addition, we reviewed Army guidance covering documentation of 

soldiers’ medical limitations prior to deployment and conditions under 

which soldiers with medical conditions are considered deployable. We 

reviewed a sample of medical records and interviewed medical providers,

Army commanders, and soldiers at selected installations to identify and

evaluate installation procedures for documenting medical limitations and 

training provided regarding this issue at each installation. 

We selected three Army installations—Fort Benning, Fort Stewart, and 

Fort Drum. We selected Fort Stewart and Fort Drum based on the number 

of active component soldiers deployed from each installation to Iraq or 

Afghanistan between April 1, 2006, and March 31, 2007; and we selected 

Fort Benning based on initial allegations of active component soldiers 

being deployed with significant medical limitations from this installation. 

For our medical records review, we selected random samples of active 

component soldiers at Fort Benning, Fort Stewart, and Fort Drum. In 

order to create the sample, we used the universe of soldiers from each 

installation who were preparing for deployment from April 1, 2006, to 

March 31, 2007, to Iraq or Afghanistan and answered “yes” to question 

number 3 on the pre-deployment health assessment (form DD 2795)1

which asks, “Are you currently on a profile, or light duty, or are you 

undergoing a medical board?” Our statistical samples are representative of

soldiers at these installations who meet our eligibility criteria. Those who 

 1

See appendix V for a copy of the pre-deployment health assessment form 2795. 
Appendix I: Scope and Methodology 

did not complete a pre-deployment health assessment during this time 

frame had no chance of being selected. Of the soldiers preparing to 

deploy, soldiers may have their deployment delayed or may ultimately not 

be deployed for various reasons, such as not completing required training 

and not having proper security clearances for deployment, as well as not 

meeting medical readiness standards. 

For various reasons, medical records were not always available for review. 

Therefore, we reviewed more medical records than our target sample size 

on the assumption we might not meet our desired precision. Specifically, 

there were seven reasons identified for not being able to physically secure 

soldiers’ medical records for review: 

1. Charged to patient. When a patient visits a clinic (on-post or offpost), the medical record is physically given to the patient. The 

procedure is that the medical record will be returned by the patient 

following their clinic visit. 

2. Charged out to Medical Evaluation Board. Soldier is in the process 

of a medical review board and their medical record is retained by the 

board members. 

3. Charged out to Physical Evaluation Board. Soldier is in the 

process of a physical review board and their medical record is retained 

by the board members. 

4. Expired term of service. Soldier separates from the Army and their 

medical record is sent to the Veterans Administration Records 

Management Center St. Louis, Missouri. 

5. Record is missing and not accounted for by the medical records 

department. No tracking sheet is in the file system to indicate the 

patient has checked it out or otherwise. 

6. Permanent change of station. Soldier is still in the Army, but has 

transferred to another installation. The medical record was sent to the 

new installation with the soldier. 

7. Temporary duty off site. Soldier has left the Army installation, but is 

expected to return. The temporary duty is long enough to warrant that 

the medical record accompany the soldier. (Note: In the sample, there 

were no cases for which the soldier was on temporary duty off site.) 

Page 36 GAO-08-546 Medical Condition of Deployed Soldiers
Appendix I: Scope and Methodology 

The sample size for our medical record review was determined to provide 

a 95 percent confidence interval for an attribute measure with a precision

of at least 5 percent. Because we followed a probability procedure based 

on random selections, the sample is only one of a large number of samples 

that we might have drawn. Since each sample could have provided 

different estimates, we express our confidence in the precision of our 

particular sample’s results as a 95 percent confidence interval (e.g., plus or

minus 5 percentage points). This is the interval that would contain the 

actual population value for 5 percent of the samples we could have drawn.

As a result, we are 95 percent confident that each of the confidence 

intervals will include the true values in the study population. At two of the 

three installations we visited, we reviewed more records than needed to 

meet our target sample size because medical officials made available more 

medical records than our targeted sample amount. The number of soldiers 

in the samples and the total records reviewed of soldiers at the 

installations visited are shown in table 3. 

