Military Personnel: Army Needs to Better Enforce Requirements and
Improve Record Keeping for Soldiers Whose Medical Conditions May 
Call for Significant Duty Limitations (10-JUN-08, GAO-08-546).	 
                                                                 
The increasing need for warfighters for the Global War on	 
Terrorism has meant longer and multiple deployments for soldiers.
Medical readiness is essential to their performing needed duties,
and an impairment that limits a soldier's capacities represents  
risk to the soldier, the unit, and the mission. Asked to review  
the Army's compliance with its guidance, GAO examined the extent 
to which the Army is (1) adhering to its medical and deployment  
requirements regarding decisions to send soldiers with medical	 
conditions to Iraq and Afghanistan, and (2) deploying soldiers	 
with medical conditions requiring duty limitations, and assigning
them to duties suitable for their limitations. GAO reviewed Army 
guidance, and medical records for those preparing to deploy	 
between April 2006 and March 2007; interviewed Army officials and
commanders at Forts Benning, Stewart, and Drum, selected for	 
their high deployment rates; and surveyed deployed soldiers with 
medical limitations.						 
-------------------------Indexing Terms------------------------- 
REPORTNUM:   GAO-08-546 					        
    ACCNO:   A82307						        
  TITLE:     Military Personnel: Army Needs to Better Enforce	      
Requirements and Improve Record Keeping for Soldiers Whose	 
Medical Conditions May Call for Significant Duty Limitations	 
     DATE:   06/10/2008 
  SUBJECT:   Army personnel					 
	     Combat readiness					 
	     Defense operations 				 
	     Government information dissemination		 
	     Health policy					 
	     Information management				 
	     Medical care evaluation				 
	     Medical examinations				 
	     Medical information systems			 
	     Medical records					 
	     Military health services				 
	     Military operations				 
	     Military personnel 				 
	     Military personnel deployment			 
	     Military personnel records 			 
	     Military policies					 
	     Mission critical information			 
	     Needs assessment					 
	     Records management 				 
	     Risk assessment					 
	     Standards evaluation				 
	     DOD Operation Iraqi Freedom			 
	     Operation Enduring Freedom 			 

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GAO-08-546

This is the accessible text file for GAO report number GAO-08-546 
entitled 'Military Personnel: Army Needs to Better Enforce Requirements 
and Improve Record Keeping for Soldiers Whose Medical Conditions May 
Call for Significant Duty Limitations' which was released on June 10, 
2008.

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United States Government Accountability Office: 
GAO: 

Report to Congressional Requesters: 

June 2008: 

Military Personnel: 

Army Needs to Better Enforce Requirements and Improve Record Keeping 
for Soldiers Whose Medical Conditions May Call for Significant Duty 
Limitations: 

GAO-08-546: 

GAO Highlights: 

Highlights of GAO-08-546, a report to congressional requesters. 

Why GAO Did This Study: 

The increasing need for warfighters for the Global War on Terrorism has 
meant longer and multiple deployments for soldiers. Medical readiness 
is essential to their performing needed duties, and an impairment that 
limits a soldierï¿½s capacities represents risk to the soldier, the unit, 
and the mission. Asked to review the Armyï¿½s compliance with its 
guidance, GAO examined the extent to which the Army is (1) adhering to 
its medical and deployment requirements regarding decisions to send 
soldiers with medical conditions to Iraq and Afghanistan, and (2) 
deploying soldiers with medical conditions requiring duty limitations, 
and assigning them to duties suitable for their limitations. GAO 
reviewed Army guidance, and medical records for those preparing to 
deploy between April 2006 and March 2007; interviewed Army officials 
and commanders at Forts Benning, Stewart, and Drum, selected for their 
high deployment rates; and surveyed deployed soldiers with medical 
limitations. 

What GAO Found: 

Army guidance allows commanders to deploy soldiers with medical 
conditions requiring duty limitations, subject to certain requirements, 
but the Army lacks enforcement mechanisms to ensure that all 
requirements are met, and medical record keeping problems obstruct the 
Armyï¿½s visibility over these soldiersï¿½ conditions. A soldier diagnosed 
with an impairment must be given a physical profile form designating 
numerically the severity of the condition and, if designated 3 or 
higher (more severe), must be evaluated by a medical board. Commanders 
must then determine proper duty assignments based on soldiersï¿½ profile 
and commandersï¿½ staffing needs. From a random projectable sample, GAO 
estimates that 3 percent of soldiers from Forts Benning, Stewart, and 
Drum who had designations of 3 did not receive required board 
evaluations prior to being deployed to Iraq or Afghanistan for the 
period studied. In some cases, soldiers were not evaluated because 
commanders lacked timely access to profiles; in other cases, commanders 
did not take timely actions. The Army also had problems with retention 
and completeness of profiles; although guidance requires that approved 
profiles be retained in soldiersï¿½ medical records, 213 profiles were 
missing from the sample of 685 records reviewed. The Army was not 
consistent in assigning numerical designations reflecting soldiersï¿½ 
abilities to perform functional activities. GAO estimates from a random 
projectable sample that 7 percent of soldiers from these three 
installations had profiles indicating their inability to perform 
certain functional activities, yet carrying numerical designators below 
3. While medical providers can ï¿½upgradeï¿½ numerical designations 
discretionarily based on knowledge of soldiersï¿½ conditions, the 
upgrades can mask limitations and cause commanders to deploy soldiers 
without needed board evaluations. While GAO found no evidence of 
widespread revision in profile designations, some soldiers interviewed 
or surveyed disagreed with their designations yet were reluctant to 
express concerns for fear of prejudicial treatment. The Army has 
instituted a program to provide ombudsmen to whom soldiers can bring 
medical concerns, but it is targeted at returning soldiers and is not 
well publicized as a resource for all soldiers with medical conditions. 
Without timely board evaluations and retention of profile information 
for deploying soldiers with medical conditions, the Army lacks full 
visibility and commanders must make medical readiness, deployment, and 
duty assignment decisions without being fully informed of soldiersï¿½ 
medical limitations. 

GAO estimates that about 10 percent of soldiers with medical conditions 
that could require duty limitations were deployed from the three 
installations, but survey response was too limited to enable GAO to 
project the extent to which they were assigned to suitable duties. 
Along with interviews, however, responses suggest that both soldiers 
and commanders believe soldiers are generally assigned to duties that 
accommodate their medical conditions. Occasional exceptions have 
occurred when a profile did not reflect all necessary medical 
information or a soldierï¿½s special skill was difficult to replace. 
Officials said soldiers sometimes understate their conditions to be 
deployed with their units, or overstate them to avoid deployment. 

What GAO Recommends: 

The Army needs to take specific measures, such as developing an 
enforcement mechanism to ensure timely performance of medical board 
evaluations and enhancing soldiersï¿½ and their familiesï¿½ access to an 
ombudsman, to help safeguard soldiers with medical conditions from 
being deployed and assigned to duties unsuitable to their medical 
limitations. In written comments on a draft of the report, DOD 
concurred with GAOï¿½s recommendations. 

To view the full product, including the scope and methodology, click on 
[hyperlink, http://www.gao.gov/cgi-bin/getrpt?GAO-08-546]. For more 
information, contact Brenda S. Farrell, (202) 512-3604 or 
[email protected]. 

[End of section] 

Contents: 

Letter: 

Results in Brief: 

Background: 

Army Is Not Meeting All Requirements for Deploying Soldiers with 
Medical Conditions and Has Unresolved Problems with Medical Record 
Keeping: 

Army Requirements for Deploying Soldiers with Medical Conditions Are 
Not Always Being Met: 

Soldiers' Medical Records Are Not Always Complete and Do Not Always 
Retain Profiles, and Numerical Designations Are Not Consistently 
Determined: 

One In 10 Soldiers in the Projectable Sample Who Has a Medical 
Condition Has Deployed, but We Were Unable to Determine Duty 
Suitability: 

Some Deploying Soldiers Have Medical Conditions: 

Extent to Which Commanders Assigned Soldiers to Duties Suitable to 
Their Medical Conditions Cannot Be Determined: 

Conclusions: 

Recommendations for Executive Action: 

Agency Comments and Our Evaluation: 

Appendix I: Scope and Methodology: 

Appendix II: Army Physical Profile (DA Form 3349): 

Appendix III: PULHES Definitions: 

Appendix IV: Army Physical Profile Codes: 

Appendix V: Department of Defense Pre-Deployment Health Assessment (DD 
Form 2795): 

Appendix VI: Comments from the Department of Defense: 

Appendix VII: GAO Contact and Staff Acknowledgments: 

Related GAO Products: 

Tables: 

Table 1: Number of Soldiers in the Sample with Permanent Physical 
Profile Designations of 3 Who Did Not Receive Pre-Deployment Evaluation 
by MMRB or MEB: 

Table 2: Numbers and Percentages of Medical Conditions That May Require 
Significant Duty Limitations, by Physical Profile Category, across 
Profiles of Deployed Soldiers in the Sample: 

Table 3: Soldier Sample Universe, Target Sample Sizes, and Number of 
Records Reviewed at Each Visited Installation: 

Figures: 

Figure 1: Estimated Percentage of Soldiers with Physical Profile 
Designations of Permanent 3 Who Deployed and Percentage of Soldiers Who 
Did Not Receive Pre-Deployment Evaluation by MMRB or MEB: 

Figure 2: Estimated Percentage of Soldiers Unable to Perform Functional 
Activities Yet Designated as 2 in Their Profiles: 

Figure 3: Comparison of Estimated Percentages of Soldiers with Profiles 
Who May Require Significant Duty Limitations against Those Who Do Not: 

Figure 4: Comparison of Estimated Percentages of Soldiers Having 
Medical Conditions That May Require Significant Duty Limitations Who 
Deployed against Those Who Did Not: 

Abbreviations: 

AHLTA: Armed Forces Health Longitudinal Technology Application: 

DOD: Department of Defense: 

MEB: Medical Evaluation Board: 

MEDPROS: Army Medical Protection System: 

MMRB: Military Occupational Specialty Medical Retention Board: 

MOS: Military Occupational Specialty: 

[End of section] 

United States Government Accountability Office: Washington, DC 20548: 

June 10, 2008: 

The Honorable Ike Skelton: 
Chairman: 
Committee on Armed Services: 
House of Representatives: 

The Honorable Susan A. Davis: 
Chairwoman: 
Subcommittee on Military Personnel: 
Committee on Armed Services: 
House of Representatives: 

The Honorable Vic Snyder:
Member of Congress:
House of Representatives: 

From fiscal years 2004 through 2007, the average number of active and 
reserve servicemembers deployed by the Department of Defense (DOD) has 
increased about 19 percent, from 216,000 to 256,000 servicemembers, in 
support of Operation Iraqi Freedom and the Global War on Terrorism. The 
Army has been the major source of servicemembers supporting continued 
operations, and the increasing need for able warfighters has meant 
longer and multiple deployments for its soldiers. Serving in the armed 
forces requires the medical readiness necessary to plan and execute 
duties to meet operational goals. Any medical or psychological 
condition that limits the ability of a servicemember to execute his or 
her duties represents a risk to the servicemember, the unit, and the 
accomplishment of the mission. Military commanders, medical providers, 
and servicemembers share the responsibility for medical readiness as an 
integrated effort to ensure that servicemembers are ready to fight in 
support of ongoing operations. 

Whenever a soldier is diagnosed with a medical condition, Army guidance 
requires that medical providers document the soldier's limitations in 
his or her medical record with a permanent or temporary physical 
profile,[Footnote 1] describing the soldier's medical condition and 
physical capability. These medical providers, who serve as the 
profiling officers, must also assign a numerical designation reflecting 
the extent of any limitation on a scale from 1 to 4, such that a 
designation of 1 indicates that a soldier has a high level of medical 
fitness, while a designation of 4 signifies a drastically limited 
ability to perform military duties due to one or more medical 
conditions or defects.[Footnote 2] A designation of 3 indicates that a 
soldier has one or more medical conditions that may require significant 
duty limitations, and the soldier should receive duty assignments that 
are commensurate with his or her limitations. Once soldiers receive a 
permanent profile indicating that they have a permanent or chronic 
medical condition that may require significant limitations in 
assignment, Army guidance generally requires further evaluation of the 
soldiers' ability to perform duties in their current job assignments. 
Moreover, DOD guidance requires soldiers to be evaluated for medical 
readiness prior to deployment. 

In prior reports, we have highlighted long-standing issues with the 
medical deployability of servicemembers.[Footnote 3] Specifically, we 
have found continuing problems with the completion of pre-and post- 
deployment health assessments. We also reported in October 2005 that we 
found reserve component servicemembers were deploying with preexisting 
medical conditions, and we provided various recommendations for more 
guidance and better visibility over servicemembers with medical 
conditions in theater.[Footnote 4] DOD has taken action based on these 
recommendations, such as establishing tracking and reporting of key 
force health protection and quality assurance elements such as 
immunizations and pre-and post-deployment health assessments. 

From March through October 2007, the Army Office of the Inspector 
General conducted an inquiry at Fort Benning based on media allegations 
that soldiers were deployed with significant medical limitations. Army 
Inspector General officials interviewed the soldiers named in the news 
articles, numerous medical providers, and unit leaders to obtain their 
testimonies regarding their pre-deployment medical reviews. The 
Inspector General officials reviewed the standards for completing 
physical profiles, the compliance with these standards, commanders' 
decisions or actions that were based on these profiles, and whether any 
reprisals may have occurred against soldiers with regard to complaints 
and concluded that the Army followed standards in all but one instance 
where a soldier's profile was changed without proper authority and the 
soldier deployed. The soldier was reevaluated in theater and redeployed 
to Fort Benning. They found no instances of reprisal. According to an 
Inspector General official, further investigation of one medical 
provider led to no findings of wrongdoing. The report recommended that 
the Army direct (1) a special inspection of medical fitness procedures, 
which is ongoing; (2) leaders and soldiers to review and follow Army 
standards for documenting and assessing medical limitations; and (3) 
the Army Surgeon General to revise the physical profile form to include 
a Privacy Act statement, instructions for using the physical profile 
form, and definitions of key terms. 

The Chairs of the House Armed Services Committee and the Military 
Personnel Subcommittee requested that we review the Army's compliance 
with guidance on the deployment of soldiers with medical conditions. 
[Footnote 5] As agreed with congressional staff, we examined: 

1. the extent to which the Army is adhering to its medical and 
deployment requirements regarding decisions to send soldiers with 
medical limitations to Iraq and Afghanistan; and: 

2. the extent to which the Army is deploying soldiers with medical 
conditions requiring duty limitations to Iraq and Afghanistan, and 
whether it is assigning them to duties suitable to their limitations. 

