Defense Health Care: Army Has Not Consistently Assessed the Health Status of Early-Deploying Reservists
Published: 2003-07-09T00:00:00

Fast Facts:

Highlights:
section_title: Why GAO Did This Study
paragraphs: During the 1990-91 Persian Gulf War, health problems prevented the deployment of a significant number of Army reservists. As required by the National Defense Authorization Act for Fiscal Year 2002, GAO reported on the Army's efforts to assess the health status of its early-deploying reservists (Defense Health Care: Army Needs to Assess the Health Status of All Early-Deploying Reservists ( GAO-03-437 , Apr. 15, 2003)). GAO was asked to testify on its findings on the Army's health status assessments efforts and the implications of those assessments for the Department of Veterans Affairs (VA). Specifically, GAO was asked to determine if the Army is collecting and maintaining information on reservists' health and review the value and advisability of providing examinations. For its report, GAO reviewed medical records at seven Army early-deploying reserve units to determine the number of required examinations that have been conducted and obtained expert opinion on the value of periodic examinations.
section_title: What GAO Found
paragraphs: The Army has not consistently carried out the statutory requirements for monitoring the health and dental status of its early-deploying reservists. As a result, the Army does not have sufficient information to know how many reservists can perform their assigned duties and are ready for deployment. At reserve units GAO visited, approximately 66 percent of the medical records were available for review. At those locations, GAO found that about 13 percent of the 5-year physical examinations had not been performed, about 49 percent of early-deploying reservists lacked current dental examinations, and none of the annual medical certificates required of reservists were completed by them and reviewed by the units. Medical experts recommend periodic physical and dental examinations as an effective means of assessing health. Army early-deploying reservists need to be healthy to meet the specific demands of their occupations; examinations and other health screenings can be used to identify those who cannot perform their assigned duties. Without adequate examinations, the Army may train, support, and mobilize reservists who are unfit for duty. DOD concurred with GAO's recommendations to comply with statutory requirements to conduct medical and dental examinations and provide dental treatment. VA's ability to perform its missions to provide medical care to veterans and compensate them for their service-connected disabilities could be hampered if the Army's medical surveillance system contains inadequate or incomplete information.

section_title: Letter
paragraphs: We are pleased to be here as you discuss health assessments for the men  and women in the armed services.  Both the Department of Defense  (DOD) and the Department of Veterans Affairs (VA) need this information  to perform their missions. DOD needs health status information to help  ensure the deployment of healthy forces and the continued fitness of those  forces. VA’s Veterans Benefits Administration (VBA) uses health  information to adjudicate veterans’ claims for disability compensation  related to service-connected injuries or illnesses. In addition, the Veterans  Health Administration (VHA) needs this information to fulfill its mission to  provide health care services to veterans. In this context, you asked us to  discuss our recent report on the Department of the Army’s (Army)  assessment of the health status of its reserve forces.  The Army is  increasingly relying on its 560,000 reservists to supplement the capabilities  of our nation’s active duty forces for peacetime support operations as well  as for war.
When reservists were mobilized during the 1990-91 Persian Gulf War, the  Army discovered that due to medical reasons or poor dental status a  significant number of them could not be deployed or had their deployment  delayed.  In an effort to help ensure that Army reservists meet the  military’s health standards and are ready to perform their assigned duties,  the Congress augmented health assessment requirements that had been in  place prior to the Persian Gulf War.  Specifically, the Congress required  the Army to monitor the health status of those designated as early- deploying reservists by providing annual medical screenings, annual  dental screenings, selected dental treatment, and for those over age 40,  physical examinations every 2 years.  All reservists, including early  deployers, are also required to disclose annually to the Army the status of  their physical and dental condition, and those under age 40 are required to  undergo a physical examination once every 5 years.
My testimony today is based on our April 2003 report on the Army’s efforts  to assess the health status of the approximately 90,000 reservists who are  specifically designated as early-deploying reservists.  We examined  medical records to determine whether the Army is collecting and  maintaining information on the health status of its early-deploying  reservists. We also assessed the value of periodic physical and dental  examinations and determined the advisability of the statutory  requirements for the Army’s early-deploying reservists.
