As a general marker of the prevalence of musculoskeletal conditions in the applicant population, the committee accessed information on reasons for medical disqualifications (or “failures”) at the MEPS. These data were provided by the U.S. Military Enlistment Processing Command (USMEPCOM). It should be noted that, in general, recruiters do not send a potential applicant to a MEPS if he or she has a musculoskeletal condition that the recruiter perceives will not be waived. Thus, in terms of providing information about the prevalence of musculoskeletal conditions in the applicant population, these data suffer from a recruiter selection bias common to all MEPS databases.

For the period May 1, 2003, to April 30, 2005, there was a total of approximately 429,116 applicants who underwent the physical/medical screen at the MEPS (this is essentially the number of potential applicants who successfully completed the Armed Services Vocational Aptitude Battery exam). Of these, 239,940 (60 percent) entered a Service. Among the total accessions, there were 26,326 (11 percent) who were “medically disqualified” (i.e., did not pass the screen) at the MEPS and received a waiver. An additional 43,708 applicants were medically failed and either did not apply for a waiver or else were not waived and thus were not accessed. (See tables in Appendix B.)

The most common reasons for medical failure were being overweight (23 percent), self-reported marijuana use (13 percent), and musculoskeletal conditions of the upper or lower extremities (10 percent). The codes used for upper or lower extremity musculoskeletal conditions reflect a great variety of disorders, and many of the codes are unspecific (i.e., “other lower extremity conditions”). To the extent possible, the basic distribution of these codes is described below.

For the lower extremity, knee and patella conditions were the most common category, accounting for 15 percent of lower extremity failures. Within the knee category, repairs to the anterior cruciate ligament accounted for 7 percent of lower extremity failures. However, it should be noted that a history of this repair is widely perceived by the military Services to be a waiverable condition, and thus is probably overrepresented in this data source relative to the general applicant population. Ankle and foot conditions accounted for 4 percent of lower extremity failures, joint pain or stiffness for 8 percent, and presence of an orthopedic device or “complications of medical care” for an additional 5 percent. The remaining conditions (68 percent of all lower extremity failures) represented a wide variety of conditions, no single one of which was larger than 2 percent.

For the upper extremity, shoulder conditions were the most common category, accounting for 12 percent of all upper extremity failures. Within the shoulder category, a variety of types of shoulder dislocation codes

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