To address the extent to which the Army is adhering to its medical and 
deployment requirements regarding decisions to send soldiers with 
medical limitations to Iraq and Afghanistan, we reviewed Army guidance 
regarding documentation of soldiers' medical limitations prior to 
deployment and conditions under which soldiers with medical conditions 
are considered deployable. We selected three Army installations--Fort 
Benning and Fort Stewart in Georgia, and Fort Drum in New York--that 
met one or both of the following two factors: (1) these installations 
had a large number of active component soldiers deployed from each 
installation to Iraq or Afghanistan between April 1, 2006, and March 
31, 2007; or (2) these installations had initial allegations of 
soldiers being deployed with significant medical limitations from these 
installations. For these locations, we prepared a random, projectable 
sample of active component soldiers preparing for deployment who 
indicated that they may be under a profile. We reviewed medical records 
of soldiers in this sample and identified a subset of the soldiers who 
had received profiles documenting medical conditions that may require 
significant duty limitations prior to preparing to deployment.[Footnote 
6] We interviewed medical providers, personnel officials, Army 
commanders, and soldiers to identify and evaluate the installation's 
procedures for documenting medical limitations in physical profiles and 
the training provided at each installation. We did not review 
documentation of medical limitations other than the physical profiles. 
To determine the extent to which the Army is deploying soldiers with 
medical conditions requiring duty limitations to Iraq and Afghanistan, 
and whether it is assigning them to duties suitable to their 
limitations, we compared the medical data on the subset of soldiers who 
had significant medical limitations from April 2001 to March 2007 with 
the soldiers' deployment data from Forts Benning, Stewart, and Drum. 
From this analysis, we identified the number of soldiers who had a 
profile in effect at the time of their deployment from each 
installation. We reviewed Army processes for tracking soldiers while 
deployed. We interviewed Army officials and commanders about any 
procedures in place to ensure that soldiers are assigned within their 
limitations. We also surveyed 66 active component Army soldiers 
deployed with medical conditions to Iraq and Afghanistan and received 
responses from 24 of them, for a response rate of about 36 percent. 
While we cannot project the results of the surveys to all soldiers with 
medical conditions across the Army deployed to Iraq and Afghanistan, we 
present the information we obtained to illustrate these issues. 

For a complete discussion of our scope and methodology, see appendix I. 
We conducted this performance audit from April 2007 through April 2008 
in accordance with generally accepted government auditing standards. 
Those standards require that we plan and perform the audit to obtain 
sufficient, appropriate evidence to provide a reasonable basis for our 
findings and conclusions based on our audit objectives. We believe that 
the evidence obtained provides a reasonable basis for our findings and 
conclusions based on our audit objectives. 

Results in Brief: 

Commanders may deploy soldiers who have medical conditions that may 
require significant limitations in duty assignment, subject to certain 
requirements; however, the Army lacks enforcement mechanisms to ensure 
that all requirements are met, and various other problems exist with 
regard to record keeping of physical profiles. Based on a random 
projectable sample of soldiers preparing to deploy during April 2006 
through March 2007, we estimate that 3 percent[Footnote 7] of soldiers 
from Fort Benning, Fort Stewart, and Fort Drum who met the criteria for 
higher evaluation by a medical board did not receive needed evaluations 
prior to being deployed to Iraq or Afghanistan. Army guidance requires 
a soldier diagnosed with a limiting medical condition to be given a 
physical profile indicating the severity of the limitation, and in 
certain cases, to be reviewed by a Military Occupational Specialty 
Medical Retention Board (MMRB) or a Medical Evaluation Board (MEB). 
Commanders, with the assistance of personnel management officers, are 
responsible for determining proper duty assignments for soldiers based 
on their knowledge of the soldiers' physical profiles and assignment 
limitations, and soldier's job duties. According to personnel 
officials, in some cases soldiers do not receive needed board 
evaluations prior to deployment because medical officials did not 
distribute profiles to commanders in a timely way, or because 
commanders did not take needed action prior to the soldiers' 
deployments. Without performing required medical board evaluations, the 
Army lacks a systematic method for ensuring that commanders recognize 
all cases of medical limitations and assign soldiers to duty 
assignments that suitably accommodate them. Additionally, the Army 
continues to have problems with the completeness and retention of 
physical profiles, and it has been inconsistent in its designations of 
soldiers' abilities to perform certain functional activities. Once 
physical profiles are prepared, signed, and approved as needed, Army 
guidance requires that the physical profiles be retained in soldiers' 
medical records. At Forts Benning, Stewart, and Drum, we found that 213 
physical profiles were missing from the 685 medical records of soldiers 
with medical conditions that may require significant limitations. Of 
the physical profiles retained in the sample of these medical records, 
we determined that 20 profiles were not complete, for example, they 
lacked necessary approval signatures. We found that each installation 
uses its own process for retaining physical profiles, leading to 
inconsistencies in retention across Army installations. The Army 
intends for all physical profiles to be processed and retained in its 
official electronic medical record system, in an effort to correct 
inconsistencies in profile procedures; however, steps have not been 
taken to implement this change and current plans do not ensure that 
information will be entered and distributed in a timely manner. 
Moreover, from the random projectable sample of soldiers preparing to 
deploy, we estimate that about 7 percent[Footnote 8] of soldiers from 
Forts Benning, Stewart, and Drum had medical records that indicated 
they could not perform certain functional activities and yet were not 
designated accordingly. While Army medical providers have some 
flexibility to upgrade soldiers' numerical designations to indicate 
less severe medical conditions based on knowledge of the soldiers' 
medical conditions, these discretionary upgrades can mask soldiers' 
limitations and cause commanders to deploy soldiers without needed 
medical board evaluations. While we found no evidence of widespread 
revision in profile designations, some soldiers told us that they 
disagreed with the numerical designations they were assigned yet were 
reluctant to bring their concerns to their commanders for fear of 
prejudicial treatment. The Army has instituted an ombudsman program to 
provide a point of contact to whom soldiers and family members can 
bring their concerns, but the program is targeted at returning rather 
than deploying injured soldiers, and it is not well publicized as a 
resource for active duty soldiers with medical conditions. 

From our random projectable sample of soldiers preparing for deployment 
between April 2006 and March 2007, we estimate that about 10 percent 
[Footnote 9] of soldiers from Forts Benning, Stewart, and Drum who have 
medical conditions that could require significant limitations in duty 
assignments were deployed to Iraq and Afghanistan, but we were unable 
to determine whether those soldiers were assigned to duties suitable to 
their medical conditions. We were told that soldiers, at times, 
understate their conditions or negotiate with medical providers in 
order to be deployed with their units or to remain in the Army; 
conversely, in some cases soldiers have overstated their medical 
conditions in order to avoid deployment. We estimate that about 86 
percent of soldiers from the three installations did not have profiles 
indicating medical conditions that could require significant 
limitations. Of the estimated 14 percent who had such medical 
conditions, approximately two-thirds were deployed. Most of the 
deploying soldiers whose medical records indicated a potential 
requirement for significant duty limitations had conditions such as 
herniated discs, various forms of back pain, or chronic knee pain. We 
could not determine the extent to which the Army assigned soldiers with 
medical conditions to duties that were suitable to their limitations 
because of the limited response to our survey. However, our limited 
survey responses and interviews with soldiers and commanders revealed 
that most respondents in both surveys and interviews believed soldiers 
were generally assigned to duties that were suitable to their 
limitations. We spoke with commanders at Forts Benning, Stewart, and 
Drum, and they reported that they were aware of the medical conditions 
of the soldiers with whom they had deployed and always took these 
conditions into account when assigning duties. Most soldiers whom we 
interviewed or who responded to our survey revealed that they were able 
to accomplish most of their duties. For example, one soldier who had 
back pain limiting his ability to carry all necessary combat equipment 
reported that he had discussed this problem with his commander while in 
theater, and the commander had reassigned him to duties that did not 
require wearing all his equipment. Commanders we interviewed noted that 
they occasionally required their soldiers to perform duties potentially 
exceeding the soldiers' medical limitations, in some cases because a 
soldier's physical profile did not reflect all necessary medical 
information, or in other cases because the soldier had special skills 
that were difficult to replace. 

We are recommending that the Army take several actions; first, to help 
ensure that soldiers with medical conditions are appropriately 
evaluated and assigned to suitable duties while deployed, and second, 
to help ensure that active duty soldiers and their families have access 
to a point of contact to whom they can bring concerns regarding 
recognition of their medical limitations prior to and during 
deployment. In commenting on a draft of this report, DOD concurred with 
our recommendations; we summarize these comments and provide our 
response in our Agency Comments section. 

Background: 

Various pieces of DOD guidance provide overall direction and require 
the services to define medical deployment standards to ensure that 
servicemembers deploying to a theater of operations are in optimal 
health.[Footnote 10] DOD allows the military services to deploy 
servicemembers who do not meet the services' medical standards under 
certain conditions. For example, a service is required to obtain a 
waiver from the Combatant Command Surgeon if the service wishes to 
deploy a servicemember who does not meet deployment standards and can 
receive medical treatment at deployed locations that will render them 
fit for duty.[Footnote 11] DOD guidance requires the services to 
continue to employ measures that ensure servicemembers are medically 
and psychologically fit for worldwide deployability, taking into 
account additional guidance provided by the combatant commander on 
theater-specific medical limitations. The Assistant Secretary of 
Defense for Health Affairs is planning to release new guidance that 
provides more guidelines on medical conditions that, in general, should 
preclude servicemembers from being deployed. Because DOD has not 
determined the issue date and has not yet implemented this new 
guidance, we were not able to evaluate its effect during our review. 

The Offices of the Surgeon General of each military service have 
established procedures to evaluate the health conditions of their 
servicemembers according to service-specific medical standards. 
[Footnote 12] Our prior work has shown that the Army, Air Force, Navy, 
and Marine Corps all have different methods of assessing their 
servicemembers' medical readiness prior to deployment and documenting 
any medical conditions and limitations. The Army's guidance, similar to 
the other services' guidance, allows the commander to have the ultimate 
authority to deploy servicemembers and make proper duty assignments, if 
certain procedures are followed, while taking into account the medical 
provider's assessment of a servicemember's medical condition and duty 
limitations. 

Army Guidance: 

The Army Office of the Surgeon General and Army Deputy Chief of Staff 
(G-1) provide guidance on soldiers' medical readiness. Regarding 
medical matters, the Army Office of the Surgeon General heads the Army 
Medical Command, which provides guidance to Army medical treatment 
facilities. Medical Evaluation Boards (MEB) of soldiers are conducted 
at medical treatment facilities at Army installations. Regarding 
command matters, the Army Manpower and Reserve Affairs Office works 
with the Army Deputy Chief of Staff G-1 to provide guidance to human 
resource directorates at each installation. The Deputy Chief of Staff 
G-1 has overall responsibility for the Physical Performance Evaluation 
System which involves an administrative screening board known as the 
Military Occupational Specialty Medical Retention Board (MMRB). 

Physical Profiles: 

Army Regulation 40-501 requires that the Army document physical and 
mental conditions that may limit a soldier's ability to perform his or 
her duties on the physical profile form. Using the physical profile, 
Army medical providers, who serve as profiling officers, provide 
recommendations on a soldier's medical limitations in order to assist 
the commander in properly assigning the soldier to duties that 
contribute to the unit's mission. A profiling officer creates a 
physical profile that documents any limitations found during a medical 
examination, and identifies whether the medical limitation is 
temporary, in which case a short-term condition can be improved by 
further treatment, or permanent, in which case a chronic condition will 
not improve with medical treatment at that point in time. The profiling 
officer classifies the medical limitations under six categories: 

* physical capacity; 
* upper extremities: 
* lower extremities; 
* hearing; 
* eyes; 
* psychiatric. 

These categories are often abbreviated as the "PULHES" factors (see 
app. III for further detail). The medical limitations in physical 
profiles are also given a numerical designation from 1 to 4 to reflect 
the different levels of functional capability and severity of 
impairment. Soldiers with physical profiles designated by the number 1 
are considered to have a high level of medical fitness; a 2 indicates 
that a soldier has some medical condition or physical defect that may 
require some activity limitations; a 3 under one or more of the factors 
indicates that the soldier has a medical condition or physical defect 
that may require significant limitations in duty assignment; and 
soldiers designated by the number 4 must have their military duties 
drastically limited.[Footnote 13] Profiling officers must also specify 
whether the soldier can perform certain functional activities 
comprising the minimum requirements needed in order to be medically 
qualified for worldwide deployment. 

Profiling officers should evaluate a soldier who has a temporary 
profile at least once every 3 months to determine whether the soldier's 
medical condition has improved or, if not, whether an extension of up 
to 12 months is needed. If an extension is needed beyond 12 months, a 
temporary profile should be changed to a permanent profile. Permanent 
and temporary profiles normally require the signature of only the 
profiling officer. Both the signatures of the profiling officer and a 
higher level medical provider, who is designated the approving 
authority, are required when a permanent profile number is designated 
at 3 or 4, or when a permanent profile designation has been changed 
from a 3 to a 2. 

According to profiling officers, during the preparation of the physical 
profile and medical evaluation of the soldier, the profiling officer 
may communicate with the commander of the soldier for the purpose of 
better identifying the soldier's medical limitations. All permanent 
physical profiles are coded to designate any assignment limitations, 
including whether a soldier has been reviewed by an MMRB or a Physical 
Evaluation Board.[Footnote 14] Once the physical profile is signed by 
profiling officer, and approved by the designated approving authority 
as needed, Army regulation 40-501 requires that the completed physical 
profile should be retained in the soldier's medical record and copies 
of it should be distributed to the unit commander and the soldier. For 
permanent physical profiles, one more copy is distributed to the 
military personnel office. 

Army medical records comprise both hard copy documents and an 
electronic system called the Armed Forces Health Longitudinal 
Technology Application (AHLTA), the official system for retaining 
soldiers' medical documentation. AHLTA is used DOD-wide and gives 
medical providers access to soldiers' medical information, including 
medical evaluation history, prescriptions, diagnostic tests, and 
physical profile information. The Army also tracks soldiers' medical 
readiness information through the Army Medical Protection System 
(MEDPROS), in order to allow commanders to have access to soldiers' 
medical information that might affect readiness, but this system 
retains limited information only on permanent physical profiles and 
does not supply any detailed description of medical limitations or 
incapacity to perform functional activities. 

MMRB and MEB Evaluations: 

Because physical profiles merely represent medical recommendations made 
by the profiling officer to a soldier's commander, physical profile 
designations do not automatically determine whether a soldier is 
deployable or not. Three Army regulations require higher levels of 
review for soldiers with a numerical designation of at least a 3 in 
order to assist commanders in properly assigning soldiers to duties 
suitable to their medical limitations.[Footnote 15] Army guidance 
states that once soldiers receive a permanent profile designation of at 
least a 3, they are not deployable for the duration of the MMRB or MEB 
until the board is concluded.[Footnote 16] 

If a soldier receives a permanent profile of at least a 3, the 
profiling officer and approving authority must provide an initial 
determination of whether the soldier meets Army medical standards or 
not.[Footnote 17] If they believe that a soldier meets medical 
standards, Army regulation 600-60 requires that the soldier be reviewed 
by an MMRB to determine whether the soldier is able to complete the 
duties in his or her job assignment or needs to be reassigned to a job 
that accommodates his or her limitations. The MMRB consists of five 
voting members, including a medical provider, a senior commander, and 
when reasonably available, soldiers of the same branch or specialty as 
the soldier being evaluated as well as non-voting members including a 
personnel advisor, a recorder, and anyone else to ensure a fair 
hearing. Once the personnel office receives the permanent profile from 
the medical administrative office and convenes an MMRB, the recorder 
will assemble the soldier's personnel records and medical records. The 
commander will prepare an evaluation of the impact of the profile 
limitations on the soldier's ability to perform the full range of 
duties in the soldier's job assignment, known as a Military 
Occupational Specialty (MOS). During the MMRB, the personnel advisor 
will summarize the details of the soldier's current MOS and common 
duties, and the medical provider will brief the MMRB on the soldier's 
physical profile. The soldier will also present facts or call witnesses 
relevant to his or her physical performance, current MOS retention, or 
MOS reclassification preference. The MMRB can recommend either that (1) 
the soldier remain in the Army under his or her current military 
occupational specialty or specialty code, (2) the soldier be placed in 
probationary status for up to 6 months to improve the condition of a 
disease or injury, (3) the soldier be reclassified into another 
occupational specialty, or (4) the soldier be referred to the MEB for 
medical disqualification processing. 