Table 3: Soldier Sample Universe, Target Sample Sizes, and Number of Records 

Reviewed at Each Visited Installation 

Installation 

Number of soldiers who 

fit the criteria for the 

sample (universe)

Target sample

sizes 

Total records 

reviewed

Fort Benning 336 180 189

Fort Stewart 794 259 259

Fort Drum 552 227 237

Total 1682 666 685

Source: GAO analysis of Army soldiers’ records. 

At each location, we examined medical documentation for evidence of 

physical profiles (form DA 3349)2

 that were created between April 2001

and March 2007. We selected this time frame because it would include any 

profile in effect when a soldier in the sample deployed. We reviewed both

hard copy soldier medical records for evidence of physical profiles as well 

as any profiles located in Armed Forces Health Longitudinal Technology 

Application (AHLTA), the department of defense’s electronic medical 

record. In addition, we requested that installation medical personnel 

provide any information on profiles from the Army’s Medical Protection 

System (MEDPROS) for each of the soldiers in the sample to ensure that 

 2

See appendix II for a copy of the Army physical profile form 3349. 

Page 37 GAO-08-546 Medical Condition of Deployed Soldiers
Appendix I: Scope and Methodology 

our review of medical records was complete and that we identified all 

physical profiles. Even though MEDPROS is not an official medical record, 

it is used in the determination of medical readiness in preparation for 

deployment and contains medical limitation information and dates of 

physical profiles. After gathering all physical profiles, we reviewed them 

for completeness, and analyzed them to determine if they were completed 

in accordance with Army guidance. From the soldiers that received a 

physical profile between April 2001 and March 2007, we identified the 

subset of soldiers with medical conditions that may require significant 

medical limitations, specifically soldiers with permanent or temporary 

profile designation of at least a 3, or a designation of 2 showing inability to 

do certain functional activities. We did not review documentation of 

medical limitations other than the physical profiles. According to Army 

officials, mental health conditions are not generally documented in 

physical profiles unless the conditions limited a soldier’s ability to 

accomplish his or her duty. Commanders were also notified of their 

soldiers’ mental conditions by medical providers if they requested a mental 

health evaluation of the soldiers. 

Although we have taken many steps to ensure accurate data analysis of 

active component soldiers with a physical profile, previous GAO reviews 

have found that Army medical records do not contain all medical 

documentation as required, thus, our review may not encompass the full 

extent of soldiers with physical profiles. 

To determine the extent to which the Army is deploying soldiers to Iraq 

and Afghanistan with medical conditions requiring duty limitations, and 

whether it is assigning them to duties suitable to their limitations, we 

requested deployment data on the subset of soldiers who we identified as 

having a significant medical limitation from the time period of April 2001 

to March 2007. We then compared data from our medical record review at

Forts Stewart, Benning, and Drum to deployment data for soldiers in the 

sample provided by Army officials to identify soldiers with a medical 

condition that may require significant limitations who had deployed to Iraq 

or Afghanistan. We reviewed Army processes for tracking soldiers while 

deployed. We interviewed Army officials including commanders and 

medical providers about established procedures in place to ensure soldiers 

are assigned within their limitations. We also surveyed by e-mail 66 

soldiers we identified who had deployed with medical conditions to Iraq 

and Afghanistan. We received responses from 24 of these soldiers, for a 

response rate of about 36 percent. These responses do not allow us to 

project the extent to which deployed soldiers with medical conditions 

across the Army were assigned to duties suitable to their medical 

Page 38 GAO-08-546 Medical Condition of Deployed Soldiers
Appendix I: Scope and Methodology 

limitations in Iraq and Afghanistan; nevertheless, we present the 

information we obtained to illustrate these issues. 

We conducted this performance audit from April 2007 through April 2008 

in accordance with generally accepted government auditing standards. 

Those standards require that we plan and perform the audit to obtain 

sufficient, appropriate evidence to provide a reasonable basis for our 

findings and conclusions based on our audit objectives. We believe that 

the evidence obtained provides a reasonable basis for our findings and 

conclusions based on our audit objectives. 

