a

GAO

United States Government Accountability Office

Report to Congressional Committees

October 2005 MILITARY 

PERSONNEL

Top Management 

Attention Is Needed to 

Address Long-standing 

Problems with 

Determining Medical 

and Physical Fitness 

of the Reserve Force 

GAO-06-105
What GAO Found

United States Government Accountability Office

Why GAO Did This Study

Highlights

Accountability Integrity Reliability

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

To view the full product, including the scope 

and methodology, click on the link above. 

For more information, contact Derek B. 

Stewart, (202) 512-5559, stewartd@gao.gov. 

Highlights of GAO-06-105, a report to 

congressional committees 

October 2005

MILITARY PERSONNEL

Top Management Attention Is Needed to 

Address Long-standing Problems with 

Determining Medical and Physical Fitness 

of the Reserve Force 

DOD is unable to determine the extent to which the reserve force complied 

with routine examinations due to lack of complete or reliable data. Although 

each reserve component employs a tracking system capable of monitoring 

compliance with medical exams, only one component has taken the 

necessary quality assurance steps to ensure the reliability of its data. While 

the Office of the Under Secretary of Defense for Personnel and Readiness 

has the responsibility for overseeing medical and physical fitness policy and 

processes, it has not established a management control framework and 

executed a plan to oversee compliance with routine examinations. 

Specifically, this office has not enforced holding all responsible levels 

accountable, ensuring that all requirements are being met, and that complete 

and reliable data are being entered into the appropriate tracking system. For 

example, this office has not enforced its own requirement for the services to 

report on the components’ physical fitness status. Without complete and 

reliable data, DOD is not in a sound position to provide the Secretary of 

Defense or Congress assurances that the reserve force is medically and 

physically fit when called to active duty. 

DOD has only limited visibility over the health status of reserve members 

after they are called to duty and is unable to determine the extent of care 

provided to those members deployed with preexisting medical conditions 

despite the existence of various sources of medical information. The 

components collect various types of medical data, but vary in their ability to 

systematically identify, track, and report information on those with 

temporary and permanent conditions that may limit deployability. In 

addition, medical information is captured on predeployment forms for all 

members and entered into a DOD-wide centralized database. GAO has 

previously reported that the database has missing and incomplete health 

data, and DOD is working to correct this through its quality assurance 

program. GAO found during this review that DOD has continued to make 

progress entering the data from the forms into the database, but the data are 

still incomplete and the reasons why members are determined medically 

nondeployable are not captured in a way that is easily discernable. While 

the Under Secretary of Defense continues to have responsibility for 

overseeing the medical and physical fitness of reserve members after they 

are called to duty, the combatant commanders, under the Joint Chief of 

Staff, have this responsibility for the theater. DOD is unable to determine the 

care provided to those deployed with preexisting medical conditions 

because DOD has not determined what preexisting conditions may be 

allowed into a specific theater and, thus, does not know what conditions to 

track. Evidence GAO developed suggests that members are deployed into 

theater with preexisting conditions, such as diabetes, heart problems, and 

cancer. The impact of those who are not medically and physically fit for 

duty could be significant for future deployments as the pool of reserve 

members from which to fill requirements is dwindling and those who have 

deployed are not in as good health as they were before deployment. 

The Department of Defense’s 

(DOD) operations in time of war or 

national emergency depend on 

sizeable reserve force involvement 

and DOD expects future use of the 

reserve force to remain high. 

Operational readiness depends on 

healthy and fit personnel. Longstanding problems have been 

identified with reserve members 

not being in proper medical or 

physical condition. Drilling 

members in the reserve force by 

law are required to have a medical 

exam every 5 years and an annual 

certificate of their medical status. 

Also, DOD policies require an 

annual dental exam and an annual 

evaluation of physical fitness. 

Compliance with these routine 

requirements is the first step in 

determining who is fit for duty. 

Public Law 108-375 required GAO 

to study DOD's management of the 

health status of reserve members 

activated for Operations Enduring 

Freedom and Iraqi Freedom. GAO 

assessed DOD’s (1) ability to 

determine reserve force 

compliance with routine exams, 

and (2) visibility over reserve 

members’ health status after they 

are called to duty and the care, if 

any, provided to those deployed 

with preexisting conditions. 

What GAO Recommends

GAO is making a number of 

recommendations to improve 

DOD’s management of the health 

status of reserve members. In 

commenting on a draft of this 

report, DOD did not concur with 

two of our six recommendations. 
Page i GAO-06-105 Reserve Components' Health 

Letter 1

Results in Brief 3 

Background 7 

Lack of DOD Oversight Hinders DOD’s Ability to Determine 

Reserve Components’ Compliance with Routine Medical and 

Physical Fitness Examination Requirements, but Indications of 

Noncompliance Exist 16 

DOD Lacks Visibility over the Health Status of Reserve 

Components after Being Called to Active Duty and the Extent to 

which Members with Preexisting Conditions Required Care 

during Deployment 36 

Conclusions 52 

Recommendations for Executive Action 53 

Agency Comments and Our Evaluation 54 

Appendix I Scope and Methodology 60 

Appendix II Comments from the Department of Defense 67 

Appendix III GAO Contact and Staff Acknowledgments 73 

Related GAO Products 74 

Tables 

Table 1: Service Decisions Concerning Reserve Components’ 

Deployability, November 2001 through June 2005 40 

Table 2: Service Decisions Concerning Active Components’ 

Deployability, November 2001 through June 2005 41 

Table 3: Total Predeployment Referral Rate by Reserve 

Component, November 2001 through June 2005 42 

Table 4: Total Predeployment Referral Rate by Active Component, 

November 2001 through June 2005 42 

Table 5: Rate of Servicemembers Health Status as Recorded on 

Pre- and Postdeployment Forms for Active and Reserve 

Components from November 2001 through June 2005 47 

Contents 
Page ii GAO-06-105 Reserve Components' Health 

Figures 

Figure 1: Rate of Medical Referrals by Type for Active and Reserve 

Components from November 2001 through June 2005 43 

Figure 2: Medical Conditions of Army National Guard and Army 

Reserve Members in a Medical Holdover Status as of 

August 11, 2005 45 
Page iii GAO-06-105 Reserve Components' Health 

Abbreviations 

AFAA Air Force Audit Agency 

AFFMS Air Force Fitness Management System 

AMSA Army Medical Surveillance Activity 

ANG Air National Guard 

APFT Army Physical Fitness Test 

CENTCOM U.S. Central Command 

DIMHRS Defense Integrated Military Human Resources System 

DNBI Disease Nonbattle Injury 

DOD Department of Defense 

GAO Government Accountability Office 

HCP Health Care Provider 

IMR Individual Medical Readiness 

JMeWS Joint Medical Work Station 

JMROC Joint Medical Readiness Oversight Committee 

JPTA Joint Patient Tracking Application 

MEDPROS Medical Protection System 

MND-TM Medical Nondeployable Tracking Module 

MODS Medical Operational Data System 

MORDT Mobilization Operational Readiness Deployment Test 

MRRS Medical Readiness Reporting System 

NDAA National Defense Authorization Act 

OSD Office of the Secretary of Defense 

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

 Readiness 

PHA Preventive Health Assessment 

PHAM Periodic Health Assessment Monitor 

PIMR Preventive Health Assessment and Individual Medical 

Readiness 

PRIMS Physical Readiness Information Management System 

RCPHA Reserve Component Periodic Health Assessment 

TRAC2ES TRANSCOM Regulating Command and Control Evacuation 

 System 

TRANSCOM U.S. Transportation Command 

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Page 1 GAO-06-105 Reserve Components' Health 

October 27, 2005 

The Honorable John Warner 

Chairman 

The Honorable Carl Levin 

Ranking Minority Member 

Committee on Armed Services 

United States Senate 

The Honorable Duncan L. Hunter 

Chairman 

The Honorable Ike Skelton 

Ranking Minority Member 

Committee on Armed Services 

House of Representatives 

The Department of Defense’s (DOD) operations in time of war or national 

emergency are currently dependent upon sizeable National Guard and 

Reserve involvement and DOD expects future use of the reserve force to 

remain high. DOD policy acknowledges the importance that reserve 

component1

 members are medically and physically fit2 for deployment3

when called to active duty. As of June 2005, more than 323,000 reserve 

component members had deployed in support of Operation Enduring 

Freedom and Operation Iraqi Freedom,4

 which is almost three times the 

number of reserve component members deployed in support of Operations 

 1

 DOD’s reserve components include the collective forces of the National Guard including 

the Army Guard and the Air Guard, as well as the forces from the Army Reserve, the Navy 

Reserve, the Marine Corps Reserve, the Air Force Reserve, and the Coast Guard Reserve. 

This report does not address the Coast Guard Reserve. 

2

 For the purposes of this report, medical fitness equates to compliance with routine or 

periodic medical (physical) examinations that identify the diseases and medical conditions 

that may prevent members from performing their military duties. Physical fitness equates 

to compliance with routine or periodic examinations that test a member’s physical skills 

needed to perform the mission. 

3

 Deployment is a troop movement resulting from a Joint Chiefs of Staff and Unified 

Command Deployment Order for 30 continuous days or greater to a land-based location 

outside the United States. 

4

 Operation Enduring Freedom includes ongoing operations in Afghanistan and in certain 

other countries; Operation Iraqi Freedom includes ongoing operations in Iraq. 

United States Government Accountability Office

Washington, DC 20548 
Page 2 GAO-06-105 Reserve Components' Health 

Desert Shield and Desert Storm. Reserve forces played a vital role in 

Operations Desert Shield and Desert Storm. However, problems were 

revealed with reserve component members not being in proper medical or 

physical condition for these deployments. Some members could not 

deploy to the Persian Gulf, and others had difficulty performing their 

missions while there. In an effort to help obviate similar problems in the 

future, Congress passed legislation during the 1990s to help monitor and 

track the health status of deployed members of the Armed Forces, 

including reserve component members.5

Public Law 108-375, the Ronald W. Reagan National Defense Authorization 

Act for Fiscal Year 2005, requires GAO to study DOD’s management of the 

health status of reserve component members ordered to active duty in 

support of Operation Enduring Freedom and Operation Iraqi Freedom. 

Specifically, GAO assessed: (1) DOD’s ability to determine the reserve 

components’ compliance with routine medical and physical fitness 

examinations, and (2) DOD’s visibility over reserve components’ health 

status after they are called to duty and the care, if any, provided to those 

deployed with preexisting conditions. 

To address our first objective, we reviewed federal statutes and Office of 

the Secretary of Defense (OSD) applicable directives and instructions to 

identify and understand the roles and responsibilities of the offices within 

DOD for management of the health status of the reserve components. We 

discussed these statutes and guidance with senior officials in the Office of 

the Under Secretary of Defense for Personnel and Readiness. We 

discussed service policies for medical and physical fitness with military 

officials within the service surgeon general offices and officials 

responsible for physical fitness in the service personnel and operations 

functions. We also analyzed reserve component regulations and policies 

and discussed these with responsible reserve component officials. We 

took steps to assess the reliability of these reserve component compliance 

data and we discuss the results of our assessment in the report. We also 

visited several unit-level commands in all six reserve components. In 

addition, we conducted a limited medical and personnel file review and 

group discussions at an Army National Guard unit in the Mid-Atlantic and 

an Army Reserve unit in the Mid-west for the purposes of understanding 

some of the issues confronting the Army components in terms of 

compliance. 

 5

 10 U.S.C. § 1074f. 
Page 3 GAO-06-105 Reserve Components' Health 

To address our second objective, we interviewed reserve component 

headquarters officials and active component officials responsible for 

mobilizing the reserve components and observed an Army mobilization of 

Army National Guard and Army Reserve members at Fort Bliss, Texas to 

obtain information on processes used to screen members for their medical 

deployability. We obtained and analyzed data provided on medical 

deployability from DOD’s centralized database on pre- and 

postdeployment health assessments, maintained at the Army Medical 

Surveillance Activity (AMSA) and discussed available data with AMSA 

officials. We also obtained and analyzed data on Army reserve component 

members held at mobilization stations for medical reasons and discussed 

these data with officials from the Office of the Assistant Secretary of the 

Army for Manpower and Reserve Affairs and the Army Office of the 

Surgeon General. Based on our review of the AMSA database we used, we 

determined that the data from it were reliable for the purposes of this 

report. To address the extent of medical care provided in theater for 

preexisting medical conditions, we reviewed the Joint Chiefs of Staff 

policy for Deployment Health Surveillance and Readiness and information 

provided by the U.S. Central Command (CENTCOM) Surgeon General 

office regarding medical deployment criteria for Operation Enduring 

Freedom and Operation Iraqi Freedom and discussed these policies with 

the appropriate DOD officials. We met with medical officials who served in 

theater and discussed situations they witnessed related to reserve 

members who had deployed with preexisting conditions. We conducted 

our review from October 2004 through September 2005 in accordance with 

generally accepted government auditing standards. A more thorough 

description of our scope and methodology is provided in appendix I. 

DOD is unable to determine the extent to which the reserve components 

comply with routine medical and physical fitness examination 

requirements due to a lack of OSD guidance and oversight, and incomplete 

or unreliable compliance data supplied by the components. Although the 

Office of the Under Secretary of Defense for Personnel and Readiness 

(OUSD/P&R) has the responsibility for overseeing medical and physical 

fitness policy and processes, this office has not established a management 

control framework and executed a plan to oversee compliance with 

routine examinations. For example, OUSD/P&R has not provided guidance 

to the reserve components regarding requirements for the 5-year medical 

examination and an annual medical certificate. Thus, each reserve 

component has developed its own implementing policies with differences 

in scope, frequency, and administration of the medical examination. Lack 

of OSD guidance makes oversight difficult because uniform criteria 

Results in Brief 
Page 4 GAO-06-105 Reserve Components' Health 

against which to measure compliance do not exist. DOD’s ability to 

determine the extent of compliance has been hindered because OSD does 

not track reserve components’ compliance with routine medical 

examinations. In addition, the data reported at the reserve component 

level have been incomplete and unreliable for purposes of determining 

compliance with routine medical and physical fitness examination 

requirements, and responsibility for compliance has not been enforced. 

For example, although each reserve component employs a tracking system 

capable of monitoring compliance with medical examinations, only one 

reserve component—the Navy Reserve—has taken the necessary quality 

assurance steps to ensure the reliability of its data on compliance. 

Further, DOD has not enforced its own requirement for the services to 

report on the status of the reserve and active components’ physical fitness. 

No reserve component has a tracking system that can report complete and 

reliable data on compliance with physical fitness examinations on a 

componentwide basis. Moreover, although the reserve components place 

the responsibility for tracking compliance with medical and physical 

fitness examinations on the unit commander, the reserve components do 

not always hold the unit commanders accountable and the unit 

commanders do not always enforce the compliance of their members. 

OUSD/P&R has not enforced holding all responsible levels accountable, 

ensuring that all requirements are being met, and complete and reliable 

data are being entered into the appropriate tracking system. Despite 

DOD’s inability to determine the extent of reserve component compliance 

with routine medical and physical fitness examinations, we found 

indications of noncompliance. For example, a limited review of medical 

files at one Army National Guard and one Army Reserve location, data 

from a Navy report, test results of two units in a Marine Corps battalion, 

and data from a review conducted by the Air Force Audit Agency indicate 

some noncompliance at all components with routine examination 

requirements. OSD’s lack of oversight could negatively impact operational 

readiness for future deployments as the number of needed personnel may 

not be medically and physically fit when called to active duty. 

DOD has limited visibility over the health status of reserve component 

members after they are called to duty and is unable to determine the 

extent of care provided to those members deployed with preexisting 

medical conditions despite the existence of various sources of medical 

information. For example, the reserve components all collect various 

types of medical data, but vary in their ability to systematically identify, 

track, and report information on members with both temporary and 

permanent conditions that limit medical deployability. In addition, medical 
Page 5 GAO-06-105 Reserve Components' Health 

information is captured on predeployment forms for all reserve members 

and entered into a DOD-wide centralized database, but the data are 

incomplete and the reasons why members were found nondeployable are 

not captured in a way that is easily discernable. Furthermore, DOD is 

unable to determine the care provided to those deployed with preexisting 

medical conditions because DOD has not determined what preexisting 

conditions may be allowed into a specific theater of operations and 

therefore does not know what conditions to track. The medical 

deployment criteria specific to Operations Iraqi Freedom and Enduring 

Freedom are still evolving, and although DOD has a number of systems for 

tracking medical conditions in theater, the current databases do not 

capture data on known preexisting conditions. Developing and updating 

specific medical criteria for a theater of operations are the responsibilities 

of the combatant command. In the absence of specific theater guidance, 

the services relied on their own deployment criteria. For the Army, 

specific deployment medical criteria did not exist until February 2005. 

Evidence we developed suggests that reserve members did deploy with 

preexisting medical conditions that could not be adequately addressed in 

theater, such as diabetes, heart problems, and cancer. The impact on 

operations of those determined nondeployable or those deployed with 

mission-limiting medical conditions is unknown. However, the impact 

could be significant for future deployments as the pool of Guard and 

Reserve members from which to fill requirements is dwindling and those 

who have deployed are not in as good health as they were before 

deployment. 

