Assessing Fitness for Military Enlistment

Physical, Medical, and Mental Health Standards

Committee on the Youth Population and Military Recruitment: Physical, Medical, and Mental Health Standards

Paul R. Sackett and Anne S. Mavor, Editors

Board on Behavioral, Cognitive, and Sensory Sciences

Division of Behavioral and Social Sciences and Education

NATIONAL RESEARCH COUNCIL OF THE NATIONAL ACADEMIES

THE NATIONAL ACADEMIES PRESS
Washington, D.C.
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Assessing Fitness for Military Enlistment: Physical, Medical, and Mental Health Standards Assessing Fitness for Military Enlistment Physical, Medical, and Mental Health Standards Committee on the Youth Population and Military Recruitment: Physical, Medical, and Mental Health Standards Paul R. Sackett and Anne S. Mavor, Editors Board on Behavioral, Cognitive, and Sensory Sciences Division of Behavioral and Social Sciences and Education NATIONAL RESEARCH COUNCIL OF THE NATIONAL ACADEMIES THE NATIONAL ACADEMIES PRESS Washington, D.C. www.nap.edu

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Assessing Fitness for Military Enlistment: Physical, Medical, and Mental Health Standards THE NATIONAL ACADEMIES PRESS 500 Fifth Street, N.W. Washington, DC 20001 NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance. The study was supported by Award No. M67004-00-C-0030 between the National Academy of Sciences and the U.S. Marine Corps. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the view of the organizations or agencies that provided support for this project. Library of Congress Cataloging-in-Publication Data National Research Council (U.S.). Committee on the Youth Population and Military Recruitment. Assessing fitness for military enlistment : physical, medical, and mental health standards / Committee on the Youth Population and Military Recruitment ; Paul R. Sackett and Anne S. Mavor, editors. p. cm. ISBN 0-309-10079-8 (full book)—ISBN 0-309-65580-3 (pdfs) 1. United States—Armed Forces—Recruiting, enlistment, etc.—Standards 2. Soldiers—Health and hygiene—United States. 3. Youth—Health and hygiene—United States. 4. United States—Armed Forces—Medical examinations. 5. Manpower—United States. I. Sackett, Paul R. II. Mavor, Anne S. III. Title. UB333.N382 2006 355.6′1—dc22 2005036191 Additional copies of this report are available from The National Academies Press, 500 Fifth Street, N.W., Lockbox 285, Washington, DC 20055; (800) 624-6242 or (202) 334-3313 (in the Washington metropolitan area); Internet, http://www.nap.edu Printed in the United States of America Copyright 2006 by the National Academy of Sciences. All rights reserved. Suggested citation: National Research Council. (2006). Assessing Fitness for Military Enlistment: Physical, Medical, and Mental Health Standards. Committee on the Youth Population and Military Recruitment: Physical, Medical, and Mental Health Standards, Paul R. Sackett and Anne S. Mavor, editors. Board on Behavioral, Cognitive, and Sensory Sciences, Division of Behavioral and Social Sciences and Education. Washington, DC: The National Academies Press.

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Assessing Fitness for Military Enlistment: Physical, Medical, and Mental Health Standards THE NATIONAL ACADEMIES Advisers to the Nation on Science, Engineering, and Medicine The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences. The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Wm. A. Wulf is president of the National Academy of Engineering. The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine. The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. Wm. A. Wulf are chair and vice chair, respectively, of the National Research Council. www.national-academies.org

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Assessing Fitness for Military Enlistment: Physical, Medical, and Mental Health Standards COMMITTEE ON THE YOUTH POPULATION AND MILITARY RECRUITMENT: PHYSICAL, MEDICAL, AND MENTAL HEALTH STANDARDS PAUL R. SACKETT (Chair), Department of Psychology, University of Minnesota, Twin Cities DAVID J. ARMOR, School of Public Policy, George Mason University NOREEN M. CLARK, School of Public Health, University of Michigan, Ann Arbor MARK J. EITELBERG, Graduate School of Business and Public Policy, Naval Postgraduate School BARBARA C. HANSEN, Obesity, Diabetes and Aging Research Center at the College of Medicine of the University of South Florida, Tampa PAUL F. HOGAN, The Lewin Group Inc., Falls Church, VA WILLIAM S. MARRAS, Institute for Ergonomics, Ohio State University STEPHEN W. MARSHALL, Department of Epidemiology and Orthopedics, University of North Carolina, Chapel Hill RUSSELL R. PATE, Department of Exercise Science, University of South Carolina, Columbia GARRISON RAPMUND, Krasnow Institute for Advanced Study, George Mason University THOMAS L. SCHWENK, Department of Family Medicine, University of Michigan, Ann Arbor WILLIAM J. STRICKLAND, HumRRO, Alexandria, VA STEPHEN B. THOMAS, Center for Minority Health and Graduate School of Public Health, University of Pittsburgh KAREN D. WAGNER, Department of Psychiatry and Behavioral Sciences, University of Texas, Galveston ANNE S. MAVOR, Study Director WENDY E. KEENAN, Senior Project Assistant

