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

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. 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. 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. 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. 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. 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. 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. 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. However, we did not get a  sufficiently high response rate to enable us to project findings from the  survey respondents. 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. 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. 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 reviewed Army processes for tracking soldiers while  deployed. We received responses from 24 of these soldiers, for a  response rate of about 36 percent. Possesses impairments that limit functions or assignments. 3.
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 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.

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 Army's visibility over these soldiers' 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 soldiers' profile and commanders' 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 soldiers' medical records, 213 profiles were missing from the sample of 685 records reviewed. The Army was not consistent in assigning numerical designations reflecting soldiers' 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 "upgrade" numerical designations discretionarily based on knowledge of soldiers' 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 soldiers' 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 soldier's 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.