We are making several recommendations in this report. For DOD to have 

visibility over the reserve components’ compliance with routine 

examinations, we recommend that DOD establish a management control 

framework and execute a plan for improving oversight and take steps to 

enforce the service reporting requirement on the status of their members’ 

physical fitness. To improve DOD’s visibility over reserve component 

members’ health status after they are called to duty, we recommend that 

DOD oversee the development of the reserve components’ tracking 

systems to identify and track members’ temporary and permanent medical 

conditions that limit deployability and modify the predeployment forms to 

better capture the reasons for nondeployment and medical referrals. To 

help prevent the deployment of members with preexisting medical 

conditions that could adversely affect the mission and strain resources in 

theater, we recommend that DOD develop medical criteria for specific 

theaters and explore using existing tracking systems to track those with 

treatable preexisting medical conditions. 
Page 6 GAO-06-105 Reserve Components' Health 

In written comments on a draft of this report, DOD did not concur with 

our first and fourth recommendation, partially concurred with our fifth 

recommendation, and concurred with our second, third and sixth 

recommendations. DOD did not concur with our first recommendation 

that it establish a management control framework and execute a plan for 

issuing guidance, establishing quality assurance for data reliability, and 

tracking compliance with routine medical examinations. DOD did not 

state that it disagreed with our findings; however, DOD stated that it had 

initiatives underway that addressed our recommendation. We disagree 

with DOD’s conclusion because, based on our review, we do not believe 

that DOD’s initiatives are far enough along to dismiss further action, and 

we continue to believe that our recommendation has merit. DOD 

concurred with our second recommendation that DOD take steps to 

enforce the services’ reporting requirement on the status of their members’ 

physical fitness. During our review none of the reports had been submitted 

to the Principal Deputy as required. We raised concerns in this report 

about the data reliability of the tracking systems for physical fitness. Just 

as we found with routine medical examinations, we also found that DOD 

lacked quality assurance of the data on compliance with physical fitness 

examinations in its tracking systems. We note that the responsible office 

for physical fitness oversight, the Office of Morale, Welfare, and 

Recreation, does not participate on the Joint Medical Readiness Oversight 

Committee that is directed to oversee improvements in medical readiness, 

nor are we aware of any DOD plans to include improvements in the 

oversight of physical fitness in its comprehensive medical readiness plan. 

Therefore, we have expanded our first recommendation to include routine 

physical fitness examinations in the actions to be addressed. 

DOD concurred with our recommendation that DOD oversee the 

development of the reserve components’ tracking systems to identify and 

track members’ temporary and permanent medical conditions that limit 

deployability. DOD did not concur with our recommendation that DOD 

modify the medical predeployment form to better capture reasons for 

nondeployment and medical referrals. DOD stated that the best sources of 

accurate information about what medical reasons kept service members 

from deploying are the permanent medical records. We continue to believe 

our recommendation has merit because DOD has no way to systematically 

analyze the information to determine why servicemembers are medically 

nondeployable. DOD partially concurred with our recommendation that 

DOD determine what preexisting medical conditions should be allowed 

into a specific theater of operations, especially during the initial stages of 

operations, and take steps to consistently utilize these criteria for 

determining medical deployability. DOD also noted that due to the ever-
Page 7 GAO-06-105 Reserve Components' Health 

changing nature of a theater of operations and the inexact nature of 

medicine, a list of nondeployable preexisting conditions will never be fully 

comprehensive or fully enforceable. We agree that a list of nondeployable 

preexisting medical conditions can never be fully comprehensive; 

however, we still believe DOD could establish a list of what preexisting 

medical conditions should be allowed into specific theaters of operations, 

especially during the initial stages of operations, so that in future 

deployments DOD would not experience situations such as those that 

occurred with members being deployed into Iraq who clearly had 

preexisting conditions that should have prevented their deployment. DOD 

concurred with our recommendation that DOD explore using existing 

tracking systems to track those who have treatable preexisting medical 

conditions in theater. DOD noted that refinements to medical tracking 

system are ongoing. We wish to note that before DOD’s tracking systems 

can be used to track those who have treatable preexisting medical 

conditions in theater, DOD must determine what preexisting medical 

conditions should be allowed into a specific theater of operations as called 

for in our fifth recommendation. 

As required by law,6

 each reserve component is to make available qualified 

personnel for active duty in the armed forces in time of war or national 

emergency and at such other times as national security requires. With this 

requirement comes the responsibility that each reserve component 

provides personnel who are medically and physically fit for active duty. As 

noted in DOD guidance,7

 fitness specifically includes the ability to 

accomplish the task and duties unique to a particular operation, and ability 

to tolerate the environmental and operational conditions of the deployed 

location, including wear of protective equipment. 

DOD reserve components include the Army Reserve, the Army National 

Guard, the Air Force Reserve, the Air National Guard, the Navy Reserve, 

and the Marine Corps Reserve. Reserve forces consist of three categories: 

the Ready Reserve, the Standby Reserve, and the Retired Reserve. The 

Ready Reserve had approximately 1.1 million National Guard and Reserve 

members at the end of fiscal year 2004, and its members were the only 

 6

 10 U.S.C. § 10102. 

7

 Minimal Standards of Fitness for Deployment to the CENTCOM Area of Responsibility, 

January 2005. 

Background 

Reserve Components and 

Routine Medical and 

Physical Fitness 

Examinations 
Page 8 GAO-06-105 Reserve Components' Health 

reservists who were subject to involuntary mobilization under the partial 

mobilization authorized by President Bush following the attacks of 

September 11, 2001. Within the Ready Reserve, there are three 

subcategories: the Selected Reserve, the Individual Ready Reserve, and the 

Inactive National Guard. Members of all three subcategories are subject to 

a mobilization under a partial mobilization but routine medical and 

physical fitness policies apply primarily to the Selected Reserve, consisting 

of about 850,000 members at the end of fiscal year 2004.8

DOD administers medical examinations to military personnel for various 

reasons at different intervals. These include examinations at accession, 

mobilization,9

 for special duty assignments, and at separation and 

retirement. The examinations that are required routinely for Selected 

Reserve members to ensure ongoing medical and physical fitness include 

two that are prescribed by federal statute and the second two prescribed 

by DOD regulations and policy. Compliance with these routine 

requirements is the first step toward determining who is fit for duty. 

Federal statute10 prescribes that each member of the Selected Reserve11

who is not on active duty is required to: 

• be examined as to the member’s physical (medical) fitness every 5 years, 

or more often as the respective Secretary considers necessary; and 

• complete an annual certificate of medical condition. 

DOD policy prescribes that each member of the Selected Reserve: 

• receive an annual dental examination; and 

 8

 The Selected Reserve’s members include individual mobilization augmentees—individuals 

who train regularly, for pay, with active component units—as well as members who 

participate in regular training as members of National Guard or Reserve units. 

9

 Mobilization is the process of assembling and organizing personnel and equipment, 

activating or federalizing units and members of the National Guard or Reserves for active 

duty, and bringing the armed forces to a state of readiness for war or other national 

emergency. 

10 10 U.S.C. § 10206(a). 

11 Prior to 2002, this statute applied to members of the Individual Ready Reserve and 

Inactive National Guard as well. Currently, the law requires that the Individual Ready 

Reserve be examined as to their medical fitness as a condition of military duty or 

promotion, or attendance at a military school or other career-related action. 10 U.S.C. § 

10206(b). 
Page 9 GAO-06-105 Reserve Components' Health 

• be evaluated annually for physical fitness for duty, to include an 

assessment of aerobic capacity, muscular strength, muscular endurance, 

and desirable fat composition. 

Within the constraints of the existing mobilization authorities12 and DOD 

guidance, the services have flexibility as to how, where, and when they 

conduct mobilization processing. As a result, the services differ in how 

they mobilize and consequently medically screen members upon 

notification that a unit or individual will be called to active duty. The Army 

and Navy use centralized approaches, mobilizing their reserve component 

forces at a limited number of locations. The Army uses 15 primary sites 

that it labels “power projection platforms” and 12 secondary sites called 

“power support platforms.” The Navy has 15 geographically dispersed 

Navy Mobilization Processing Sites but is currently using only 5 of these 

sites because of the relatively small numbers of personnel who are 

mobilizing. 

By contrast, the Air Force uses a decentralized approach, mobilizing its 

reserve component members at their home stations—135 for the Air Force 

Reserve and 90 for the Air National Guard—where all medical screening is 

performed. The Marine Corps uses a hybrid approach. It has five 

Mobilization Processing Centers to centrally mobilize individual reservists 

and is currently using three of these centers. However, the Marine Corps 

uses a decentralized approach to mobilize its units. Selected Marine Corps 

Reserve units do most of their mobilization processing at their home 

stations, including medical screening, and then report to their gaining 

commands. 

Within the Office of the Under Secretary of Defense for Personnel and 

Readiness, the Office of the Assistant Secretary of Health Affairs is 

responsible for developing medical policies and processes; the Principle 

Deputy to the Under Secretary oversees the Office of Morale, Welfare, and 

Recreation for developing physical fitness policies; and the Office of the 

Assistant Secretary for Reserve Affairs serves in an advisory capacity to 

the Under Secretary to determine how the reserve components can better 

implement these requirements. Each service’s Assistant Secretary for 

 12 Most reserve members who were called to active duty for other than normal training 

after September 11, 2001, were mobilized under one of three legislative authorities: 

10 U.S.C. § 12304, 12302, 12301(d). 

Reserve Components 

Differ in Approaches to 

Mobilize and Medically 

Screen Members for 

Deployment 

Roles and Responsibilities 

for Developing and 

Implementing Examination 

Requirements 
Page 10 GAO-06-105 Reserve Components' Health 

Manpower and Reserve Affairs provides force management policy for both 

the active and reserve components. It is then the responsibility of each 

National Guard and Reserve Command—the Chief, Army Reserve, the 

Director of the Army National Guard, the Chief of the Navy Reserve 

(Commander of Navy Reserve Forces and Commander of Marine Corps 

Reserve Forces), Chief of the Air Force Reserve, and the Director of the 

Air National Guard—that the policies for medical and physical fitness 

examinations are properly implemented for their respective commands. 

Each National Guard and Reserve unit commander is responsible for 

ensuring that the members under his or her command are provided routine 

medical and physical examinations in a timely manner, and for identifying 

and processing members who are not medically qualified or physically fit 

for active duty. The reserve component member is responsible for meeting 

scheduled medical examination requirements, obtaining any 

recommended follow-up medical and dental care from his or her personal 

(civilian) medical provider, and truthfully reporting any changes in his or 

her medical or dental condition to military unit commanders and military 

medical personnel. Upon mobilization, responsibility for the medical and 

physical fitness of the reserve component members transfers to the active 

duty counterparts. 

Several studies identified medical issues with the reserve component 

members called to duty for Operations Desert Storm and Desert Shield. A 

1991 Army Inspector General report13 estimated that as many as 8,000 

reserve component personnel were found to be medically nondeployable 

upon arrival at mobilization stations. Even though all but 1,100 eventually 

deployed, the nondeployable soldiers disrupted the mobilization process 

because units had to undergo extensive efforts to replace nondeployable 

reserve members with those who could be deployed. The report also noted 

that some soldiers who had coronary bypass surgery, cancer, and 

amputations had not been identified at their home stations and reported to 

their mobilization station. In 1991, we reported14 that medical screenings 

conducted at mobilization stations identified numerous problems that 

impaired soldiers’ ability to deploy, including ulcers, chronic asthma, 

 13 Special Assessment of Operations Desert Shield/Storm Mobilization, 

Department of the Army, Inspector General, December 1991. 

14 GAO, National Guard: Peacetime Training Did Not Adequately Prepare Combat 

Brigades for the Gulf War, GAO/NSIAD-91-263 (Washington, D.C.: Sept. 24, 1991).

Problems Identified with 

Medical Deployability 

during Operations Desert 

Shield and Desert Storm 
Page 11 GAO-06-105 Reserve Components' Health 

spinal arthritis, hepatitis, seizures, and diabetes. In 1992, we reported15 that 

because many medical personnel were found nondeployable for various 

reasons, including medical reasons, many units deployed with medical 

personnel shortages and were not fully mission capable upon arrival in the 

Persian Gulf. For example, two reserve component surgeons—one who 

was unable to stand for more than 30 minutes and another who had 

Parkinson’s disease—reported for duty but were unable to deploy due to 

their conditions. A 1992 Sixth U.S. Army Inspector General report16 stated 

that many soldiers deployed to Southwest Asia had to return to the United 

States because of medical conditions that had not been previously 

diagnosed. This report noted that home unit commanders were not 

identifying soldiers with severe medical problems, some permanent, to 

determine if they were medically fit to perform their duties and job 

assignments before deploying. 

In 1994,17 we did a comprehensive review of the medical and physical 

fitness policies for reserve component members serving in Operations 

Desert Storm and Desert Shield and found that at one Army mobilization 

station nearly 4 percent of the reserve component members reporting for 

duty had serious medical conditions including cancer and heart disease. 

One soldier had double kidney failure, one had muscular dystrophy, and 

another had a gunshot wound to the head. We found that DOD medical 

policy, which permits the services to retain nondeployable reservists, was 

inconsistent with a military strategy that requires forces to be capable of 

responding quickly to unexpected military contingencies anywhere in the 

world and we recommended that DOD revise its policy that allows 

members not to be worldwide deployable, but DOD disagreed and did not 

take action. We also found that DOD was not aware of the physical fitness 

problems because the services were not reporting fitness information as 

DOD required and GAO recommended that DOD revise its directive to 

require services to report on their members’ physical fitness status. DOD 

concurred with our recommendations and agreed to take actions. Other 

related GAO products are found at the end of this report. 

 15GAO, Operation Desert Storm: Full Army Medical Capability Not Achieved, 

GAO/NSIAD-92-175 (Washington, D.C.: Aug. 18, 1992).

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

1992. 

17GAO, 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). 
Page 12 GAO-06-105 Reserve Components' Health 

Section 1074f of Title 10, United States Code requires that the Secretary of 

Defense establish a system to assess the medical condition of members of 

the armed forces (including members of the reserve components) who are 

deployed outside of the United States or its territories or possessions as 

part of a contingency operation or combat operation. It further requires 

that records be maintained in a centralized location to improve future 

access to records, and that the secretary establish a quality assurance 

program to evaluate the success of the system in ensuring that members 

receive pre- and postdeployment medical examinations and that recordkeeping requirements are met. 

DOD policy requires that the services collect pre- and postdeployment 

health information from their members, and submit copies of the forms 

that are used to collect this information to the Army Medical Surveillance 

Activity (AMSA).18 Initially, deployment health assessments were required 

for all active and reserve component personnel who were on troop 

movements resulting from deployment orders of 30 continuous days or 

greater to land-based locations outside the United States that did not have 

permanent U.S. military treatment facilities. However, on October 25, 

2001, the Assistant Secretary of Defense for Health Affairs updated DOD’s 

policy and required deployment-related health assessments for all reserve 

component personnel called to active duty for 30 days or more. The policy 

specifically stated that the assessments were to be done “whether or not 

the personnel were deploying outside the United States.” Both 

assessments use a questionnaire designed to help military healthcare 

providers in identifying health problems and providing needed medical 

care. The predeployment health assessment is generally administered at 

the service mobilization site or unit home station before deployment. 

On February 1, 2002, the Chairman of the Joint Chiefs of Staff issued 

updated deployment health surveillance procedures. Among other things, 

these procedures specified that active and reserve component personnel 

must complete or revalidate the health assessment within 30 days prior to 

deployment. The procedures also stated that the original completed health 

assessment forms were to be placed in the military member’s permanent 

medical record and a copy “immediately forwarded to AMSA.” 

Both forms include demographic information about the servicemember, 

member-provided information about the member’s general health, and 

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

DOD’s System to Assess 

Active and Reserve 

Component Members’ 

Health Status Prior to 

Deployments 
Page 13 GAO-06-105 Reserve Components' Health 

information about referrals that are issued when service medical providers 

review the health assessments. The predeployment assessment also 

includes a final medical disposition that shows whether the member was 

deployable or not. 

In September 2003,19 we reported that DOD did not maintain a complete, 

centralized database of the active Army and Air Force components’ 

member health assessments and immunizations. Following our 2003 

review, DOD established a deployment health quality assurance program 

to improve data collection and accuracy. The department’s first annual 

report documenting issues relating to deployment health assessments was 

issued in May 2005. 

In September 2004,20 we reported similar findings for the reserve 

component members. We reported that DOD’s ability to effectively 

manage the health status of its reserve component members is limited 

because its centralized database has missing and incomplete health 

records and it has not maintained full visibility over reserve component 

members with medical problems. For example, the Marine Corps did not 

send predeployment health assessments to DOD’s database as required, 

due to unclear guidance and a lack of compliance monitoring. The Air 

Force has visibility of involuntarily mobilized members with health 

problems, but lacks visibility of members with health problems who are on 

voluntary orders. As a result, some Air Force reserve component 

personnel had medical problems that had not been resolved for up to 18 

months, but the full extent of this problem was unknown since the Air 

Force did not have a mechanism for tracking members who are on 

voluntary duty orders with medical problems. We made several 

recommendations regarding improvements in this area and DOD generally 

concurred with our recommendations and agreed to take actions. 

 19 GAO, Defense Health Care: Quality Assurance Process Needed to Improve Force Health 

Protection and Surveillance, GAO-03-1041 (Washington, D.C.: Sept. 19, 2003). 

20 GAO, Military Personnel: DOD Needs to Address Long-term Reserve Force Availability 

and Related Mobilization and Demobilization Issues, GAO-04-1031 

(Washington D.C.: Sept. 15, 2004). 
Page 14 GAO-06-105 Reserve Components' Health 

Section 731 of the Ronald W. Reagan National Defense Authorization Act 

for Fiscal Year 2005 (NDAA) requires the Secretary of Defense to develop 

and implement a comprehensive plan to improve medical readiness of 

members of the Armed Services by focusing on areas such as health 

status, health surveillance, and accountability for medical readiness. The 

mandate also required that the Secretary of Defense establish a Joint 

Medical Readiness Oversight Committee (JMROC) with a specified 

membership to oversee the development and implementation of a 

comprehensive medical readiness plan.21

In response to the act, the first meeting of the JMROC was held in 

February 2005 during this review. The committee is chaired by the Under 

Secretary of Defense for Personnel and Readiness and membership 

includes the Assistant Secretaries of Defense for Reserve Affairs and 

Health Affairs, the Joint Staff Surgeon, the Chief of the National Guard 

Bureau, Army Reserve, Navy Reserve, Air Force Reserve and the 

Commander of the Marine Corps Reserve, as well as the Vice Chiefs of 

Staff of the Army, Vice Chief of Navy Operations, the Vice Chief of Staff of 

the Air Force and the Assistant Commandant of the Marine Corps as well 

as their respective Surgeon Generals and Assistant Secretaries for 

Manpower and Reserve Affairs, and a representative of the Department of 

Veterans Affairs. 

A draft copy of the Comprehensive Medical Readiness Plan which 

addresses all defense medical issues identified in the act was signed by the 

Under Secretary of Defense for Personnel and Readiness on June 23, 2005. 

Officials from the Force Health Protection Directorate in the OSD Office 

of Health Affairs—which is providing the staff for drafting and overseeing 

this effort—stated that financial and legislative constraints, which may 

limit the implementation of the plan, will have to be identified and 

addressed, and indicators for measuring progress will have to be 

developed before the plan is finalized. 