To do our work, we visited seven early-deploying U.S. Army Reserve units  in the states of Georgia, Maryland, and Texas and reviewed all available  medical and dental records of reservists assigned to those units. Our  analysis of the information gathered at these units is not projectable. We  reviewed U.S. Army Reserve medical policies and regulations pertaining to  early-deploying reservists. We also reviewed Army National Guard policies  and procedures governing reservists’ health care but did not review  medical or dental records at Army National Guard units. Additionally, we  analyzed Army data showing the cost to perform periodic physical and  dental examinations and to provide dental treatment. We also reviewed  studies and information on the effectiveness of periodic physical and  dental examinations published by DOD, the Department of Health and  Human Services (HHS), the National Institutes of Health, the American  Medical Association, the Academy of General Dentistry, and others. We  interviewed DOD officials in the offices of the Assistant Secretary of  Defense for Reserve Affairs and the Assistant Secretary for Health Affairs,  and officials in the Office of the Surgeon General, U.S. Army Forces  Command and the Office of the Surgeon General, U.S. Army Reserve  Command to obtain information on the health care provided to Army  early-deploying reservists. We conducted our work from May 2002 through  April 2003 in accordance with generally accepted government auditing  standards.
In summary, the Army has not consistently carried out the statutory  requirements for monitoring the health and dental status of Army early- deploying reservists.  As a result, the Army does not have sufficient  information to know how many reservists can perform their assigned  duties and are ready for deployment.  At the seven units we visited,  approximately 66 percent of the medical records were available for our  review.  Based on our review of available records, we found that about 13  percent of the 5-year physical examinations had not been performed, and  none of the annual medical certificates had been completed by reservists  and reviewed by the units.  Furthermore, 49 percent of early-deploying  reservists lacked a current dental examination and 68 percent of those  over the age of 40 lacked a current biennial physical examination.  In  addition, the Army does not have an automated system for maintaining  accurate and complete medical information on early-deploying reservists.   Periodic physical and dental examinations for early-deploying reservists  are valuable for the Army because such examinations provide a means of  determining reservists’ health status and ensuring the medical readiness of  reserve forces.  Without adequate examinations, the Army runs the risk of  mobilizing early-deploying reservists who cannot be deployed because of  their health. In the case of early-deploying reservists who cannot be  deployed, the Army loses not only the amount it invested in salaries and  training but also the particular skill or occupation it was relying on to fill a  specific military need.  In addition, for reservists who may become eligible  for VA benefits, inadequate health information can make it more difficult  to adjudicate claims for service-connected disabilities in an accurate and  timely manner and to provide quality medical care.
We made recommendations that the Army comply with existing statutory  requirements to help ensure that early-deploying reservists are healthy to  carry out their duties. DOD agreed with our recommendations.
subsections: section_title: Background
paragraphs: In recent years, reservists have regularly been called on to augment the  capabilities of the active-duty forces. The Army is increasingly relying on  its reserve forces to provide assistance with military conflicts and  peacekeeping missions. As of April 2003, approximately 148,000 reservists  from the Army National Guard and the U.S. Army Reserve were mobilized  to active duty positions. In addition, other reservists are serving  throughout the world in peacekeeping missions. The involvement of  reservists in military operations of all sizes, from small humanitarian  missions to major theater wars, will likely continue under the military’s  current war-fighting strategy and its peacetime support operations.
The Army has designated some Army National Guard and U.S. Army  Reserve units and individuals as early-deploying reservists to ensure that  forces are available to respond rapidly to an unexpected event or for any  other need. Usually, those designated as early-deploying reservists would  be the first troops mobilized if two major ground wars were underway  concurrently. The units and individual reservists designated as early- deploying reservists change as the missions or war plans change. The  Army estimates that of its 560,000 reservists, approximately 90,000 are  reservists who have been individually categorized as early-deploying  reservists or are reservists who are assigned to Army National Guard and  U.S. Army Reserve units that have been designated as early-deploying  units.
The Army must comply with the following six statutory requirements that  are designed to help ensure the medical and dental readiness of its early- deploying reservists.
All reservists including early-deployers are required to    have a 5-year physical examination, and    complete an annual certificate of physical condition.
All early-deploying reservists are also required to have    a biennial physical examination if over age 40,    an annual medical screening,    an annual dental screening, and    dental treatment.
