Military Personnel: Army Needs to Better Enforce Requirements and Improve Record Keeping for Soldiers Whose Medical Conditions May Call for Significant Duty Limitations
Highlights
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.
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.
Recommendations
Recommendations for Executive Action
| Agency Affected | Recommendation | Status |
|---|---|---|
| Department of the Army | To safeguard soldiers with significant medical limitations from being deployed and assigned to duties unsuitable for their limitations, the Secretary of the Army should 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 Medical Evaluation Board (MEB) and Military Occupational Specialty Medical Retention Board (MMRB) evaluation boards prior to deployment. |
Closed – Implemented
DOD concurred with this recommendation. The Army 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. Also, the Army and DOD are implementing some initiatives to improve and automate the process for completion of permanent physical profiles and referral to an MEB or MMRB. As of July 2009, the Army Reserve and National Guard use the eProfile automated system to enter and route electronic physical profiles to the correct administrative action. EProfile currently routes all permanent 3 and 4 profiles to the MEB physician for review, and is projected to route profiles to the MMRB module by September 2010. The Army is implementing eProfile throughout the Active component, with full deployment anticipated in June 2011. The Army has staffed updates to Army Regulating 40-501 and DODI 6490.07 was published in February 2011 to address this recommendation. As of December 2010, the Army projects that by February 2011, eProfile will be fully implemented in all three Army components. Commanders have real time access to profiles and medical readiness classifications. EProfile also retains profiles, displays history and specific actions and milestones. Copies of the profiles are available through the Army Knowledge Online system and visible to medical providers via the Armed Forces Health Longitudinal Technology Application (AHLTA), which is used DOD-wide as the official electronic medical recordkeeping system. Based on the progress made, DODIG recommended the case be closed.
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| Department of the Army | To safeguard soldiers with significant medical limitations from being deployed and assigned to duties unsuitable for their limitations, the Secretary of the Army should direct the Office of the Army Surgeon General and the Army Deputy Chief of Staff G-1 to 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 (1) the timely distribution of profiles to commanders and the military personnel office and (2) that the medical record keeping system include all information in the approved physical profiles, and that all profiles be retained in soldiers' medical records. |
Closed – Implemented
DOD concurred with this 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. As of July 2009, the Army Reserve and National Guard use the eProfile automated system to enter and route electronic physical profiles to the correct administrative action. EProfile currently routes all permanent 3 and 4 profiles to the MEB physician for review, and is projected to route profiles to the MMRB module by September 2010. The Army is implementing eProfile throughout the Active component, with full deployment anticipated in June 2011. The Army has staffed updates to Army Regulation 40-501 and DODI 6490.07 was published in February 2011 to address this recommendation. As of December 2010, the Army projects that by February 2011, eProfile will be fully implemented in all three Army components. Commanders have real time access to profiles and medical readiness classifications. EProfile also retains profiles, displays history and specific actions and milestones. Copies of the profiles are available through the Army Knowledge Online system and visible to medical providers via the Armed Forces Health Longitudinal Technology Application (AHLTA), which is used DOD-wide as the official electronic medical recordkeeping system. Based on the progress made, DODIG recommended the case be closed.
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| Department of the Army | To safeguard soldiers with significant medical limitations from being deployed and assigned to duties unsuitable for their limitations, the Secretary of the Army should 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. |
Closed – Implemented
DOD concurred with this recommendation. In its comments, 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. 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. As of August 2008, the Army stated that it continues to use the Ombudsman program and Wounded Soldier and Family Hotline to assist soldiers in resolving any medical issues, whether the soldier is deployed or preparing to deploy. The Army also continues to aggressively advertise the availability of these resources and established metrics to report to Army senior leaders.
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