As required by law, 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, 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 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. DOD administers medical examinations to military personnel for various reasons at different intervals. These include examinations at accession, mobilization, 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 statute prescribes that each member of the Selected Reserve 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 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 authorities 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 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 report 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 reported that medical screenings conducted at mobilization stations identified numerous problems that impaired soldiers’ ability to deploy, including ulcers, chronic asthma, spinal arthritis, hepatitis, seizures, and diabetes. In 1992, we reported 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 report 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, 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. 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 record- keeping 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). 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.