Army regulations state that the 5- and 2-year physical examinations are  designed to provide the information needed to identify health risks,  suggest lifestyle modifications, and initiate treatment of illnesses. While  the two examinations are similar, the biennial examination for early- deploying reservists over age 40 contains additional age-specific  screenings such as a prostate examination, a prostate-specific antigen test,  and a fasting lipid profile that includes testing for total cholesterol, low- density lipoproteins, and high-density lipoproteins. The Army pays for  these examinations.
The examinations are also used to assign early-deploying reservists a  physical profile rating, ranging from P1 to P4, in six assessment areas: (a)  Physical capacity, (b) Upper extremities, (c) Lower extremities, (d)  Hearing-ears, (e) Vision-eyes, and (f) Psychiatric. (See app. I for the  Army’s Physical Profile Rating Guide.) According to the Army, P1  represents a non-duty-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 reservist in a nondeployable status or may result  in the changing of the reservist’s job classification.
Army regulations that implement the statutory certification requirement  provide that all reservists—including early-deploying reservists—certify  their physical condition annually on a two-page certification form. Army  early-deploying reservists must report doctor or dentist visits since their  last examination, describe current medical or dental problems, and  disclose any medications they are currently taking. In addition, the Army is  required to conduct an annual medical screening for all early-deploying  reservists. According to Army regulations, the Army is to meet the annual  medical screening requirement by reviewing the medical certificate  required of each early-deploying reservist.
Further, Army early-deploying reservists are required to undergo, at the  Army’s expense, an annual dental examination. The Army is also required  to provide and pay for the dental treatment needed to bring an early- deploying reservist’s dental status up to deployment standards—either  dental class 1 or 2.   Reservists in dental class 3 and 4 are not deployable.
Class 3 reservists could have dental emergencies in the next 12 months,  and reservists in class 4 have not had the required annual dental  examination.
section_title: The Army Has Not Collected and Maintained All Required Medical and Dental Information on Early-Deploying Reservists
paragraphs: The Army has not consistently carried out the requirements that early- deploying reservists undergo 5- or 2-year physical examinations, and the  required dental examination.  In addition, the Army has not required early- deploying reservists to complete the annual medical certificate of their  health condition, which provides the basis for the required annual medical  screening.  Accordingly, the Army does not have sufficient health  information on early-deploying reservists.  Furthermore, the Army does  not have the ability to maintain information from medical and dental  records and annual medical certificates at the aggregate or individual  level, and therefore does not know the overall health status of its early- deploying reservists.
subsections: section_title: Examinations Have Not Always Been Performed and Annual Medical Certificates Have Not Been Completed and Reviewed
paragraphs: We found that the Army has not consistently met the statutory  requirements to provide early-deploying reservists physical examinations  at 5- or 2-year intervals.  At the seven Army early-deploying reserve units  we visited, about 66 percent of the medical records were available for our  review.  Based on our review of these records, 13 percent of the  reservists did not have a current 5-year physical examination on file.   Further, our review of the available records found that approximately 68  percent of early-deploying reservists over age 40 did not have a record of a  current biennial examination.
Army early-deploying reservists are required by statute to complete an  annual medical certificate of their health status, and regulations require  the Army to review the form to satisfy the annual screening requirement.   In performing our review of the records on hand, we found that none of  the units we visited required that its reservists complete the annual  medical certificate, and consequently, none of them were available for  review.  Furthermore, Army officials stated that reservists at most other  units have not filled out the certification form and that enforcement of this  requirement was poor.
The Army is also statutorily required to provide early-deploying reservists  with an annual dental examination to establish whether reservists meet  the dental standards for deployment.  At the seven early-deploying units  we visited, we found that about 49 percent of the reservists whose records  were available for review did not have a record of a current dental  examination.