 21 The mandate directed that the Secretary establish the committee 120 days after passage 

of the act, which was in October 2004. 

Recent DOD Efforts in 

Response to the 2005 

National Defense 

Authorization Act 
Page 15 GAO-06-105 Reserve Components' Health 

Among other things, the draft plan specifies that DOD: 

(l) institutionalize the Individual Medical Readiness22 (IMR) reporting 

process by developing a DOD instruction for the IMR and requires that this 

information be provided to commanders to assist them in improving the 

health status of members of their units; 

(2) expand and improve the pre- and postdeployment assessment process 

by refining the predeployment survey to improve consistency with the 

postdeployment survey and develop periodic postdeployment health 

reassessments; 

(3) develop a policy defining the circumstances under which treatment for 

medical conditions may be provided in theater and circumstances under 

which medical conditions are to be resolved prior to deployment; and 

(4) review the results of this GAO study. 

 22 OSD’s Office of Health Affairs has begun a process requiring each active and reserve 

component to quarterly report the percentage of its members who are in compliance with 

six medical readiness elements: (1) dental class I or II; (2) immunizations; (3) medical 

readiness laboratory tests, such as DNA blood sample; (4) no deployment-limiting 

conditions; (5) periodic health assessment; and (6) medical equipment, such as eyeglass 

inserts for gas masks. 
Page 16 GAO-06-105 Reserve Components' Health 

DOD is unable to determine the extent to which the reserve components 

are in compliance with routine medical and physical fitness examination 

requirements primarily due to a lack of OSD guidance, oversight, and 

incomplete or unreliable compliance data supplied by the components. 

Although the Office of the Under Secretary of Defense for Personnel and 

Readiness (OSD/P&R) has the responsibility for overseeing medical and 

physical fitness policy and processes, this office has not established a 

management control framework and executed a plan to oversee 

compliance with routine examinations. For example, OSD/P&R has not 

provided guidance to the reserve components regarding requirements for 

the 5-year medical examination and an annual medical certificate. Thus, in 

the absence of OSD guidance, each reserve component has developed its 

own implementing policies, resulting in differences in scope, frequency, 

and administration making it difficult because uniform criteria against 

which to measure compliance do not exist; however, OSD has provided 

consistent guidance for dental and physical fitness examinations. DOD’s 

ability to determine the extent of compliance has been hindered because 

OSD does not oversee reserve component members’ compliance with the 

routine physical fitness or medical examination requirements. 

Furthermore, the data reported at the reserve component level have been 

incomplete and unreliable for purposes of determining compliance with 

routine medical and physical fitness examinations, and responsibility for 

compliance has not been enforced. We found indications of 

noncompliance during our site visits and reviews of existing audit reports 

and investigations. OSD’s lack of oversight could negatively impact 

operational readiness for future deployments, as the number of needed 

personnel may not be medically and physically fit for active duty. 

Although OSD/P&R has the responsibility for overseeing medical and 

physical fitness policy and processes, this office has not established a 

management control framework and executed a plan that includes issuing 

guidance to the reserve components on compliance with the requirements 

for the 5-year medical examination and an annual medical certificate. For 

example, the statutory requirement for the 5-year medical examination has 

not been defined by OSD, leaving each reserve component to develop 

implementing guidance, resulting in differences in scope, frequency, and 

administration of the examination among the components. In addition, 

there has not been any OSD implementing guidance regarding the 

statutory requirement for an annual medical certificate, and so different 

guidance has been developed by the surgeons’ general offices responsible 

for each of the six reserve components. Lack of OSD guidance makes 

oversight difficult to determine because the uniform criteria against which 

Lack of DOD 

Oversight Hinders 

DOD’s Ability to 

Determine Reserve 

Components’ 

Compliance with 

Routine Medical and 

Physical Fitness 

Examination 

Requirements, but 

Indications of 

Noncompliance Exist 

Lack of OSD Guidance 

Contributes to Variations 

in Examination Policies 

among the Components 
Page 17 GAO-06-105 Reserve Components' Health 

to measure the components’ compliance do not exist. OSD, through the 

Office of the Assistant Secretary of Defense for Health Affairs, has 

established a consistent requirement and implementation policy for an 

annual dental examination. OSD has also established a consistent 

requirement for a physical fitness examination, although the specific 

content of the physical fitness examination varies among the components 

and it is not coordinated with the medical examinations. 

The requirement for a routine medical examination has been in effect for 

all active and reserve components since at least 1960.23 Yet, as of 

September 2005, OSD has not developed a plan or provided direction to 

the components on how to implement this requirement.24 In the absence of 

OSD guidance, the surgeons general responsible for the four services and 

six reserve components have each developed their own separate 

implementing guidance for the current requirement25 for a 5-year medical 

examination, resulting in differences in scope, frequency, and 

administration among the components as illustrated below. 

Routine medical examinations include assessments in six areas: physical 

capacity or stamina, upper extremities, hearing and ears, lower 

extremities, eyes/vision, and psychiatric.26 For Army active and reserve 

component members older than age 40, there are additional age-specific 

 23 10 U.S.C. § 10206 states that “each member of the Selected Reserve who is not on active 

duty shall be examined as to his physical fitness every five years, or more often as the 

Secretary concerned considers necessary.” In 1993, the interval was changed from every 4 

years to every 5 years. 

24 In 2003, DOD asked the Armed Forces Epidemiological Board to review the appropriate 

methodology and interval for routine medical examinations to be applied similarly across 

all services. Based on the board’s recommendations, the Assistant Secretary of Defense for 

Health Affairs is currently drafting a policy that would replace the 5-year medical 

examination with an annual periodic health assessment. Congress is currently considering 

changing the frequency requirement for a physical examination from every 5 years to 

annually as part of the 2006 national defense authorization act. 

25 In 1993, Congress mandated that these examinations be conducted at least once every 5 

years. Prior to 1993, the requirement was once every 4 years. 

26 Members are given a (PUHLES) physical capacity or stamina, upper extremities, hearing, 

lower extremities, eyes, psychiatric score of 1 to 4 for each of the six assessment areas. P1 

represents a nonduty-limiting condition, meaning that the individual is fit for duty and 

possesses no physical or psychiatric impairments. P2 means a condition may exist; 

however, it is not duty-limiting. P3 or P4 means that the individual has a duty-limiting 

condition in one of the six assessment areas. P4 means the individual functions below the 

P3 level. A rating of either P3 or P4 puts the servicemember in a nondeployable status or 

may result in the changing of the reserve component member’s job classification. 

5-Year Medical Examination 

Requirements Vary among the 

Components 
Page 18 GAO-06-105 Reserve Components' Health 

screenings such as prostate examination, a prostate-specific antigen test, 

and a fasting lipid profile that includes testing for total cholesterol, lowdensity lipoproteins, and high-density lipoproteins. The Department of the 

Navy conducts routine medical examinations on all Navy and Marine 

Corps active component and reserve members that include height and 

weight measurements, blood pressure testing, urinalysis, serology, and 

mental issues. Those being examined are also questioned about their past 

and present medical history, including serious illnesses, injuries, chronic 

conditions, and operations. The Air Force reserve components’ medical 

examination for nonflyers has been significantly reduced to minimize lost 

training time due to annual medical requirements. The scope of the 

current testing exam requirement is essentially limited to brief skin exams 

for scars and cancer and limited laboratory blood work, and excludes 

EKGs, cholesterol, lipid panels, depth perception, glaucoma, and 

mammograms. One question asked on the questionnaire addresses mental 

status and whether the member has a history of anxiety or depression. 

In addition to the differing scope, the different implementing guidance 

across the services has resulted in variations among the services in the 

frequency and administration of the 5-year medical examinations. For 

example, Army guidelines require that Selected Reserve members 

complete a medical examination once every 5 years. During our review, 

the Navy and Marine Corps personnel were examined at slightly different 

intervals: every 5 years through age 50, every 2 years through age 60, and 

annually after age 60. The Air Force is even more different, in that it no 

longer requires a traditional medical examination physical be completed 

every 5 years for nonflyers.27 Instead, members are required to complete an 

annual Preventive Health Assessment (PHA), the answers to which—

combined with the member’s age, gender, health risk factors, medical 

history, and occupations—will determine the types of screening and 

laboratory tests required and if the member needs to be seen by a military 

health care provider. At a minimum, however, Air Force reserve 

component members are required to have a visit with a military health 

care provider, or Periodic Health Assessment Monitor (PHAM),28 at least 

once every 3 years, while Air National Guard members are required to visit 

 27 The Air Force Reserve and Air National Guard discontinued utilizing the “complete or 

comprehensive” long physical exams in July 2001 and January 2003, respectively. However, 

annual physical exams for flying personnel continue to be conducted in both components. 

28 A PHAM is a credentialed health care provider, and may be a physician, nurse 

practitioner, or physician’s assistant. A PHAM performing examinations for flying 

personnel must be a flight surgeon. 
Page 19 GAO-06-105 Reserve Components' Health 

a Health Care Provider (HCP)29 at least once every 5 years. Thus, 

differences exist between the two Air Force reserve components. 

In the absence of any implementing guidance from OSD, guidance for the 

annual certification of medical condition has been developed by the 

surgeon general’s offices responsible for each of the six reserve 

components. Like the 5-year medical examination, the annual certificate of 

medical condition is prescribed by statute30 which states that “each 

member of the Selected Reserve who is not on active duty shall execute 

and submit annually to the Secretary concerned a certificate of physical 

condition.” This requirement has been in law since at least 1960 and is 

especially important for the reserve components, since they are not seen 

by military health care providers as often as the active duty. 

The different guidance from each of the services has resulted in differing 

definitions from each service as to what is involved in the annual medical 

certificate. For example, Department of Army regulations require that all 

members of the Army Reserve and Army National Guard certify their 

medical condition annually on a two-page certification form, where 

members report physician and dentist visits since their last examination, 

describe current medical or dental problems, and disclose any 

medications they are currently taking. Navy and Marine Corps Selected 

Reserve members complete an Annual Certificate of Physical Condition 

that provides information including the location of their health and dental 

records, the dates and purpose or type of their last complete physical and 

dental examinations, and the date of their last HIV blood test among 

others. Reservists are also expected to disclose any injury, illness, or 

disease that occurred within the last 12 months and resulted in 

hospitalization, or caused them to be absent from work, school, or duty for 

more than 3 consecutive days; if they have been under a physician’s care 

or taken prescription medications during the past 12 months; and any 

physical defects, family issues, or mental problems that would prevent 

them from being mobilized. The Air Force has combined this annual 

requirement into its PHA screening process. Within the Air Force Reserve, 

the PHA process involves all members initially completing a Reserve 

Component Health Risk Assessment, which was formerly known as the 

 29 An HCP is a credentialed health care provider, and may be a physician, nurse 

practitioner, or physician’s assistant. An HCP performing flying personnel examinations 

must be a flight surgeon. 

30 10 U.S.C. § 10206(a)(2). 

Annual Certification of 

Members Medical Condition 

Varies among Components 
Page 20 GAO-06-105 Reserve Components' Health 

Annual Medical Certificate. In the Air National Guard, the PHA involves all 

the members initially completing an annual Health History 

Questions/Interval History, which was formerly known as the Annual 

Medical Certificate. 

The annual dental examination is a consistent requirement across the 

reserve components that was established by DOD policy and provided 

consistent standards for active duty and Selected Reserve members to 

improve dental readiness.31 In 1998, the Office of the Assistant Secretary of 

Defense for Health Affairs, under the Under Secretary of Defense for 

Personnel and Readiness, directed that all active duty and Selected 

Reserve members obtain an annual dental examination so that DOD would 

have a clear picture of members’ dental readiness and fitness for duty.32

Although the 1998 directive required all services to provide 

implementation plans for completing all dental examinations by 2001, 

Health Affairs recognized that the services were having difficulty 

identifying both the mechanisms for compliance and the tracking system 

for documentation, and extended the goal of 90 percent compliance until 

February 2004. A year and half later, DOD still does not have complete and 

reliable information on all reserve components’ compliance. 

According to Army regulation, all soldiers within the Army National Guard 

are required to have a dental examination on an annual basis.33 The current 

annual dental examination requires an assessment of the current state of 

oral health; risk for future dental disease, including periodontal 

assessment; and oral cancer screening. Prior to early 2004, the Army 

 31 On December 19, 1996, the Assistant Secretary of Defense for Health Affairs issued DOD 

policy in Health Affairs Memo 97-020, standardizing dental classifications: Class I indicates 

no dental treatment or reevaluation required within the next 12 months; Class II indicates 

patients have the potential for dental emergencies with the next 12 months but it is not 

likely if certain treatments are obtained; Class III represents patients with oral conditions 

that if not treated are expected to result in dental emergencies within the next 12 months; 

and Class IV represents patients requiring a dental examination and whose dental 

classification is unknown. 

32 On February 19, 1998, the Assistant Secretary of Defense for Health Affairs issued DOD 

policy, in Health Affairs Memo 98-021, requiring annual dental examinations and stipulating 

that personnel shall not deploy in Dental Class III or IV except under extreme 

circumstances. 

33 While Army regulation, AR 40-501, only addresses an annual dental examination for the 

Army National Guard, according to the Army Dental Command and the Army Reserve, 

Army Reserve members adhere to the same dental standard. 

Dental Examination 

Requirements Are Consistent 

among Components 
Page 21 GAO-06-105 Reserve Components' Health 

reserve components were still conducting only a dental screening.34 In 

March 2000, the Navy issued instructions requiring Navy and Marine Corps 

reservists to undergo an annual dental examination. Currently, both the 

Air Force Reserve and Air National Guard require annual dental 

examinations in line with DOD’s requirement. The Air Force Reserve made 

this a requirement in January 2003, but the Air National Guard did not 

make it a requirement until September 2004. Prior to these times, the 

required dental exam interval was once every 3 years for the Air Force 

Reserve and once every 5 years for the Air National Guard. 

Although the specific content of the physical fitness examination varies 

among the components, the requirement for at least an annual physical 

fitness examination is consistent across the components because it was 

established by DOD policy which is to be monitored by the Principal 

Deputy Under Secretary of Defense for Personnel and Readiness, Office of 

Morale, Welfare, and Recreation.35 Specifically, the policy requires that all 

military services and reserve components develop and use physical fitness 

tests that evaluate aerobic capacity (e.g., a timed run), muscular strength, 

and muscular endurance (e.g., push-ups, pull-ups, sit-ups), and that all 

service members be formally evaluated and tested for the record at least 

annually (unless they are under a medical waiver). 

The specific content of the physical fitness examination varies among the 

components because different physical abilities are needed to meet the 

services’ different missions. The Army Physical Fitness Test (APFT) is a 

performance test that indicates a member’s ability to perform physically 

and handle his or her own body weight. The APFT is required annually for 

the Army National Guard. As of October 2004, the Chief of the Army 

Reserve required Army reservists to be tested twice a year, as are their 

active component counterparts. The APFT consists of 2 minutes of pushups, 2 minutes of sit-ups, and a 2-mile run (the same test is administered to 

both the active and reserve component). The number of push-ups and situps and the 2-mile run time are based on the soldier’s age range and sex 

(the physical fitness test required to enter the Army has the same 

requirements for all ages, but different requirements for gender). All Navy 

personnel, regardless of age and component (active or reserve), are 

required to participate semiannually in a Physical Fitness Assessment that 

 34 The dental screening was more limited than the current dental examination. It included a 

mouth-mirror, and explorer or tongue depressor evaluation only. 

35 DOD Directive 1308.1, “DOD Physical Fitness and Body Fat Program”. 

Physical Fitness Examination 

Requirements Consistent 

among the Components, but 

Content Varies and It Is Not 

Coordinated with Medical 

Examination Requirements 
Page 22 GAO-06-105 Reserve Components' Health 

includes a Body Composition Assessment and Physical Readiness Test 

unless medically prohibited from doing so. Body composition is assessed 

by an initial weight and height screening or an approved circumference 

technique to estimate body fat percentage. Testing includes a series of 

physical events designed to evaluate an individual’s flexibility through a 

sit-reach activity, muscular strength and endurance through curl-ups and 

push-ups, and aerobic capacity through a 1.5-mile run/walk, or 500-yard or 

450-meter swim. Individuals who fail either the Body Composition 

Assessment or the Physical Readiness Test or both are considered to have 

failed the entire assessment. The Marine Corps has also developed a Body 

Composition Program and Physical Fitness Test to assess each Marine’s 

fitness level. Active component Marines are tested semiannually while 

Marine Corps Reservists are tested annually. Body composition standards 

are health- and performance-based limits for body weight and body fat. 

Physical fitness testing includes pull-ups for males, flexed-arm hang for 

females, a timed abdominal crunch event, and a timed 3-mile run. These 

events are designed to test the strength and stamina of the upper body, 

midsection, and lower body, as well as the cardiovascular system. The Air 

Force fitness program requires an annual physical assessment to motivate 

all members to participate in a year-round physical conditioning program, 

including proper aerobic conditioning, strength/flexibility training, and 

healthy eating. Fitness assessment results are based on a composite score 

calculated from results of an aerobic assessment (1.5-mile run), muscular 

fitness assessment (push-ups and crunches), and body composition 

measurement (abdominal circumference measurement). 

Although DOD has directed the military physical fitness programs to 

complement the health promotion program within OSD’s Office of Health 

Affairs and senior medical officials have told us that medical and physical 

fitness go “hand-in-hand,” physical fitness policies are not coordinated 

with medical fitness policies at the OSD, service, reserve component, or 

unit levels. Furthermore, DOD did not consider physical fitness a factor 

for determining the medical deployability of reserve component members 

prior to deployment to Iraq and Afghanistan, even though we reported in 

199436 that several Army reports on Operations Desert Shield and Desert 

Storm noted fitness-related problems that hindered wartime operations. 

For example, one report noted that poor fitness contributed to the deaths 

 36GAO, 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). 
Page 23 GAO-06-105 Reserve Components' Health 

by heart attack of eight reserve component personnel deployed to the 

Persian Gulf. 

