Defense Health Care: Army Needs to Assess the Health Status of All Early-Deploying Reservists
Published: 2003-04-15T00:00:00

Fast Facts:

Highlights:
section_title: Why GAO Did This Study
paragraphs: During the 1990-1991 Persian Gulf War, health problems prevented the deployment of a significant number of Army reservists. To help correct this problem the Congress passed legislation that required reservists to undergo periodic physical and dental examinations. The National Defense Authorization Act for 2002 directed GAO to review the value and advisability of providing examinations. GAO also examined whether the Army is collecting and maintaining information on reservist health. GAO obtained expert opinion on the value of periodic examinations and visited seven Army reserve units to obtain information on the number of examinations that have been conducted.
section_title: What GAO Found
paragraphs: Medical experts recommend periodic physical and dental examinations as an effective means of assessing health. Periodic physical and dental examinations for early-deploying reservists provide a means for the Army to determine their health status. 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. The Army has not consistently carried out the statutory requirements for monitoring the health and dental status of Army early-deploying reservists. At the early-deploying units GAO visited, approximately 66 percent of the medical records were available for review. For example, we found that about 68 percent of the required 2-year physical examinations for those over age 40 had not been performed and that none of the annual medical certificates required of reservists were completed by reservists and reviewed by the units. The Army's automated health care information system does not contain comprehensive physical and dental information on early-deploying reservists. According to Army officials, in 2003 the Army plans to expand its system to maintain accurate and complete medical and dental information to monitor the health status of early-deploying reservists.