Active component Army soldiers should appear before an MMRB within 60 
days of the date the physical profile is signed by the medical provider 
who is designated the approval authority. Army regulation 600-60 
requires that personnel officials responsible for convening the MMRB 
maintain statistics on each case in order to assess whether or not MMRB 
evaluations are convened within the 60-day time limit. As of March 
2008, officials now are required to report the statistics to the Deputy 
Chief of Staff of the Army. 

Alternatively, if a profiling officer and the approving authority 
believe that a soldier with a permanent profile designation of at least 
a 3 does not meet medical standards, Army regulation 40-501 requires 
that the soldier should be reviewed by an MEB to fully ascertain the 
soldier's medical condition and limitations. From the MEB results, a 
subsequent Physical Evaluation Board determines whether the soldier is 
to be retained in the Army or not, and the applicable disability 
rating.[Footnote 18] 

There are two ways in which an MEB is initiated: by referral from the 
medical provider designated as the approving authority or by referral 
from an MMRB. When an MEB is referred by an approving authority, the 
soldier's physical profile is distributed to the Physical Evaluation 
Board liaison officer at the medical treatment facility, who is 
responsible for the case management of the soldier. A medical provider 
reexamines the servicemember and reviews his or her medical history, 
including prior test results, diagnoses, and treatments. The medical 
provider will then complete a narrative summary to document the nature 
and degree of severity of the soldier's condition. The commander also 
provides a letter describing how the soldier's medical condition 
affects job performance and deployability status. Also provided is a 
summary of the soldier's chief complaint, stated in the soldier's own 
words. MEBs are composed of two or more physicians, one being a senior 
medical provider with detailed knowledge of Army medical standards and 
procedures, and other members having familiarity with these matters. 
MEB evaluations must be completed within 90 days of approval of the 
physical profile, or of the date when the MMRB referral is received by 
the liaison officer. The MEB could result in several outcomes, 
including: (1) the soldier is returned to duty, with a profile marked 
that he or she meets medical retention standards; or (2) the soldier is 
referred to a Physical Evaluation Board to determine whether he or she 
has lost the ability to perform assigned duties because of a medical 
condition and thus is unfit for duty, or the soldier is fit for duty 
and thus is retained in the Army. 

An Army memorandum requires that the liaison officers track certain 
statistics and use an electronic database system to ensure that MEB 
evaluations are completed within 90 days.[Footnote 19] This information 
is reported quarterly to the Deputy Under Secretary of Defense for 
Military Personnel Policy. 

Pre-deployment Health Assessments: 

According to a DOD instruction,[Footnote 20] within 60 days prior to 
deployment, soldiers complete a pre-deployment health assessment 
form[Footnote 21] to reflect soldiers' medical readiness with respect 
to immunizations, dental, hearing/eye exams, and medical limitations on 
physical profiles. If a soldier indicates on the pre-deployment health 
assessment form that he or she is on a profile, or light duty, or 
undergoing a medical board, the soldier is referred to a medical care 
provider for reevaluation and verification of the medical limitations 
under the physical profile. If a soldier does not meet the medical 
requirements under the pre-deployment health assessment, the soldier is 
classified as not deployable, until the soldier receives further 
treatment. Moreover, if a soldier is also undergoing an MMRB or MEB, 
the soldier is considered not deployable until the evaluation is 
completed and the soldier is found fit for duty. The pre-deployment 
health assessment is updated to indicate that the soldier is deployable 
once he or she receives treatment or undergoes a board screening and is 
found fit for duty. 

Under Army regulation 40-501, Army commanders have the ultimate 
authority to deploy soldiers, but commanders are required to recognize 
soldiers' limiting conditions and assign them duties consistent with 
their limiting conditions, with the assistance of personnel management 
officers from Army Forces Command and Human Resources Command. 

Army Is Not Meeting All Requirements for Deploying Soldiers with 
Medical Conditions and Has Unresolved Problems with Medical Record 
Keeping: 

The Army allows commanders to deploy soldiers who have medical 
conditions that may require significant limitations in duty assignment 
as long as they meet requirements in the guidance, including board 
evaluations, suitable duty assignments, and available medical treatment 
in deployed locations, if needed; however, the Army is not meeting all 
requirements to ensure board evaluations are conducted within 
prescribed time frames, and various problems exist with regard to 
physical profile record keeping. Army requirements for deploying 
soldiers with medical conditions are not always being met; commanders 
are not always aware of medical limitations in a timely way, and in the 
sample review, we found that commanders are not always adhering to 
guidance to ensure that soldiers are not being deployed to Iraq or 
Afghanistan prior to having needed MMRB or in some cases MEB 
evaluations. Furthermore, the Army continues to have problems with 
retention and completeness of its physical profiles, as well as a lack 
of consistency in designations with regard to soldiers' abilities to 
perform functional activities. While we did not find widespread 
revision of profiles prior to deployment, we found that soldiers were 
concerned about how the Army was addressing their medical problems 
prior to deployment. While commanders may recognize medical limitations 
on a case by case basis, without performing required medical board 
evaluations, the Army lacks a method for ensuring that all such cases 
are appropriately recognized. 

Army Requirements for Deploying Soldiers with Medical Conditions Are 
Not Always Being Met: 

While Army guidance allows commanders to deploy soldiers with medical 
conditions that may require significant limitations in duty 
assignments, subject to certain requirements, we found that commanders 
are not always aware of soldiers' medical limitations when making 
deployment decisions, and they do not always adhere to these 
requirements. Army guidance requires that whenever a new physical 
profile is created, copies of physical profile documentation, once 
authorized by the approving medical authority, should be added to a 
soldier's medical record and given to the soldier, his or her 
commander, and the command's personnel office.[Footnote 22] Army 
guidance stipulates that soldiers with a permanent profile containing a 
numerical designation of a 3 or 4 who meet Army medical retention 
standards should be evaluated by an MMRB within 60 days of receiving 
the approved physical profile, to determine whether the soldier is able 
to complete all the duties in his or her current job assignment or 
should alternatively be reassigned to a job that accommodates his or 
her medical limitation(s).[Footnote 23] Alternatively, a soldier with a 
permanent profile of a 3 or 4 who is believed by a profiling officer 
not to meet medical standards must be evaluated by an MEB within 90 
days to determine whether that soldier should be retained in the 
Army.[Footnote 24] Moreover, within 60 days prior to deployment, DOD 
guidance requires the Army to review soldiers for medical readiness. 
[Footnote 25] During this pre-deployment assessment, soldiers who 
report having a physical profile must be referred to a medical 
provider, which according to medical providers may result in an updated 
confirmation of their numerical designation. If a soldier receives a 
new profile indicating a medical condition that may require significant 
limitations in assignment, Army guidance categorizes the soldier as not 
deployable until he or she is reviewed by an MMRB or in some cases 
MEB.[Footnote 26] Commanders, with the assistance of personnel 
management officers, are responsible for determining proper duty 
assignments for soldiers based on their knowledge of soldiers' physical 
profiles, assignment limitations, and the need for accomplishing 
necessary duties within the soldiers' MOS. Commanders may also consider 
the availability of medical treatment at deployed locations when 
determining the deployability of soldiers with physical profiles. 

At Forts Benning, Stewart, and Drum, we found that commanders are not 
always adhering to requirements in Army guidance to ensure that needed 
board evaluations are performed. After reviewing 685 medical records 
and the deployment information of soldiers who were preparing for 
deployment in the statistically valid sample, we estimate that 6 
percent of soldiers from Forts Benning, Stewart, and Drum were deployed 
with designations of permanent 3 in their physical profiles--signifying 
to a commander that they have medical conditions that may require 
significant limitations.[Footnote 27] These soldiers should have been 
reviewed prior to deployment by a MMRB, or MEB as needed, in accordance 
with Army regulations.[Footnote 28] Further, we estimate that about 3 
percent of the soldiers from Forts Benning, Stewart, and Drum had 
profiles that indicated that they met medical retention standards and 
required an MMRB, or may not meet standards and required an MEB, but 
were deployed without having been reviewed by an MMRB or MEB.[Footnote 
29] Figure 1 summarizes percentages (and confidence intervals) of 
soldiers with profile designations of permanent 3 who deployed from 
Forts Benning, Stewart, and Drum, and the percentage of those soldiers 
who did not receive evaluation by an MMRB or MEB prior to deployment. 

Figure 1: Estimated Percentage of Soldiers with Physical Profile 
Designations of Permanent 3 Who Deployed and Percentage of Soldiers Who 
Did Not Receive Pre-Deployment Evaluation by MMRB or MEB: 

This figure is a vertical bar graph, depicting the following data: 

Installation: Ft. Benning (n=189); 
Soldiers who deployed with a permanent 3 profile: 6%; 95 percent 
confidence interval, upper and lower bounds for each estimate: 10%/3%; 
Soldiers who deployed with a permanent 3 profile not reviewed by MEB or 
MMRB: 3%; 95 percent confidence interval, upper and lower bounds for 
each estimate: 6%/2%. 

Installation: Ft. Stewart (n=259); 
Soldiers who deployed with a permanent 3 profile: 6%; 95 percent 
confidence interval, upper and lower bounds for each estimate: 10%/3%; 
Soldiers who deployed with a permanent 3 profile not reviewed by MEB or 
MMRB: 3%; 95 percent confidence interval, upper and lower bounds for 
each estimate: 5%/2%. 

Installation: Ft. Drum (n=237); 
Soldiers who deployed with a permanent 3 profile: 6%; 95 percent 
confidence interval, upper and lower bounds for each estimate: 10%/3%;
Soldiers who deployed with a permanent 3 profile not reviewed by MEB or 
MMRB: 2%; 95 percent confidence interval, upper and lower bounds for 
each estimate: 6%/2%. 

Installation: Total (n=685); 
Soldiers who deployed with a permanent 3 profile: 6%; 95 percent 
confidence interval, upper and lower bounds for each estimate: 10%/3%;
Soldiers who deployed with a permanent 3 profile not reviewed by MEB or 
MMRB: 3%; 95 percent confidence interval, upper and lower bounds for 
each estimate: 5%/2%. 

Source: GAO analysis of DOD data. 

[See PDF for image] 

[End of figure] 

In our sample, we found that of the 42 soldiers who had profile 
designations of permanent 3, 17 soldiers did not receive needed board 
evaluations prior to their deployment. Although we could project this 
as a percentage of the soldiers from Forts Benning, Stewart, and Drum, 
we did not project this as a percentage of the 42 soldiers who had 
profile designations of a permanent 3 because the size of this subgroup 
in the sample is not sufficient to report a reliable confidence 
interval for a population estimate. Table 1 shows the number of 
soldiers in the sample with permanent physical designations of 3 who 
did not receive pre-deployment evaluations by MMRB or MEB. 

Table 1: Number of Soldiers in the Sample with Permanent Physical 
Profile Designations of 3 Who Did Not Receive Pre-Deployment Evaluation 
by MMRB or MEB: 

Army installation: Fort Benning; 
Number of soldiers who deployed with permanent profiles of 3: 11; 
Number of deployed soldiers with permanent profiles of 3 not reviewed 
by MMRB or MEB: 5. 

Army installation: Fort Stewart; 
Number of soldiers who deployed with permanent profiles of 3: 16; 
Number of deployed soldiers with permanent profiles of 3 not reviewed 
by MMRB or MEB: 7. 

Army installation: Fort Drum; 
Number of soldiers who deployed with permanent profiles of 3: 15; 
Number of deployed soldiers with permanent profiles of 3 not reviewed 
by MMRB or MEB: 5. 

Army installation: Total; 
Number of soldiers who deployed with permanent profiles of 3: 42; 
Number of deployed soldiers with permanent profiles of 3 not reviewed 
by MMRB or MEB: 17. 

Source: GAO analysis of DOD data. 

Notes: The size of this subgroup in the sample is not sufficient to 
report a reliable confidence interval for a population estimate. 
Therefore, we did not project this subgroup to the population of Forts 
Benning Stewart, and Drum. MEB evaluations are conducted in cases where 
retention is in question. 

[End of table] 

These needed evaluations may not be occurring because each of the three 
installations lacked an enforcement mechanism to ensure all procedures 
are followed. According to medical providers, commanders, and personnel 
officials, in some cases soldiers do not receive their MMRB or MEB 
evaluations because profiles were not distributed by the approving 
authority or medical administrative office in time to inform commanders 
of the existence of the profiles. In other cases, according to 
personnel officials, commanders were given notice of the profiles but 
did not take needed action on time, but we were not able to determine 
why this occurred. 

Moreover, we found that while Army personnel officials at the three 
installations we visited were maintaining proper data on MEB 
evaluations, they were not maintaining required statistics on the 
performance of MMRB evaluations. Army guidance requires that medical 
and personnel officials have to maintain certain statistics in order to 
know whether MEB or MMRB evaluations are conducted within set time 
frames.[Footnote 30] Personnel officials told us that they kept 
informal data on each MMRB case in separate files, such as the date of 
the approved profile, the date it was received, and the date of the 
MMRB. However, this information was not summarized as would be needed 
in order to calculate the period of time that elapsed between the 
stages of MMRB evaluations. Prior to February 2008, the Army did not 
require that these statistics be reported to anyone. The Army revised 
its regulation 600-60 to require the reporting of quarterly statistics 
to the Deputy Chief of Staff of the Army beginning in March 2008. That 
change may lead to better oversight of the timeliness of the MMRB, but 
we were not able to assess the impact of this recent change during this 
review. 

Without performing all required medical board evaluations or tracking 
the timeliness of board evaluations, the Army lacks a systematic method 
for confirming that commanders recognize all cases of medical 
limitations and assign soldiers to duty assignments that suitably 
accommodate them. 

Soldiers' Medical Records Are Not Always Complete and Do Not Always 
Retain Profiles, and Numerical Designations Are Not Consistently 
Determined: 

Medical records are intended to provide a soldier's history of medical 
treatment and limitations, and Army regulation 40-501 requires that 
once physical profiles are prepared and signed, the profiles should be 
kept in a soldier's medical record. These completed profiles include 
the numerical designation, a description of medical limitations, the 
signature of the profiling officer and approving authority, as needed, 
and the dates of the signatures. Medical records comprise both the hard 
copy and electronic versions of medical information. Commanders use 
physical profiles to assess soldiers' physical ability to perform their 
duties. 

When we compared records in the official electronic medical system, 
AHLTA, and hard copy records with those in an electronic medical 
readiness system, MEDPROS, we found that 213 physical profiles were 
missing from the 685 medical records of soldiers in the sample who had 
a medical condition that may require significant limitations at Forts 
Benning, Stewart, and Drum. Further, of the physical profiles that were 
retained in the sample of medical records of soldiers with medical 
conditions that may require significant limitations, we found that 20 
were not complete. Specifically, both hardcopy and electronic medical 
records lacked profiles with the appropriate signatures and dates of 
final approval. 

These problems may be occurring because each installation uses its own 
informal process for approving and distributing completed physical 
profiles to the soldier, commander, and medical record. For example, at 
Forts Benning and Stewart, a profiling officer would consult with the 
soldier and his commander in creating the profile, and if the physical 
profile were permanent and designated a 3 or 4, the medical provider 
who created the profile would provide it to the approving medical 
provider. The approving medical provider would then provide it to 
personnel officials in order to initiate an MMRB or to the liaison 
officer to initiate an MEB, if needed, and would also provide it to the 
medical administrative office, to be retained in the medical record. 
Officials did not strictly adhere to time frames during this process, 
and personnel officials expressed doubt to us as to whether they 
received all physical profiles. Medical and command officials at Fort 
Drum stated that their process was also informal and they did not 
strictly adhere to timeframes, but they retained hard copies of all 
permanent physical profiles separate from the soldiers' medical records 
at the liaison officer's administrative office. Without a systematic 
method for approving and distributing profiles, current informal 
processes have led to inconsistencies in retention of the physical 
profiles in the medical record. The electronic personnel system also 
contains medical information, and we found that it is not being 
routinely updated. As a result, communication to commanders about 
physical limitations in many cases comes from the soldiers themselves, 
rather than the medical record system or personnel system. 