OSD does not have a plan to oversee reserve components’ compliance 

with the routine medical or physical fitness examinations, which hinders 

DOD’s ability to determine the extent of compliance. For example, OSD 

does not track reserve component members’ compliance with routine 

medical examinations. In addition, OSD does not enforce its own directive 

requiring the services to report on their members’ compliance with 

physical fitness examinations. 

Although OSD’s Office of Health Affairs has begun to track medical 

readiness indicators, it does not have a plan to track compliance with 

routine medical examinations and does not attempt to track compliance 

with physical fitness examinations. OSD’s Office of Health Affairs has 

initiated a process requiring that all reserve components report quarterly 

the percentage of their members who are in compliance with the following 

six indicators of medical readiness: dental class I or II; immunizations; 

medical readiness laboratory tests, such as providing a blood sample; no 

deployment-limiting conditions; periodic health assessment; and medical 

equipment, such as eyeglass inserts for face masks. This process continues 

to evolve as the Office of Health Affairs wrestles with inconsistencies in 

requirements among the reserve components, especially in regard to the 

periodic health assessment since each reserve component implements the 

requirement for a periodic 5-year medical examination differently.37

Without centralized oversight and management for tracking compliance, 

DOD’s ability to determine the extent of compliance with routine medical 

examinations may be impeded. 

OSD has not enforced its own directive requiring the reserve and active 

components to report on their members’ compliance with physical fitness 

examinations by March 2005. Although DOD policy states that physical 

fitness is a vital element of combat readiness and is essential to the 

general health and well-being of military personnel, OSD and the reserve 

components have been lax in reporting compliance with physical fitness 

examination requirements and do not fully utilize available systems that 

could report physical fitness status on a servicewide basis. DOD 

 37 The Assistant Secretary of Defense for Health Affairs is currently drafting a policy 

intended to help standardize implementation of the medical examination requirements. 

OSD Does Not Oversee 

Compliance with Routine 

Medical and Physical 

Fitness Examinations 

OSD Does Not Track 

Compliance with Routine 

Medical Examinations 

OSD Has Not Enforced Its 

Directive Requiring the 

Services to Report on 

Compliance with Physical 

Fitness Exams 
Page 24 GAO-06-105 Reserve Components' Health 

established a reporting requirement for physical fitness in November 2002, 

in response to recommendations from our prior reports; however, it has 

not enforced compliance with this new requirement. 

The new physical fitness policy requires that each military service 

establish and maintain a data repository that provides baseline statistics 

and a tracking mechanism that monitors physical fitness and body fat for 

both the active and reserve components. The policy was developed over 

the course of many years. In response to a recommendation in our 1994 

report,38 the Under Secretary of Defense for Personnel and Readiness 

stated that revised DOD guidance39 would “require the services to provide 

an annual report assessing their physical fitness and health promotion 

programs, to include a brief summary on how physically fit and healthy 

they view their military members, both active and reserve components.” 

Not only did the original directive fail to require the services to submit an 

annual report on the status of servicemembers’ physical fitness, but senior 

military officials in the office responsible for developing these directives 

told us that no service ever submitted a status report on their physical 

fitness programs as required by the revised directive. In 1998, we again 

reported that DOD’s oversight of the physical fitness program was 

inadequate and that DOD had not enforced the annual reporting 

requirement.40 Officials in the Office of Morale, Welfare, and Recreation 

stated that in response to our report, DOD guidance was again revised in 

November 2002, to require the services to report annually to the Principal 

Deputy Under Secretary of Defense for Personnel and Readiness41 on a 

number of very specific physical fitness statistics, including the number of 

personnel tested, the number of personnel who failed the test, and the 

number placed in remedial training programs. The first report was due to 

the Principal Deputy Under Secretary of Defense for Personnel and 

Readiness by the military services by March 31, 2005. However, during our 

review we were told by officials in the Office of Morale, Welfare, and 

Recreation that none of the reports had been submitted to the Principal 

 38GAO, Reserve Forces: DOD Policies Do Not Ensure That Personnel Meet Medical and 

Physical Fitness Standards, GAO/NSIAD-94-36 (Washington, D.C.: Mar. 23, 1994). 

39 DOD Directive 1308.1. 

40GAO, Gender Issues: Improved Guidance and Oversight Are Needed to Ensure Validity 

and Equity of Fitness Standards, GAO/NSIAD-99-9 (Washington, D.C.: Nov. 17, 1998). 

41 This position was referred to as the Assistant Secretary of Defense (Force Management 

Policy) at the time the directive was revised in 2002. 
Page 25 GAO-06-105 Reserve Components' Health 

Deputy as required. The Air Force, Navy, and Marine Corps were 

developing their information during this review. The Army had until March 

2007 to report because, according to a signed memorandum by the 

Principal Deputy Under Secretary of Defense for Personnel and Readiness, 

the Army is taking steps to report this information as part of the Defense 

Integrated Military Human Resources System (DIMHRS). Until this 

reporting requirement is enforced, DOD’s ability to determine compliance 

with the physical fitness examinations may continue to be hindered. 

Incomplete and unreliable data at the reserve component level regarding 

compliance with routine medical and physical fitness examinations have 

hindered DOD’s ability to determine the extent of the reserve components’ 

compliance with the examination requirements. Each reserve component 

employs a tracking system capable of monitoring compliance with medical 

examinations, but only one reserve component—the Navy Reserve—has 

data that are reliable for determining compliance with routine medical 

examinations. Furthermore, even though DOD policy calls for each 

military service to establish and maintain a physical fitness data 

repository, no reserve component has demonstrated that its tracking 

system can report complete and reliable compliance data on physical 

fitness. Although the reserve components place the responsibility for 

tracking compliance with medical and physical fitness examinations on 

the unit commander, the reserve components do not always hold the unit 

commanders accountable and the unit commanders do not always enforce 

the compliance of their members. No centralized oversight exists to hold 

all levels accountable, thus ensuring that all requirements are being met. 

All of the reserve components are now employing systems that can track 

compliance with medical examinations, but only one reserve component—

the Navy Reserve—has taken the necessary quality assurance steps to 

ensure the reliability of its data on compliance with routine medical 

examinations. In contrast, we found that the data captured by the systems 

used by the Army and the Air Force were unreliable for determining 

compliance with routine medical examinations. We did not assess the 

reliability of the data used by the Marine Corps because it is in the process 

of implementing and testing the use of the Navy’s system. 

Assessing data for their reliability includes quality assurance steps to 

consider the completeness and currency of the data, i.e., determining 

whether there are assurances that all members are included and the 

information is up to date; quality control measures, such as conducting 

periodic testing of the data against medical records, to ensure the 

accuracy and reliability of the data; and examining who is using the data 

Reporting of Compliance 

at Reserve Component 

Level Is Hindered by 

Incomplete and Unreliable 

Data and Lack of 

Enforcement 

Most Reserve Component Data 

on Compliance with Routine 

Medical Examinations Are 

Unreliable 
Page 26 GAO-06-105 Reserve Components' Health 

and for what purposes, and how reliable the user thinks the data are. We 

found that the Navy Reserve had taken such quality assurance steps. For 

example, the Navy has directed its Readiness Commands to conduct 

routine inspections to verify medical data accuracy in the Navy Reserve’s 

Medical Readiness Reporting System (MRRS) and required reserve units to 

review 10 percent of their medical records for accuracy after each drill 

weekend. In addition, Navy Reserve units are also required to keep the 

Commander, Navy Reserve Forces Command informed about medical and 

dental compliance on a biweekly basis. 

In contrast, we found that the compliance data on routine medical 

examinations captured by the Army Medical Protection System 

(MEDPROS) were unreliable for the purposes of determining compliance 

with routine medical examinations. MEDPROS was developed in 1998 to 

track anthrax compliance and has since matured to meet current 

mobilization requirements. All Army components—active, reserve, and 

guard—are required to enter members’ medical compliance data into 

MEDPROS. We found the data captured by this system are unreliable for 

monitoring compliance with routine requirements for several reasons, 

including missing data, failure to include data for all Army units, and lack 

of quality assurance assessments on data content being performed to test 

the data’s reliability. Until quality control measures are instituted, the 

Army will not be able to reliably use MEDPROS to track compliance with 

the requirements for the 5-year medical examination, the annual medical 

certificate, and the annual dental examination. 

We also found that the Air National Guard’s Preventive Health Assessment 

and Individual Medical Readiness (PIMR) system and the Air Force 

Reserve’s Reserve Component Periodic Health Assessment (RCPHA) 

system were unreliable for the purposes of determining compliance with 

routine medical examinations. We found that neither system produces 

data that are reliable for the purposes of determining compliance with 

routine medical examinations because: (1) both the Air Force Audit 

Agency and Air Force Inspection Agency have reported discrepancies in 

their review of medical records and the data from these systems, and 

(2) there is a high reliance on unit commands to test and verify the 

reliability of the data. In addition, during our site reviews, we found 

medical staff at several commands having difficulty entering large 

backlogs of medical data, which raised concerns about the timeliness of 

the data. Often, this backlog took several weeks to resolve and required 

the assistance of full-time reservists. However, according to program 

managers and database administrators, the quality of the data, in terms of 

their completeness and accuracy, ranges from quite good to exceptional 
Page 27 GAO-06-105 Reserve Components' Health 

when subjected to internal system software checks. Until resources 

necessary to input and verify the data in a timely manner are provided, the 

Air Force will not be able to rely on PIMR and RCHPA data to determine 

compliance with routine medical examination requirements. 

We did not assess the reliability of the data used by the Marine Corps 

because it is in the process of implementing and testing the use of Navy’s 

system. According to a Marine Corps official, once the new system is fully 

implemented, the Marine Corps will have the same oversight capability 

over medical compliance that the Navy Reserve currently has. 

Even though DOD policy calls for each military service to establish and 

maintain a physical fitness data repository, no reserve component has a 

tracking system that can report complete and reliable data on compliance 

with physical fitness examinations on a componentwide basis. In fact, the 

Army Reserve, the Army National Guard, and the Marine Corps Reserve do 

not have systems that are designed to track compliance with physical 

fitness examinations on a componentwide basis. 

The Navy Reserve, the Air National Guard, and Air Force Reserve each 

have systems that can track compliance with physical fitness 

examinations on a componentwide basis. The Navy Reserve system, 

however, may not be producing reliable data at this time. Further, we have 

concerns regarding the reliability of the data produced by the Air National 

Guard and the Air Force Reserve because such data are not reviewed or 

validated on a regular basis. 

The Army does not report physical fitness on a componentwide basis. 

According to a Department of Army memo, dated April 19, 2004, and 

confirmed through our discussions with Army and OSD officials, physical 

fitness and body composition data will eventually be tracked in DIMHRS, 

in which the Army is the first component to participate. Until DIMHRS is 

used, the Army will be unable to report complete and reliable data on 

componentwide compliance with the physical fitness examination 

requirements. According to Army Reserve officials, physical fitness data 

can be tracked in the regional level application software database, but the 

information may not be updated by the units in a timely or consistent 

manner. This information is then updated in the Total Army Personnel 

database, which updates the Individual Training and Readiness System. In 

the Army National Guard, the states may use the personnel database to 

record the scores and dates of physical fitness examinations, but not 

consistently. The Army’s first report on the status of its physical fitness 

compliance for all its components will be due March 31, 2007, because the 

Reserve Components Are 

Unable to Report Complete and 

Reliable Data on Compliance 

with Routine Physical Fitness 

Examinations on a 

Componentwide Basis 
Page 28 GAO-06-105 Reserve Components' Health 

Office of the Under Secretary of Defense for Personnel and Readiness 

granted the Army a 2-year extension for its requirement to report on the 

physical fitness status of all members (active, reserve, and guard). The 

data in this report, if complete and reliable, could enable DOD to 

determine the Army’s compliance with the physical fitness examination 

requirement. According to the 2004 Department of the Army Memo, if 

DIMHRS is not on line by September 2006, the Army will manually report 

these data. 

Compliance with physical fitness examination requirements is tracked at 

headquarters level for the Navy Reserve, but we found that the Navy is 

unable to report complete and reliable compliance data. The Navy requires 

all commands to report their physical fitness assessment data, including 

physical readiness test results, through the Physical Readiness 

Information Management System (PRIMS). However, we found the data 

generated by this system to be unreliable because, according to a Navy 

Official, there are about 2,000 duplicate records that need to be purged 

and about 25 percent of the Body Composition Assessment scores have 

not been reported by unit commanders. Until internal controls are 

established to eliminate duplication and ensure completeness of data, the 

Navy will be unable to report complete and reliable data on 

componentwide compliance with the physical fitness examination 

requirement. The Navy submitted its annual report on physical fitness, due 

March 31, 2005, to DOD 3 months late, on July 8, 2005. According to a DOD 

official, the Navy did not request an extension or provide an explanation 

for the late submission. Because the data in this report came from the 

PRIMS system that we found to be unreliable, we do not believe that DOD 

can reliably use the information in the report to determine the Navy’s 

compliance with the physical fitness examination requirement. 

The Marine Corps is unable to report complete and reliable data on 

compliance with the physical fitness examination because, in contrast to 

the Navy, the Marine Corps does not have a dedicated physical fitness 

reporting system. Instead, the Marine Corps requires unit commanding 

officers to record physical fitness scores in unit diaries, personnel records, 

and the Marine Corps Total Force System, a Marine Corps-wide personnel 

system. Units that input data into this system are responsible for reviewing 

the data and certifying that they are correct. However, a Marine Corps 

official indicated that the data are assumed to be correct when transmitted 

to higher commands, but no steps are taken to verify accuracy of the data. 

As of August 2005, the Marine Corps had provided DOD with a draft report 

addressing calendar year 2004 physical fitness scores. According to a DOD 

official, the Marine Corps did not request an extension or provide an 
Page 29 GAO-06-105 Reserve Components' Health 

explanation for the late draft submission. Further, as of September 2005, 

the Marine Corps had not responded to our official request for the annual 

physical fitness report. Without an ongoing quality assurance program to 

consistently and continuously ensure the completeness and reliability of 

the data in the Marine Corps Total Force System, we did not rely on the 

data in the draft Marine Corps Physical Fitness Report provided to DOD. 

Although both the Air Force Reserve and Air National Guard each have a 

dedicated system to track the physical fitness status of their members, we 

found quality assurance procedures lacking, possibly leading to 

incomplete and unreliable data with which to track physical fitness 

compliance. The Air Force Reserve’s software system Program—the Air 

Force Fitness Management System (AFFMS)—only tracks fitness program 

results on a current basis and only retains data entered from 2004 forward. 

However, quality assurance procedures are not followed. For example, 

there are delays in entering data; compliance of individual units is only 

reviewed if there is a question; and headquarters does not routinely assess 

members’ currency. This program relies on a fitness program manager 

within each unit command to monitor program metrics. According to an 

AFFMS system official, the only true way of determining the reliability of 

the data in this system is to compare these data with the data in the 

respective member’s personnel files, and this has not been done. The Air 

National Guard (ANG) tracking system for compliance with physical 

fitness examinations is ANG’s Fitness Age and was first implemented in 

late 2003, although many ANG units lagged in their use of Fitness Age until 

after April 2004. ANG’s Fitness Age database only reflects calendar year 

information as of a specific point in time, and does not track or measure 

performance based on a running 12-month period. The ANG Fitness 

Program requires an assessment on all ANG members once per calendar 

year. According to ANG officials, most physical fitness testing is 

performed within the last few months of the calendar year. Because the 

data are cumulative, the only time that physical fitness information can be 

assessed for all members taking the test is at the end of the calendar year. 

In other words, most reservists would appear out of compliance until they 

take their annual exam even though they are probably still within their 1-

year window for testing. Furthermore, information on the number of 

reservists not tested at all or who are overdue is not captured by the ANG 

Fitness Age database. According to an ANG official, the responsibility for 

managing the physical fitness program rests with the respective ANG 

installation’s command. The respective ANG installations (unit 

commands) have visibility over their respective “overdue” members. 

However, ANG headquarters lacks sufficient oversight to assess 

compliance. Without ongoing quality assurance programs to consistently 
Page 30 GAO-06-105 Reserve Components' Health 

and continuously ensure the completeness and reliability of the data in the 

Air National Guard and Air Force Reserve systems, we did not rely on the 

data in these systems. 

In general, throughout the reserve components, the individual members 

are responsible for maintaining their physical and medical fitness and the 

unit commanders are responsible for ensuring members’ compliance with 

medical and physical fitness examinations; however, the reserve 

components do not always hold the unit commanders accountable and the 

unit commanders do not always enforce the members’ compliance. 

Accountability for compliance is fragmented at various levels of command. 

No centralized oversight exists to hold all levels accountable ensuring that 

all requirements are being met. Individual members are responsible for 

attending all scheduled examinations and assessments, seeking timely 

medical advice when necessary, reporting changes in their medical health 

on the annual medical certificate, and successfully completing the 

requirements of the physical fitness examinations. False statements may 

result in reassignment, discharge, or other disciplinary action. Unit 

commanders are responsible for implementing any administrative and 

command provisions for examinations, informing members of the 

examination requirements, establishing training programs for physical 

fitness, taking actions against reserve members who fail to comply with 

the requirements, and reporting the current medical and dental status of 

reservists through the applicable tracking systems, and they are ultimately 

responsible for the accuracy of medical and physical fitness information 

relied on by higher commands. However, reserve components do not 

always hold the unit commanders accountable for these responsibilities 

and the unit commanders we interviewed expressed concern about the 

many competing responsibilities they have, such as meeting training 

requirements, and how they must prioritize the use of their limited 

resources. One unit commander also expressed concern about enforcing 

medical and physical fitness policies if it meant losing a “good soldier” 

who otherwise performs his duties well. Without oversight and 

accountability at the OSD and respective service and reserve component 

levels, unit commanders may not have the incentive or resources to fully 

enforce the medical and physical fitness examination requirements and 

compliance may suffer. 

Accountability to Comply with 

Routine Medical and Physical 

Fitness Examination Is Not 

Always Enforced 
Page 31 GAO-06-105 Reserve Components' Health 

Although DOD can not determine the extent of reserve components’ 

compliance with routine medical and physical fitness examinations, we 

found indications of noncompliance during our site visits and in our 

reviews of existing audit reports and investigations. For example, a limited 

review of medical files at one Army National Guard and one Army Reserve 

location, data from a Navy report, test results of two units in a Marine 

Corps battalion, and data from a review conducted by the Air Force Audit 

Agency indicate some noncompliance at all components with the routine 

medical examination, annual medical certificate, annual dental 

examination, and annual physical fitness examination. 