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Assessing Fitness for Military Enlistment: Physical, Medical, and Mental Health Standards BOARD ON BEHAVIORAL, COGNITIVE, AND SENSORY SCIENCES ANNE C. PETERSEN (Chair), W.K. Kellogg Foundation, Battle Creek, MI STEPHEN J. CECI, Department of Human Development, Cornell University EUGENE K. EMORY, Department of Psychology, Emory University ANTHONY W. JACKSON, Asia Society, Los Angeles ELISSA L. NEWPORT, Department of Brain and Cognitive Sciences, University of Rochester MICHAEL L. RUTTER, Social, Genetic, and Developmental Psychiatry Research Centre, London JAMES W. STIGLER, Department of Psychology, University of California, Los Angeles CHRISTINE R. HARTEL, Board Director

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Assessing Fitness for Military Enlistment: Physical, Medical, and Mental Health Standards Acknowledgments The committee is grateful for the many individuals who contributed information to this report and who were helpful throughout the study process (see Appendix C for a complete list of contributors). We would particularly like to thank Jeffrey Hoyle, Ohio State University, and Jennifer Grubb, University of South Carolina, for their contributions to the review and analyses of the military literature on musculoskeletal injury and fitness. The committee extends its gratitude to Bruce Jones, U.S. Army Center for Health Promotion and Injury Prevention, for his extensive briefings and assistance in data retrieval and analysis related to military fitness and injury and to Deborah Gebhardt, Human Performance Systems, Inc., for the information she provided on physical, medical, and mental health screening for civilian employment. We would also like to thank Margot Krauss and David Niebuhr for their informative presentations of findings from studies conducted at the Accessions Medical Standards Analysis and Research Activity. The committee is most grateful to Curt Gilroy, director of accession policy, and Jane Arabian, assistant director for accession policy, Office of the Under Secretary of Defense (Personnel and Readiness), for their interest and encouragement and in providing support for the study. Staff of the National Research Council has contributed to this report in many ways. We would especially like to thank Wendy Keenan, the committee’s senior project assistant, for her indispensable work in organizing meetings, arranging travel, and compiling agenda material. We are also indebted to Christine McShane, who edited and significantly improved the report.

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Assessing Fitness for Military Enlistment: Physical, Medical, and Mental Health Standards This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the National Research Council’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the following individuals for their review of this report: Wm. Cameron Chumlea, Departments of Community Health and Pediatrics, Wright State University Boonshoft School of Medicine, Dayton, OH; G. Bruce Copley, Consultant, Flemington, NJ; Matthew J. Friedman, National Center for Post Traumatic Stress Disorders, White River Junction, VT; Robert R. McMeekin, Consultant, Bethesda, MD; Ann Quigley, Transportation Security Administration, Department of Homeland Security; Manmohan Ranadive, U.S. Army Medical Research Institute of Infectious Diseases, Department of the Army, Ft. Detrick, MD; Hendrick W. Ruck, Human Effectiveness Directorate, Air Force Research Laboratory; Brian J. Sharkey, Technology and Development Center, USDA Forest Service, Missoula, MT; and Martin F. Wiskoff, Northrop Grumman Mission Systems, Monterey, CA. Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations nor did they see the final draft of the report before its release. The review of this report was overseen by Johanna Dwyer, Office of Dietary Supplements, National Institutes of Health. Appointed by the National Research Council, she was responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authoring committee and the institution. Paul R. Sackett, Chair Anne S. Mavor, Study Director

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Assessing Fitness for Military Enlistment: Physical, Medical, and Mental Health Standards Contents     Executive Summary   1 1   Introduction   11 2   Procedures, Requirements, and Standards   21 3   Framework for Evaluating Medical and Physical Standards   47 4   Physical Fitness and Musculoskeletal Injury   66 5   Medical Factors   109 6   Mental Health   135 7   Substance Abuse and Cigarette Use   152 8   Conclusions and Recommendations   177     References   197     Appendixes     A   Medical Standards for Appointment, Enlistment, or Induction in the Armed Forces   213 B   Analysis of Waivers for Disqualifying Conditions   215 C   Sponsors and Contributors   234 D   Biographical Sketches of Committee Members and Staff   236     Index   243

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