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Army Readiness Eroded By Increasing Numbers of Medically Unfit Soldiers

by U.S. Medicine

November 1, 2011

WASHINGTON — As troops are being drawn down, even while the demand on the force continues, a growing percentage of Army troops are medically unfit for duty, Army officials said at the recent Association of the U.S. Army 2011 Annual Meeting and Exposition.


Capt. Alisha Harvey (right), physical therapy clinic chief, 47th Combat Support Hospital, from Richmond VA., uses a muscular system diagram as a visual for a soldier after his physical therapy treatment on Contingency Operating Base Adder. – Photo by Spc. Anthony T. Zane

About 30% of the National Guard and Reserve and as many as 15% of the active-duty force are not able to deploy for medical reasons, with musculoskeletal injuries being the most common cause. Body mass and nutritional deficits also contribute to the problem, they said. Frequent headaches also can be an issue.

Army Surgeon General Lt. Gen. Eric Schoomaker, MD, noted medically unfit soldiers is a problem that “has begun to erode the readiness of the Army as a whole.” It is an issue, he said, that the leadership of the Army has “identified as a major problem” and one that Army medical officials are tackling.

“We begin to see a growing number of medically non-ready soldiers with a smaller population of soldiers overall available for continued demand for deployment,” he said.

In addition to severely injured soldiers in Warrior Transition Units, Brig. Gen. Brian Lein, command surgeon at U.S. Forces Command explained that there are medically nondeployable soldiers who are going to the medical evaluation or physical evaluation board but whose injuries are not complex enough to go into a Warrior Transition Unit; soldiers who are returning from deployment who have medical issues that need attention; and soldiers who are available for deployment by Army regulation but are not able to deploy because of a medical condition that bars them from entering a combat theater.

“As that temporary end-strength draws down slowly over the course of the next several years, if we don’t get our arms around the nondeployable population and the biggest population, the medically nondeployable population, we’re going to have a significant problem manning our units to be able to get them to go downrange,” he said. 

Army Medicine Addresses Medically Nondeployable

The Army is addressing this problem on several fronts. Maj. Gen. Richard Stone, deputy surgeon general for mobilization, said an electronic-profile system now allows leaders to track medical readiness of units. Secondly, all medical readiness standards are in an electronic system called The Medical Protection System (MEDPROS), which tracks all immunization, medical readiness and deployability data for all Active and Reserve components of the Army, as well as civilians, contractors and others.

“We have unprecedented visibility of the Army through those two tools,” he said.

Stone said the Army also is looking at other areas to improve the health of the force and prevent injury. That includes ways to prevent and manage musculoskeletal injuries, which are the main reasons for evacuation from theater, according to Stone. Each year, the Army has more than 1 million visits to military facilities each year for musculoskeletal injuries, with the impact of these injuries putting 68,000 soldiers on limited duty, he said.

In ongoing studies, Stone said, Army Medicine has developed a way to determine which soldiers are prone to musculoskeletal injuries by screening factors such as agility, strength, core strength, arch height, leaping ability and sprint ability.

“You can actually predict, based on the upcoming mission, what the potential is for injury,” he said. “In about a five-day period, you can look at an entire brigade combat team and then predict to the commander their injury rate.”

Army Readiness Eroded By Increasing Numbers of Medically Unfit Soldiers Cont.

As an example of the system’s reliability, Stone noted that one unit was predicted to have a 40% musculoskeletal injury rate, and, in the first six months of that unit’s deployment, it had a 39.5% musculoskeletal injury rate.

“It is very accurate, and we have 10 different programs going on around the Army to look at this,” he said.

Over the next six to 12 months, Stone said, those programs will begin to show data that can point to ways to actually reduce these injuries.

“Simply by taking individuals with the wrong arch height and putting them in the correct boot, by identifying those soldiers who have weaknesses in various core strengths and to begin training them through various physical fitness programs, physical therapists and occupational therapists, we can change the dynamics and reduce from a 40% in an individual unit to much lower levels of injury,” he said.”

Lt. Gen Eric Schoomaker, Army surgeon general (left), leads a panal discussion Monday at the 2011 Association of the U.S Army Annual Meeting and Exposition – (Army Photo)

Army Scrutinizes Diet

Another problem is that, of the approximately 140,000 new recruits, about 25% come to the Army with low iron levels and high body masses, he added. In addition, female recruits are coming in with lower bone density and lower calcium levels than the Army has ever seen.

“We have seen in initial entrance training, a small but emerging and increasing numbers of pelvis and hip fractures in 18 to 24 year olds,” he said. “In fact, last year we sustained over 100 pelvis and hip fractures in [soldiers aged] 18 to 24 years.”

To address all these problems, the Army is reviewing how recruits are trained, including issues such as diet.

The Army’s “Go for Green,” program implemented in 2010, uses a system in which the food at the basic training dining halls is tagged with a red, yellow or green color to indicate how healthy the choices are, with green being the healthiest. It is hoped that recruits will choose to eat healthier with more information.

The question remains whether programs to improve eating habits during the 9½weeks of basic training can make a difference after recruits are assigned the regular duties or move on to additional training.

“We are about 12 months away from being able to provide some sort of data that will show whether this 9½ weeks of basic training makes a difference when they get to their first duty station or when they get to advanced individual training,” he said.

When Stone was asked by a member of the audience why the Army did not simply take away all unhealthy food options in the basic training dining halls, he responded that basic training is being used to educate the soldiers and influence their eating habits after they leave.

“We have taken a tack where we have put choices in front of them and then helped them make decisions by color-coding. The drill sergeant is standing right there in the line … the question will be, ‘What happens after the 9½ weeks, when they can make their own choices?’” he said.

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