section_title: Army’s Automated Systems Do Not Contain Comprehensive Health Information on Early- Deploying Reservists
paragraphs: The Army’s two automated information systems for monitoring reservists’  health do not maintain important medical and dental information for early- deploying reservists—including information on the early-deploying  reservists’ overall health status, information from the annual medical  certificate form, dental classifications, and the date of dental  examinations.  In one system, the Regional Level Application Software, the  records provide information on the dates of the 5-year physical  examination and the physical profile ratings.  In the other system, the  Medical Occupational Database System, the records provide information  on HIV status, immunizations, and DNA specimens.  Neither system allows  the Army to review medical and dental information for entire units at an  aggregate level.  The Army is aware of the information shortcomings of  these systems and acknowledges that having sufficient, accurate, and  current information on the health status of reservists is critical for  monitoring combat readiness.  According to Army officials, in 2003 the  Army plans to expand the Medical Occupational Database System to  provide access to current, accurate, and relevant medical and dental  information at the aggregate and individual level for all of its reservists— including early-deploying reservists.  According to Army officials, this  information will be readily available to the U.S. Army Reserve Command.   Once available, the Army can use this information to determine which  early-deploying reservists meet the Army’s health care standards and are  ready for deployment.
section_title: Periodic Physical and Dental Examinations Are Valuable for Assessing Health Status and Provide Beneficial Information to the Army and VA
paragraphs: Medical experts recommend physical and dental examinations as an  effective means of assessing health.  For some people, the frequency and  content of physical examinations vary according to the specific demands  of their job.  Because Army early-deploying reservists need to be healthy  to fulfill their professional responsibilities, periodic examinations are  useful for assessing whether they can perform their assigned duties.   Furthermore, the estimated annual cost to conduct periodic  examinations—about $140—is relatively modest compared to the  thousands of dollars the Army spends for salaries and training of early- deploying reservists—an investment that may be lost if reservists can not  perform their assigned duties.  Such information is also needed by VA to  adjudicate disability claims and to provide health benefits.
subsections: section_title: Experts Look to Screening and Examinations as Key Indicators of Health
paragraphs: Physical and dental examinations are geared towards assessing and  improving the overall health of the general population.  The U.S.  Preventive Services Task Force and many other medical organizations no  longer recommend annual physical examinations for adults—preferring  instead a more selective approach to detecting and preventing health  problems.  In 1996, the task force reported that while visits with primary  care clinicians are important, performing the same interventions annually  on all patients is not the most clinically effective approach to disease  prevention.  Consistent with its finding, the task force recommended that  the frequency and content of periodic health examinations should be  based on the unique health risks of individual patients.  Today, many  health associations and organizations are recommending periodic health  examinations that incorporate age-specific screenings, such as cholesterol  screenings for men (beginning at age 35) and women (beginning at age 45)  every 5 years, and clinical breast examinations every 3 to 5 years for  women between the ages of 19 and 39.  Further, oral health care experts  emphasize the importance of regular 6- to 12-month dental examinations.
Both the private and public sectors have established a fixed schedule of  physical examinations for certain occupations to help ensure that workers  are healthy enough to meet the specific demands of their jobs.  For  example, the Federal Aviation Administration requires commercial pilots  to undergo a physical examination once every 6 months.  U.S. National  Park Service personnel who perform physically demanding duties have a  physical examination once every other year for those under age 40, and on  an annual basis for those over age 40.  Additionally, guidelines published  by the National Fire Protection Association recommend that firefighters  have an annual physical examination regardless of age.
In the case of Army early-deploying reservists, the goal of the physical and  dental examinations is to help ensure that the reservists are fit enough to  be deployed rapidly and perform their assigned jobs.  Furthermore, the  Army recognizes that some jobs are more demanding than others and  require more frequent examinations.  For example, the Army requires that  aviators undergo a physical examination once a year, while marine divers  and parachutists have physical examinations once every 3 years.
While governing statutes and regulations require physical examinations at  specific intervals, the Army has raised concerns about the appropriate  frequency for them.  In a 1999 report to the Congress, the Offices of the  Assistant Secretaries of Defense for Health Affairs and Reserve Affairs  stated that while there were no data to support the benefits of conducting  periodic physical examinations, DOD was reluctant to recommend a  change to the statutory requirements.  The report stated that additional  research needs to be undertaken to identify and develop a more cost- effective, focused health assessment tool for use in conducting physical  exams for reservists—in order to ensure the medical readiness of reserve  forces.  However, as of February 2003, DOD had not conducted this  research.