A review of available medical files at one Army National Guard and one 

Army Reserve location, data from a Navy report, test results of two units 

in a Marine Corps battalion, and data from a review conducted by the Air 

Force Audit Agency indicate some noncompliance with the routine 

medical examination and the annual medical certificate at all components. 

For example, in April 2005 we conducted a review of 39 medical files at an 

Army National Guard unit that was deployed to Iraq in 2003 for 1 year. We 

found that 13 members were not in compliance with the routine medical 

examination at the time of our review. Further, while 36 members were in 

compliance with the annual medical certificate at the time of our review, 

only 3 members were in compliance with the annual medical certificate 

prior to the unit being alerted of their most recent mobilization date for 

deploying to Iraq. According to the commander of this unit, there are a 

number of actions that need to be accomplished during weekend drills, 

and with limited time and resources available, completing routine medical 

requirements is low on the long list of priorities. In addition, during June 

2005, we reviewed 175 medical files of an Army Reserve unit that deployed 

to Afghanistan in 2003 for 10-month deployment. We found that all but 2 

members were in compliance with the 5-year medical examination. While 

150 members were in compliance with the annual medical certificate at 

the time of our review, not a single member was in compliance with the 

annual medical certificate prior to the unit receiving alert orders of their 

mobilization. Furthermore, many of the soldiers that we spoke with during 

our review stated that they were unfamiliar with the annual medical 

certificate. In addition, a February 2005 Army Inspector General Report 

noted that virtually all reserve component leaders they contacted during 

their review expressed frustration with their inability to maintain the 

medical deployability status of their soldiers using the annual medical 

Indications of 

Noncompliance with 

Medical and Physical 

Fitness Examination 

Requirements Exist 

Indications of Noncompliance 

with 5-Year Medical 

Examination and Annual 

Medical Certificate Exist at All 

Components 
Page 32 GAO-06-105 Reserve Components' Health 

certificate process.42 Leaders noted the certificate only reflects what a 

soldier is willing to share. Often the only medical personnel available to 

review and sign the certificate is a unit medic, who can do little more than 

ask if the data are correct. 

In July 2005, the Navy reported that 96.8 percent of reserve members had 

completed the routine 5-year medical examination and 94 percent of 

reserve members had completed the annual medical certificate. These high 

rates are due, in part, to the high priority placed on medical and dental 

compliance throughout the Navy Reserve. 

Although the Marine Corps Reserve does not currently have 

componentwide automated information on medical compliance, it does 

conduct a periodic site inspection called the Mobilization Operational 

Readiness Deployment Test (MORDT). We reviewed the results of the 

MORDT at two units of a Selected Reserve Battalion that had been 

mobilized. The first unit test results we reviewed indicated that 98 percent 

of the reservists had completed a routine physical examination within 5 

years, and 90 percent had submitted annual health certifications. The 

second unit test results also indicated that 98 percent of the reservists had 

completed a routine annual physical within 5 years, and 88 percent had 

submitted annual health certifications. According to Marine Corps Reserve 

officials, all Marine Corps Selected Reserve units are subjected to an 

unannounced test prior to mobilization to ensure the unit can deploy. 

The Air Force Audit Agency (AFAA) recently concluded its review of the 

Service’s Individual Deployment Process, during which it found significant 

problems with the Guard’s and Reserve’s medical records. Ten Air 

National Guard and Air Force Reserve installations included in a sample of 

20 installations designed to be able to produce estimates for all Air Force 

personnel who were eligible to be deployed during the 90-day window 

between June 1, 2004, and August 31, 2004, were in compliance with 

medical requirements such as, but not limited to, annual medical 

assessments and dental examinations. The AFAA reviewed the medical 

records and associated documentation for accuracy and completeness. 

Based on AFAA’s review and analysis of 14,121 eligible Guard and Reserve 

members combined, about 13 percent43 were found to have medical 

 42 Over 1,400 active and reserve component leaders, soldiers, and civilians in 35 locations in 

the United States were contacted by the Army Inspector General during its review. 

43 We are 90 percent confident that the true percentage of medical discrepancies is within 

+/-6.1 percentage points of our estimate. 
Page 33 GAO-06-105 Reserve Components' Health 

discrepancies in their medical records. At 2 of the unit commands 

included in AFAA’s review that we also visited in our review, command 

officials said that they agreed with the AFAA’s findings and were taking 

corrective action. 

Indications of noncompliance with the dental examination requirement 

were also present at all the reserve components. For example, as 

previously noted, in April 2005, we conducted a review of 39 medical files 

of an Army National Guard unit; of these, 33 were not in compliance with 

the annual dental examination at the time of our review. Furthermore, 32 

members were not in compliance with the annual dental examination prior 

to alert. In June 2005, we visited an Army Reserve unit to conduct a review 

of 175 medical files. Although only 13 members were not in compliance 

with the annual dental examination at the time of our review, over 130 

members were not in compliance with the dental examination prior to 

alert. 

Other evidence indicates that compliance with dental requirements has 

been a particular matter of concern for the Army reserve components. 

According to a February 2005 Army Inspector General Report,44 there are 

examples of reserve component service members with multiple tooth 

extractions at nearly every mobilization station. Furthermore, in cases 

where members presented dental records during mobilization, often the 

only entries are dated to the members’ basic training and initial exams and 

procedures. We found a stark example of what happens during 

mobilization when a member’s dental status is allowed to remain below 

Class I or II. In one unit we visited, we interviewed a member who had 30 

teeth extracted prior to deployment. According to the member, although 

dental screenings were conducted annually, indicating that he was a dental 

class III he took no follow-up action to correct his dental problems 

because he had no dental insurance and correcting the problem was not a 

priority. At the time this servicemember was being mobilized, a 

Department of the Army memo dated December 6, 2002, stated that 

soldiers assigned to designated units scheduled to deploy within 75 days of 

mobilization and identified as being within dental class III or IV have 

necessary dental treatment initiated to bring them up to dental 

classification II, the deployment standard. 

 44 Department of the Army Inspector General Special Inspection of Army 

Mobilization/Demobilization in Support of Recent and Ongoing Operations, November 

2003-June 2004, February 28, 2005. 

Indications of Noncompliance 

with Dental Examinations Exist 

at All Reserve Components 
Page 34 GAO-06-105 Reserve Components' Health 

Although we did not review individual medical and dental records at Navy 

and Marine Corps Reserve sites we visited, we did review specific reports 

to assess whether these components monitored members’ dental status. 

We found that the Navy Reserve compliance appears to be improving. For 

example, in early July 2005, the Navy reported that 88.6 percent of selected 

reservists were in a Dental Class I or II category, an increase over the 69 

percent reported in the Dental Class I or II category in December 2002. We 

also reviewed MORDT results for two Marine Corps units during a site 

visit to a Marine Corps Reserve Battalion that had been mobilized. We 

found that test results for the first unit indicated that 85 percent were 

categorized as Dental Class I or II while 77 percent in the second unit were 

categorized as Dental Class I or II. 

Analysis provided by the AFAA from its review, mentioned earlier, 

indicated that about 13 percent45 of the Air National Guard and Air Reserve 

members who were eligible to be deployed between June 1, 2004, and 

August 31, 2004, were found to have discrepancies in their dental records. 

In addition to the AFAA review, in 2004 the Air Force Inspection Agency 

conducted health services inspections and found discrepancies in dental 

readiness classifications in 49 percent of the 37 installations reviewed. 

As with the other examination requirements, we also found indications of 

noncompliance with the physical fitness examination requirement at all 

six components. 

During our review in April 2005 we also reviewed 29 physical fitness files 

of the Army National Guard unit that deployed to Iraq. Of the 29 physical 

fitness files we reviewed, only 18 members showed compliance with the 

physical fitness examination requirement during 2004. Of these 18 

members, 11 passed the physical fitness test and 7 failed. According to the 

unit commander, some soldiers possess skills that are greatly needed for 

unit continuity and strength and usually outweigh the ramifications of 

having to separate the member due to physical fitness test failures. We 

also conducted a review in June 2005 of 227 physical fitness files of the 

Army Reserve unit that deployed to Afghanistan. Of the 227 physical 

fitness files we reviewed, only 117 members showed evidence of 

compliance with the physical fitness examination requirement during 

2005. Of these 117 members, 89 passed the physical fitness test and 16 

 45 We are 90 percent confident that the true percentage of medical discrepancies is within 

+/-6.1 percentage points of our estimate. 

Indications of Noncompliance 

with Physical Fitness 

Examination Requirement 

Exist at All Reserve 

Components 
Page 35 GAO-06-105 Reserve Components' Health 

failed.46 In group discussions held at this time, members stated that there 

were no repercussions for failing the physical fitness test. As previously 

reported in our 1994 report,47 we also found that physical fitness scores 

had been inappropriately changed and servicemembers were not 

discharged even after repeated test failures, primarily because 

commanders placed more emphasis on maintaining unit strength. 

While visiting a Navy Reserve Activity, we obtained a single unit’s physical 

fitness test results to ensure data were properly maintained in the Physical 

Readiness Information Management System. However, when we asked the 

Navy Personnel Command to provide a copy of the required physical 

fitness report, we learned the report would be submitted to OSD late. 

According to a Navy official, the Navy had identified over 2,000 duplicate 

record entries and estimated that nearly 25 percent of the body fat scores 

were missing from the data totals. In its report to OSD, the Navy reported 

that it had not mandated separation processing for individuals who failed 

the physical fitness test since May 2001. 

During a visit to a Marine Corps Reserve Center, we also obtained 

information that indicated individual Marine Corps reservists’ physical 

fitness scores were recorded in the Marine Corps Total Force System. 

Subsequent to our visit, however, we learned that the Marine Corps also 

provided an unofficial “draft” physical fitness report to the OSD after the 

deadline. In order to review Marine Corps physical fitness statistical data, 

we requested a copy of the report on April 6, 2005. As of October 2005, the 

Marine Corps had not responded to our request. 

The Air Force did not meet OSD’s required due date in submitting its first 

annual report on its assessment of the physical fitness, body fat, and 

health promotion program for the active service, the Air National Guard, 

and the Air Force Reserve. The Air Force did not submit its annual report 

until May 4, 2005. Based on the data provided by the Air Force for the Air 

National Guard and the Air Force Reserve, only 83 percent of the force 

members were tested, with 13.2 percent of those tested falling into the 

 46 At the time of our review, 110 members did not have an APFT on file. In addition, there 

were service members who did not take a physical fitness test for the record during 2005, 

nor did they have a temporary or permanent profile when completing the physical fitness 

test. 

47GAO, 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). 
Page 36 GAO-06-105 Reserve Components' Health 

poor category. However, the Air Force’s assessment of one of its reserve 

component’s statistical data may not be entirely correct. In its reported 

statistical information of the numbers of members tested, those members 

testing in the poor category are higher than those numbers directly 

reported by the Air National Guard to the Air Force Medical Support 

Agency, which consolidated the respective components’ data and in turn 

submitted the overall report to the Assistant Secretary of Defense for 

Force Management Policy. In addition, as discussed earlier, we were 

unable to determine that the data used from the Air National Guard and 

Air Force Reserve databases that generated these data are reliable. 

DOD does not have complete visibility over the health status of reserve 

component members after they are called to duty and is unable to 

determine the extent of care provided to those members deployed with 

preexisting medical conditions. Despite the existence of various sources of 

medical information, DOD has incomplete visibility over members’ health 

status when called to active duty, primarily because the reserve 

components vary in their ability to systematically identify, track, and 

report members’ medical deployability and the DOD-wide centralized 

database cannot provide complete information—both of which hinder 

DOD’s ability to accurately determine what forces remain for future 

deployments. In addition, DOD is unable to determine the extent to which 

reserve component members received care for preexisting medical 

conditions while deployed; however, evidence suggests that reserve 

component members did deploy with preexisting medical conditions that 

could not be adequately addressed in theater and that some of these 

conditions may have stressed in-theater medical capabilities. 

Although DOD has some visibility over reserve component members after 

they are called to active duty or mobilized, this visibility is limited despite 

several potential sources of information. For example, the reserve 

components vary in their ability to systematically identify, track, and 

report information about members’ medical deployability, which limits 

DOD’s visibility over the health status of members. In addition, although 

medical information is captured on predeployment forms for all reserve 

component members and entered into a DOD-wide centralized database 

during mobilization, some data are still missing and information regarding 

the reasons why members were found nondeployable is not captured in a 

way that can be easily searched through the database. Moreover, medical 

referral data captured on the predeployment forms provide some insight 

into the care that members may have required during mobilization, but this 

care is not always related to why a member was determined to be 

DOD Lacks Visibility 

over the Health Status 

of Reserve 

Components after 

Being Called to Active 

Duty and the Extent 

to which Members 

with Preexisting 

Conditions Required 

Care during 

Deployment 

Visibility over Health 

Status of Reserve Members 

after They Are Called to 

Active Duty Is Limited 
Page 37 GAO-06-105 Reserve Components' Health 

medically nondeployable. Some data on the medical reasons why Army 

Guard and Reserve members were not deployed after being activated can 

be obtained from an analysis of the Army’s medical holdover database, but 

this information is insufficient to provide DOD with visibility over 

members’ health status since it is only gathered on the numbers of Army 

reserve components held prior to deployment and this population is 

diminishing due to positive changes in Army’s medical holdover policy. 

DOD’s limited visibility over reserve component members’ health status 

when they are called to active duty could affect planning for future 

deployments because the pool of available Guard and Reserve component 

members from which to fill requirements for certain skills and grades is 

dwindling, and members’ health status is deteriorating following 

deployments. 

The reserve components vary in their ability to systematically identify, 

track, and report members’ medical deployability, and only three reserve 

components—the Navy Reserve, the Air Force Reserve, and Air National 

Guard—can currently identify and track members with both temporary 

and permanent conditions that limit medical deployability. This limited 

visibility over reserve component members’ medical deployability status 

hinders DOD’s ability to identify the pool of available Guard and Reserve 

members who are available for deployment. 

The Navy Reserve uses the Medical Readiness Reporting System (MRRS) 

to track and report the status of reservists classified as Temporarily Not 

Physically Qualified for duty because of an illness, injury, or other medical 

condition that should be resolved within 6 months. This system is also 

used to track and report the status of reservists, classified as Not 

Physically Qualified for duty, with more serious medical conditions such 

as cancer or heart disease that will not be resolved in 6 months and may 

lead to a medical review or board retention decision. As the Marine Corps 

Reserve continues to fully implement the Navy’s Medical Readiness 

Reporting System, it too will have these same capabilities. Both the Air 

National Guard and the Air Force Reserve’s medical tracking systems—

PIMR and RCPHA, respectively—can identify and track members with 

specific medical conditions that limit deployment; however, neither 

system can distinguish between temporary and permanent limitations. In 

addition, the Air Force has a system called Military Personnel Data System 

that captures information on all medical profiles and can report specific 

queries on specific categories such as temporary and permanent 

conditions. Although the Army tracks active, guard, and reserve members 

with medical profiles that limit deployment through their medical tracking 

system, MEDPROS, the active Army and Army Reserve do not presently 

Reserve Components Vary in 

Ability to Identify, Track, and 

Report Medical Nondeployable 

Members 
Page 38 GAO-06-105 Reserve Components' Health 

track members with temporary medical conditions that render them 

nondeployable. However, the Army National Guard is in the process of 

implementing a system, called the Medical Non-Deployable Tracking 

Module (MND-TM), that will track its members who have a temporary or 

permanent medical condition that renders them nondeployable. Army 

National Guard officials expect all states to use this system for its 

members by July 2007. Until all six reserve components are able to 

systematically identify and track members’ medical deployability status, 

DOD will not have the most accurate information to centrally manage 

estimating the remaining available pool of guard and reserve members for 

future deployments. 

DOD has some visibility over reserve component members’ medical status 

during mobilization through the centralized DOD-wide database operated 

by the Army Medical Surveillance Activity (AMSA). All active and reserve 

component members are required to complete a medical predeployment 

form to document the member’s medical deployability status, which is 

then forwarded to AMSA for entry into the database. Thus, information 

can be obtained from the centralized database on reserve and active 

component members who were determined nondeployable during 

mobilization due to medical reasons. The member also completes a health 

assessment form after deployment. However, we have noted in previous 

reports that the centralized database has missing and incomplete forms. In 

our last report issued in September 2004,48 we found that for the required 

forms from reserve component members (1) not all of the forms had 

reached AMSA, (2) only some of the forms that had reached AMSA had 

been entered into the database, and (3) not all of the forms contained 

complete information, thus limiting analysis. 

We also noted that while the components were not in complete 

compliance with the requirement to submit pre- and postdeployment 

assessments, the number of assessments had grown significantly. During 

this review, we found that DOD has continued to make progress toward 

collecting the pre- and postdeployment forms. According to AMSA 

officials, the database contained about 140,000 assessments at the end of 

1999, grew to about 1 million assessments by May 2003, almost doubled at 

1,960,125 by June 2004, and was at 2,241,177 by June 2005. 

 48 GAO-04-1031. 

Centralized DOD-wide 

Database Provides Some 

Visibility over Health Status 

During Mobilization, but Data 

Could Be Further Improved 
Page 39 GAO-06-105 Reserve Components' Health 

Further, DOD has established a centralized deployment health quality 

assurance program to improve data collection and accuracy.49 Each 

service has also developed a deployment health quality assurance 

program. The department’s first annual report, documenting, among other 

things, issues relating to predeployment health assessments, was issued in 

May 2005. The DOD quality assurance program includes (1) periodic site 

visits jointly conducted with staff from the Office of the Assistant 

Secretary for Health Affairs and staff from the military services to assess 

compliance with the deployment health requirements, (2) periodic reports 

from the services on their quality assurance programs, and (3) periodic 

reports from AMSA on health assessment data maintained in the 

centralized database. The report noted that centralized management of 

quality assurance had improved accountability of the preassessment forms 

on the part of the services. 

For this review, we obtained predeployment information from AMSA 

officials based on over 1 million active and reserve component 

predeployment health assessment forms collected between November 

2001 and June 2005. More than 5 percent of the reserve component and 

more than 6 percent of the active component predeployment health 

assessment forms did not record the servicemember’s deployability status. 