Army officials intend to require that all physical profiles be 
processed and retained in the AHLTA electronic medical system; however, 
steps have not been taken to implement the system change. The system 
change will require that physical profiles be approved and routed 
electronically to commanders, medical providers, and the personnel 
offices to initiate MEB and MMRB proceedings. This change is intended 
to correct the limited visibility over profile information and 
inconsistencies in profile procedures, similar to the issues we have 
found in this review at Forts Benning, Stewart, and Drum. However, Army 
officials told us they have not finalized plans for actions needed and 
associated milestones to implement these changes. Moreover, current 
plans do not ensure that the information will be entered and 
distributed in a timely manner, as officials who convene the MMRB or 
MEB do not have authority to compel timely system input by commanders 
and medical providers. 

Finally, the Army is not consistent in its use of numerical 
designations in profiles to reflect a soldier's ability to perform 
certain functional activities. Army guidance states that when soldiers 
are not able to meet certain requirements they are given a numerical 
designation of at least 3, and this designation should result, in most 
instances, in a review of their cases by an MMRB or MEB. When profiling 
officers prepare physical profiles carrying a designation of 2, these 
profiles do not generally receive further review, until the soldier 
indicates he or she is under a physical profile at the pre-deployment 
assessment. Based on our random projectable sample of soldiers 
preparing to deploy between April 2006 and March 2007, we estimate that 
about 7 percent of the soldiers who were preparing for deployment at 
Forts Benning, Stewart, and Drum had physical profiles in their medical 
record showing the inability to perform functional activities yet were 
not designated with a score of at least 3.[Footnote 31] Figure 2 shows 
the estimated percentage (and confidence intervals) of soldiers by Army 
installation who had profiles that indicated that they were unable to 
perform certain functional activities, yet the profiles had a 
designation of 2. 

Figure 2: Estimated Percentage of Soldiers Unable to Perform Functional 
Activities Yet Designated as 2 in Their Profiles: 

This figure is a vertical var graph depicting the following data: 

Installation: Ft. Benning (n=189); 
Soldiers with profile designations of 2, unable to perform functional 
activities: 14%; 
95 percent confidence interval, upper and lower bounds for each 
estimate: 21%/9%. 

Installation: Ft. Stewart (n=259); 
Soldiers with profile designations of 2, unable to perform functional 
activities: 9%; 
95 percent confidence interval, upper and lower bounds for each 
estimate: 14%/6%. 

Installation: Ft. Drum (n=237); 
Soldiers with profile designations of 2, unable to perform functional 
activities: 0; 
95 percent confidence interval, upper and lower bounds for each 
estimate: 2%/0. 

Installation: Total (n=685); 
Soldiers with profile designations of 2, unable to perform functional 
activities: 7%
95 percent confidence interval, upper and lower bounds for each 
estimate: 10%/5%. 

[See PDF for image] 

Source: GAO review of Army records. 

[End of figure] 

The physical profile form defines performance of functional activities 
according to whether the soldier is: (1) able to carry and fire his or 
her individually assigned weapon; (2) able to move a fighting load of 
48 pounds for at least 2 miles; (3) able to wear his or her protective 
mask and all chemical defense equipment; (4) able to construct an 
individual fighting position; (5) able to perform 3-5 second rushes 
under direct or indirect fire; and (6) healthy, without any medical 
condition that prevents deployment. Army regulation 40-501 allows for 
some flexibility in the medical provider's designation of numerical 
designation in a soldier's profile, and according to medical providers, 
they may upgrade designations based on their knowledge of the soldier's 
medical condition and the soldier's capacity to handle medical 
limitations. However, discretionary upgrades can mask a soldier's 
limitations such that a commander might deploy the soldier without 
benefit of MMRB evaluation and may place the soldier in duties 
unsuitable to his or her limitations. 

We did not find widespread revision of profiles by profiling officers 
or approving authorities prior to deployment. Only 1 percent of the 
physical profiles we reviewed were changed from a permanent 3 to 2 
within a few months prior to the soldier's deploying. Upgrades in 
numerical designations are generally annotated by remarks in the 
descriptive text included in a soldier's profile, and they must include 
a second approving medical provider's signature. However, informal 
discussions between soldier and medical provider can result in a change 
in the profile designation that may not be noted in the profile. In one 
case, we found that a soldier's profile was changed from a 3 to a 2 
without meaningful annotation, and lacking the requisite second 
approving signature. This soldier reported to us that she had not 
undergone a new medical diagnosis prior to the profile upgrade; 
however, she also had told her medical provider that she did not want 
to go through an MMRB or MEB and thereby risk being removed from the 
Army. According to Army officials, soldiers' medical conditions may 
have improved for various reasons, such as undergoing surgery or 
additional physical therapy. 

Although we found no evidence of widespread revision in numerical 
designations, in our surveys to deployed soldiers or our interviews 
with Army personnel officials and family members of deployed soldiers, 
some soldiers or family members expressed concerns to us that they were 
uninformed about how the Army was addressing their medical problems 
prior to deployment, and they knew of no venue to resolve their 
complaints. In surveys, two additional soldiers also stated that they 
did not feel they had been correctly graded in their physical profile 
designations, but were reluctant to discuss the matter with their 
commanding officers for fear of prejudicial treatment. One soldier 
stated that her physical profile had been changed without further 
physical examination. The other soldier noted that her physical profile 
designation was upgraded even though a medical provider had added more 
limitations after examining her, and she did not agree that the profile 
expressed all the limitations caused by her back, knee, and shoulder 
ailments. We reviewed the documentation in the physical profiles of 
these soldiers and the profiles contained requisite approving 
signatures, dates, and descriptions of limitations. However, our 
analysis did not evaluate the medical providers' diagnoses of the 
medical conditions, because we are not qualified to evaluate the 
providers' medical judgment. Moreover, we would not be able to 
determine from the documentation if the soldier did not agree with the 
profile, whether the profile was changed without further physical 
examination, or whether the medical provider or the soldier fully 
communicated all of the issues involved. 

Army personnel officials told us that they were unable to assist 
soldiers bringing complaints about not being evaluated by a medical 
board when the soldiers received a new permanent profile prior to their 
deployment, because the officials do not have access to soldiers' 
medical information and do not have the authority to enforce time 
frames. These officials had also been contacted by soldiers' family 
members who were concerned that the soldiers would be deployed and 
their conditions would worsen at deployed locations. An Army personnel 
official told us that soldiers sometimes questioned whether they were 
to be evaluated by a board prior to deployment, but by the time this 
official received the physical profile to initiate an MMRB, the 
soldiers had already been deployed. Because the officials do not have 
access to all medical information, they would not be able to verify 
whether soldiers' profiles were approved. These situations may be 
occurring because physical profiles are not being distributed in a 
timely manner. Also, because Army personnel officials do not have the 
authority to enforce time frames, they could not compel commanders to 
provide timely input for the approval of the profile or compel 
designated approving authorities to distribute the approved profiles. 
Thus, although Army personnel officials may believe that physical 
profiles are not being delivered in a timely manner, they do not have 
the ability to resolve these soldiers' complaints. 

Issues regarding proper medical evaluation of soldiers prior to 
deployment could be resolved by having a designated point of contact to 
whom soldiers and family members can bring their concerns. Such a point 
person would require access to the soldier's medical information and 
the ability to resolve any problems and questions about a soldier's 
medical readiness. This person would also need to work independently of 
the operations commander in order to prevent bias or coercion by the 
commander in resolving soldier issues. 

In September 2007, the Army Medical Command created a program to 
designate an ombudsman, or point of contact, available for each 
installation to whom soldiers can bring concerns on issues such as 
health care, pay, physical disability processing, and transition to the 
Veterans Administration. The Army memorandum[Footnote 32] establishing 
this program states that ombudsmen will resolve complaints, assist in 
obtaining accurate information, and act as advocates specifically for 
soldiers assigned to the Warrior Transition Unit and their families. 
According to ombudsmen at Forts Benning, Stewart, and Drum, they may 
also provide support for any soldier or family member of a soldier who 
needs assistance, through walk-ins or through the Army Wounded Soldier 
and Family Hotline. In accordance with the memorandum, the ombudsman 
will be independent from commanders at the installation, and will work 
closely with the Medical Assistance Group, which is part of the Army 
Medical Command under the Army Surgeon General's leadership at Fort Sam 
Houston, Texas. However, the ombudsman program is not broadly 
publicized as a resource for active duty soldiers with medical 
conditions or their family members. We were not able to fully evaluate 
how effectively the ombudsman program would be able to resolve the 
issues brought by deploying soldiers as opposed to soldiers in the 
Warrior Transition Unit and their family members, as the ombudsman 
program has only recently been implemented. It was not fully 
implemented at the time of our review at Forts Benning, Stewart, and 
Drum. Ensuring that soldiers who are not part of the Warrior Transition 
Unit and their family members are aware of and have access to the 
ombudsman program may help to alleviate some of these concerns brought 
forth by deploying soldiers. 

As a result of the various medical record deficiencies and 
discretionary profile revisions discussed, commanders' visibility over 
their soldiers' potential medical conditions cannot be ensured. 
Furthermore, without a well-publicized ombudsman program, soldiers 
preparing for deployment cannot be assured of having the opportunity to 
air and resolve their medical concerns. 

One In 10 Soldiers in the Projectable Sample Who Has a Medical 
Condition Has Deployed, but We Were Unable to Determine Duty 
Suitability: 

Based our review of medical records from Forts Benning, Stewart, and 
Drum, we estimate that about 10 percent of active duty soldiers with 
profiles indicating medical conditions that could require significant 
limitations in duty assignments were deployed to Iraq and Afghanistan. 
Although Army guidance allows for the deployment of soldiers with 
medical conditions, it requires commanders to assign soldiers to duties 
that are suitable to their limitations. Because of the low response 
rate to our survey, we were unable to determine the extent to which 
these soldiers were in fact assigned duties suitable to their medical 
conditions. From the limited responses to our survey and from 
interviews with soldiers, most reported that they were able to 
accomplish most of their duties, although they were sometimes required 
to perform duties exceeding their medical limitations. 

Some Deploying Soldiers Have Medical Conditions: 

We reviewed 685 medical records taken from a random projectable sample 
of active component soldiers who were preparing for deployment between 
April 2006 and March 2007 from Forts Benning and Stewart, in Georgia, 
and Fort Drum, in New York. From these installations, we estimate that 
86 percent of soldiers, did not have profiles indicating medical 
conditions that could require significant limitations in duty 
assignments.[Footnote 33] We estimate that 14 percent of soldiers 
preparing to deploy from Forts Benning, Stewart, and Drum had profiles 
indicating conditions that could require significant limitations: 
specifically, soldiers with physical profile designations of 3 or 4, or 
who indicated that they could not perform certain functional 
activities.[Footnote 34] Figure 3 shows the total number of records 
reviewed and the estimated percentage (and confidence intervals) of 
soldiers who had medical impairments that could require significant 
limitations by installation from Forts Benning, Stewart, and Drum. 

Figure 3: Comparison of Estimated Percentages of Soldiers with Profiles 
Who May Require Significant Duty Limitations against Those Who Do Not: 

This figure is a vertical bar graph depicting the following data: 

Installation: Ft. Benning (n=189); 
Soldiers who do not have medical conditions that may require 
significant duty limitations: 84%; 95 percent confidence interval, 
upper and lower bounds for each estimate: 90/78; 
Soldiers who have medical conditions that may require significant duty 
limitations: 16%; 95 percent confidence interval, upper and lower 
bounds for each estimate: 22/12. 

Installation: Ft. Stewart (n=259); 
Soldiers who do not have medical conditions that may require 
significant duty limitations: 87%; 95 percent confidence interval, 
upper and lower bounds for each estimate: 92/82; 
Soldiers who have medical conditions that may require significant duty 
limitations: 13%; 95 percent confidence interval, upper and lower 
bounds for each estimate: 18/10. 

Installation: Ft. Drum (n=237); 
Soldiers who do not have medical conditions that may require 
significant duty limitations: 86%; 95 percent confidence interval, 
upper and lower bounds for each estimate: 91/81; 
Soldiers who have medical conditions that may require significant duty 
limitations: 14%; 95 percent confidence interval, upper and lower 
bounds for each estimate: 18/10. 

Installation: Total (n=685); 
Soldiers who do not have medical conditions that may require 
significant duty limitations: 86%; 95 percent confidence interval, 
upper and lower bounds for each estimate: 90/78; 
Soldiers who have medical conditions that may require significant duty 
limitations: 14%; 95 percent confidence interval, upper and lower 
bounds for each estimate: 16/12. 

Source: GAO review of Army records. 

[See PDF for image] 

[End of figure] 

As shown in figure 4, of the estimated 14 percent of soldiers preparing 
to deploy from Forts Benning, Stewart, and Drum who had medical 
conditions that could require significant limitations in duty 
assignment, approximately two-thirds--about an estimated 10 percent of 
the total number of soldiers[Footnote 35]--were deployed to Iraq or 
Afghanistan. These soldiers with medical conditions included soldiers 
having a physical profile designation of at least a 3, or indicating 
that they could not perform certain functional activities. The 
remaining estimated 4 percent of soldiers with medical conditions that 
could require significant limitations did not deploy.[Footnote 36] 

Figure 4: Comparison of Estimated Percentages of Soldiers Having 
Medical Conditions That May Require Significant Duty Limitations Who 
Deployed against Those Who Did Not: 

This figure is a vertical bar graph depicting the following data: 

Installation: Ft. Benning (n=189); 
Soldiers with medical conditions that may require significant medical 
limitations who did not deploy: 6%; 
95 percent confidence interval estimate: 10/3; 
Soldiers with medical conditions that may require significant medical 
limitations who were deployed: 10%; 
95 percent confidence interval estimate: 15/5. 

Installation: Ft. Stewart (n=259); 
Soldiers with medical conditions that may require significant medical 
limitations who did not deploy: 5%; 
95 percent confidence interval estimate: 8/2; 
Soldiers with medical conditions that may require significant medical 
limitations who were deployed: 8%; 
95 percent confidence interval estimate: 13/5. 

Installation: Ft. Drum (n=237); 
Soldiers with medical conditions that may require significant medical 
limitations who did not deploy: 3%; 
95 percent confidence interval estimate: 7/1; 
Soldiers with medical conditions that may require significant medical 
limitations who were deployed: 11%; 
95 percent confidence interval estimate: 15/8. 

Installation: Total (n=685); 
Soldiers with medical conditions that may require significant medical 
limitations who did not deploy: 4%; 
95 percent confidence interval estimate: 6/3; 
Soldiers with medical conditions that may require significant medical 
limitations who were deployed: 9%; 
95 percent confidence interval estimate: 13/8. 

Source: GAO review of Army records. 

