Figure 3 summarizes the most common  recruiting, screening, and training process for new enlistees. DOD’s Yearly Medical Early and Overall Attrition Rates Were Generally Stable for Fiscal Years 2005 through 2015

		Medical Early Attrition Rates during Enlistees’ Initial Terms of Commitment Were Generally Stable for Fiscal Years 2005 through 2015

Based on our analysis of DOD accession and attrition data, early attrition  rates due to medical reasons during an enlistee’s initial term of  commitment were generally stable for fiscal years 2005 through 2015. For example, the medical early attrition rate at the 48-month point  of enlistees’ initial term of commitment was an estimated 14.9 percent in  fiscal year 2005 and an estimated 13.7 percent in fiscal year 2011—the  most recent year for which 48 months of data were available—with  fluctuations between these years. According to this analysis,  the leading category of early attrition due to medical reasons is  “Unqualified for active duty, other” which DOD defines as a nondisability  medical condition, such as obesity, motion sickness or allergies, that  interferes with the performance of duties and contributes to the failure to  meet physical readiness standards. This is because DOD does not have a process for the military services’  training bases to provide USMEPCOM all of the medical records of  enlistees who separate early due to medical reasons. Specifically, the draft instruction  does not identify a clear process with defined roles and responsibilities. USMEPCOM officials  stated that they are currently in the process of repairing the database, but  they could not provide a schedule for its completion. Without a schedule for these database  repairs, USMEPCOM has limited assurance that this tool will be available  to it expeditiously. However, until USMEPCOM uses EPTS  separation information to provide regular and specific feedback to MEPS  chief medical officers, USMEPCOM may not be assured that it is  adequately identifying medically disqualifying conditions among  applicants for military service before the military services invest  substantial resources in the applicants’ initial training. DOD Has Not Implemented Its New Electronic Health Record at MEPS Locations

DOD has not implemented its new electronic health record system at the  MEPS and its schedule to do so is uncertain. This new system is intended to give DOD the capability  to electronically share more complete medical data with and between  both federal and private sector medical facilities that are similarly  equipped. Without a  clear and complete schedule for implementation of its new system, DOD  has limited assurance that the system will be support the MEPS as  planned. This means that the phased implementation of MHS GENESIS at the  MEPS is likely to be several years away at a minimum. DOD partially concurred with our recommendation to develop a schedule  for deploying the new electronic health record system, MHS GENESIS,  within USMEPCOM. To determine the extent to which USMEPCOM obtains, analyzes, and  uses information about enlistee early attrition due to medical reasons, we  reviewed DOD memorandums and USMEPCOM regulations related to  obtaining, analyzing, and using information about enlistee early attrition  due to medical reasons. To determine the extent to which DOD has implemented its new  electronic health record system at the MEPS to obtain and document  applicants’ medical information, we reviewed selected DOD,  USMEPCOM, and military regulations related to applicant medical  screening processes.
Why GAO Did This Study

For fiscal years 2005 through 2015, the military services enlisted over 1.7 million servicemembers at an estimated cost of approximately $75,000 each. Incomplete medical information or inadequate screening of enlistees at MEPS may result in them not fulfilling their initial terms of commitment and the military services losing their investment in them.
The House Report accompanying a proposed bill for the Fiscal Year 2017 National Defense Authorization Act included a provision for GAO to review applicant medical screening issues at the MEPS. This report assesses the extent to which (1) enlistees have not completed their initial terms of commitment due to medical reasons; (2) USMEPCOM obtains, analyzes, and uses information about enlistee medical early attrition; and (3) DOD has implemented its new electronic health record system at the MEPS. GAO analyzed accession and attrition data for fiscal years 2005 through 2015 (the most recent available), visited selected MEPS near services' training bases, and reviewed selected DOD, USMEPCOM, and service policies.

What GAO Found

GAO's analysis of Department of Defense (DOD) accession and attrition data found that early attrition rates due to medical reasons during an enlistee's initial term of commitment were generally stable for fiscal years 2005 through 2015. As shown in the figure, the medical early attrition rate at the 48-month point was an estimated 14.9 percent in fiscal year 2005 and an estimated 13.7 percent in fiscal year 2011—the most recent year for which 48 months of data were available. The leading category for early attrition was “unqualified for active duty, other,” which DOD defines as a nondisability condition such as obesity.
U.S. Military Entrance Processing Command (USMEPCOM), DOD's organization responsible for medically qualifying applicants for military service, does not fully obtain, analyze and use information about enlistees who separate early due to medical reasons. This is because DOD does not have a clearly defined process for the military services to provide USMEPCOM with all relevant medical records. Further, the database that USMEPCOM relies on to analyze these records is inoperable and no schedule has been developed to repair it. As a result, USMEPCOM has provided limited feedback to chief medical officers—responsible for the medical qualification decisions—that they could use to improve screening outcomes. Without addressing these issues, DOD has limited assurance that medically disqualifying conditions among new enlistees will be identified before the services invest substantial resources in their initial training.
DOD has not implemented its new electronic health record system at the Military Entrance Processing Stations (MEPS) and its schedule to do so is uncertain. Known as MHS GENESIS, this new system is intended to give DOD the capability to electronically share more complete medical data with and between both federal and private sector medical facilities that are similarly equipped. Without a clear and complete schedule for implementation of MHS GENESIS, DOD has limited assurance that the system will support the MEPS as planned.

What GAO Recommends

GAO recommends that DOD develop a clear process for USMEPCOM to obtain medical early separation records, a schedule to repair the database used to analyze the records, and a schedule to deploy MHS GENESIS at the MEPS. DOD concurred with the first two recommendations and partially concurred with the third, stating it is already developing such a schedule. GAO continues to believe action is needed as discussed in the report.