Military Personnel: Improvements Needed in the Management of Enlistees' Medical Early Separation and Enlistment Information
Highlights
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.
Figure: Cumulative Medical Early Attrition Rates by Selected Intervals by Accession Year Cohorts for Fiscal Years 2005 through 2015
Note: Medical early attrition rates for all time periods are not available as enlistees in later accession years have not been in military service long enough to determine longer-term early attrition rates.
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.
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.
Recommendations
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.
Recommendations for Executive Action
| Agency Affected | Recommendation | Status |
|---|---|---|
| Department of Defense | The Secretary of Defense should direct the Under Secretary of Defense for Personnel and Readiness to, in coordination with the Director, USMEPCOM, and the military services develop a clear process with defined roles and responsibilities to ensure that complete Existed Prior to Service (EPTS) separation medical records for enlistees who separated within 180 days of service from the military services' basic training sites are provided to USMEPCOM. |
In its comments to our report, DOD concurred with this recommendation. In May 2018, DOD reissued an instruction (DODI 6130.03) which establishes policy, assigns responsibilities, and prescribes procedures for physical and medical standards for appointment, enlistment, or induction into the military services. This revised instruction specifically assigns responsibility to the Secretaries of the Military Departments to ensure that medical information for "Existed Prior to Service" (EPTS) discharges is provided to USMEPCOM by the service training centers that conduct basic military training. Further, it instructs that specific information be provided, such as a copy of the trainee's medical discharge summary and related medical documents; copies of the trainee's accession medical prescreening, medical history reports, medical exam, and any supplemental behavioral health screening documents; and any consultation reports or other medical documentation used in the enlistment process and qualification decision. Because of the release of this new instruction, USMEPCOM will have more complete information to review and analyze reasons behind early medical separation of enlistees from basic training which may help decrease the number who leave military service before their initial terms of commitment are fulfilled thus saving money. This action meets the intention of the GAO recommendation and therefore, the recommendation should be closed as implemented.
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| Department of Defense | The Secretary of Defense should direct the Under Secretary of Defense for Personnel and Readiness to, in coordination with the Director, USMEPCOM, establish a schedule to repair the internal EPTS database so that USMEPCOM can provide more regular and specific feedback to MEPS chief medical officers. |
DOD concurred with this recommendation and said that the database was inoperable but that it was being reviewed as part of a multi-year information technology modernization effort to transition all military medical records to a new system known as MHS (Military Health System) GENESIS. They noted that the capability for USMEPCOM to conduct EPTS medical records review would be available within MHS GENESIS' business intelligence tools once implemented. When asked about the status of any actions taken to address this recommendation by preparing a schedule as to when this internal database would be repaired, DOD responded in January 2018 that USMEPCOM is unable to expend any funds to repair or replace the EPTS database system as this functionality is to be incorporated into the upcoming MHS GENESIS program. DOD officials confirmed that USMEPCOM's initial site testing will occur in FY 2019. While DOD officials are not able to repair its current internal database needed to complete its statistical analysis of these particular medical records, MHS GENESIS will be able to provide USMEPCOM with this capability. In August 2019, a senior DOD official confirmed that using MHS GENESIS is still the primary course of action to address this recommendation. He said that its implementation is planned for 2020/2021; however, there has been another delay and the department is waiting for a new implementation date to be established. In May 2020, this same official provided updated information that said MHS Genesis was delayed until 2021. As of May 2021, DOD stated that although ad hoc functionality in the database has been restored, the deployment of MHS GENESIS is still the ultimate plan for implementing this recommendation. The implementation has been further delayed to October 2022. As of July 2022, DOD confirmed that the implementation of MHS GENESIS and our recommendation is on track for October 2022. In February 2023, DOD provided us with documentation that showed the EPTS database had been repaired and MHS GENESIS had been deployed to the MEPS enabling reporting to CMOs at the MEPS to resume as well as to AMSARA who completes a report on several things including EPTS discharges. These actions meet the intent of our recommendation.
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| Department of Defense | The Secretary of Defense should direct the Under Secretary of Defense for Personnel and Readiness to, in coordination with the Under Secretary of Defense for Acquisition, Technology, and Logistics and the DOD Healthcare Management Systems Program Executive Office, develop a schedule of actions for deploying its new electronic health record system, MHS GENESIS, within USMEPCOM that includes key activities such as the major actions required to accomplish this effort, completion dates for all actions leading up to these events, and dates for the system's deployment to MEPS locations. |
DOD partially concurred with this recommendation and stated that it began fielding MHS GENESIS and anticipated issuing a Full Deployment Decision (FDD) certification in 2018 to proceed to the remaining sites. Further, when asked about the status of any actions taken to address this recommendation, DOD responded in January 2018 that USMEPCOM's inclusion in MHS GENESIS is scheduled for approval in late fiscal year 2018 with initial MEPS site testing in fiscal year 2019. According to DOD, USMEPCOM officials are working closely with the program management officials and the MHS GENESIS team to develop information requirements for approval and inclusion in the MHS GENESIS deployment plan once FDD is granted. The estimated completion date for the roll out to all remaining MEPS locations is fiscal year 2021. In August 2019, a senior DOD official confirmed that the department's primary course of action for addressing this recommendation remains the use of MHS GENESIS. However, he said that DOD has experienced a delay and in May 2020, he stated that MHS Genesis had been delayed until FY 21. In May 2021, DOD stated that MHS GENESIS has been further delayed until October of 2022. As of July 2022, DOD stated that they are still on track for October 2022 for deployment of MHS GENESIS at the MEPS. In February 2023, DOD provided us with documentation that MHS GENESIS had been deployed to all of the MEPS. This action meets the intent of our recommendation.
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