Of the approximately 94 percent of forms that were complete, nearly the 

same percent of reserve component and active component members were 

found medically deployable, 94 percent of the reserve component 

members compared to 96 percent of the active component members. 

Unfortunately, the forms do not always capture information regarding the 

reasons why members were found medically nondeployable or do not 

capture that information in a systematic way. For example, although the 

form has an entry for a narrative explanation to explain why a member is 

medically nondeployable, an AMSA official informed us that these 

explanations are often incomplete or not decipherable, and can not be 

easily categorized. Furthermore, although the forms do provide space for 

the member’s deployment destination, this information is not always filled 

in because, according to AMSA officials, deployment destination is often 

not known by the member or is classified. Therefore, the data presented 

here are for all worldwide deployments, including the United States, and 

 49 This program was established following our 2003 review, GAO, Defense Health Care: 

Quality Assurance Process Needed to Improve Force Health Protection and Surveillance, 

GAO-03-1041 (Washington, D.C.: Sept. 19, 2003). 
Page 40 GAO-06-105 Reserve Components' Health 

could change after the initial deployment, thus preventing an analysis by 

operation. 

As seen in table 1, the total nondeployable rate for all six reserve 

components was more than 5 percent, while table 2 shows the total 

nondeployable rate for the active component was almost 4 percent. While 

the Army Reserve had the highest percentage of nondeployable 

servicemembers among the reserve components, at about 9 percent, the 

active Army had the highest percentage of nondeployable servicemembers 

among the active components, at almost 6 percent. According to medical 

officials, some of these nondeployable personnel, such as those who had 

suffered multiple heart attacks, should have been discharged prior to the 

time that they received their mobilization orders. Others had temporary 

conditions, such as broken bones and pregnancies, that did not warrant 

medical discharges but made the servicemember nondeployable at the 

time of the assessment. 

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

Source: GAO analysis of AMSA data. 

Reserve 

Components Deployable Nondeployable 

Deployable or 

nondeployable 

answer missing 

on form

Percentage with 

missing answer

Total number of 

predeployment 

health assessments 

completed

Percentage 

nondeployable

Army Reserve 100,286 9,842 5,578 4.82 115,707 8.51

Army National 

Guard 

181,160 10,959 6,584 3.31 198,703 5.52

Navy Reserve 8,597 99 1,445 14.25 10,141 .98

Air Force Reserve 13,164 156 2,341 14.95 15,661 1.00

Air National Guard 35,025 243 3,335 8.64 38,603 .63

Marine Corps 

Reserve 

3,886 31 763 16.30 4,684 .66

Total 342,118 21,330 20,046 5.23 383,499 5.56
Page 41 GAO-06-105 Reserve Components' Health 

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

Active 

Components Deployable Nondeployable 

Deployable or 

nondeployable 

answer missing 

on form

Percentage with 

missing answer

Total number of 

predeployment 

health assessments 

completed

Percentage 

nondeployable

Army 347,057 21,018 19,451 5.02 387,528 5.42

Navy 20,190 109 1,627 7.42 21,928 0.50

Air Force 150,045 1,477 14,544 8.76 166,066 0.90

Marine Corps 47,318 166 4,191 8.11 51,678 0.32

Total 564,610 22,770 39,813 6.35 627,200 3.63

Source: GAO analysis of AMSA data. 

The predeployment health assessment forms capture information on 

specific medical referrals given to members by the reviewing health care 

official during mobilization, which is useful in gaining some insight into 

the care that members may have required during mobilization. These data 

are not as helpful in determining why a member was not medically 

deployable since they are not always related to why a member was 

determined to be nondeployable. According to a senior OSD official, 

although any indicated referral may be related to a disposition of 

nondeployable, this is not always the case. Three common scenarios 

illustrate this relationship: (1) a member is found to be clearly 

nondeployable from a medical standpoint, and no referral is made; (2) a 

member is referred for further evaluation for a condition for which 

deployability is questionable, in which case there is a direct relation 

between the referral and the determination of deployable or 

nondeployable; or (3) a member is found to be deployable, but has a minor 

medical issue for which the health provider provides a referral for 

treatment. According to a senior OSD official, the last scenario is a fairly 

uncommon reason for a referral. Examples might include a referral for a 

routine preventive test, such as a Pap test in a gynecological clinic. The 

Pap test is a desired preventive medical test, but depending on the date 

and result of the last Pap exam and the individual’s personal history and 

risk factors, it is not always necessary to perform one prior to deployment. 

More than 50,000 referrals were made on the predeployment health 

assessments from November 2001 through June 2005 for both the active 

and reserve components. As shown in table 3, of the 21,000 forms with 

referrals for reserve component members, the referral rate averaged more 

than 5 percent. As shown in table 4, of the 24,633 forms with referrals for 

their active duty counterparts, the referral rate was about 4 percent. 

Medical Referral Data Provide 

Insight on Care Provided 

during Mobilization 
Page 42 GAO-06-105 Reserve Components' Health 

Within the reserve components, the Army Reserve had the highest referral 

rate at nearly 8 percent, while the Air National Guard and Air Force 

Reserve had the lowest rates, both at less than 1 percent. 

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

through June 2005 

Reserve component 

Total number of 

predeployment events 

with referrals 

Total predeployment 

referral rate

Army National Guard 11,609 5.84

Army Reserve 8,750 7.56

Air National Guard 201 0.52

Air Force Reserve 145 0.93

Navy Reserve 211 2.08

Marine Corps Reserve 84 1.79

Total 21,000 5.48

Source: GAO analysis of AMSA data. 

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

through June 2005 

Active component 

Total number of 

predeployment events 

with referrals 

Total predeployment 

referral rate

Army 20,312 5.24

Air Force 3,047 1.83

Navy 572 2.61

Marine Corps 702 1.36

Total 24,633 3.93

Source: GAO analysis of AMSA data. 

Note: Predeployment Health Assessment forms may contain no referrals, one referral, or multiple 

referrals per completed form. 

There are 18 categories of referrals that can be checked on the 

predeployment form, of which 1 is “other” and does not provide any 

further detail. As seen in figure 1, the top 3 medical referrals for the 

reserve components were “other,” “dental,” and “eye,” whereas the top 3 

referrals for active components were “other,” “dental,” and “orthopedics.” 

The rate of medical referrals for the reserve components was almost 40 

percent and for the active components was almost 50 percent. 
Page 43 GAO-06-105 Reserve Components' Health 

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

Although the AMSA referral data do provide some insight into the medical 

care required during mobilization, the referral data are not detailed enough 

to determine the type of medical referral or determine the reason for 

nondeployment. 

The Army’s medical holdover database, a module within the Medical 

Operational Data System (MODS), does provide DOD with a snapshot of 

data about the number of Army National Guard and Reserve members who 

were not deployed after being called to active duty because of medical 

problems and the medical reasons why they were not deployed after being 

activated. Although all of the services may keep reserve component 

members on active duty if they incur an injury in the line of duty following 

deployment, only the Army has held reserve component members in need 

of medical care at military treatment facilities prior to deployment. These 

Army Medical Holdover 

Database Provides Data on 

Activated Members Who Were 

Not Deployed Due to Medical 

Problems 

0

.05

1.0

1.5

2.0

2.5

3.0

3.5

4.0

4.5

5.0

Other dental Eye Ortho GYN Mental Cardiac ENT Pulmonary Derm Neuro GI GU PregnancyFamily Fatigue Combat Audiology

Rates of referrals

Types of referrals

Source: GAO analysis of AMSA data.

Reserve component

Active component

Audiology

Combat

Fatigue

Family

Pregnancy

GI

GU

Derm

Neuro

Pulmonary

ENT

Mental

Cardiac

GYN

Ortho

Eye

Other

Dental
Page 44 GAO-06-105 Reserve Components' Health 

servicemembers are referred to as the medical holdover population. 

Because of the large numbers of activated Army National Guard and Army 

Reserve members placed in medical holdover by the Army in the early part 

of Operation Iraqi Freedom, the Army Office of the Surgeon General 

created a module in an existing database to track them. We examined the 

Army medical holdover data to obtain information about the possible 

reasons why servicemembers were found to be medically nondeployable. 

However, the data cannot provide complete visibility over members’ 

health status because the population receiving medical care from the Army 

prior to deployment is diminishing due to changes in Army’s medical 

holdover policy. Further, until January 2005, MODS was not used 

consistently by all case managers50 responsible for servicemembers in 

medical holdover. 

Between December 2002 and October 2003, 4,850 activated Army reserve 

component members were found medically nondeployable and kept on 

active duty until their medical problems had been resolved and they were 

returned to full duty or until they had been referred to a medical board and 

discharged from the Army. In October 2003, the Army changed its policy to 

allow the demobilization of personnel who were found to be 

nondeployable within the first 25 days of activation. In accordance with 

this policy, reserve component servicemembers identified in the first 25 

days as having a medical condition that renders the individual 

nondeployable may be released from active duty immediately. As a result 

of this policy change, the Army was able to demobilize reserve component 

members who were found to be nondeployable within the first 25 days of 

their mobilization. The change also reduced the inflow of reserve 

component members on active duty with medical problems who were 

identified during the predeployment health assessment process. As of 

August 11, 2005,51 only 860 reserve component members52 were in a 

medical holdover status as a result of a medical condition found prior to 

deployment. 

 50Draft regulation for the Medical Holdover Case Management Program states that a case 

manager is normally a registered nurse who is assigned to manage the medical care 

provided each medical holdover soldier. The case manager implements the case 

management process with a focus on clinical evaluation and outcomes. 

51 As of August 11, 2005, the total number in medical holdover was 4,866—860 of whom 

were placed there prior to deployment, and the remainder of whom were placed there due 

to a medical condition developed during deployment. 

52 According to an Army official, 87 of these 860 have been in a medical holdover status for 

over a year due to complex medical conditions, such as cancer. 
Page 45 GAO-06-105 Reserve Components' Health 

As shown in figure 2, the most common medical condition that has 

prevented a reserve component member from deployment53 is orthopedic 

in nature—accounting for 56 percent of the 860 Army National Guard and 

Army Reserve members who were found medically nondeployable and 

placed in a medical holdover status—followed by internal medicine at 16 

percent, and neurological problems at 8 percent. 

Figure 2: Medical Conditions of Army National Guard and Army Reserve Members 

in a Medical Holdover Status as of August 11, 2005 

 53 Conditions that could disqualify a reserve component servicemember from deployment 

and would cause the member to be released if identified medically nondeployable during 

the first 25 days of activation include temporary and permanent conditions that do not 

meet medical deployment standards as outlined in AR 40-501, Chapter 3. 

4%

General surgery

56%

8%

Internal medicine

Mental health

Orthopedic

Neurological

Source: GAO analysis of Army data.

Cardiovascular

2%

Ear, nose and throat

16%

5%

5%

2%

Diabetes

2%

Dental
Page 46 GAO-06-105 Reserve Components' Health 

Despite the more specific information about medical status that can be 

obtained by reviewing these medical holdover data, the data are fairly new 

and limited to those held at medical treatment centers. 

Although senior military officials at various levels of command told us that 

the health status of reserve component members did not affect 

deployment schedules, the extent to which unit commanders have had to 

find replacement members to fill in for members who were medically 

unqualified upon alert, the reasons why, and how, or if, this impacted 

planning of operations in Iraq and Afghanistan are unknown. However, 

DOD’s lack of visibility over reserve component members’ health status 

when they are called to active duty could affect planning for future 

deployments as the demand for troops for the Global War on Terrorism 

continues. 

The Army has had to transfer reserve component personnel from 

nonmobilized units to mobilized units to meet mission requirements. For 

example, the Army Inspector General reported in February 2005 that with 

increasing frequency, Army units identified for alert and mobilization had 

previously provided members to other units. The report noted that 

frequently more than half of a deploying unit’s personnel had been 

transferred into the unit to meet personnel requirements. This “ripple 

effect” is occurring across the Army reserve force, and each subsequent 

mobilization requires more and more personnel transfers to meet 

personnel requirements. The need for these personnel transfers is largely 

due to an outdated Cold War strategy that planned to use the reserve 

forces as a later deploying force and therefore did not give them full 

resources. As more units are used for this “cross-leveling”, it becomes 

even more important that the Army have good visibility over the health 

status of the remaining reserve component members. 

In addition, as shown in table 5, the health status has declined for active 

and reserve components after returning from deployment as shown by 

data from the pre- and postdeployment health assessments. The Army 

National Guard and Army Reserve had the highest percentage of 

servicemembers indicating their health as fair to poor on the 

postdeployment health assessment. 

Lack of Visibility over Reserve 

Component Members’ Health 

Status Could Affect Planning 

for Future Deployments 
Page 47 GAO-06-105 Reserve Components' Health 

Table 5: Rate of Servicemembers’ Health Status as Recorded on Pre- and Postdeployment Forms for Active and Reserve 

Components from November 2001 through June 2005 

Military component 

Predeployment:

 good to excellent

Postdeployment: 

good to excellent

Predeployment: 

fair to poor 

Postdeployment: 

fair to poor

Reserve component: 

Army Reserve 95.77 87.05 2.70 12.30

Army National Guard 96.57 89.07 2.27 10.31

Marine Corps Reserve 98.36 89.90 0.99 8.95

Air National Guard 99.13 97.43 0.42 1.73

Air Force Reserve 99.00 96.49 0.40 2.16

Navy Reserve 98.60 93.67 0.64 5.08

Active component: 

Army 95.00 90.53 3.44 8.32

Marine Corps 97.51 93.49 1.74 5.59

Air Force 98.82 97.73 0.86 1.73

Navy 96.88 94.27 2.55 5.08

Source: GAO analysis of AMSA data. 

As the pace of operations for the reserve forces continues to be high and 

the health status of returning members is diminished, it becomes even 

more important that DOD has good visibility over the availability of 

remaining units. Improved visibility and tracking of the health status and 

medical deployability of these members is a key component in the 

calculation of the members available for planning future deployments. 
Page 48 GAO-06-105 Reserve Components' Health 

DOD cannot determine the extent to which reserve component members 

received care for preexisting medical conditions while deployed in 

theater54 because DOD has not determined what preexisting medical 

conditions may be allowed into specific theaters of operations. The 

purpose of examining members and properly screening them at the 

mobilization stations is to help ensure that members are medically and 

physically fit to deploy and do not have any condition that would 

adversely affect the mission. As noted in DOD guidance,55 fitness 

specifically includes the ability to accomplish the task and duties unique to 

a particular operation, and the ability to tolerate the environmental and 

operational conditions of the deployed location. Specific medical 

deployment criteria for proper screening are essential for determining 

preexisting medical conditions that can not be adequately addressed in 

theater and could stress in theater medical capabilities. While evidence 

suggests that members did deploy with preexisting conditions, the total 

impact of this is unknown. 

Developing and updating medical criteria for a specific theater of 

operations are the responsibilities of the combatant commands—for 

Operation Enduring Freedom and Operation Iraqi Freedom this is U.S. 

Central Command (CENTCOM). The CENTCOM medical deployment 

criteria have been evolving over the course of these operations. 

CENTCOM has updated this guidance six times throughout these 

operations to include more specific guidance to the theater of operations; 

the last update was issued in January 2005. During the initial mobilizations 

for these operations, the services were dependent on CENTCOM general 

deployment criteria issued in May 2001, which did not identify medical 

conditions that would render a member medically unfit for these 

operations. In the absence of specific guidance early on during the 

operations, the services relied upon their own medical deployment 

criteria. For the Army, specific criteria did not exist until February 2005.56

 54 For the purposes of this report, preexisting medical conditions refer to those medical 

conditions that were not identified during mobilization that may limit a member’s ability to 

perform his or her mission and cannot be adequately addressed in theater. 

55 Minimal Standards of Fitness for Deployment to the CENTCOM Area of Responsibility, 

January 2005. 

56 Army Regulation 40-501 was updated to include standards for deployment in February 

2005. 

Extent to which Members 

with Preexisting Medical 

Conditions Required 

Treatment during 

Deployment Cannot Be 

Determined 

While Specific Deployment 

Criteria for Operations 

Enduring Freedom and Iraqi 

Freedom Continue to Evolve, 

Tracking of Known Preexisting 

Conditions Has Not Begun 
Page 49 GAO-06-105 Reserve Components' Health 

The original CENTCOM deployment criteria made a general statement that 

all personnel must be assessed and determined to be medically and 

psychologically fit for worldwide deployment to a combat theater and that 

the in-theater health infrastructure provides only limited medical care. Not 

until May 2004 did CENTCOM update its deployment criteria to include 

more specific guidance. This updated guidance stated that 

servicemembers who have existing medical conditions may deploy if all of 

the following conditions were met: (1) an unexpected worsening of the 

condition is not likely to have a medically grave outcome; (2) the condition 

is stable; and (3) any required ongoing health care or medications must be 

immediately available in theater in the military health system, and have no 

special handling, storage, or other requirements, such as electrical power. 

The criteria provided a list of conditions that may preclude medical 

clearance for DOD civilians and contractors (including current heart 

failure, history of heat stroke, and uncontrolled hypertension); however, 

according to CENTCOM officials, this list of conditions did not apply to 

servicemembers because they were already covered by service-specific 

guidelines. The most recent CENTCOM deployment criteria applicable to 

all servicemembers and DOD civilians and contractors were issued in 

January 2005, and update theater-specific immunization requirements and 

provide more detailed guidance on contact lens wear, among other things. 

As these policies are developed, the combatant command is to provide 

them to the services, which are then responsible for determining how they 

implement the screening requirements in terms of screening their 

deploying forces, including activated reservists. 

Because DOD has not determined what preexisting conditions may be 

allowed into a specific theater of operations, it has not known what 

preexisting conditions to track. As noted, the medical deployment criteria 

for the current theater of operations have been evolving, but specific 

medical deployment criteria have not been developed for other potential 

theaters of operation. However, some preexisting medical conditions may 

be common to all theaters of operation. DOD has not determined this. 

Further, although DOD has a number of systems for tracking medical 

conditions in theater, the current databases have not been modified to 

capture data on known preexisting conditions for this specific operation. 