section_title: Cost of Conducting Physical and Dental Examinations and Providing Dental Treatments
paragraphs: For its early-deploying reservists, the Army conducts and pays for physical  and dental examinations and selected dental treatments at military  treatment facilities or pays civilian physicians and dentists to provide  these services.  The Army could not provide us with information on the  cost to provide these services at military hospitals or clinics primarily  because it does not have a cost accounting system that records or  generates cost data for each patient.  However, the Army was able to  provide us with information on the amount it pays civilian providers for  these examinations under the Federal Strategic Health Care Alliance  program (FEDS_HEAL )—an alliance of private physicians and dentists  and other physicians and dentists who work for VA and HHS’s Division of  Federal Occupational Health. FEDS_HEAL is a program that allows Army  early-deploying reservists to obtain required physical and dental  examinations and dental treatment from local providers.
Using FEDS_HEAL contract cost information, we estimate the average  cost of the examinations to be about $140 per early-deploying reservist per  year.  We developed the estimate over one 5- year period by calculating the  annual cost for those early-deploying reservists requiring a physical  examination once every 5 years, calculating the cost for those requiring a  physical examination once every 2 years, and calculating the cost for those  requiring an initial dental examination and subsequent yearly dental  examinations.  The FEDS_HEAL cost for each physical examination for  those under 40 is about $291, and for those over 40 is about $370.  The  Army estimates that the cost of annual dental examinations under the  program to be about $80 for new patients and $40 for returning patients.   The Army estimates that it would cost from $400 to $900 per reservist to  bring those who need treatment from dental class 3 to dental class 2.
section_title: Benefits of Conducting Periodic Examinations For the Army
paragraphs: For the Army, there is likely value in conducting periodic examinations  because the average cost to provide physical and dental examinations per  early-deploying reservist—about $140 annually over a 5-year period—is  relatively low compared to the potential benefits associated with such  examinations.  These examinations could help protect the Army’s  investment in its early-deploying reservists by increasing the likelihood  that more reservists will be deployable.  This likelihood is increased when  the Army uses examinations to identify early-deploying reservists who do  not meet the Army’s health standards and are thus not fit for duty.  The  Army can then intervene by treating, reassigning, or dismissing these  reservists with duty-limiting conditions—before their mobilization and  before the Army needs to rely on the reservists’ skills or occupations.
Furthermore, by identifying duty-limiting conditions or the risks for  developing them, periodic examinations give early-deploying reservists the  opportunity to seek medical care for their conditions—prior to  mobilization.
Periodic examinations may provide another benefit to the Army.  If the  Army does not know the health condition of its early-deploying reservists,  and if it expects some of them to be unfit and incapable of performing  their duties, the Army may be required to maintain a larger number of  reservists than it would otherwise need in order to fulfill its military and  humanitarian missions.  While data are not available to estimate these  benefits, the benefit associated with reducing the number of reservists the  Army needs to maintain for any given objective could be large enough to  more than offset the cost of the examinations and treatments.  The  proportion of reservists whom the Army maintains but who cannot be  deployed because of their health may be significant.  For instance,  according to a 1998 U.S. Army Medical Command study, a “significant  number” of Army reservists could not be deployed for medical reasons  during mobilization for the Persian Gulf War (1990-1991).  Further,  according to a study by the Tri-Service Center for Oral Health Studies at  the Uniformed Services University of the Health Sciences, an estimated 25  percent of Army reservists who were mobilized in response to the events  of September 11, 2001, were in dental class 3 and were thus  undeployable.  In fact, our analysis of the available current dental  examinations at the seven early-deploying units showed a similar  percentage of reservists—22 percent—who were in dental class 3.  With  each undeployable reservist, the Army loses, at least temporarily, a  significant investment that is large compared to the cost of examining and  treating these reservists.  The annual salary for an Army early-deploying  reservist in fiscal year 2001 ranged from $2,200 to $19,000.  The Army  spends additional amounts to train and equip each reservist and, in some  cases, provides allowances for subsistence and housing.  Additionally, for  each reservist it mobilizes, the Army spends about $800.  If it does not  examine all of its early-deploying reservists, the Army risks losing its  investment because it will train, support, and mobilize reservists who  might not be deployed because of their health.