Page 39 GAO-08-546 Medical Condition of Deployed Soldiers
Appendix II: Army Physical Profile (DA Form

3349) 

Page 40 GAO-08-546 Medical Condition of Deployed Soldiers

Appendix II: Army Physical Profile (DA Form 

3349) 
Appendix II: Army Physical Profile (DA Form

3349) 

Source: U.S. Army

Page 41 GAO-08-546 Medical Condition of Deployed Soldiers
Appendix III: PULHES Definitions 

Page 42 GAO-08-546 Medical Condition of Deployed Soldiers

Appendix III: PULHES Definitions 

Category definitions

P—Physical Capacity or Stamina Normally includes conditions of the heart; respiratory system; gastrointestinal system, 

genitourinary system; nervous system; allergic, endocrine, metabolic and nutritional diseases; 

diseases of the blood and blood forming tissues; dental conditions; diseases of the breast, and 

other organic defects and diseases that do not fall under other specific factors of the system. 

U—Upper Extremities Concerns the hands, arms, shoulder girdle, and upper spine (cervical, thoracic, and upper

lumbar) in regard to strength, range of motion, and general efficiency. 

L—Lower Extremities Refers to the feet, legs, pelvic girdle, lower back musculature and lower spine (lower lumbar 

and sacral) in regard to strength, range of motion, and general efficiency. 

H—Hearing and Ears Relates to auditory acuity and disease and defects of the ear. 

E—Eyes Centers on visual acuity and diseases and defects of the eye. 

S—Psychiatric Concerns personality, emotional stability, and psychiatric diseases. 

Source: Army Regulation 40-501. 

Profile numerical designations 

Numerical Designation definitions

1 Indicates a high level of medical fitness. 

2 Refers to some medical condition or physical defect that may require some activity limitations. 

3 Signifies one or more medical conditions or physical defects that may require significant 

limitations. The individual should receive assignments commensurate with his or her physical 

capability for military duty. 

4 Indicates one or more medical conditions or physical defects of such severity that performance 

of military duty must be drastically limited. 

Source: Army Regulation 40-501. 
Appendix IV: Army Physical Profile Codes 

Page 43 GAO-08-546 Medical Condition of Deployed Soldiers

Code Description/assignment limitation Medical criteria (examples) 

CODE A No assignment limitation. No demonstrable anatomical or 

physiological impairment 

within standards established in table 7–1. 

CODE B May have assignment limitations that are intended to protect 

against further physical damage/injury. May have minor 

impairments under one or more PULHES factors that disqualify 

for certain MOS training or assignment. 

Minimal loss of joint motion, visual and 

hearing loss 

CODES C through P* Possesses impairments that limit functions or assignments. The 

codes listed below are for military personnel administrative 

purposes. Corresponding limitations are general guidelines and 

are not to be taken as verbatim limitations. (For example, a

Soldier with a code C may not be able to run but may have no 

restrictions on marching or standing.) Item 3 of DA Form 3349 

will contain the specific limitations. 

CODE C Limitations in running, marching, standing for long periods etc. Orthopedic or neurological conditions 

CODE D Limitations in any type of strenuous physical activity. Organic cardiac disease; pulmonary 

insufficiency 

CODE E Limitations requiring dietary restrictions preventing consumption 

of combat rations. 

Endocrine disorders–recent or repeated

peptic ulcer activity–chronic 

gastrointestinal disease requiring dietary 

management. 

CODE F Limitations prohibiting assignment or deployment to OCONUS 

areas where definitive medical care is not available. 

Individuals who require continued medical 

supervision with hospitalization or frequent 

outpatient visits for serious illness or injury.

CODE G Limitations prohibiting wearing Kevlar, LBE, lifting heavy 

materials required of the MOS, overhead work. 

Arthritis of the neck or joints of the 

extremities with restricted motion; disk 

disease; recurrent shoulder dislocation. 

CODE H Limitations on duty where sudden loss of consciousness would 

be dangerous to self or to others such as work on scaffolding, 

vehicle driving, or near moving machinery. 

Seizure disorders; other disorders 

producing syncopal attacks of severe 

vertigo, such as Ménierè’s syndrome. 