For example, the Joint Medical Workstation (JMeWS) provides medical 

treatment status and medical surveillance information, as well as tracks 

and reports patient location within a theater of operations and during 

evacuation from frontline medical units to stateside medical treatment 

facilities. The U.S. Transportation Command (TRANSCOM) utilizes the 

TRANSCOM Regulating Command and Control Evacuation System 

(TRAC2ES) to document patient movements, such as medical evacuations. 
Page 50 GAO-06-105 Reserve Components' Health 

The Joint Patient Tracking Application (JPTA) was initially designed for 

use within Landstuhl Regional Medical Center in Germany as a way to 

manage Operations Enduring Freedom and Iraqi Freedom patients. In 

2004, the services were directed by the Assistant Secretary of Defense for 

Health Affairs to implement JPTA at military treatment facilities in theater 

and the continental United States to improve patient tracking and 

management. The Disease Nonbattle Injury (DNBI) rates for the services 

in Operations Enduring Freedom and Iraqi Freedom are tracked in the 

DNBI database by the Air Force Institute for Operational Health. We did 

not evaluate these systems since they do not distinguish care provided for 

preexisting medical conditions. 

Although DOD does not systematically develop or report information 

about the extent of care that was provided in theater to reserve 

component members for preexisting medical conditions,57 senior military 

medical officials who served in theater have provided examples of reserve 

component members who were deployed with preexisting medical 

conditions that could not be adequately addressed in theater. Some 

officials told us that such treatments strained in theater medical 

capabilities and infrastructure. 

According to a senior military official in the surgeon’s office of the 

commander in chief of the U.S. Central Command (CENTCOM), there 

were many instances of individuals, from all services, who deployed into 

the Iraq and Afghanistan theater of operations with conditions for which 

they should have been considered nondeployable. Also, medical officials 

from both the Army and Navy cited examples of conditions seen in theater 

that should have rendered members nondeployable. Among the examples 

cited were members with a history of heart attack, severe asthmatics (the 

desert conditions were not suitable for these members), severe 

hypertension, a woman 4 months into chemotherapy for breast cancer, 

and a man who had received a kidney transplant 2 weeks prior to 

deploying. Other examples included cases involving members deployed 

with sleep apnea requiring machines that are run by electricity, even 

though electricity was either unavailable or unpredictable. Another 

soldier, we were told, who arrived in theater was diabetic and required an 

insulin pump for treatment. We were also told of a number of psychiatric 

 57 Although some systems exist to track various aspects of medical care provided in 

theater, we did not identify any system that tracks care provided to reserve component 

members for preexisting conditions. 

Evidence Suggests that Reserve 

Component Members Have 

Been Deployed into Theater 

with Preexisting Medical 

Conditions 
Page 51 GAO-06-105 Reserve Components' Health 

patients who were suffering from conditions such as bipolar disorder who 

should not have been in the desert because the medications that they were 

taking caused them to sweat profusely. One Air Force Reserve medical 

official who served in theater preparing members to be medically 

evacuated estimated that of the approximate 2,000 reservists she helped to 

evacuate, 10 percent being evacuated were due to preexisting conditions 

such as diabetes and heart problems, with the most common condition 

being diabetes. The commander of an Army Guard unit deployed to Iraq 

told us about a member who had deployed with a preexisting knee 

problem for which he had to be returned to the United States to correct. 

The issue was eventually resolved and the member was allowed to 

redeploy with his unit. 

According to a September 2004 Air National Guard Surgeon General 

memorandum,58 unacceptable dental health should preclude a member 

from deploying under any circumstances because dental resources do not 

exist in theater. However, the Air National Guard’s Surgeon General has 

noted that dental emergencies are historically and currently the most 

common preventable reason for loss of manpower in the wartime theater.59

In addition, the Air Force’s Air Surgeon Chief of Medical Services 

Directorate commented on January 17, 2003, in response to a case 

involving an Air National Guard member who had been sent into theater 

with an obvious major preexisting dental condition, that it is unreasonable 

to expect deployed doctors and dentists to perform remedial procedures 

and provide care that should have been accomplished at home because it 

takes too much time away from treating injured and ill in theater, and it 

results in lost man hours for the gaining unit that it needs to accomplish its 

war-fighting requirements. In our small group discussions with Army 

National Guard, one servicemember said that he was told that he would 

receive dental care in theater, although this care was never provided. At 

one Air National Guard unit command we visited, officials informed us of 

a member who was mobilized and subsequently deployed with preexisting 

dental problems in late 2003, because (1) the dental condition was not 

disclosed by the member and (2) the unit command did not have a current 

dental exam in his medical records to prove otherwise. The member 

would not have been deployed had his true dental condition been initially 

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

standard. 

59 The Air National Guard issued the memorandum, via SG Log Letter 04-026, on September 

27, 2004. 
Page 52 GAO-06-105 Reserve Components' Health 

identified, but he received substantial dental work while deployed.60

According to a unit command official, the member was subsequently 

returned to his unit command because his dental costs and related work 

downtime were excessive. 

In addition to a lack of specific guidance from CENTCOM to the services 

early in the operations, military medical officials told us other reasons why 

members may have arrived in theater with preexisting medical conditions. 

First, military officials stated that in some cases members did not disclose 

their preexisting medical conditions because they wanted to serve their 

country. A Navy official, for example, stated that a Navy officer with 

hypertension did not disclose his medical condition in order to deploy to 

Iraq to support Operation Iraqi Freedom. Because the officer’s medical 

condition worsened in Iraq, the Navy had to return him to his home unit 

and find a replacement to fill his position. We were also told of members 

who arrived in theater with preexisting conditions with the expectation 

that they would be taken care of while they were there. For example, a 

senior medical official stated that one servicemember arrived in theater 

with one kidney and in need of dialysis, which was not available in theater. 

Early in operations several servicemembers with hernias were deployed 

with the expectation that the surgery would be conducted in theater. 

It is important to have up-to-date medical criteria specific to a theater of 

operations to alert members to changing condition in theater or new 

information on vaccinations, for example. Developing and updating 

medical criteria for a specific theater of operations is the responsibility of 

the commander in chief of the combatant command—in this case, 

CENTCOM. As these polices are completed and updated, the combatant 

command is to provide them to the services, who are then responsible for 

determining how they implement the requirements in terms of screening 

their deploying forces including activated reservists. 

The findings we present in this report are not new. In the aftermath of the 

first Persian Gulf War, a number of DOD and GAO studies were issued that 

identified problems with guard and reserve personnel being medically and 

physically fit for duty. DOD agreed with many of the studies’ findings and 

 60 From November 2003 through January 2004, the reservist incurred a total of 20 dental 

office and clinic visits and received two fillings, two extractions, four root canals, and three 

crowns, at a cost of about $5,200 to the military. 

Other Reasons Members May 

Have Arrived in Theater with 

Preexisting Conditions 

Conclusions 
Page 53 GAO-06-105 Reserve Components' Health 

recommendations but never developed a plan with goals, time frames, and 

measurable results to improve visibility over reserve component members’ 

health status. At times, Congress has stepped in and directed DOD to make 

a number of improvements, especially for quality assurance and tracking 

of health assessment data collected before and after a member’s 

deployment. Congress recently directed OSD to develop and implement a 

comprehensive plan to improve management of the health status of the 

reserve component. The importance of such a plan has become even more 

important in the current environment, where the pool of guard and reserve 

members with the right skills from which to fill requirements for DOD’s 

overseas and domestic commitments is dwindling. 

Further, many of DOD’s personnel policies, including its medical policies, 

are outdated, as they are based on Cold War strategy that allowed the 

reserve force more time to mobilize before deployment. Now the reserve 

force deploys with the active force and is expected to be medically and 

physically fit when called to duty. The lack of oversight of reserve 

members’ health status, however, does not appear to be unique to the 

reserve component. Oversight, as seen in the area of enforcing DOD’s 

reporting requirement on the status of physical fitness for both the active 

and reserve components, has not taken place. No repercussions exist if a 

service does not provide this report on time, nor are there any deadlines 

for the annual report to be submitted to OSD. 

OUSD/P&R has the authority to set medical and physical fitness policy and 

processes to oversee this area; however, OUSD/P&R has not taken action 

to exercise its authority to address these long-standing problems. 

As DOD proceeds to develop a comprehensive plan for improving 

management over the health status of the reserve components in response 

to the Ronald W. Reagan National Defense Authorization Act for Fiscal 

Year 2005, we recommend six actions. 

To have visibility over reserve components’ compliance with routine 

medical and physical fitness examinations, we recommend that the 

Secretary of Defense 

• direct the Under Secretary for Personnel and Readiness, in concert with 

the Assistant Secretary for Health Affairs and the Principal Deputy to the 

Under Secretary, to establish a management control framework and 

execute a plan for issuing guidance, establishing quality assurance for data 

Recommendations for 

Executive Action 
Page 54 GAO-06-105 Reserve Components' Health 

reliability, and tracking compliance with routine medical and physical 

fitness examinations; and 

• direct the Under Secretary for Personnel and Readiness, in concert with 

the Principle Deputy who oversees the Office of Morale, Welfare, and 

Recreation, to take steps to enforce the service reporting requirement on 

the status of members’ physical fitness in conjunction with the actions 

taken in the first recommendation. 

To improve DOD’s visibility over reserve components’ health status after 

they are called to duty, we recommend that the Secretary of Defense 

• direct the Under Secretary of Defense for Personnel and Readiness, in 

concert with the Assistant Secretary of Health Affairs, to also oversee the 

development of the reserve components’ tracking systems to identify and 

track members’ temporary and permanent medical conditions that limit 

deployability; and 

• direct the Under Secretary of Defense for Personnel and Readiness, in 

concert with the Assistant Secretary of Health Affairs, to modify the 

medical predeployment forms to better capture reasons for 

nondeployment and medical referrals. 

To help prevent the deployment of reserve component members with 

preexisting medical conditions that could adversely affect the mission and 

strain resources in theater, and to provide visibility over those members 

deployed with preexisting conditions for which treatment can be provided 

in theater, we recommend that the Secretary of Defense: 

• direct the Chairman of the Joint Chief of Staff to determine what 

preexisting medical conditions should not be allowed into specific 

theaters of operations, especially during the initial stages of the operation, 

and to take steps to ensure that each service component consistently 

utilizes these as criteria for determining the medical deployability of its 

reserve component members during mobilization; and 

• direct the Chairman of the Joint Chief of Staff, in concert with the service 

secretaries, to explore using existing tracking systems to track those who 

have treatable preexisting medical conditions in theater. 

In written comments on a draft of this report, DOD did not concur with 

our first and fourth recommendations, partially concurred with our fifth 

recommendation, and concurred with our second, third, and sixth 

recommendations. DOD did not concur with our recommendation that it 

establish a management control framework and execute a plan for issuing 

guidance, establishing quality assurance for data reliability, and tracking 

Agency Comments 

and Our Evaluation 
Page 55 GAO-06-105 Reserve Components' Health 

compliance with routine medical examinations. DOD did not state that it 

disagreed with our findings; however, DOD stated that it had initiatives 

underway that addressed our recommendation. DOD further noted that 

because policies, programs, and instructions are already in place or in 

process, it did not see the need for any additional action. We disagree with 

DOD’s conclusion because, based on our review, we do not believe that 

DOD’s initiatives are far enough along to dismiss further action, and we 

continue to believe that our recommendation has merit. We agree that the 

initiatives DOD cited in its written comments are positive steps toward 

correcting the identified problems, but management and planning remain a 

concern. We have not seen enough evidence to agree that DOD has put in 

place a management control framework that will enforce holding all 

responsible levels accountable, ensuring that all routine medical 

requirements are being met, and that complete and reliable data are being 

entered into the appropriate tracking systems. As noted in our report, the 

problems with determining the health status of the reserve force were 

revealed during Operations Desert Shield and Desert Storm, and in the 

decade that has passed since then DOD has made little progress to correct 

the identified problems. As a result, in 2004, Congress directed DOD to 

establish a Joint Medical Readiness Oversight Committee to oversee the 

development and implementation of a comprehensive medical readiness 

plan. As also noted in our report, the committee held its first meeting in 

February 2005, and a plan to improve medical readiness was being 

developed during this review. We do not believe that a committee can be 

held accountable for ensuring that such actions take place. Ultimately, the 

Under Secretary of Defense for Personnel and Readiness, in concert with 

the Assistant Secretary for Health Affairs, are accountable for enforcing 

the requirements for routine medical examinations. 

Moreover, DOD stated that it has established a new quality assurance 

program that monitors electronic data with validation through medical 

record reviews of a wide range of force health protection measures. We 

did not find this to be true during our review. With the exception of the 

Navy Reserve, the reserve components do not monitor electronic data of 

routine medical examinations with validation through medical record 

reviews. Further, we found the data in the reserve components’ tracking 

systems to be unreliable for purposes of determining compliance with 

routine medical examinations. As noted in our report, compliance with 

these routine medical examinations is the first step toward determining 

who is medically fit or ready for duty. DOD stated that its compliancemonitoring Individual Medical Readiness program regularly reports the 

overall medical readiness status for each servicemember. However, we 

found that the Individual Medical Readiness program’s outcomes are 
Page 56 GAO-06-105 Reserve Components' Health 

derived from data in the reserve components’ tracking systems, which we 

have found to be unreliable, with the exception of the Navy Reserve, for 

the purposes of determining compliance with routine medical 

examinations. DOD stated that its Individual Medical Readiness program’s 

data are being incorporated into overall unit readiness status reports, 

providing visibility of reserve component medical readiness throughout 

the line command structure. We believe that until top management at DOD 

ensures that complete and reliable data on routine medical examinations 

are being entered into its tracking systems, DOD and Congress will 

continue to have a false picture of medical readiness for the reserve 

components. We believe that our first recommendation still has merit. 

DOD concurred with our recommendation that DOD take steps to enforce 

the services’ reporting requirement on the status of their members’ 

physical fitness. DOD stated that DOD instruction 1308.3, dated November 

5, 2002, among other things, requires the active and reserve components to 

provide an annual report to the Principal Deputy of the OUSD/P&R not 

later than March 31. DOD stated that the Air Force, the Navy, and the 

Marine Corps have submitted their reports. DOD noted that exceptions to 

the reporting requirement for the Air Force and the Army had been 

approved. However, during our review we were told that none of the 

reports had been submitted to the Principal Deputy as required. We raised 

concerns in this report about the data reliability of the tracking systems 

for physical fitness. We found that the reserve components are unable to 

report complete and reliable data on compliance with routine physical 

fitness examinations on a componentwide basis due to incomplete and 

unreliable data. Just as we found with routine medical examinations, we 

also found that DOD lacked quality assurance of the data on compliance 

with physical fitness examinations in its tracking systems. We do not know 

what data reliability issues DOD will cite in its annual reports on physical 

fitness. We note that the responsible office for physical fitness oversight, 

the Office of Morale, Welfare, and Recreation, does not participate in the 

Joint Medical Readiness Oversight Committee that is directed to oversee 

improvements in medical readiness, nor are we aware of any DOD plans to 

include improvements in the oversight of physical fitness in its 

comprehensive medical readiness plan. Therefore, we have expanded our 

first recommendation to include routine physical fitness examinations in 

the actions to be addressed. 

DOD concurred with our recommendation that DOD oversee the 

development of the reserve components’ tracking systems to identify and 

track members’ temporary and permanent medical conditions that limit 

deployability. DOD stated that it is already actively adapting existing 
Page 57 GAO-06-105 Reserve Components' Health 

systems, and in some cases creating new ones, that can be used to track 

the medical status of active and reserve members, to include those known 

conditions that could limit an individual’s deployability. DOD noted that it 

continues to pursue better integration between medical and personnel 

data systems to improve visibility regarding deployment-limiting medical 

conditions, whether temporary or permanent, but the overall effectiveness 

will continue to be limited by lack of access to civilian medical records of 

reserve component members. 

DOD did not concur with our recommendation that DOD modify the 

medical predeployment form to better capture reasons for nondeployment 

and medical referrals. DOD stated that the best sources of accurate 

information about what medical reasons kept service members from 

deploying are the permanent medical records. This may be the case, but 

we continue to believe our recommendation has merit because DOD has 

no way to systematically analyze the information to determine why 

servicemembers are medically nondeployable. Because the predeployment 

form is used to document whether a servicemember is deployable, this 

existing form could be modified to better capture the reasons for 

determining why a servicemember is determined nondeployable. Although 

the form has an entry for a narrative explanation to state why a member is 

medically nondeployable, AMSA officials informed us that these 

explanations are often not decipherable, incomplete, and can not be easily 

categorized. DOD also stated that the existing predeployment form already 

includes a list of the most common referral categories to simplify the 

documentation process for the health care provider. In addition, DOD also 

noted that data from the forms are captured electronically and are readily 

available to monitor for trends in referral patterns, among other things. We 

do not believe that any meaningful analysis for referrals can be determined 

from these forms because we found that the top medical referral category 

for the reserve and active components was “other”. This heavy use of the 

category “other” does not provide any insight as to what medical care a 

member is receiving after being called to duty. Given that the rate of 

medical referrals for the reserve components was almost 40 percent and 

for the active components was almost 50 percent, we continue to believe 

that DOD should modify the predeployment form to better capture reasons 

for nondeployment and medical referrals. 

DOD partially concurred with our recommendation that DOD determine 

what preexisting medical conditions should be allowed into a specific 

theater of operations, especially during the initial stages of operations, and 

take steps to consistently utilize these criteria for determining medical 

deployability. DOD stated that certain conditions clearly should render a 
Page 58 GAO-06-105 Reserve Components' Health 

member nondeployable, and the services have made strides in defining 

these conditions and incorporating them into their applicable policies and 

procedures. But DOD also noted that due to the ever-changing nature of a 

theater of operations and the inexact nature of medicine, a list of 

nondeployable preexisting conditions will never be fully comprehensive or 

fully enforceable. We agree that a list of nondeployable preexisting 

medical conditions can never be fully comprehensive; however, we still 

believe DOD could establish a list of what preexisting medical conditions 

should be allowed into specific theaters of operations, especially during 

the initial stages of operations, so that in future deployments DOD would 

not experience situations such as those that occurred with members being 

deployed into Iraq who clearly had preexisting conditions that should have 

prevented their deployment. 

