Compliance with these routine  requirements is the first step toward determining who is fit for duty. Although the Office of the Under Secretary of Defense for Personnel and  Readiness (OSD/P&R) has the responsibility for overseeing medical and  physical fitness policy and processes, this office has not established a  management control framework and executed a plan to oversee  compliance with routine examinations. According to Army regulation, all soldiers within the Army National Guard  are required to have a dental examination on an annual basis. OSD Has Not Enforced Its Directive Requiring the Services to Report on Compliance with Physical Fitness Exams

OSD has not enforced its own directive requiring the reserve and active  components to report on their members’ compliance with physical fitness  examinations by March 2005. Each reserve component  employs a tracking system capable of monitoring compliance with medical  examinations, but only one reserve component—the Navy Reserve—has  data that are reliable for determining compliance with routine medical  examinations. Units that input data into this system are responsible for reviewing  the data and certifying that they are correct. However, quality assurance procedures are not followed. DOD Lacks Visibility over the Health Status of Reserve Components after Being Called to Active Duty and the Extent to which Members with Preexisting Conditions Required Care during Deployment

DOD does not have complete visibility over the health status of reserve  component members after they are called to duty and is unable to  determine the extent of care provided to those members deployed with  preexisting medical conditions. Despite the existence of various sources of  medical information, DOD has incomplete visibility over members’ health  status when called to active duty, primarily because the reserve  components vary in their ability to systematically identify, track, and  report members’ medical deployability and the DOD-wide centralized  database cannot provide complete information—both of which hinder  DOD’s ability to accurately determine what forces remain for future  deployments. In addition, although  medical information is captured on predeployment forms for all reserve  component members and entered into a DOD-wide centralized database  during mobilization, some data are still missing and information regarding  the reasons why members were found nondeployable is not captured in a  way that can be easily searched through the database. During  this review, we found that DOD has continued to make progress toward  collecting the pre- and postdeployment forms. Because DOD has not determined what preexisting conditions may be  allowed into a specific theater of operations, it has not known what  preexisting conditions to track. To have visibility over reserve components’ compliance with routine  medical and physical fitness examinations, we recommend that the  Secretary of Defense    direct the Under Secretary for Personnel and Readiness, in concert with  the Assistant Secretary for Health Affairs and the Principal Deputy to the  Under Secretary, to establish a management control framework and  execute a plan for issuing guidance, establishing quality assurance for data  reliability, and tracking compliance with routine medical and physical  fitness examinations; and    direct the Under Secretary for Personnel and Readiness, in concert with  the Principle Deputy who oversees the Office of Morale, Welfare, and  Recreation, to take steps to enforce the service reporting requirement on  the status of members’ physical fitness in conjunction with the actions  taken in the first recommendation. To help prevent the deployment of reserve component members with  preexisting medical conditions that could adversely affect the mission and  strain resources in theater, and to provide visibility over those members  deployed with preexisting conditions for which treatment can be provided  in theater, we recommend that the Secretary of Defense:    direct the Chairman of the Joint Chief of Staff to determine what  preexisting medical conditions should not be allowed into specific  theaters of operations, especially during the initial stages of the operation,  and to take steps to ensure that each service component consistently  utilizes these as criteria for determining the medical deployability of its  reserve component members during mobilization; and    direct the Chairman of the Joint Chief of Staff, in concert with the service  secretaries, to explore using existing tracking systems to track those who  have treatable preexisting medical conditions in theater. We have not seen enough evidence to agree that DOD has put in  place a management control framework that will enforce holding all  responsible levels accountable, ensuring that all routine medical  requirements are being met, and that complete and reliable data are being  entered into the appropriate tracking systems. We chose units that had deployed for  Operations Enduring Freedom or Iraqi Freedom. To assess DOD’s visibility over reserve components’ health status after  they are called to duty and the care, if any, provided to those deployed  with preexisting conditions, we collected and analyzed information from a  variety of sources throughout DOD. Reserve Forces: DOD Policies Do Not Ensure That Personnel Meet  Medical and Physical Fitness Standards.
Why GAO Did This Study

The Department of Defense's (DOD) operations in time of war or national emergency depend on sizeable reserve force involvement and DOD expects future use of the reserve force to remain high. Operational readiness depends on healthy and fit personnel. Long-standing problems have been identified with reserve members not being in proper medical or physical condition. Drilling members in the reserve force by law are required to have a medical exam every 5 years and an annual certificate of their medical status. Also, DOD policies require an annual dental exam and an annual evaluation of physical fitness. Compliance with these routine requirements is the first step in determining who is fit for duty. Public Law 108-375 required GAO to study DOD's management of the health status of reserve members activated for Operations Enduring Freedom and Iraqi Freedom. GAO assessed DOD's (1) ability to determine reserve force compliance with routine exams, and (2) visibility over reserve members' health status after they are called to duty and the care, if any, provided to those deployed with preexisting conditions.

What GAO Found

DOD is unable to determine the extent to which the reserve force complied with routine examinations due to lack of complete or reliable data. Although each reserve component employs a tracking system capable of monitoring compliance with medical exams, only one component has taken the necessary quality assurance steps to ensure the reliability of its data. While the Office of the Under Secretary of Defense for Personnel and Readiness has the responsibility for overseeing medical and physical fitness policy and processes, it has not established a management control framework and executed a plan to oversee compliance with routine examinations. Specifically, this office has not enforced holding all responsible levels accountable, ensuring that all requirements are being met, and that complete and reliable data are being entered into the appropriate tracking system. For example, this office has not enforced its own requirement for the services to report on the components' physical fitness status. Without complete and reliable data, DOD is not in a sound position to provide the Secretary of Defense or Congress assurances that the reserve force is medically and physically fit when called to active duty. DOD has only limited visibility over the health status of reserve members after they are called to duty and is unable to determine the extent of care provided to those members deployed with preexisting medical conditions despite the existence of various sources of medical information. The components collect various types of medical data, but vary in their ability to systematically identify, track, and report information on those with temporary and permanent conditions that may limit deployability. In addition, medical information is captured on predeployment forms for all members and entered into a DOD-wide centralized database. GAO has previously reported that the database has missing and incomplete health data, and DOD is working to correct this through its quality assurance program. GAO found during this review that DOD has continued to make progress entering the data from the forms into the database, but the data are still incomplete and the reasons why members are determined medically nondeployable are not captured in a way that is easily discernable. While the Under Secretary of Defense continues to have responsibility for overseeing the medical and physical fitness of reserve members after they are called to duty, the combatant commanders, under the Joint Chief of Staff, have this responsibility for the theater. DOD is unable to determine the care provided to those deployed with preexisting medical conditions because DOD has not determined what preexisting conditions may be allowed into a specific theater and, thus, does not know what conditions to track. Evidence GAO developed suggests that members are deployed into theater with preexisting conditions, such as diabetes, heart problems, and cancer. The impact of those who are not medically and physically fit for duty could be significant for future deployments as the pool of reserve members from which to fill requirements is dwindling and those who have deployed are not in as good health as they were before deployment.