[See PDF for image] 

[End of figure] 

Soldiers in the sample who deployed with medical conditions that could 
require significant limitations had conditions such as herniated discs, 
back pain, chronic knee pain, type 2 diabetes, or mild asthma. A 
soldier might have a physical profile that indicates multiple medical 
limitations that fall under different categories.[Footnote 37] Table 2 
shows that of the 66 deployed soldiers who had medical conditions that 
could require significant limitations, 55 percent deployed with defects 
of the lower extremities (under the "L" category). For example, one 
soldier's physical profile showed chronic hip pain that restricted 
physical training pace and limited the soldier to lifting no more than 
48 pounds. Medical conditions of the eyes and psychiatric conditions 
had the lowest rates of occurrence. While we did not review 
documentation of medical limitations other than the soldiers' physical 
profiles, according to Army medical officials, mental health conditions 
are not generally documented in physical profiles unless the conditions 
limited a soldier's ability to accomplish his or her duty. Commanders 
were also notified of a soldier's mental condition by medical providers 
if commanders requested the mental health evaluation of the soldier. 

Table 2: Numbers and Percentages of Medical Conditions That May Require 
Significant Duty Limitations, by Physical Profile Category, across 
Profiles of Deployed Soldiers in the Sample: 

Category of medical conditions in physical profiles: "P" Physical 
Capacity; 
Number of medical conditions: 15; 
Percentage of medical conditions: 23%. 

Category of medical conditions in physical profiles: "U" Upper 
Extremities; 
Number of medical conditions: 7; 
Percentage of medical conditions: 11%. 

Category of medical conditions in physical profiles: "L" Lower 
Extremities; 
Number of medical conditions: 36; 
Percentage of medical conditions: 55%. 

Category of medical conditions in physical profiles: "H" Hearing and 
Ears; 
Number of medical conditions: 10; 
Percentage of medical conditions: 15%. 

Category of medical conditions in physical profiles: "E" Eyes; 
Number of medical conditions: 3; 
Percentage of medical conditions: 5%. 

Category of medical conditions in physical profiles: "S" Psychiatric; 
Number of medical conditions: 2; 
Percentage of medical conditions: 3%. 

Source: GAO review of Army soldiers' medical records. 

Note: The 73 total occurrences of medical limitations in the sample 
were indicated in the physical profiles of 66 soldiers with medical 
conditions that may require significant limitations who were deployed 
to Iraq and Afghanistan. The percentages of occurrences do not equal 
100 percent because some soldiers have a medical condition that may 
require significant limitations in more than one category. 

[End of table] 

Extent to Which Commanders Assigned Soldiers to Duties Suitable to 
Their Medical Conditions Cannot Be Determined: 

We were unable to determine the extent to which deployed soldiers in 
the sample with medical conditions were assigned duties suitable to 
their limitations. While Army guidance requires commanders to assign 
soldiers to duties that are suitable to their medical conditions, it 
does not require that they track the assignments of their soldiers to 
duties that accommodate their limitations. In order to determine the 
extent to which they had been assigned to duties suitable for those 
conditions, we surveyed by e-mail a sample of deployed soldiers with 
medical conditions. In our survey, we asked these soldiers for 
information on their ability to perform the duties to which they were 
assigned. However, we did not get a sufficiently high response rate to 
enable us to project findings from the survey respondents. We sent the 
survey to 66 soldiers, but received responses from only 24. Of the 24 
soldiers who responded, 19 reported that they were able to complete 
most or all of their duties, and 22 of the 24 said they wanted to 
deploy with their units. None said that they could perform only a few 
or none of their duties. However, 5 of the soldiers we surveyed 
indicated that they were able to perform only some of their duties. 

Survey responses indicated that some soldiers had experienced job 
reassignments to accommodate the limitations of their medical 
conditions. For example, one soldier had a shoulder injury that limited 
his ability to wear all of his body armor. When his unit was deployed 
to Iraq, he was assigned to duties in Kuwait so that he would not have 
to wear all of his body armor. Another soldier with a hearing deficit 
had his occupational category changed from infantry to supply 
specialist to protect him from exposure to loud noise. One soldier had 
degenerative disc disease, with lower back and leg pain, and his 
commander reassigned him from being leader of his unit to base security 
to accommodate his medical condition by limiting the time he had to 
wear his equipment. However, three of our survey respondents reported 
that their duties or occupational categories were not changed, although 
they believed they should have been. For example, one soldier often 
fell asleep during guard duty because his sleep apnea treatment was 
impaired by the irregularity of electric power availability, which he 
needed to support his continuous positive airway pressure machine. 

Although we were unable to speak with the commanders of the particular 
soldiers surveyed in the sample, we spoke with other commanders at 
Forts Benning, Stewart, and Drum to help explain these survey 
responses. These commanders reported that they were aware of the 
medical conditions of the soldiers with whom they had deployed and that 
they always considered these conditions in their duty assignments. Army 
commanders told us that soldiers with medical impairments may on 
occasion be required to perform job duties exceeding their limitations 
because they have special skills that are hard to replace using other 
personnel. Commanders may also sometimes assign soldiers to duties 
exceeding their limitations because they are unaware of the extent of 
the limitations, as soldiers' physical profiles may not reflect all of 
their medical information. Furthermore, according to both soldiers and 
senior medical officials whom we interviewed, soldiers may conceal the 
extent of their medical limitations or may negotiate with medical 
providers in order to remain with their units or in the Army. For 
example, one soldier did not agree with the upgrading of her physical 
profile designation, but also did not want to fully disclose her 
medical condition for fear of not meeting Army medical standards. Two 
soldiers stated that they agreed with their physical profile 
designation, which masks the severity of their limitations, and they 
were deployed although their medical condition was progressively 
worsening while at deployed locations. In both these cases, the 
soldiers stated that they were nearing retirement and did not want to 
be discharged from the Army due to a medical board evaluation before 
they were eligible to receive their full retirement pensions, and they 
confirmed that their commanders accommodated their medical conditions. 

Conversely, Army officials have stated that soldiers may overstate 
their medical conditions in order to avoid deployment and they must 
take into account their other experiences with the soldiers' 
limitations when evaluating their medical deployability. For example, 
one commander told us that one soldier brought up a foot injury to 
delay her deployment, although it was diagnosed by a medical provider 
outside the military and it was not in her military medical record. The 
commander allowed the soldier time to recuperate and allowed her to 
purchase a specific type of boot to accommodate her injury. However, 
when the soldier did not purchase the boots in a timely manner in order 
to further delay her deployment, the commander found the boots at a 
nearby supply store and deployed the soldier into theater. 

Although we were not able to determine the extent to which Army 
commanders have assigned soldiers to duties that are suitable for their 
limitations, there may be soldiers who had proper evaluations performed 
prior to deployment yet still have concerns about the suitability of 
their assigned duties. Soldiers should have access to a program at 
deployed locations that is similar to the ombudsman program available 
at Army installations. The soldiers who have medical conditions that 
develop or worsen while at deployed locations and may not believe they 
are assigned to appropriate duties should have access to a contact 
person who can address their concerns. This person should have access 
to the soldier's medical information and the authority to resolve any 
problems, and he or she should work independently from the soldier's 
commander. 

Conclusions: 

Long-standing issues regarding the medical deployability of 
servicemembers have become increasingly important as the Global War on 
Terrorism continues and large numbers of servicemembers are deployed. 
The Army is hampered by its lack of an enforcement mechanism from 
ensuring that soldiers' MMRB or MEB evaluations are conducted within 
prescribed time frames and not delayed by the failure of commanders or 
medical providers to provide required information on time. Of the 6 
percent of soldiers from Forts Benning, Stewart, and Drum that we 
estimate were deployed with medical conditions that required further 
evaluation by a MMRB or MEB, we estimate that 3 percent of these 
soldiers did not receive these needed evaluations prior to deployment. 
Furthermore, the commanders and medical providers who must make medical 
readiness and deployment decisions about soldiers do not always have 
full visibility over the soldiers' medical limitations because physical 
profile documentation is not always properly retained or complete. The 
Army intends to establish centralized electronic documentation and 
distribution of physical profiles to improve visibility, but it has not 
finalized plans for needed actions, associated milestones, and 
timeliness of the process. Without timely MMRB or MEB evaluations and 
the retention of complete physical profile information for deploying 
soldiers with medical conditions, commanders who assign duties can not 
be fully informed of soldiers' medical limitations. We did not find 
widespread cases of improper duty assignments for deployed soldiers 
with medical conditions; however, the weaknesses in the Army procedures 
could permit this to occur. Although the Army ombudsman program may 
help alleviate concerns from soldiers and family members, they should 
be made aware of the program and the program should be made available 
for soldiers prior to and during deployment. Unless soldiers have been 
fully evaluated, have an independent contact person to promote their 
concerns, and commanders have full knowledge of the soldiers' 
limitations, the Army cannot safeguard soldiers with medical conditions 
from being deployed and assigned to duties unsuitable for their 
limitations. 

Recommendations for Executive Action: 

To safeguard soldiers with significant medical limitations from being 
deployed and assigned to duties unsuitable for their limitations, we 
recommend that the Secretary of the Army: 

1. direct the Office of the Army Surgeon General and the Army Deputy 
Chief of Staff G-1 to collaboratively develop an enforcement mechanism 
to ensure that medical providers and commanders follow procedures so 
that soldiers whose permanent physical profiles indicate significant 
medical limitations are properly referred to and complete MEB and MMRB 
evaluation boards prior to deployment; 

2. direct the Office of the Army Surgeon General and the Army Deputy 
Chief of Staff G-1 to move forward with plans to electronically process 
and retain physical profiles, including specific actions and 
milestones, and to implement guidance to help ensure: 

* the timely distribution of profiles to commanders and the military 
personnel office and; 

* that the medical record keeping system include all information in the 
approved physical profiles, and that all profiles be retained in 
soldiers' medical records; 

3. direct the Army Human Resources Command to disseminate information 
and provide soldiers and their families access to an independent 
ombudsman program prior to and during deployment to ensure that they 
are fully informed about this resource for addressing their concerns 
and to add independent oversight of Army medical and deployment 
processes in the interests of the soldiers. 

Agency Comments and Our Evaluation: 

DOD provided written comments on a draft of this report and concurred 
with each of our recommendations. In commenting on our first 
recommendation, DOD stated that our findings do not suggest the 
existence of a widespread problem throughout the Army, as the number of 
soldiers in our sample deployed without appearing before a medical 
evaluation board was 17; and furthermore, that survey and interview 
responses indicate that commanders appear to be assigning soldiers with 
medical limitations to suitable duties. However, we note that the 17 
soldiers who deployed without receiving proper board evaluations 
represent a sizeable proportion of the 42 soldiers in our sample who 
should have received such a review prior to deployment. These 17 
soldiers, furthermore, can be projected from our sample to represent 
approximately 3 percent of the soldiers who were preparing for 
deployment at the three installations; we are providing further 
clarification regarding this figure in the body of this report. 
Furthermore, as we have noted in our report, ad hoc measures to assign 
soldiers to suitable duties are not as reliable as an enforcement 
mechanism for ensuring that soldiers are so assigned. While we could 
not determine the number of soldiers who may have been assigned to 
unsuitable duties, as the Army does not track this information and our 
survey responses were limited, neither could we confirm that soldiers 
with medical limitations were consistently assigned to suitable duties. 

DOD noted that it had actions planned or underway to conduct a thorough 
inspection of the policies and procedures supporting a commander's 
determination of soldier deployability, and to release new guidance 
regarding medical conditions that should preclude affected 
servicemembers from deployment, along with other initiatives, and we 
commend these efforts. 

In commenting on our second recommendation, DOD stated that the Office 
of the Army Surgeon General has identified and submitted requirements 
for the automation of physical profiles, beginning development by the 
end of 2008, and we commend this planned initiative. We note that it is 
important for these plans to have specific actions and milestones, and 
for the Army to implement guidance to ensure timely distribution of 
profiles to commanders and military personnel officials through the 
automated system. 

In commenting on our third recommendation, DOD stated that two 
programs, the Army Ombudsman Program and the Wounded Soldier and Family 
Hotline, are available to assist all soldiers (and their families) 
whether preparing to deploy, deployed, or redeploying. However, we note 
that the Wounded Soldier and Family Hotline does not constitute a 
resource independent of the command. Although DOD states that 
retribution is not tolerated against those using the hotline, we 
maintain our view that soldiers should be able to turn to a resource 
independent of the command. With regard to the Ombudsman Program, 
though it is independent of the command, we continue to assert our view 
that broad advertisement is needed for soldiers and their families to 
be made aware of this resource for those soldiers not only returning 
from deployment, but also prior to and during deployment. 

The Army's comments are reprinted in appendix VI. In addition, the Army 
provided technical comments, which we have incorporated as appropriate. 

We are sending copies of this report to interested congressional 
committees; the Secretary of Defense; the Secretaries of the Army, the 
Navy, and the Air Force; and the Commandant of the Marine Corps. We 
will also make copies available to others upon request. In addition, 
the report will be available at no charge on the GAO Web site at 
[hyperlink, http://www.gao.gov]. 

If you or your staff have any questions concerning this report, please 
contact me at (202) 512-3604 or [email protected]. Contact points for 
our Offices of Congressional Relations and Public Affairs may be found 
on the last page of this report. Key contributors to this report are 
listed in appendix VII. 

Signed by: 

Brenda S. Farrell, Director: 
Defense Capabilities and Management: 

[End of section] 

Appendix I: Scope and Methodology: 

To address the extent to which the Army is adhering to its medical and 
deployment requirements regarding decisions to send soldiers with 
medical limitations to Iraq and Afghanistan, we reviewed relevant DOD 
and Army guidance related to medical standards and deployment 
procedures. We discussed the deployment of servicemembers with medical 
conditions with a variety of officials from the Office of the Assistant 
Secretary of Defense for Health Affairs, the Department of the Army, 
and the Office of the Army Surgeon General. As agreed with 
congressional staff, we also met with the Offices of the Air Force and 
Navy Surgeons General as well as the Navy Bureau of Medicine and 
Surgery to gain an understanding of those services' guidance on medical 
standards and deployment procedures. In December 2007, we provided a 
briefing to congressional staff that included a discussion of these 
services' guidance regarding deployment of servicemembers with medical 
conditions. 

In addition, we reviewed Army guidance covering documentation of 
soldiers' medical limitations prior to deployment and conditions under 
which soldiers with medical conditions are considered deployable. We 
reviewed a sample of medical records and interviewed medical providers, 
Army commanders, and soldiers at selected installations to identify and 
evaluate installation procedures for documenting medical limitations 
and training provided regarding this issue at each installation. 

We selected three Army installations--Fort Benning, Fort Stewart, and 
Fort Drum. We selected Fort Stewart and Fort Drum based on the number 
of active component soldiers deployed from each installation to Iraq or 
Afghanistan between April 1, 2006, and March 31, 2007; and we selected 
Fort Benning based on initial allegations of active component soldiers 
being deployed with significant medical limitations from this 
installation. 

For our medical records review, we selected random samples of active 
component soldiers at Fort Benning, Fort Stewart, and Fort Drum. In 
order to create the sample, we used the universe of soldiers from each 
installation who were preparing for deployment from April 1, 2006, to 
March 31, 2007, to Iraq or Afghanistan and answered "yes" to question 
number 3 on the pre-deployment health assessment (form DD 
2795)[Footnote 38] which asks, "Are you currently on a profile, or 
light duty, or are you undergoing a medical board?" Our statistical 
samples are representative of soldiers at these installations who meet 
our eligibility criteria. Those who did not complete a pre-deployment 
health assessment during this time frame had no chance of being 
selected. Of the soldiers preparing to deploy, soldiers may have their 
deployment delayed or may ultimately not be deployed for various 
reasons, such as not completing required training and not having proper 
security clearances for deployment, as well as not meeting medical 
readiness standards. 