DOD concurred with our recommendation that DOD explore using 

existing tracking systems to track those who have treatable preexisting 

medical conditions in theater. DOD noted that refinements to medical 

tracking system are ongoing. We wish to note that before DOD’s tracking 

systems can be used to track those who have treatable preexisting medical 

conditions in theater, DOD must determine what preexisting medical 

conditions should be allowed into a specific theater of operations as called 

for in our fifth recommendation. 

DOD noted in its overall comments that the reserve and active forces use 

many of the same reporting tools within each service and face the same 

basic challenges in ensuring data quality. DOD stated that where tracking 

systems are shared, the reserve components depend on the active 

components to develop and fund those systems, and that priority for 

deployment of large systems has historically been given to the active 

component. DOD also pointed out that our report indicates that the health 

status of members deteriorates with multiple deployments and that the 

data we used are self-reported and should be taken with great caution and 

in the proper context. We used the self-reported data from 

postdeployment health assessments to help demonstrate the importance 

of good visibility over the reserve forces. We noted that the demand for 

reserve personnel, especially within the Army components, continues, and 

the pool of reserve members used to fill requirements is dwindling. 

Further, the health status of returning reserve and guard members is not 

as good as it was before deployment as our analysis of the pre- and 

postdeployment health assessments showed. Therefore, it becomes even 

more important that DOD have good visibility over the health status of 

remaining reserve force to help determine what is left for future 

deployments. 
Page 59 GAO-06-105 Reserve Components' Health 

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

We are sending copies of this report to the Secretary of Defense; the 

Secretaries of the Army, the Navy, and the Air Force; the Commandant of 

the Marine Corps; the Chairman of the Joint Chiefs of Staff; and the 

Director, Office of Management and Budget. We will also make copies 

available to others upon request. In addition, the report will be available at 

no charge on the GAO Web site at http://www.gao.gov. 

If you or your staff has any questions concerning this report, please 

contact me at (202) 512-5559 or stewartd@gao.gov. Contact points for our 

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

last page of this report. GAO staff who made major contributions to this 

report are listed in appendix III. 

Derek B. Stewart 

Director, Defense Capabilities and Management 
Appendix I: Scope and Methodology 

Page 60 GAO-06-105 Reserve Components' Health 

To assess the Department of Defense’s (DOD) ability to determine the 

reserve components’ compliance with routine medical and physical fitness 

examinations, we reviewed federal statutes and Office of the Secretary of 

Defense (OSD) applicable directives and instructions to identify and 

understand the roles and responsibilities of the offices within DOD for 

management of the health status of the reserve components. We discussed 

these statutes and guidance with senior officials in the Office of the Under 

Secretary of Defense for Personnel and Readiness. We reviewed and 

discussed service policies and regulations for medical and physical fitness 

with military officials within the service surgeons’ general offices and 

other service headquarters’ officials responsible for physical fitness in the 

service personnel and operations functions. We also reviewed and 

discussed reserve component policies and guidance for medical and 

physical fitness examinations with officials within the reserve component 

surgeons’ general offices and other reserve component officials 

responsible for physical fitness in the respective reserve component 

personnel and operations functions. We interviewed cognizant officials 

involved with policy development, administration, tracking, and reporting 

on compliance with medical and physical fitness examinations from the 

following offices or commands:1

Office of the Secretary of Defense 

• Assistant Secretary of Defense for Health Affairs, Deployment Health 

Support Directorate; 

• Assistant Secretary of Defense for Reserve Affairs; and 

• Principal Deputy Under Secretary of Defense for Personnel and Readiness, 

the Office of Morale, Welfare, and Recreation. 

Army 

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

• U.S. Army Office of the Surgeon General and Commanding General, Army 

Medical Command; 

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

• National Guard Bureau; 

• Army National Guard; 

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

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

 1

 Unless otherwise noted, the officials listed in this appendix have their offices in the 

Pentagon or at locations in the Washington, D.C., metropolitan area. 

Appendix I: Scope and Methodology 
Appendix I: Scope and Methodology 

Page 61 GAO-06-105 Reserve Components' Health 

• Army Fitness School, Ft. Benning, Georgia; 

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

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

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

• Army Audit Agency; and 

• MEDPROS Program Office. 

Navy 

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

• Office of the Chief of Navy Operations; 

• Office of the Chief of Navy Reserve; 

• Bureau of Medicine and Surgery; 

• Commander Navy Reserve Forces Command, New Orleans, Louisiana; and 

• Navy Personnel Command, Millington, Tennessee. 

Marine Corps 

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

• U.S. Marine Corps Manpower and Reserve Affairs, Headquarters, 

Quantico, Virginia; and 

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

Air Force 

• Department of the Air Force, Headquarters; 

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

• Office of Air Force Reserve, Headquarters; 

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

• National Guard Bureau; 

• Air National Guard, Headquarters; 

• Air National Guard Readiness Center; and 

• Air Reserve Personnel Center, Denver, Colorado. 

We also conducted medical and physical fitness file reviews with an Army 

National Guard unit from the Mid-Atlantic region and an Army Reserve 

unit from the Mid-west region. We chose units that had deployed for 

Operations Enduring Freedom or Iraqi Freedom. During these visits we 
Appendix I: Scope and Methodology 

Page 62 GAO-06-105 Reserve Components' Health 

collected and analyzed information from available2 medical and personnel 

files to assess the reserve component members’ compliance with routine 

medical and physical fitness examinations. We also documented 

difficulties the units had in ensuring that all members complied with 

medical and physical fitness examinations. Finally, during the site visits, 

we conducted group discussions with unit members regarding their 

experience with routine examination requirements. 

To gain a better understanding of how the components collect data about 

their members’ compliance with routine medical and dental examinations 

and physical fitness assessments, we assessed the reliability of data 

produced by several services’ databases. Assessing the reliability of the 

services’ data included consideration of issues such as the completeness 

and currency of the data from the respective database system’s program 

managers, administrators, and contractors; assurances that all members 

are included and the information is up to date; and examination of who is 

using the data and for what purposes, and the users’ assessment of 

reliability. We also examined whether the data tracked through the 

services’ systems was subjected to quality control measures, such as 

conducting periodic testing of the data against medical records, to ensure 

the accuracy and reliability of the data. In addition, we reviewed existing 

documentation related to the data sources and interviewed knowledgeable 

agency officials about the data. Overall, the reserve components’ data we 

assessed regarding compliance with routine medical and dental 

examinations and fitness assessments did not accurately reflect the total 

population of service members, had limited data quality assurance, and 

were unreliable for the purposes of this report; however, we determined 

that the Navy Reserve’s medical data were sufficiently reliable for our 

purposes. Data from the Navy Reserve’s Medical Readiness Reporting 

System were found reliable because Readiness Commands conduct 

inspections that include examining the data for accuracy, Medical 

Department Representatives verify 10 percent of the updated medical 

records after each weekend drill, and the data are reported to the 

Commander, Navy Reserve Forces Command biweekly. Further, we did 

not assess the reliability of the Marine Corps Reserve’s medical data 

because the Marine Corps was in the process of changing from the 

Shipboard Automated Medical System, a stand-alone non-Web-based 

 2

 We reviewed all available medical and physical fitness files during our visits to the units. 

Some files were not available because (1) members who had deployed with the unit had 

transferred to another unit or were no longer serving, (2) some files had been misplaced, 

and (3) some members were having a routine exam and their file was with them. 
Appendix I: Scope and Methodology 

Page 63 GAO-06-105 Reserve Components' Health 

system, to the Navy Reserve’s system. All reserve components’ physical 

fitness data that we reviewed had missing or incomplete information, had 

limited data quality controls, or did not accurately reflect the total 

population of service members due to limited access to the database. 

Therefore, we determined the data to be unreliable for the purposes of 

assisting us in determining reserve component members’ compliance with 

physical fitness examinations. 

To assess DOD’s visibility over reserve components’ health status after 

they are called to duty and the care, if any, provided to those deployed 

with preexisting conditions, we collected and analyzed information from a 

variety of sources throughout DOD. We interviewed officials at the six 

reserve component headquarters and officials responsible for mobilizing 

the reserve components. We also observed the mobilization of Army 

National Guard and Army Reserve members at Fort Bliss, Texas, to obtain 

information on their health status during this process. We obtained and 

analyzed data provided on medical deployability from the DOD-wide 

centralized database on pre- and postdeployment health assessments, 

maintained at the Army Medical Surveillance Activity, and discussed 

available data with these officials. We also obtained and analyzed data on 

Army servicemembers who were held at mobilization stations for medical 

reasons from the Army’s medical holdover database (Medical Operational 

Data System). Based on our review of databases we used, we determined 

that the DOD-provided data were reliable for the purposes of this report. 

To address the extent of medical care provided in theater for preexisting 

medical conditions, we reviewed the Joint Chiefs of Staff procedures for 

Deployment Health Surveillance and Readiness and information provided 

by the U.S. Central Command Surgeon’s General office regarding medical 

deployment criteria for Operations Enduring Freedom and Iraqi Freedom. 

We also collected and reviewed the services’ medical instructions, 

memoranda, policies, and medical data. We reviewed several databases for 

relevance regarding collecting in theater medical data on preexisting 

conditions. Specifically, we obtained information and discussed the 

following databases: Joint Medical Workstation, the U.S. Transportation 

Command Regulating Command and Control Evacuation System, the Joint 

Patient Tracking Application, and the Air Force Institute for Operational 

Health Disease Nonbattle Injury database. 

However, we did not identify any databases used to collect information on 

members that may have had preexisting conditions when deployed. We 

also interviewed military medical officials who had served in theater to 

obtain information on preexisting conditions of reserve component 

members while deployed. In addition to those offices and commands 
Appendix I: Scope and Methodology 

Page 64 GAO-06-105 Reserve Components' Health 

previously listed, we discussed reserve component medical deployment 

policies, medical and physical fitness policies and instructions, and data 

regarding medical and physical fitness issues with responsible officials 

from: 

Department of Defense 

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

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

• U.S. Central Command, MacDill, AFB, Florida; and 

• Army Medical Surveillance Activity. 

Army 

• U.S. Army Office of the Surgeon General and Commanding General, Army 

Medical Command; 

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

• Army Reserve Unit, Mid-west region; 

• Walter Reed Army Medical Center; and 

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

Navy 

• Navy Reserve Readiness Command Southwest, California; 

• Navy and Marine Corps Reserve Center, California; and 

• Navy Branch Medical Clinic, Virginia. 

Marine Corps 

• Marine Corps Mobilization Command, Kansas City, Missouri; and 

• 4th Combat Engineer Battalion, Maryland. 

Air Force 

• Air Force Institute for Operational Health; 

• 142nd Fighter Wing Air National Guard, Portland International Airport, 

Oregon; 

• 163rd Air Refueling Wing Air National Guard, March Air Reserve Base, 

California; 

• 349th Air Mobility Wing U.S. Air Force Reserve, Travis Air Force Base, 

California; and 

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

California. 
Appendix I: Scope and Methodology 

Page 65 GAO-06-105 Reserve Components' Health 

We reviewed Air Force audit and inspection reports. We interviewed 

officials with the Air Force Audit Agency regarding its report on the Air 

Force’s Individual Deployment Process3

 to obtain a better understanding 

of the report’s scope and methodology to assess reserve components’ 

compliance with medical and dental requirements. We assessed the 

reliability of the Air Force Audit Agency’s analyses by (1) reviewing 

relevant documentation of their analyses, and (2) interviewing 

knowledgeable officials about the audit work and analyses. We 

determined the analyses were sufficiently reliable to use as one of the 

sources of evidence describing the extent of discrepancies in Air Force 

medical and dental records. We also reviewed the Air Force Inspection 

Agency’s Health Services reports and its annual analysis reports for 

calendar year 2004.4

We also found DOD’s Army Medical Surveillance Activity (AMSA) 

database and the Army’s Medical Operational Data System (MODS) to be 

sufficiently reliable for the purposes of our report due to their data quality 

controls and currency. In addition, through our review of existing 

information about the systems and the resulting data and through 

discussions with cognizant agency officials, we found the data sufficiently 

reliable for the purposes of this report. 

We interviewed the Chief of AMSA. We discussed the information in the 

DOD-wide centralized health assessment database and obtained selected 

data from all the reserve and active component members’ pre- and 

postdeployment health assessments that were completed from November 

2001 through June 2005. Assessments became mandatory for all mobilized 

reserve component members on October 25, 2001. The data we obtained 

contained predeployment health assessment records for 383,449 reserve 

component members and 627,200 for active members. We analyzed the 

data that we obtained to determine the categories of medical referrals and 

deployability status.5

 We also analyzed data on the self-reported general 

 3

 Air Force Audit Agency, Individual Deployment Process, Audit Report F2005-0005-FD3000 

(June 13, 2005). 

4

 Air Force Inspection Agency, Health Services Inspection, ARC Inspection Results, ARC 

Element Results, Annual Analysis Calendar Year 2004 (as of June 20, 2005). 

5

The data represent deployment events. A deployment event is defined as a servicemember 

completing a pre- or postdeployment health assessment form with no recent history 

(within 6 months) of completing a separate pre- or postdeployment health assessment 

form. 
Appendix I: Scope and Methodology 

Page 66 GAO-06-105 Reserve Components' Health 

health of the reserve component members and compared the data from 

predeployment assessments with the data from postdeployment 

assessments. All of our analyses compared data across the reserve 

components to look for differences or trends. 

Further, we reviewed the Army’s medical holdover data in MODS and 

found them reliable for our reporting purposes. The Office of the Army 

Surgeon General uses MODS to monitor and track the medical holdover 

population. The intended use of this system is for the MEDCOM and other 

command elements to track active and reserve component 

servicemembers in outpatient medical treatment, while still on active duty 

status. 

We conducted our review from October 2004 through September 2005 in 

accordance with generally accepted government auditing standards. 
Appendix II: Comments From the Department 

of Defense 

Page 67 GAO-06-105 Reserve Components' Health 

Appendix II: Comments From the 

Department of Defense 
Appendix II: Comments From the Department 

of Defense 

Page 68 GAO-06-105 Reserve Components' Health 
Appendix II: Comments From the Department 

of Defense 

Page 69 GAO-06-105 Reserve Components' Health 
Appendix II: Comments From the Department 

of Defense 

Page 70 GAO-06-105 Reserve Components' Health 
Appendix II: Comments From the Department 

of Defense 

Page 71 GAO-06-105 Reserve Components' Health 
Appendix II: Comments From the Department 

of Defense 

Page 72 GAO-06-105 Reserve Components' Health 
Appendix III: GAO Contact and Staff 

Acknowledgments 

Page 73 GAO-06-105 Reserve Components' Health 

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

In addition to the contact named above, Brenda S. Farrell, Assistant 

Director; James Bancroft, Larry Bridges, Renee S. Brown, Sara Hackley, 

Kenya Jones, Ron La Due Lake, Karen Kemper, Julia Matta, Jen Popovic, 

and Nicole Volchko. 

Appendix III: GAO Contact and Staff 

Acknowledgments 

GAO Contact 

Acknowledgments 
Related GAO Products 

Page 74 GAO-06-105 Reserve Components' Health 

Defense Health Care: Improvements Needed in Occupational and 

Environmental Health Surveillance during Deployment to Address 

Immediate and Longstanding Health Issues. GAO-05-632. Washington, 

D.C.: July 19, 2005. 

Reserve Forces: An Integrated Plan is Needed to Address Army Reserve 

Personnel and Equipment Shortages. GAO-05-660. Washington, D.C.: July 

12, 2005. 

Defense Health Care: Force Health Protection and Surveillance Policy 

Compliance Was Mixed, but Appears Better for Recent Deployments.

GAO-05-120. Washington, D.C.: November 12, 2004. 

Military Personnel: DOD Needs to Address Long-term Reserve Force 

Availability and Related Mobilization and Demobilization Issues. 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. 

Defense Health Care: Quality Assurance Process Needed to Improve 

Force Health Protection and Surveillance. GAO-03-1041. Washington, 

D.C.: September 19, 2003. 

Military Personnel: DOD Needs More Data to Address Financial and 

Health Care Issues Affecting Reservists. GAO-03-1004. Washington, D.C.: 

September 10, 2003. 

Military Personnel: DOD Actions Needed to Improve the Efficiency of 

Mobilizations for Reserve Forces. GAO-03-921. Washington, D.C.: August 

21, 2003. 

Defense Health Care: Army Has Not Consistently Assessed the Health 

Status of Early- Deploying Reservists. GAO-03-997T. Washington, D.C.: 

July 9, 2003. 

Defense Health Care: Army Needs to Assess the Health Status of All 

Early-Deploying Reservists. GAO-03-437. Washington, D.C.: April 15, 2003. 

Defense Health Care: Most Reservists Have Civilian Health Coverage but 

More Assistance Is Needed When TRICARE is Used. GAO-02-829. 

Washington, D.C.: September 6, 2002. 

Related GAO Products 
Related GAO Products 

Page 75 GAO-06-105 Reserve Components' Health 

VA and Defense Health Care: Military Medical Surveillance Policies in 

Place, but Implementation Challenges Remain. GAO-02-478T. 

Washington, D.C.: February 27, 2002. 

Gender Issues: Improved Guidance and Oversight Are Needed to Ensure 

Validity and Equity of Fitness Standards. GAO/NSIAD-99-9. Washington, 

D.C.: November 17, 1998. 

Defense Health Care: Medical Surveillance Improved Since Gulf War, but 

Mixed Results in Bosnia. GAO/NSIAD-97-136. Washington, D.C.: May 13, 

1997. 

Reserve Forces: DOD Policies Do Not Ensure That Personnel Meet 

Medical and Physical Fitness Standards. GAO/NSIAD-94-36. Washington, 

D.C.: March 23, 1994. 

Operation Desert Storm: War Highlights Need to Address Problem of 

Nondeployable Personnel. GAO/NSIAD-92-208. Washington, D.C.: August 

31, 1992. 

Operation Desert Storm: Full Army Medical Capability Not Achieved.

GAO/NSIAD-92-175. Washington, D.C.: August 18, 1992. 

National Guard: Peacetime Training Did Not Adequately Prepare 

Combat Brigades for Gulf War. GAO/NSIAD-91-263. Washington, D.C.: 

September 24, 1991. 

(350604) 
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