section_title: Letter
paragraphs: The Department of the Army (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. Of these reservists,  approximately 90,000 are specifically designated as early-deploying  reservists. Because of this designation, they are entitled to health benefits  not afforded to other reservists. The remaining reservists—about  470,000—become early-deploying reservists 75 days prior to their  scheduled deployment date, at which time they are entitled to the same  benefits afforded to those who are specifically designated as early- deploying reservists.
When reservists were mobilized during the Persian Gulf War in 1990-1991,  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 obviate similar problems, the Congress passed  four statutory requirements to monitor the health status of those  designated as early-deploying reservists. These requirements are in  addition to two requirements that had been in place prior to the Persian  Gulf War. To meet these requirements, the Army is to provide annual  medical screenings, annual dental screenings, selected dental treatment,  and for those over age 40, physical examinations every 2 years. Early- deploying reservists are 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. These six  requirements are used to help ensure that the reservists meet the military’s  health standards so they are ready to perform their assigned duties.
The National Defense Authorization Act for Fiscal Year 2002 directed that  we obtain information on the value of periodic physical and dental  examinations and determine the advisability of the statutory requirements  for the Army’s early-deploying reservists. We also agreed with the  committees of jurisdiction to determine if the Army is collecting and  maintaining information on the health status of its early-deploying  reservists.
To answer these questions we focused our work on units that have been  specifically designated as early-deploying reservists. 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. However, 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 reviewed studies from  the Department of Defense (DOD) including its 1999 report to the  Congress on ways to improve the medical and dental care provided to  reservists. We also reviewed studies and information on the effectiveness  of periodic physical and dental examinations published by 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. (For more on our scope and  methodology, see app. I.) We conducted our work from May 2002 through  April 2003 in accordance with generally accepted government auditing  standards.
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 in the Balkans, Africa,  Latin America, and the Pacific Rim. 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. II 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.
Beginning in January 2003, early-deploying reservists with a permanent  rating of P3 or P4 in one of the assessment areas must be evaluated by an  administrative screening board—the Military Occupational  Specialty/Medical Retention Board (MMRB). This evaluation determines if  reservists can satisfactorily perform the physical requirements of their  jobs. The MMRB recommends whether a reservist should retain a job, be  reassigned, or be discharged from the military.
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. (See app. III for a copy  of the annual medical certificate—DA Form 7349.) 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.
In addition, 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. (See table 1 for a general description of each dental  classification.)
According to Army officials, most of the 5-year and 2-year physical  examinations, the dental examinations, and the dental treatments that  have been performed were administered by military medical personnel.  However, beginning in March 2001, the Army started outsourcing some  examinations through the Federal Strategic Healthcare Alliance  (FEDS_HEAL)—an alliance of private physicians and dentists and other  physicians and dentists who work for the Department of Veterans Affairs  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. The Army contracts and pays for these examinations. About  12,000 of these providers nationwide participate in FEDS_HEAL. The  Army plans to increase its reliance on FEDS_HEAL to provide physical  and dental examinations, and dental treatment for early-deploying  reservists.
section_title: Periodic Physical and Dental Examinations Are Valuable for Assessing Health Status and Provide Beneficial Information to the Army
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.
subsections: section_title: Experts Look to Screenings 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 was needed to identify and develop a more cost-effective,  focused health assessment tool for use in conducting physical  examinations 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 FEDS_HEAL program.
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
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: 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 current 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, the  Army is also required to provide physical examinations every 2 years for  Army early-deploying reservists over the age of 40. However, 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  that 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 the Army with access to current, accurate, and relevant medical  and dental information at the aggregate and individual levels 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: Conclusions
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 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.
section_title: Recommendations for Executive Action
paragraphs: To help ensure that early-deploying reservists are healthy to carry out their  duties, we recommend that the Secretary of Defense direct the Secretary  of the Army to comply with existing statutory requirements to ensure that  the 5-year physical examinations for early-deploying reservists under 40  and the biennial physical examinations for early-deploying reservists over  40 are current and complete,    all early-deploying reservists complete their annual medical certificate of  health status and that the appropriate Army personnel review the  certificate, and  the required dental examinations and treatments for all early-deploying  reservists are complete.
section_title: Agency Comments and Our Evaluation
paragraphs: The Department of Defense provided written comments on a draft of this  report, which are found in appendix IV. DOD concurred with the report’s  recommendations.
DOD raised some concerns about our evaluation. For example, DOD  stated that the intermittent use of the terms “The Army,” “Reserve  Component,” and “Army Reserve” would lead to a misunderstanding of the  organization of Army Components. While DOD did not offer specific  examples, we reviewed the draft to ensure that terms were used  appropriately and did not make any changes. DOD also raised the concern  that we used a very narrow subject group that may not reflect a valid  representative sample and that the report findings could be incorrectly  applied to the Army National Guard. As we noted in our draft report, our  work was conducted at seven early deploying U.S. Army Reserve units— geographically dispersed in the states of Georgia, Maryland, and Texas— and our analysis of the information collected at these units is not  projectable. Finally, DOD stated that methods for annually certifying  physical conditions could also include completing the statement of  physical condition that is preprinted on the Personnel Qualification  Record, and that we did not consider whether such alternatives were used  for certification. During our visits we reviewed the medical files at all  locations, the personnel files at one location, and interviewed military  personnel who were responsible for maintaining the records of early- deploying reservists at all locations. We were unable to find one annual  medical certificate that was reviewed by military personnel to meet the  statutory requirements. In addition, some military personnel were not  aware of the requirement.
We are sending copies of this report to the Secretary of Defense,  appropriate congressional committees, and other interested parties.  Copies will also be made available to others on request. In addition, the  report is available at no charge on the GAO Web site at   http://www.gao.gov. If you or your staff have any questions about this  report, please contact me at (202) 512-7101. Another contact and major  contributors are listed in appendix V.
section_title: Appendix I: Scope and Methodology
paragraphs: We reviewed statutes and Army policies and regulations governing annual  medical and dental screenings, and periodic physical and dental  examinations. We obtained data from the Office of the Chief, U.S. Army  Reserve on the physical and dental examinations performed since 2001 on  early-deploying reservists. We reviewed our past reports that addressed  medical and dental examinations. We conducted site visits to seven U.S.  Army Reserve Units located in Georgia, Maryland, and Texas—where we  obtained and reviewed all available medical and dental records. There  were 504 early-deploying reservists assigned to the seven units we visited.  Medical records for 332 reservists were available for our review. Army  administrators told us that the remaining files were in transit, with the  reservist, or on file at another location. Our analysis of the information  gathered at these units is not projectable. We did not review medical or  dental records at Army National Guard units, but obtained information  from the Guard on its medical policies.
To calculate an average annual cost to provide physical and dental  examinations for Army early-deploying reservists, we obtained estimates  from the Army’s Federal Strategic Healthcare Alliance (FEDS_HEAL)  administrator on the costs of outsourcing the examinations. We calculated  the annual cost for those reservists requiring a physical examination once  every 5 years and those requiring a physical examination once every   2 years. In developing the annual cost estimate, we used DOD information  on the number of Army reservists that are under 40 (approximately   75 percent), and those over 40 (approximately 25 percent). We also  included the initial dental examination cost and subsequent yearly dental  examination costs. All costs were averaged over one 5-year period. The  average annual cost does not include allowances for inflation, dental  treatment, or specialized laboratory fees such as those for pregnancy,  phlebotomy, and tuberculosis. We also obtained estimates of the cost to  perform dental treatments from the Army Office of the Surgeon General  and Army Dental Command.
We obtained from DOD, HHS’s Office of Public Health and Science, the  Centers for Disease Control and Prevention, medical associations, and  dental associations studies and information concerning the advisability of  periodic physical and dental examinations. From these organizations we  also obtained published common practices and standards concerning  periodic medical and dental examinations, age and risk factors, and the  value and relevance of patients’ self-reporting of symptoms.
section_title: Appendix II: 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: Appendix III: Annual Medical Certificate
section_title: Appendix IV: Comments from the Department of Defense
section_title: Appendix V: GAO Contact and Staff Acknowledgments
subsections: section_title: GAO Contact
section_title: Acknowledgments
paragraphs: The following staff members made key contributions to this report: Aditi  S. Archer, Richard J. Wade, Krister P. Friday, Helen T. Desaulniers, and  Mary W. Reich.
section_title: Related GAO Products
paragraphs: 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.
Department of Defense: Implications of Financial Management Issues.  GAO/T-AIMD/NSIAD-00-264. Washington, D.C.: July 20, 2000.
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/NSIAD-94-58. Washington, D.C.: December 30, 1993.
Reserve Components: Factors Related to Personnel Attrition in the  Selected Reserve. GAO/NSIAD-91-135. Washington, D.C.: April 8, 1991.