Appendix IV: Army Physical Profile Codes 
Appendix IV: Army Physical Profile Codes 

Code Description/assignment limitation Medical criteria (examples) 

CODE J Given known handicaps associated with high frequency hearing 

loss similar to this, Commanders are highly recommended to 

make an individual risk assessment of any Soldier with hearing 

loss that might be tasked to perform duties that require good

hearing, for example; localization and detection of friend or foe 

sounds, scout, point, sentry, forward listening, post/observer, 

radio/telephone operator, and so forth. (See DA Pam 40–501, 

Chapter 2–4, Combat Readiness Effects.) Hearing Protection

Measures required to prevent further hearing loss. 

1. No exposure to noise in excess of 85 dBA (decibels 

measured on the A scale) or weapon firing without use of 

properly fitted hearing protection. Annual hearing test required. 

2. Further exposure to noise is hazardous to health. No duty or 

assignment to noise levels in excess of 85 dBA or weapon firing 

(not to include firing for preparation of replacements for 

overseas movement qualification or annual weapons 

qualification with proper ear protection). Annual hearing test 

required. 

3. No exposure to noise in excess of 85 dBA or weapon firing

without use of properly fitted hearing protection. This individual 

is ‘deaf’ in one ear. Any permanent hearing loss in the good ear 

will cause a serious handicap. Annual Hearing test required. 

4. Further duty requiring exposure to high intensity noise is 

hazardous to health. No duty or assignment to noise levels in 

excess of 85 dBA or weapon firing (not to include firing for 

overseas movement or weapon firing without use of properly ear 

protection). No duty requiring acute hearing. A hearing aid must 

be worn to meet medical fitness standards. 

Susceptibility to acoustic trauma. 

CODE L Limitations restricting assignment to cold climates. Documented history of cold injury; vascular 

insufficiency; collagen disease, with 

vascular or skin manifestations. 

CODE M Limitations restricting exposure to high environmental 

temperature. 

History of heat stroke; history of skin 

malignancy or other chronic skin diseases 

that are aggravated by sunlight or high 

environmental temperature. 

CODE N Limitations restricting wearing of combat boots. Any vascular or skin condition of the feet or 

legs that, when aggravated by continuous 

wear of combat boots, tends to develop 

unfitting ulcers.

CODE P Limitations restricting wearing or being exposed to required 

items necessary to perform duty (for example, Latex, wool). 

Established allergy to wool, latex. 

CODE T* WAIVER granted for a disqualifying medical condition/standard 

for initial enlistment or appointment. The disqualifying medical 

condition/standard for which a waiver was granted will be

documented in the Soldier’s accession medical examination. 

CODE U Limitation not otherwise described, to be considered individually. 

(Briefly define limitation in item 8.) 

Any significant functional assignment 

limitation not specifically identified 

elsewhere. 

Page 44 GAO-08-546 Medical Condition of Deployed Soldiers
Appendix IV: Army Physical Profile Codes 

Code Description/assignment limitation Medical criteria (examples) 

CODE V* Deployment. This code identifies a Soldier with restrictions on

deployment. Specific restrictions are noted in the medical 

record. 

CODE W* MMRB. This code identifies a Soldier with a permanent profile 

who has been returned to duty by an MMRB (MOS Medical

Review Board.) 

CODE X* This code identifies a Soldier who is allowed to continue in the 

military service with a disease, injury, or medical defect that is 

below medical retention standards, 

pursuant to a waiver of retention standards under chapter 9 or 

10 of this publication, or waiver of unfit finding and continued on 

active duty or in active 

Reserve status under AR 635–40. 

CODE Y* Fit for duty. This code identifies the case of a Soldier who has 

been determined to be fit for duty (not entitled to separation or 

retirement because of physical disability) after complete 

processing under AR 635–40.

Source: Army Regulation 40-501. 

Notes: (1) Profile codes are indicated under item 2 of the physical profile form for all permanent 

physical profiles. (2) Codes do not automatically correspond to a specific numerical designation of the 

profile but are based on the general physical/assignment limitations. 

*The Army regulation does not provide medical criteria for these codes. 

