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Research Questions

  1. If DoD or one of the military services issues new or revises existing policy pertaining to medical standards for enlistment, does the chance of a service member being medically discharged change? Are service members accessioned under tighter (looser) standards less (more) likely to be medically discharged?
  2. If so, how does the change in the likelihood of being medically discharged (higher under looser standards) alter postservice costs to DoD?

Anyone interested in enlisting in the U.S. military undergoes a medical exam. The U.S. Department of Defense (DoD) and the military services set the standards for the medical exam. The standard in place at the time of the exam dictates the requirements the recruit must meet.

In a RAND Corporation study, researchers examined whether service members whose medical exams occurred after a change in accession medical standards had different rates of medical discharge from those whose exams happened before the change. If the standard for a particular medical condition was tightened, for example, would someone subject to the new standard be less likely to have an injury associated with that condition and therefore less likely to be medically discharged with a disability rating for it? In this report, the researchers answer this question then provide estimates of how changes in the probability of medical discharge increase or decrease the postservice costs to DoD.

Key Findings

There is a relationship between the accession medical standards to which military recruits are held and medical discharges later in a career

  • Recruits who were held to stricter medical standards at the time of their entrance medical exams were less likely to be medically discharged than those who were accessioned under looser standards.
  • On the other hand, those whose medical exams occurred after accession medical standards were relaxed were no more likely to be medically discharged than those whose exams took place prior to the policy change.
  • These policy changes are associated with cost savings to DoD ranging from $1 million to $9 million per 10,000 service members accessioned after the policy change.

There are trade-offs for tightening these standards

  • Unless waivers are granted, tightening standards removes the opportunity to serve for those who do not meet these requirements.
  • The higher the standard to which recruits are held, the more difficult it is to recruit people who meet those standards.
  • One measure of success is whether a service member completes a first term. Even if a service member is discharged because of a medical condition, that person's service to the military while able to serve has important value, especially if the member is healthy enough to complete a full term of service.

Table of Contents

  • Chapter One

    Introduction

  • Chapter Two

    Documenting Policy Changes to Inform Statistical Analyses

  • Chapter Three

    Analysis of Accession Medical Standard Changes and Medical Discharges

  • Chapter Four

    Cost Analysis

  • Chapter Five

    Conclusions

  • Appendix A

    Additional Details of the Policy Review

  • Appendix B

    Veterans Affairs Schedule for Rating Disabilities — Policy Crosswalk

  • Appendix C

    Descriptive Statistics and Regression Coefficients

  • Appendix D

    Additional Accession Cohort Characteristics

  • Appendix E

    Sensitivity Analyses

This research was sponsored by the Office of the Under Secretary of Defense for Personnel and Readiness Office of Warrior Care Policy and conducted within the Forces and Resources Policy Center of the RAND National Defense Research Institute, a federally funded research and development center sponsored by the Office of the Secretary of Defense, the Joint Staff, the Unified Combatant Commands, the Navy, the Marine Corps, the defense agencies, and the defense Intelligence Community.

This report is part of the RAND Corporation research report series. RAND reports present research findings and objective analysis that address the challenges facing the public and private sectors. All RAND reports undergo rigorous peer review to ensure high standards for research quality and objectivity.

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