For various reasons, medical records were not always available for 
review. Therefore, we reviewed more medical records than our target 
sample size on the assumption we might not meet our desired precision. 
Specifically, there were seven reasons identified for not being able to 
physically secure soldiers' medical records for review: 

1. Charged to patient. When a patient visits a clinic (on-post or off- 
post), the medical record is physically given to the patient. The 
procedure is that the medical record will be returned by the patient 
following their clinic visit. 

2. Charged out to Medical Evaluation Board. Soldier is in the process 
of a medical review board and their medical record is retained by the 
board members. 

3. Charged out to Physical Evaluation Board. Soldier is in the process 
of a physical review board and their medical record is retained by the 
board members. 

4. Expired term of service. Soldier separates from the Army and their 
medical record is sent to the Veterans Administration Records 
Management Center St. Louis, Missouri. 

5. Record is missing and not accounted for by the medical records 
department. No tracking sheet is in the file system to indicate the 
patient has checked it out or otherwise. 

6. Permanent change of station. Soldier is still in the Army, but has 
transferred to another installation. The medical record was sent to the 
new installation with the soldier. 

7. Temporary duty off site. Soldier has left the Army installation, but 
is expected to return. The temporary duty is long enough to warrant 
that the medical record accompany the soldier. (Note: In the sample, 
there were no cases for which the soldier was on temporary duty off 
site.) 

The sample size for our medical record review was determined to provide 
a 95 percent confidence interval for an attribute measure with a 
precision of at least 5 percent. Because we followed a probability 
procedure based on random selections, the sample is only one of a large 
number of samples that we might have drawn. Since each sample could 
have provided different estimates, we express our confidence in the 
precision of our particular sample's results as a 95 percent confidence 
interval (e.g., plus or minus 5 percentage points). This is the 
interval that would contain the actual population value for 5 percent 
of the samples we could have drawn. As a result, we are 95 percent 
confident that each of the confidence intervals will include the true 
values in the study population. At two of the three installations we 
visited, we reviewed more records than needed to meet our target sample 
size because medical officials made available more medical records than 
our targeted sample amount. The number of soldiers in the samples and 
the total records reviewed of soldiers at the installations visited are 
shown in table 3. 

Table 3: Soldier Sample Universe, Target Sample Sizes, and Number of 
Records Reviewed at Each Visited Installation: 

Installation: Fort Benning; 
Number of soldiers who fit the criteria for the sample (universe): 336; 
Target sample sizes: 180; 
Total records reviewed: 189. 

Installation: Fort Stewart; 
Number of soldiers who fit the criteria for the sample (universe): 794; 
Target sample sizes: 259; 
Total records reviewed: 259. 

Installation: Fort Drum; 
Number of soldiers who fit the criteria for the sample (universe): 552; 
Target sample sizes: 227; 
Total records reviewed: 237. 

Installation: Total; 
Number of soldiers who fit the criteria for the sample (universe): 
1682; 
Target sample sizes: 666; 
Total records reviewed: 685. 

Source: GAO analysis of Army soldiers' records. 

[End of table] 

At each location, we examined medical documentation for evidence of 
physical profiles (form DA 3349)[Footnote 39] that were created between 
April 2001 and March 2007. We selected this time frame because it would 
include any profile in effect when a soldier in the sample deployed. We 
reviewed both hard copy soldier medical records for evidence of 
physical profiles as well as any profiles located in Armed Forces 
Health Longitudinal Technology Application (AHLTA), the department of 
defense's electronic medical record. In addition, we requested that 
installation medical personnel provide any information on profiles from 
the Army's Medical Protection System (MEDPROS) for each of the soldiers 
in the sample to ensure that our review of medical records was complete 
and that we identified all physical profiles. Even though MEDPROS is 
not an official medical record, it is used in the determination of 
medical readiness in preparation for deployment and contains medical 
limitation information and dates of physical profiles. After gathering 
all physical profiles, we reviewed them for completeness, and analyzed 
them to determine if they were completed in accordance with Army 
guidance. From the soldiers that received a physical profile between 
April 2001 and March 2007, we identified the subset of soldiers with 
medical conditions that may require significant medical limitations, 
specifically soldiers with permanent or temporary profile designation 
of at least a 3, or a designation of 2 showing inability to do certain 
functional activities. We did not review documentation of medical 
limitations other than the physical profiles. According to Army 
officials, mental health conditions are not generally documented in 
physical profiles unless the conditions limited a soldier's ability to 
accomplish his or her duty. Commanders were also notified of their 
soldiers' mental conditions by medical providers if they requested a 
mental health evaluation of the soldiers. 

Although we have taken many steps to ensure accurate data analysis of 
active component soldiers with a physical profile, previous GAO reviews 
have found that Army medical records do not contain all medical 
documentation as required, thus, our review may not encompass the full 
extent of soldiers with physical profiles. 

To determine the extent to which the Army is deploying soldiers to Iraq 
and Afghanistan with medical conditions requiring duty limitations, and 
whether it is assigning them to duties suitable to their limitations, 
we requested deployment data on the subset of soldiers who we 
identified as having a significant medical limitation from the time 
period of April 2001 to March 2007. We then compared data from our 
medical record review at Forts Stewart, Benning, and Drum to deployment 
data for soldiers in the sample provided by Army officials to identify 
soldiers with a medical condition that may require significant 
limitations who had deployed to Iraq or Afghanistan. We reviewed Army 
processes for tracking soldiers while deployed. We interviewed Army 
officials including commanders and medical providers about established 
procedures in place to ensure soldiers are assigned within their 
limitations. We also surveyed by e-mail 66 soldiers we identified who 
had deployed with medical conditions to Iraq and Afghanistan. We 
received responses from 24 of these soldiers, for a response rate of 
about 36 percent. These responses do not allow us to project the extent 
to which deployed soldiers with medical conditions across the Army were 
assigned to duties suitable to their medical limitations in Iraq and 
Afghanistan; nevertheless, we present the information we obtained to 
illustrate these issues. 

We conducted this performance audit from April 2007 through April 2008 
in accordance with generally accepted government auditing standards. 
Those standards require that we plan and perform the audit to obtain 
sufficient, appropriate evidence to provide a reasonable basis for our 
findings and conclusions based on our audit objectives. We believe that 
the evidence obtained provides a reasonable basis for our findings and 
conclusions based on our audit objectives. 

[End of section] 

Appendix II: Army Physical Profile (DA Form 3349): 

Physical Profile: 

For use of this form, see AR 40-501; the proponent agency is the Office 
of the Surgeon General.	 

1. Medical Condition: (Description in lay terms): 
Injury? 
Illness/disease? 

2. CODES (Table 7-2 AR 40-501): 

3. Temporary: 
P:
U:
L:
H:
E:
S: 

Permanent: 
P:
U:
L:
H:
E:
S: 

4. Profile Type: 

a. Temporary Profile (expiration date YYYYMMDD)	Limited to 3 months 
duration: 
Yes: 
No: 

b. Permanent Profile (reviewed and validated with every periodic exam 
or after 5 years from the data of issue): 
Yes: 
No: 

c. If A Permanent Profile With A 3 Or 4 PULHES, Does The Soldier Meet 
Retention Standards Law Chapter 3 AR 40-501? (If USAR/ARNG/ARNGUS 
Soldier Not On Active Duty See Para. 9.10 & 10.28, Ar 40501 if Soldier 
Does Not Meet Retention Standards).
Needs MMRB: 
Needs MEB/PEB: 

5. FUNCTIONAL ACTIVITIES FOR PERMANENT AND TEMPORARY PROFILES (If any 
answer (a-f) is No then the profile should be at least a 3): 	 

a. Able To Carry And Fire Individual Assigned Weapon: 
Yes: 
No: 

b. Able To Move With A Fighting Load At Least 2 Miles (48 lbs. includes 
helmet, boots, uniform, LBE, weapon, protective mask, pack, etc.): 
Yes: 
No: 

e. Able To Wear Protective Mask And All Chemical Defense Equipment: 
Yes: 
No: 

d. Able To Construct An Individual Fighting Position (Dig, fill and 
lift sandbags, etc.): 
Yes: 
No: 

e. Able To Do 3-5 Second Rushes Under Direct And Indirect Fire: 
Yes: 
No: 

f. Is Soldier Healthy Without Any Medial Condition That Prevents 
Deployment? 
Yes: 
No: 

6. APFT: 
2 MILE RUN: 
Yes: 
No: 			 

APFT SIT-UPS: 
Yes: 
No: 
		
APFT PUSH UPS: 
Yes: 
No: 

ALTERNATE APFT (Fill out if unable to do APFT run otherwise N/A): 
APFT WALK: 
N/A: 
Yes: 
No: 

APFT SWIM: 

APFT BIKE: 
N/A: 
Yes: 
No: 
	
7. Standard Or Modified Aerobic Conditioning Activities (Check all 
applicable boxes): 	
Unlimited Running: 
Yes: 
No: 
Or Run At Own Pace & Distance: 
Yes: 
No: 
			
Unlimited Walking: 
Yes: 
No: 
Or Walk At Own Pace & Distance: 
Yes: 
No: 
			
Unlimited Biking: 
Yes: 
No: 
Or Bike At Own Pace & Distance: 
Yes: 
No: 

Unlimited Swimming: 
Yes: 
No: 
Or Swim At Own Pace & Distance: 
Yes: 
No: 

8. Upper Body Weight Training (See FM 21-20): 
Yes: 
No: 

9. Lower Body Weight Training (See FM 21-20): 
Yes: 
No: 

10. Other: e.g. Functional limitations and capabilities and other 
comments: (May continue on page two): 

[This temporary profile is an extension of a temporary profile first 
issued on:] 

11. These Parameters Are Optional, Use As Needed: 
Lifting or carrying max weight ________	or ______ distance: 
	
Running maximum distance: 

Prolonged standing - maximum time per episode: 
	
Marching with standard field gear except rucksack max distance: 
	
Impact activities such as jumping max # reps in one day: 
	
12. Type Name & Grade Of Profiling Officer: 

13. Signature: 

14. Date (YYYYMMDD): 
	
15. Action By Approving Authority: 
Approved: 
Not Approved: 

16. Type Name & Grade Of Senior Profiling Officer Or Approving 
Authority: 

17. Signature: 

18. Date (YYYYMMDD): 
	
19. Action By Unit Commander (See Pro 7-12, Ar 46501): 
Yes: No: 

This Profile Requires A Change In This Soldier's MOS Or Duty 
Assignment: 
	
20. Comment: 
	
If this is a permanent profile with a PULHES serial of 3 or 4 refer to 
block 4c. 
	
21. Type Name & Grade Of Unit Commander: 

22. Signature: 

23. Date (YYYYMMDD): 
	
24. Patient's Identification (For typed or written entries give: Name 
(Last, First); grade; SSN; hospital or medical facility): 	 

25. Unit: 
		
26. Issuing Clinic, Provider E-Mail & Phone Number: 

Profiling Officer (Or Approving Authority If Applicable) Is Responsible 
For Ensuring The PULHES & Date Of Profile Is Entered Into MEOPROS. 
Original Copy Posted In Medical	Records, 1 Copy To Unit Commander, 1 
Copy Given To Soldier, 1 Copy To MLPO. 
	
DA FORM 3349, FEB 2004: 
DA FORM 3349, MAY 86, IS OBSOLETE: 
Page 1 of 2 APD BV1.020: 

Physical Profile - Page 2 (Optional): 

Continuation (From Page 1, Item 10): 

Source: U.S. Army. 

[See PDF for image] 

[End of section] 

Appendix III: PULHES Definitions: 

Table: 

Category definitions: P--Physical Capacity or Stamina; 
Normally includes conditions of the heart; respiratory system; 
gastrointestinal system, genitourinary system; nervous system; 
allergic, endocrine, metabolic and nutritional diseases; diseases of 
the blood and blood forming tissues; dental conditions; diseases of the 
breast, and other organic defects and diseases that do not fall under 
other specific factors of the system. 

Category definitions: U--Upper Extremities; 
Concerns the hands, arms, shoulder girdle, and upper spine (cervical, 
thoracic, and upper lumbar) in regard to strength, range of motion, and 
general efficiency. 

Category definitions: L--Lower Extremities; 
Refers to the feet, legs, pelvic girdle, lower back musculature and 
lower spine (lower lumbar and sacral) in regard to strength, range of 
motion, and general efficiency. 

Category definitions: H--Hearing and Ears; 
Relates to auditory acuity and disease and defects of the ear. 

Category definitions: E--Eyes; 
Centers on visual acuity and diseases and defects of the eye. 

Category definitions: S--Psychiatric; 
Concerns personality, emotional stability, and psychiatric diseases. 

Source: Army Regulation 40-501. 

[End of table] 

Profile numerical designations: 
Numerical: 1; 
Designation definitions: Indicates a high level of medical fitness. 

Profile numerical designations: 
Numerical: 2; Designation definitions: Refers to some medical condition 
or physical defect that may require some activity limitations. 

Profile numerical designations: 
Numerical: 3; Designation definitions: Signifies one or more medical 
conditions or physical defects that may require significant 
limitations. The individual should receive assignments commensurate 
with his or her physical capability for military duty. 

Profile numerical designations: Numerical: 4; 
Designation definitions: Indicates one or more medical conditions or 
physical defects of such severity that performance of military duty 
must be drastically limited. 

Source: Army Regulation 40-501. 

[End of table] 

[End of section] 

Appendix IV Army Physical Profile Codes: 

Table: 

Code: Code A; 
Description/assignment limitation: No assignment limitation; 
Medical criteria (examples): No demonstrable anatomical or 
physiological impairment; within standards established in table 7-1. 

Code: Code B; 
Description/assignment limitation: May have assignment limitations that 
are intended to protect against further physical damage/injury. May 
have minor impairments under one or more PULHES factors that disqualify 
for certain MOS training or assignment; 
Medical criteria (examples): Minimal loss of joint motion, visual and 
hearing loss. 

Code: Codes C through P*; 
Description/assignment limitation: Possesses impairments that limit 
functions or assignments. The codes listed below are for military 
personnel administrative purposes. Corresponding limitations are 
general guidelines and are not to be taken as verbatim limitations. 
(For example, a Soldier with a code C may not be able to run but may 
have no restrictions on marching or standing.) Item 3 of DA Form 3349 
will contain the specific limitations; 
Medical criteria (examples): [Empty]. 

Code: Code C; 
Description/assignment limitation: Limitations in running, marching, 
standing for long periods etc.; 
Medical criteria (examples): Orthopedic or neurological conditions. 

Code: CODE D; 
Description/assignment limitation: Limitations in any type of strenuous 
physical activity; 
Medical criteria (examples): Organic cardiac disease; pulmonary 
insufficiency. 

Code: Code E; 
Description/assignment limitation: Limitations requiring dietary 
restrictions preventing consumption of combat rations; 
Medical criteria (examples): Endocrine disorders-recent or repeated 
peptic ulcer activity-chronic gastrointestinal disease requiring 
dietary management. 

Code: Code F; 
Description/assignment limitation: Limitations prohibiting assignment 
or deployment to OCONUS areas where definitive medical care is not 
available; 
Medical criteria (examples): Individuals who require continued medical 
supervision with hospitalization or frequent outpatient visits for 
serious illness or injury. 

Code: Code G; 
Description/assignment limitation: Limitations prohibiting wearing 
Kevlar, LBE, lifting heavy materials required of the MOS, overhead 
work; 
Medical criteria (examples): Arthritis of the neck or joints of the 
extremities with restricted motion; disk disease; recurrent shoulder 
dislocation. 