section_title: Benefits of Health Assessments for VA
paragraphs: Both VBA and VHA need health assessment data obtained by the Army to  adjudicate disability claims and provide medial care. In general, a reservist  who is disabled while on active duty, or on inactive duty for training, is  eligible for service-connected disability compensation, and can file a claim  at one of VBA’s 57 regional offices. To provide such disability  compensation, VBA needs to determine that each claimed disability exists,  and that each was caused or aggravated by the veteran’s military service.  The evidence needed to prove service connection includes records of  service to identify when the veteran served and records of medical  treatment provided while the veteran was in military service. More timely  and accurate health information collection by the Army and the other  military services can help VBA provide disabled reservists with more  timely and accurate decisions on their claims for disability compensation.  Complete and accurate health data can also help VHA provide medical  care to reservists who become eligible for veterans benefits.
section_title: Concluding Observations
paragraphs: Army reservists have been increasingly called upon to serve in a variety of  operations, including peacekeeping missions and the current war on  terrorism. Given this responsibility, periodic health examinations are  important to help ensure that Army early-deploying reservists are fit for  deployment and can be deployed rapidly to meet humanitarian and  wartime needs. However, the Army has not fully complied with statutory  requirements to assess and monitor the medical and dental status of early- deploying reservists. Consequently, the Army does not know how many of  them can perform their assigned duties and are ready for deployment.
The Army will realize benefits by fully complying with the statutory  requirements. The information gained from periodic physical and dental  examinations, coupled with age-specific screenings and information  provided by early-deploying reservists on an annual basis in their medical  certificates, will assist the Army in identifying potential duty-limiting  medical and dental problems within its reserve forces. This information  will help ensure that early-deploying reservists are ready for their  deployment duties. Given the importance of maintaining a ready force, the  benefits associated with the relatively low annual cost of about $140 per  reservist to conduct these examinations outweighs the thousands of  dollars spent in salary and training costs that are lost when an early- deploying reservist is not fit for duty.
The Army’s planned expansion, in 2003, of an automated health care  information system is critical for capturing the key medical and dental  information needed to monitor the health status of early-deploying  reservists. Once collected, the Army will have additional information to  conduct the research suggested by DOD’s Offices of Health Affairs and  Reserve Affairs to determine the most effective approach, which could  include the frequency of physical examinations, for determining whether  early-deploying reservists are healthy, can perform their assigned duties,  and can be rapidly deployed.
While our work focused on the Army’s efforts to assess the health status of  its early-deploying reservists, it also has implications for veterans.  Implementing our recommendations that DOD comply with the statutory  requirements, which DOD has agreed to, will also be of benefit to VA. VA’s  ability to perform its missions to provide medical care to veterans and  compensate them for their service-connected disabilities could be  hampered if the Army’s medical surveillance system contains inadequate  or incomplete information.
Mr. Chairman, this concludes my prepared statement. I will be happy to  answer any questions you or other members of the subcommittee may  have.
section_title: Contact and Acknowledgments
paragraphs: For further information regarding this testimony, please contact Marjorie  E. Kanof at (202) 512-7101.  Michael T. Blair, Jr., Aditi S. Archer, Richard J.  Wade, and Gregory D. Whitney also contributed to this statement.
section_title: Appendix I: Army Physical Profile Rating Guide
paragraphs: Upper  extremities  Strength, range  of motion, and  general efficiency  of upper arm,  shoulder girdle,  and upper back,  including cervical  and thoracic  vertebrae.
Lower  extremities  Strength, range  of movement,  and efficiency of  feet, legs, lower  back, and pelvic  girdle.
Hearing-ears  Auditory  sensitivity and  organic disease  of the ears.
Vision-eyes  Visual acuity and  organic disease  of the eyes and  lids.
No loss of digits  or limitation of  motion; no  demonstrable  abnormality; able  to do hand-to- hand fighting.
No loss of digits  or limitation of  motion; no  demonstrable  abnormality; able  to perform long  marches, stand  over long  periods, and run.
Audiometer  average level for  each ear not  more than 25 dB  at 500, 1000, or  2000 Hz with no  individual level  greater than 30  dB. Not over 45  dB at 4000 Hz.
Uncorrected  vision acuity  20/200  correctable to  20/20 in each  eye.