Page 45 GAO-08-546 Medical Condition of Deployed Soldiers
Appendix V: Department of Defense PreDeployment Health Assessment (DD Form

2795) 

Page 46 GAO-08-546 Medical Condition of Deployed Soldiers

Appendix V: Department of Defense PreDeployment Health Assessment (DD Form 

2795) 
Appendix V: Department of Defense PreDeployment Health Assessment (DD Form

2795) 

Source: U.S. Army

Page 47 GAO-08-546 Medical Condition of Deployed Soldiers
Appendix VI: Comments from the Department 

of Defense 

Page 48 

GAO-08-546 Medical Condition of Deployed Soldiers

Appendix VI: Comments from the 

Department of Defense 
Appendix VI: Comments from the Department 

of Defense 

Page 49 

GAO-08-546 Medical Condition of Deployed Soldiers
Appendix VI: Comments from the Department 

of Defense 

Page 50 

GAO-08-546 Medical Condition of Deployed Soldiers
Appendix VI: Comments from the Department 

of Defense 

Page 51 

GAO-08-546 Medical Condition of Deployed Soldiers
Appendix VI: Comments from the Department 

of Defense 

Page 52 

GAO-08-546 Medical Condition of Deployed Soldiers
Appendix VII: 

A

GAO Contact and Staff 

cknowledgments 

Page 53 GAO-08-546 Medical Condition of Deployed Soldiers

Appendix VII: GAO Contact and Staff 

Acknowledgments 

Brenda S. Farrell, (202) 512-3604 or farrellb@gao.gov. 

In addition to the contact named above, Marilyn Wasleski, Assistant 

Director; Gina Hoffman; LaToya King; Grace Materon; Elisha Matvay; 

Sonya Phillips; Jeanett Reid; Norris Smith III; and Cheryl Weissman made 

significant contributions to the report. In addition, Terry Richardson, Carl 

Barden, and Steven Putansu provided guidance and assistance with design

and analysis; Nicole Harms provided legal advice; Steve Fox, Marcia 

Crosse, and Tom Conahan advised on message preparation; and Clara 

Mejstrik, Adam Smith, Maria Storts, and John Wren provided assistance 

during medical file reviews. 

GAO Contact 

Acknowledgments 
Related GAO Products 

Page 54 GAO-08-546 Medical Condition of Deployed Soldiers

Related GAO Products 

DOD Civilian Personnel: Medical Policies for Deployed DOD Federal 

Civilians and Associated Compensation for Those Deployed. GAO-07-

1235T. Washington, D.C.: September 18, 2007. 

Defense Health Care: Comprehensive Oversight Framework Needed to 

Help Ensure Effective Implementation of a Deployment Health Quality 

Assurance Program. GAO-07-831. Washington, D.C.: June 22, 2007. 

DOD Civilian Personnel: Greater Oversight and Quality Assurance 

Needed to Ensure Force Health Protection and Surveillance for Those 

Deployed. GAO-06-1085. Washington, D.C.: September 29, 2006. 

Military Personnel: DOD and the Services Need to Take Additional Steps 

to Improve Mobilization Data for the Reserve Components. GAO-06-1068. 

Washington, D.C.: September 20, 2006. 

Military Disability System: Improved Oversight Needed to Ensure 

Consistent and Timely Outcomes for Reserve and Active Duty Service 

Members. GAO-06-362. Washington, D.C.: March 31, 2006. 

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. Washington. D.C.: October 27,

2005. 

Defense Health Care: Improvements Needed in Occupational and 

Environmental Health Surveillance during Deployments to Address 

Immediate and Long-term Health Issues. GAO-05-632. Washington, D.C.: 

July 14, 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. GAO04-1031. 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. 
Related GAO Products 

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. 

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.

VA And Defense Health Care: Military Medical Surveillance Policies in 

Place, but Implementation Challenges Remain. GAO-02-478T. 

Washington, D.C.: February 27, 2002.

Gulf War Illnesses: Research, Clinical Monitoring, and Medical 

Surveillance. GAO/T-NSIAD-98-88. Washington, D.C.: February 5, 1998. 

Gulf War Illnesses: Improved Monitoring of Clinical Progress and 

Reexamination of Research Emphasis Are Needed. GAO/NSIAD-97-163. 

Washington, D.C.: June 23, 1997. 

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. 

(351152) Page 55 GAO-08-546 Medical Condition of Deployed Soldiers
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