Code: Code H; 
Description/assignment limitation: Limitations on duty where sudden 
loss of consciousness would be dangerous to self or to others such as 
work on scaffolding, vehicle driving, or near moving machinery; 
Medical criteria (examples): Seizure disorders; other disorders 
producing syncopal attacks of severe vertigo, such as Mï¿½nierï¿½'s 
syndrome. 

Code: Code J; 
Description/assignment limitation: Given known handicaps associated 
with high frequency hearing loss similar to this, Commanders are highly 
recommended to make an individual risk assessment of any Soldier with 
hearing loss that might be tasked to perform duties that require good 
hearing, for example; localization and detection of friend or foe 
sounds, scout, point, sentry, forward listening, post/observer, 
radio/telephone operator, and so forth. (See DA Pam 40-501, Chapter 2- 
4, Combat Readiness Effects.) Hearing Protection Measures required to 
prevent further hearing loss; 
1. No exposure to noise in excess of 85 dBA (decibels measured on the A 
scale) or weapon firing without use of properly fitted hearing 
protection. Annual hearing test required; 
2. Further exposure to noise is hazardous to health. No duty or 
assignment to noise levels in excess of 85 dBA or weapon firing (not to 
include firing for preparation of replacements for overseas movement 
qualification or annual weapons qualification with proper ear 
protection). Annual hearing test required; 
3. No exposure to noise in excess of 85 dBA or weapon firing without 
use of properly fitted hearing protection. This individual is 'deaf' in 
one ear. Any permanent hearing loss in the good ear will cause a 
serious handicap. Annual Hearing test required; 
4. Further duty requiring exposure to high intensity noise is hazardous 
to health. No duty or assignment to noise levels in excess of 85 dBA or 
weapon firing (not to include firing for overseas movement or weapon 
firing without use of properly ear protection). No duty requiring acute 
hearing. A hearing aid must be worn to meet medical fitness standards; 
Medical criteria (examples): Susceptibility to acoustic trauma. 

Code: Code L; 
Description/assignment limitation: Limitations restricting assignment 
to cold climates; 
Medical criteria (examples): Documented history of cold injury; 
vascular insufficiency; collagen disease, with vascular or skin 
manifestations. 

Code: Code M; 
Description/assignment limitation: Limitations restricting exposure to 
high environmental temperature; 
Medical criteria (examples): History of heat stroke; history of skin 
malignancy or other chronic skin diseases that are aggravated by 
sunlight or high environmental temperature. 

Code: Code N; 
Description/assignment limitation: Limitations restricting wearing of 
combat boots; 
Medical criteria (examples): Any vascular or skin condition of the feet 
or legs that, when aggravated by continuous wear of combat boots, tends 
to develop unfitting ulcers. 

Code: Code P; 
Description/assignment limitation: Limitations restricting wearing or 
being exposed to required items necessary to perform duty (for example, 
Latex, wool); 
Medical criteria (examples): Established allergy to wool, latex. 

Code: CODE T*; 
Description/assignment limitation: Waiver granted for a disqualifying 
medical condition/standard for initial enlistment or appointment. The 
disqualifying medical condition/standard for which a waiver was granted 
will be documented in the Soldier's accession medical examination; 
Medical criteria (examples): [Empty]. 

Code: Code U; 
Description/assignment limitation: Limitation not otherwise described, 
to be considered individually. (Briefly define limitation in item 8); 
Medical criteria (examples): Any significant functional assignment 
limitation not specifically identified elsewhere. 

Code: Code V*; 
Description/assignment limitation: Deployment. This code identifies a 
Soldier with restrictions on deployment. Specific restrictions are 
noted in the medical record; 
Medical criteria (examples): [Empty]. 

Code: Code W*; Description/assignment limitation: MMRB. This code 
identifies a Soldier with a permanent profile who has been returned to 
duty by an MMRB (MOS Medical Review Board); 
Medical criteria (examples): [Empty]. 

Code: Code X*; Description/assignment limitation: This code identifies 
a Soldier who is allowed to continue in the military service with a 
disease, injury, or medical defect that is below medical retention 
standards; pursuant to a waiver of retention standards under chapter 9 
or 10 of this publication, or waiver of unfit finding and continued on 
active duty or in active; Reserve status under AR 635-40; 
Medical criteria (examples): [Empty]. 

Code: Code Y*; 
Description/assignment limitation: Fit for duty. This code identifies 
the case of a Soldier who has been determined to be fit for duty (not 
entitled to separation or retirement because of physical disability) 
after complete processing under AR 635-40; 
Medical criteria (examples): [Empty]. 

Source: Army Regulation 40-501. 

Notes: (1) Profile codes are indicated under item 2 of the physical 
profile form for all permanent physical profiles. (2) Codes do not 
automatically correspond to a specific numerical designation of the 
profile but are based on the general physical/assignment limitations. 

*The Army regulation does not provide medical criteria for these codes. 

[End of table] 

[End of section] 

Appendix V: Department of Defense Pre-Deployment Health Assessment (DD 
Form 2795): 

[See PDF for image] 

Pre-Deployment Health Assessment: 

Authority: 10 U.S.C. 136 Chapter 55. 1074f, 3013, 5013, 8013 and E.O. 
9397: 

Principal Purpose: To assess your state of health before possible 
deployment outside the United States in support of military operations 
and to assist military healthcare providers in identifying and 
providing present and future medical care to you. 

Routine Use. To other Federal and State agencies and civilian 
healthcare providers, as necessary, in order to provide necessary 
medical care and treatment. 

Disclosure: (Military personal and DoD civilian Employees Only) 
Voluntary. If not provided, healthcare WILL BE furnished, but 
comprehensive care may not be possible. 

Instructions: Please read each question completely and carefully before 
marking your selections. Provide a response for each question. if you 
do not understand a question, ask the administrator. 

Demographics: 

Social Security Number: 

First Name: 
Last Name: 

Today's Date (dd/mm/yyyy): 

Deploying Unit:	
DOB (dd/mm/yyyy): 

Gender:	
Male: 
Female: 

Service Branch:	
Air Force:		
Army:Coast Guard: 
Marine Corps: 
Navy: 
Other: Component: 
Active Duty: 
National Guard: 
Reserves: 
Civilian Government Employee: 

Pay Grade
E1: 
E2: 
E3:
E4: 
E5: 
E6: 
E7: 
E8: 
E9: 
O1: 
O2: 
O3: 
O4: 
O5: 
O6: 
O7: 
O8: 
O9: 
O10: 
W1: 
W2: 
W3: 
W4: 
W5: 
Other: 
	
Location of Operation: 
Europe: 
SW Asia: 
SE Asia: 
Asia (Other):
South America: 
Australia: 
Africa: 
Central America: 
Unknown: 

Deployment Location (If Known) (City, Town, Or Base): 

List country (If Known): 

Name of Operation: 

Administrator Use Only: 

Indicate the status of each of the following: 

Medical threat briefing completed: 
Yes: 
No: 
N/A: 

Medical information sheet distributed: 
Yes: 
No: 
N/A: 

Serum for HIV drawn within 12 months: 
Yes: 
No: 
N/A: 

Immunizations current: 
Yes: 
No: 
N/A: 

PPD screening within 24 months: 
Yes: 
No: 
N/A: 

Please fill in Social Security Number: 

Health Assessment: 

1. Would you say your health in general is: 
Excellent: 
Very good: 
Good: 
Fair: 
Poor: 

2. Do you have any medical or dental problems? 
Yes: 
No: 

3. Are you currently on a profile, or light duty, or are you undergoing 
a medical board? 
Yes: 
No: 

4. Are you pregnant? (Females only): 
Yes: 
No: 

5. Do you have a 90-day supply of your prescription medication or birth 
control pills? 
N/A: 
Yes: 
No: 

6. Do you have two pairs of prescription glasses (if worn) and any 
other personal medical equipment 
N/A: 
Yes: 
No: 

7. During the past year, have you sought counseling or care for your 
mental health? 
Yes: 
No: 

8. Do you currently have any questions or concerns about your health? 
Yes: 
No: 

Please list your concerns: 

I certify that the responses on this form are true: 

Service Members Signature: 

Pre-Deployment Health Provider Review (For Health Provider Use Only): 

After interview/exam of patient, the following problems were noted and 
categorized by Review of Systems. More than one may be noted for 
patients with multiple problems. Further documentation of problems to 
be placed in medical records. 

Referral indicated: 
None: 
Cardiac: 
Combat/Operational Stress Reaction: 
Dental: 
Dermatological: 
ENT: 
Eye: 
Family Practice: 
Fatigue. Malaise, Multisystem complaint: 
GI: 
GU: 
GYN: 
Mental Health: 
Neurologic: 
Orthopedic: 
Pregnancy: 
Pulmonary: 
Other: 

Deployable: 
Not Deployable: 

I certify that this review process has been completed. 

Provider's signature and stamp: 

Date (dd/mm/yyyy): 

[End of Health Review] 

DD FORM 2795, MAY 1999: 
ASD (HA) Approved September 1998 Ver 1.3: 

Source: U.S. Army: 

[End of section] 

Appendix VI: Comments from the Department of Defense: 

Department Of The Army: 
Office Of The Deputy Chief Of Staff, G-1: 
300 Army Pentagon: 
Washington, DC 20310-0300: 

Reply to the Director of Military Personnel Management: 

Ms. Brenda S. Farrell: 
Director, Defense Capabilities and Management: 
U.S. Government Accountability Office: 
Washington, D.C. 20548: 

Dear Ms. Farrell: 

This is the Department of Defense (DoD) response to the Government 
Accountability Office Draft Report, "Military Personnel: Army Needs to 
Better Enforce Requirements and Improve Recordkeeping for Soldiers 
Whose Medical Conditions May Call for Significant Duty Limitations," 
dated May 9, 2008 (GAO Code 351152; GAO-08-546). 

The Department appreciates the opportunity to comment on the draft 
report. We greatly value GAO's efforts in examining this important and 
complex issue. As written, the Department agrees with the GAO report 
and its recommendations. Detailed comments to each of GAO's 
recommendations are enclosed. 

As you may be aware, the Secretary of the Army has directed the Army 
Inspector General to conduct a broad and thorough inspection of these 
same issues. The results of this inspection will validate our new 
initiatives that we are instituting which will help adequately address 
your cited concerns and recommendations. 

Sincerely, 

Signed by: 

Gina S. Farrisee: 
Brigadier General, U.S. Army: 
Director of Military Personnel Management: 

GAO Draft Report - Dated May 9, 2008: 
GAO Code 351152/GAO-08-546: 

"Military Personnel: Army Needs to Better Enforce Requirements and 
Improve Recordkeeping for Soldiers Whose Medical Conditions May Call 
for Significant Duty Limitations" 

Department Of Defense Comments To The Recommendations: 

Recommendation 1: The GAO recommends that the Secretary of the Army 
direct the Office of the Army Surgeon General and the Army Deputy Chief 
of Staff G-1 to collaboratively develop an enforcement mechanism to 
ensure commanders and medical providers follow procedures to make sure 
Soldiers whose permanent physical profiles indicate significant medical 
limitations are properly referred to and complete MMRB and MEB 
evaluation boards prior to deployment. (pg. 34/GAO Draft Report) 

DOD Response: 

DoD concurs. However, the findings of the GAO report do not suggest a 
widespread problem throughout the Army and commanders appear to be 
adhering to the current procedures regarding the medical fitness of 
Soldiers identified to deploy. A sample taken from Forts Benning, 
Stewart, and Drum, showed a total of 17 Soldiers found with a P3 or 
higher profile who had not appeared before a medical evaluation board 
and had deployed. The report could not confirm that these Soldiers, who 
deployed from these installations, had not been assigned to duties 
suitable to their medical condition. Survey and interview responses 
indicate that Soldiers generally felt they had been assigned to 
suitable duties and commanders reported they were aware of deployed 
Soldiers' medical conditions and these conditions had been taken into 
account when assigning duties. 

In addition, the Secretary of the Army recently directed that the 
Inspector General conduct a thorough inspection of the medical policies 
and procedures that support a commander's determination of Soldier 
deployability. The inspection will occur over several months including 
both CONUS and OCONUS units and agencies. Also, the Assistant Secretary 
of Defense for Health Affairs is planning to release new guidance, as 
mentioned in the GAO report, providing more guidelines on medical 
conditions that should preclude affected service members from being 
deployed. 

The Army and DoD are in the process of instituting a number of 
initiatives to improve the process for completion of permanent physical 
profiles and referral to an MMRB or MEB, if medically indicated. 
Physical profile information must be entered into the Medical 
Protection System (MEDPROS) which tracks all immunization, medical 
readiness, and deployability data for Soldiers in order to assist the 
chain of command in determining their medical and dental readiness. The 
Army's Periodic Health Assessment (PHA) policy requires that Soldiers' 
physical profiles be reviewed by privileged providers on an annual 
basis. Once the profile process is automated, the enforcement mechanism 
will be accomplished using the interplay between MEDPROS and the 
Medical Nondeployable Module already in use in the Reserve Component 
(United States Army Reserve and National Guard). The effort to automate 
this interplay will result in a program referred to as EProfile. The 
program highlights Soldiers without correct profile codes (Box 2 on the 
DA 3349) indicating MMRB or MEB board completion. Where codes are 
missing, Soldiers will be categorized as nondeployable and unit 
commanders will be alerted. Once the physical profile is fully 
automated, the MEB or MMRB referral process will be generated 
automatically (built into the logic of the program). Until then, it is 
the responsibility of the hospital commander to educate and enforce 
compliance with MEB/MMRB referral and profile routing requirements. The 
MEDCOM Commander allows hospital commanders to determine which 
management strategies work best for their organization. 

In addition, DoD and the Department of Veterans Affairs are 
reevaluating the complete Physical Disability Evaluation Process which 
includes the Medical Evaluation Board (MEB). The intent is to 
streamline the process and return the Soldier to duty or determine 
his/her disability. For the first quarter of FY08, the Department of 
the Army average processing time for an MEB was 40 days, with the goal 
being 30 days. 

Recommendation 2: The GAO recommends that the Secretary of the Army 
direct the Office of the Army Surgeon General and the Army Deputy Chief 
of Staff G-1 to move forward with plans to electronically process and 
retain physical profiles, including specific actions and milestones, 
and to implement guidance to help ensure the timely distribution of 
profiles to commanders and the military personnel office and that the 
medical recordkeeping system include all information in the approved 
physical profiles and that all profiles be retained in Soldiers' 
medical records. (pg. 34/GAO Draft Report) 

DOD Response: 

DoD Concurs. The Office of the Army Surgeon General identified and 
submitted the functional requirements for the automation of physical 
profiles for Defense Business Transformation Certification. This DoD 
mandated business certification is expected in July 2008 with 
appropriate funds obligated for development in the fourth quarter of 
FY08. 

Current requirements for processing and distributing paper copies of 
profiles are addressed in AR 40-501, chapter 7. One copy is forwarded 
to the unit commander, one copy to the installation Military Personnel 
Office, one copy is given to the Soldier, and one copy is retained in 
the medical record. Methods of distribution vary based on installation 
resources and support. Provider generated profile information is also 
recorded in the military's electronic health record or AHLTA (Armed 
Forces Health Longitudinal Technology Application). Profile information 
in AHLTA is not yet available to unit commanders; however, the 
automated physical profile is designed to correct this deficiency. 
Paper copies of profiles continue to be maintained in existing paper-
based medical records. 