Psychiatric  Type, severity,  and duration of  the psychiatric  symptoms or  disorder  existing at the  time the profile  is determined.  Amount of  external  precipitating  stress.  Predispositions  as determined  by the basic  personality  makeup,  intelligence,  performance,  and history of  past psychiatric  disorder  impairment of  functional  capacity.  No psychiatric  pathology; may  have history of  transient  personality  disorder.
Upper  extremities  Slightly limited  mobility of joints,  muscular  weakness, or  other musculo- skeletal defects  that do not  prevent hand-to- hand fighting and  do not disqualify  for prolonged  effort.
Lower  extremities  Slightly limited  mobility of joints,  muscular  weakness, or  other musculo- skeletal defects  that do not  prevent moderate  marching,  climbing, timed  walking, or  prolonged effort.
Vision-eyes  Distant visual  acuity correctable  to not worse than  20/40 and 20/70,  or 20/30 and  20/100, or 20/20  and 20/400.
Psychiatric  May have  history of  recovery from  an acute  psychotic  reaction due to  external or  toxic causes  unrelated to  alcohol or drug  addiction.
Defects or  impairments that  require significant  restriction of use.
Defects or  impairments that  require significant  restriction of use.
Hearing-ears  Audiometer  average level for  each ear at 500,  1000, or 2000  Hz, not more  than 30 dB, with  no individual  level greater than  35 dB at these  frequencies, and  level not more  than 55 dB at  4000 Hz; or  audiometer level  30 dB at 500 Hz,  25 dB at 1000  and 2000 Hz,  and 35 dB at  4000 Hz in better  ear. (Poorer ear  may be deaf.)   Speech reception  threshold in best  ear not greater  than 30 dB HL  measured with or  without hearing  aid, or chronic  ear disease.
Uncorrected  distant visual  acuity of any  degree that is  correctable to not  less than 20/40 in  the better eye.
Functional level  below P3.
Functional level  below P3.
Functional level  below P3.
Functional level  below P3.
Satisfactory  remission from  an acute  psychotic or  neurotic  episode that  permits  utilization  under specific  conditions  (assignment  when  outpatient  psychiatric  treatment is  available or  certain duties  can be  avoided).  Functional  level below P3.
section_title: Related GAO Products
paragraphs: Defense Health Care: Army Needs to Assess the Health Status of All  Early-Deploying Reservists. GAO-03-347. Washington, D.C.: April 15, 2003.
Military Personnel: Preliminary Observations Related to Income,  Benefits, and Employer Support for Reservists During Mobilizations.  GAO-03-549T. Washington, D.C.: March 19, 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.
Reserve Forces: DOD Actions Needed to Better Manage Relations between  Reservists and Their Employers. GAO-02-608. Washington, D.C.:   June 13, 2002.
Veterans’ Benefits: Despite Recent Improvements, Meeting Claims  Processing Goals Will Be Challenging. GAO-02-645T. Washington, D.C.:  April 26, 2002.
VA and Defense Health Care: Military Medical Surveillance Policies in  Place, But Implementation Challenges Remain. GAO-02-478T.   Washington, D.C.: February 27, 2002.
Reserve Forces: Cost, Funding, and Use of Army Reserve Components in  Peacekeeping Operations. GAO/NSAID-98-190R. Washington, D.C.:   May 15, 1998.
Defense Health Program: Future Costs Are Likely to Be Greater than  Estimated. GAO/NSIAD-97-83BR. Washington, D.C.: February 21, 1997.
Wartime Medical Care: DOD Is Addressing Capability Shortfalls, but  Challenges Remain. GAO/NSIAD-96-224. Washington, D.C.:   September 25, 1996.
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: Problems With Air Force Medical Readiness.   GAO-03-549T. Washington, D.C.: December 30, 1993.
Defense Health Care: Physical Exams and Dental Care Following the  Persian Gulf War. GAO/HRD-93-5. Washington, D.C.: October 15, 1992.
This is a work of the U.S. government and is not subject to copyright protection in the  United States. It may be reproduced and distributed in its entirety without further  permission from GAO. However, because this work may contain copyrighted images or  other material, permission from the copyright holder may be necessary if you wish to  reproduce this material separately.