fense and the Services have developed guidelines specifying the desired medical and mental health condition of members of the enlisted force. These guidelines are used as screening standards—some are based on strong clinical and scientific evidence about the links between a health condition and the ability to perform in combat (e.g., blindness, deafness), and others are based on assumptions about this relationship (e.g., body composition, certain mental health conditions).

Currently there is little or no screening for physical fitness at the MEPS. For some Services, there are conditioning programs for the recruits while they are waiting in the delayed entry program (DEP) to be shipped to basic training. Recruits may remain in the DEP for up to one year. For the most part, however, physical fitness tests administered at the beginning and throughout basic training are the selection screens. Basic training is intense and physically demanding. Those who do not pass the fitness tests at the end of training will not be able to remain in the Services. This test generally consists of sit-ups or crunches, push-ups or pullups, and a run of 1.5 to 3 miles. Maintaining fitness is also a concern. Each Service has its own set of tests and testing schedules to measure physical fitness at various points in the first term.

Medical and mental health standards for screening are contained in the recently revised DoD Instruction 6130.4 (Appendix A—<http://www.dtic.mil/whs/directives/corres/html/61304.htm>). This instruction specifies all medical conditions for which an applicant can be disqualified. As noted earlier, some of these have a clear basis, while others may be interpreted more broadly, depending on the individual case and the need of a particular Service. Thus, some conditions cannot be allowed under any circumstances while disqualification for others can be waived by a Service. Conditions that are frequently waived are of particular interest to the committee.


This report is organized into eight chapters. Chapter 2 provides an overview of enlistment processing procedures and standards and includes a description of the medical processing at MEPS. Chapter 3 discusses the methodology for linking standards to outcomes, provides an example of how the accession quality cost trade-off model can be applied, and examines the characteristics of current databases and the needs for the future. The next four chapters focus on analyses of particular standards. Each includes (1) a discussion of trends in the youth population as well as in the military enlisted force, (2) an examination of the available data on the relationship between a selected condition and injury or attrition, and (3) an analysis of various interventions found effective in the civilian sector.

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