Recommendation 3: The GAO recommends that the Secretary of the Army 
direct the Army Human Resources Command to disseminate information and 
provide Soldiers and their Families access to an independent ombudsman 
program prior to and during deployment to ensure they are fully 
informed about this resource for addressing their concerns and to add 
independent oversight of Army medical and deployment processes in the 
interests of the Soldiers. (pg. 34/GAO Draft Report) 

DOD Response: 

DoD concurs with the concerns expressed in the above recommendation; 
however, these concerns can be addressed using an existing Army 
program. In 2007, the Army established two programs to assist wounded 
or ill Soldiers and their Family members: The Wounded Soldier and 
Family Hotline and an Ombudsman Program. The Wounded Soldier and Family 
Hotline in particular, could effectively address GAO's concerns and 
assist all Soldiers (and Families), whether preparing to deploy, 
deployed, or redeployed. The Army senior leadership supports the use of 
the existing Hotline and Ombudsman programs, as they already serve as 
independent resources for addressing Soldier and Family member 
concerns. 

In March 2007, Army senior leadership established the Wounded Soldier 
Family Hotline, the purpose of which was two-fold: To offer wounded, 
injured, or ill Soldiers and their Family members a way to seek help to 
resolve medical issues and to provide an information channel of Soldier 
medical related issues directly to Army senior leadership to enable 
them to improve the way the Army serves the medical needs of Soldiers 
and their Families. The hotline was not established to circumvent the 
chain of command, but rather to give Soldiers and Family members an 
additional means to resolve medical-related issues and navigate through 
the medical care system. Retribution directed towards those who use the 
hotline is not tolerated. The hotline is managed and operated by the 
U.S. Army Human Resources Command in Alexandria, VA. Since inception, 
the hotline has fielded more than 12,000 calls, involving approximately 
3000 issues. The WSFH addresses issues for all components, Veterans, 
and Retirees. All callers' issues are captured and addressed; we have 
not turned a caller away. Callers' issues are staffed to the 
organization which can best resolve the issue which includes the 
appropriate Army Commands, Army Service Component Commands, or Direct 
Reporting Units for resolution and follow-up within three business 
days. The hotline operates 24 hours a day, seven days a week. It is 
staffed by 11 Soldiers, 34 Contractors and one DA Civilian. Many of the 
Contractors are either former Soldiers or Family members of current or 
formerly serving Soldiers. The Army Wounded Soldier and Family Hotline 
can be accessed by phone (1-800-984-8523 or DSN 312-328-0002) or email 
([email protected]). 

In April 2007, the Army established an Ombudsman Program to serve 
Soldiers and Family members assigned to Warrior Transition Units 
(WTUs). Ombudsman work as advocates to resolve issues related to health 
care, physical disability processing, Reserve Component medical 
retention issues, transition to the Veterans Administration, pay 
issues, and more. Ombudsman link Soldiers and Family members with the 
appropriate individual and/or agency that can fully address their 
concerns or questions. There are currently 48 Ombudsman supporting 29 
sites and two more will soon be added to Germany supporting two 
additional sites. To date, this program has assisted over 5,400 
Soldiers. Ombudsman work directly for the Army Medical Command (MEDCOM) 
and are independent from local commands and all information between the 
Soldier and Ombudsman are confidential in compliance with the Health 
Insurance Portability and Accountability Act of 1996 (HIPAA). While the 
majority of cases are opened directly by the Ombudsman on site, the 
MEDCOM Medical Assistance Group works closely with the Wounded Soldier 
Family Hotline to resolve any WTU medical issues called into the 
hotline. 

The Army in 2008 is entering its seventh year of persistent conflict. 
Many wounded and injured Soldiers, who have supported the Global War on 
Terror, as well as their Families, are enduring hardships in navigating 
our medical care system. Our Army is committed to providing outstanding 
medical care for the men and women who have volunteered to serve this 
great nation. Recent events at Walter Reed Army Medical Center made it 
clear the Army needs to revise how it meets the needs of our wounded 
and injured Soldiers and their Families. Part of the response by Army 
senior leaders was the creation of the two programs mentioned. The Army 
Wounded Soldier and Family Hotline is poised to assist all wounded, 
injured or ill Soldiers and their Family members regardless of whether 
the Soldier has already deployed, is currently deployed, or preparing 
to deploy. As a matter of fact, the hotline is already receiving calls 
from Soldiers who are deployed, and from their Families. The Army will 
continue to aggressively advertise the availability of this critical 
resource and established metrics will continue to be reported to Army 
senior leaders.
[End of section] 

Appendix VII: GAO Contact and Staff Acknowledgments: 

GAO Contact: 

Brenda S. Farrell, (202) 512-3604 or [email protected]. 

Acknowledgments: 

In addition to the contact named above, Marilyn Wasleski, Assistant 
Director; Gina Hoffman; LaToya King; Grace Materon; Elisha Matvay; 
Sonya Phillips; Jeanett Reid; Norris Smith III; and Cheryl Weissman 
made significant contributions to the report. In addition, Terry 
Richardson, Carl Barden, and Steven Putansu provided guidance and 
assistance with design and analysis; Nicole Harms provided legal 
advice; Steve Fox, Marcia Crosse, and Tom Conahan advised on message 
preparation; and Clara Mejstrik, Adam Smith, Maria Storts, and John 
Wren provided assistance during medical file reviews. 

[End of section] 

Related GAO Products: 

DOD Civilian Personnel: Medical Policies for Deployed DOD Federal 
Civilians and Associated Compensation for Those Deployed. [hyperlink, 
http://www.gao.gov/cgi-bin/getrpt?GAO-07-1235T]. Washington, D.C.: 
September 18, 2007. 

Defense Health Care: Comprehensive Oversight Framework Needed to Help 
Ensure Effective Implementation of a Deployment Health Quality 
Assurance Program. [hyperlink, http://www.gao.gov/cgi-bin/getrpt?GAO-07-
831]. Washington, D.C.: June 22, 2007. 

DOD Civilian Personnel: Greater Oversight and Quality Assurance Needed 
to Ensure Force Health Protection and Surveillance for Those Deployed. 
[hyperlink, http://www.gao.gov/cgi-bin/getrpt?GAO-06-1085]. Washington, 
D.C.: September 29, 2006. 

Military Personnel: DOD and the Services Need to Take Additional Steps 
to Improve Mobilization Data for the Reserve Components. [hyperlink, 
http://www.gao.gov/cgi-bin/getrpt?GAO-06-1068]. Washington, D.C.: 
September 20, 2006. 

Military Disability System: Improved Oversight Needed to Ensure 
Consistent and Timely Outcomes for Reserve and Active Duty Service 
Members. [hyperlink, http://www.gao.gov/cgi-bin/getrpt?GAO-06-362]. 
Washington, D.C.: March 31, 2006. 

Military Personnel: Top Management Attention Is Needed to Address Long- 
standing Problems with Determining Medical and Physical Fitness of the 
Reserve Force. [hyperlink, http://www.gao.gov/cgi-bin/getrpt?GAO-06-
105]. Washington. D.C.: October 27, 2005. 

Defense Health Care: Improvements Needed in Occupational and 
Environmental Health Surveillance during Deployments to Address 
Immediate and Long-term Health Issues. [hyperlink, 
http://www.gao.gov/cgi-bin/getrpt?GAO-05-632]. Washington, D.C.: July 
14, 2005. 

Defense Health Care: Force Health Protection and Surveillance Policy 
Compliance Was Mixed, but Appears Better for Recent Deployments. 
[hyperlink, http://www.gao.gov/cgi-bin/getrpt?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. 
[hyperlink, http://www.gao.gov/cgi-bin/getrpt?GAO-04-1031]. Washington, 
D.C.: September 15, 2004. 

Defense Health Care: DOD Needs to Improve Force Health Protection and 
Surveillance Processes. [hyperlink, http://www.gao.gov/cgi-
bin/getrpt?GAO-04-158T]. Washington, D.C.: October 16, 2003. 

Defense Health Care: Quality Assurance Process Needed to Improve Force 
Health Protection and Surveillance. [hyperlink, http://www.gao.gov/cgi-
bin/getrpt?GAO-03-1041]. Washington, D.C.: September 19, 2003. 

Military Personnel: DOD Needs More Data to Address Financial and Health 
Care Issues Affecting Reservists. [hyperlink, http://www.gao.gov/cgi-
bin/getrpt?GAO-03-1004]. Washington, D.C.: September 10, 2003. 

Defense Health Care: Army Has Not Consistently Assessed the Health 
Status of Early-Deploying Reservists. [hyperlink, 
http://www.gao.gov/cgi-bin/getrpt?GAO-03-997T]. Washington, D.C.: July 
9, 2003. 

Defense Health Care: Army Needs to Assess the Health Status of All 
Early-Deploying Reservists. [hyperlink, http://www.gao.gov/cgi-
bin/getrpt?GAO-03-437]. Washington, D.C.: April 15, 2003. 

VA And Defense Health Care: Military Medical Surveillance Policies in 
Place, but Implementation Challenges Remain. [hyperlink, 
http://www.gao.gov/cgi-bin/getrpt?GAO-02-478T]. Washington, D.C.: 
February 27, 2002. 

Gulf War Illnesses: Research, Clinical Monitoring, and Medical 
Surveillance. [hyperlink, http://www.gao.gov/cgi-bin/getrpt?GAO/T-NSIAD-
98-88]. Washington, D.C.: February 5, 1998. 

Gulf War Illnesses: Improved Monitoring of Clinical Progress and 
Reexamination of Research Emphasis Are Needed. [hyperlink, 
http://www.gao.gov/cgi-bin/getrpt?GAO/NSIAD-97-163]. Washington, D.C.: 
June 23, 1997. 

Defense Health Care: Medical Surveillance Improved Since Gulf War, but 
Mixed Results in Bosnia. [hyperlink, http://www.gao.gov/cgi-
bin/getrpt?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. [hyperlink, http://www.gao.gov/cgi-
bin/getrpt?GAO/NSIAD-94-36]. Washington, D.C.: March 23, 1994. 

Operation Desert Storm: War Highlights Need to Address Problem of 
Nondeployable Personnel. [hyperlink, http://www.gao.gov/cgi-
bin/getrpt?GAO/NSIAD-92-208]. Washington, D.C.: August 31, 1992. 

[End of section] 

Footnotes: 

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

[2] See appendix III for descriptions of the physical profile numerical 
designations and categories. 

[3] GAO, Defense Health Care: Comprehensive Oversight Framework Needed 
to Help Ensure Effective Implementation of a Deployment Health Quality 
Assurance Program, GAO-07-831 (Washington, D.C.: June 22, 2007); 
Defense Health Care: Quality Assurance Process Needed to Improve Force 
Health Protection and Surveillance, GAO-03-1041 (Washington, D.C.: 
Sept. 19, 2003); and Reserve Forces: DOD Policies Do Not Ensure That 
Personnel Meet Medical and Physical Fitness Standards, GAO/NSIAD-94-36 
(Washington, D.C.: Mar. 23, 1994). See the Related GAO Products section 
for more GAO reports pertaining to medical deployability. 

[4] GAO, Military Personnel: Top Management Attention Is Needed to 
Address Long-standing Problems with Determining Medical and Physical 
Fitness of the Reserve Force, GAO-06-105 (Washington. D.C.: Oct. 27, 
2005). 

[5] Representative Vic Snyder was Chair of the Subcommittee on Military 
Personnel at the time of the request. 

[6] GAO has reported in the past that military health records are often 
incomplete and do not contain all necessary documentation. GAO, Defense 
Health Care: DOD Needs to Improve Force Health Protection and 
Surveillance Processes, GAO-04-158T (Washington, D.C.: Oct. 16, 2003); 
and Gulf War Illnesses: Research, Clinical Monitoring, and Medical 
Surveillance, GAO/T-NSIAD-98-88, (Washington, D.C.: Feb. 5, 1998). Our 
analysis for this report is considered to be baseline data and cannot 
be considered comprehensive. 

[7] All percentage estimates of soldiers at these installations are 
based on random samples and are subject to sampling error. For this 
estimate, we are 95 percent confident that between 1 percent and 4 
percent of soldiers from these installations did not receive required 
evaluations prior to deployment. 

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

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

[10] Under Secretary of Defense for Personnel and Readiness, Department 
of Defense Instruction 6490.03, Deployment Health (Aug. 11, 2006); 
Under Secretary of Defense for Personnel and Readiness, Memorandum, 
Policy Guidance for Medical Deferral Pending Deployment to Theaters of 
Operation (Feb. 9, 2006); Under Secretary of Defense for Personnel and 
Readiness, Department of Defense Instruction 6025.19, Individual 
Medical Readiness (IMR) (Jan. 3, 2006); Under Secretary of Defense for 
Personnel and Readiness, Department of Defense Instruction 6200.05, 
Force Health Protection Quality Assurance Program (Feb. 16, 2007); 
Assistant Secretary of Defense, Memorandum, Policy for Department of 
Defense Deployment Health Quality Assurance Program (Jan. 9, 2004); 
U.S. Central Command, Individual Protection and Individual/Unit 
Deployment Policy, PPG Modification 8 (July 2007). 

[11] In our review, we did not find that soldiers in our sample who had 
deployed were considered not deployable due to their medical condition 
and thus, we did not find instances of waivers in order to deploy 
soldiers in our sample. 

[12] U.S. Army Regulation 40-501, Standards of Medical Fitness (Jan. 
18, 2007); U.S. Air Force Instruction 10-203, Duty Limiting Conditions 
(Oct. 25, 2007); and U.S. Navy Manual of the Medical Department NAVMED 
p-117 (Aug. 12, 2005). 

[13] During our review at the three installations, we only reviewed one 
physical profile designated at level 4. It was a temporary profile and 
the soldier did not deploy with it in effect. 

[14] Currently, no code exists for soldiers reviewed by an MEB who were 
not also reviewed by a subsequent Physical Evaluation Board. The Army 
plans to correct this oversight in the next revision of Army regulation 
40-501. See appendix IV for full description of profile codes from AR 
40-501. 

[15] Army Regulation 40-501; Army Regulation 600-60, Physical 
Performance Evaluation System (June 25, 2002); Army Regulation 40-400, 
Patient Administration (Feb. 6, 2008). 

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

[17] Army Regulation 40-501, chapter 3, lists certain diseases or 
medical conditions that could severely limit a soldier's ability to 
perform his or her duties, such as heart disease, cirrhosis of the 
liver, chronic asthma, and epilepsy. 

[18] The MEB and Physical Evaluation Board processes are together 
called the Physical Disability Evaluation System, but because a soldier 
is not evaluated by a Physical Evaluation Board without first going 
through an MEB, we refer to this in the report as the MEB process. 

[19] Chief of Staff of the United States Army, Memorandum, Metrics and 
Continuous Process Improvements for Medical Evaluation Board (MEB) and 
Physical Evaluation Board (PEB) Processing (Sept. 26, 2007). 

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

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

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

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

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

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

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

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

[28] Although the Army may obtain a waiver in order to deploy soldiers 
that do not meet medical fitness standards if medical treatment is 
available in theater according to DOD guidance, we did not find 
evidence of any waivers. 

[29] The 95 percent confidence interval for this estimate is from 1 
percent to 4 percent of soldiers. 

[30] Army regulation 600-60 (June 25, 2002); Chief of Staff of the 
United States Army, Memorandum (Sept. 26, 2007). 

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

[32] Army Office of the Surgeon General/Army Medical Command Policy 
Memorandum, Ombudsman Program in Support of Warriors in Transition 
(Sept. 6, 2007). 

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

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

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

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

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

[38] See appendix V for a copy of the pre-deployment health assessment 
form 2795. 

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

[End of section] 

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