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Research Questions

  1. What are the social issues specific to the Air Force’s culture to consider when tailoring medical standards?
  2. What other barriers may affect implementation of tailored medical standards?
  3. What options can the Air Force consider to address cultural barriers of tailoring medical standards?

Service members must meet medical standards set by the U.S. Department of Defense (DoD) to ensure that they are fit to serve in the U.S. military. However, the individual services establish additional standards for specific career field categories. To meet critical skill needs in the future, the U.S. Air Force is interested in better ways to assess and align personnel to career fields. Part of that interest focuses on tailoring medical standards to meet the needs of highly technical career fields with fewer physical demands. Tailoring medical standards involves the systematic development of alternative standards (or tests) or exemptions for one or more medical conditions for individuals or groups of individuals who otherwise meet all other requirements for military service. Although tailoring medical standards may help the Air Force and specific career fields meet manpower requirements, such changes may not be uniformly supported across the Air Force. Given these concerns, the Air Force is exploring alternative ways to assess and align personnel to career fields and jobs using medical standards, such as weight and hearing. As part of this project, the authors examined potential barriers in Air Force culture that could affect the successful implementation of tailored medical standards. This report describes the analysis of these barriers, which could limit the effectiveness of any effort to tailor medical standards. The survey also addressed perceptions related to other medical conditions (such as asthma or depression) and potential uses for genetic testing.

Key Findings

DoD policies on medical standards may present policy barriers to Air Force–tailored medical standards

  • DoD policy on worldwide deployment requirements limits the extent to which the Air Force can have airmen not meet certain medical standards even if they can complete their core occupational tasks.

In general, subject-matter experts questioned the value of tailoring medical standards

  • Requirements for deployment serve as a significant barrier.
  • The need for tailored medical standards was not apparent; experts cited the waiver process as having sufficient flexibility to tailor standards to individual cases.
  • Airmen in leadership positions who have met relaxed standards might not be perceived as effective or command respect.

Lowering standards might result in lower acceptance of coworkers

  • Survey findings revealed potential cultural barriers and suggested that relaxing medical standards might not be equally accepted by airmen.
  • Perceptions toward an airman not meeting weight standards were more negative than toward an airman with a hearing condition.
  • Concerns about an overweight coworker related to perceptions of fairness (the need for accommodation), stereotypes, and the ability to maintain self-discipline.
  • Concerns about hearing impairment focused on performance, safety, and putting coworkers at risk.

Survey results found mixed support on the use of genetic testing

  • Airmen were not fully supportive of the use of genetic testing to screen and assign airmen to specific occupations.

Recommendations

  • The Air Force should carefully proceed with any plans to further implement genetic testing or biomarkers into the accession process. First, consider a voluntary program on a trial basis that would use results to inform applicants of health risks but not to influence selection, classification, or other personnel decisions.
  • The Air Force should balance potential concerns about fairness with underlying cultural concerns when considering policy changes. Communication, systematic and transparent decisionmaking, and training and education would be essential to implementing tailored medical standards.
  • The Air Force should evaluate the potential benefits and consequences of fully tailored medical standards. Before pursuing the implementation of tailored standards, use trial tests with various options, such as limited-term waivers for a temporary condition and permanent waivers for a permanent condition, to assess the potential benefits and consequences.

Table of Contents

  • Chapter One

    Introduction and Background

  • Chapter Two

    Overview of Department of Defense and Air Force Medical Standards

  • Chapter Three

    Stakeholder and Subject-Matter Expert Perceptions of Tailoring Standards

  • Chapter Four

    Survey of Cultural Barriers to Tailoring Medical Standards

  • Chapter Five

    Conclusions and Options to Consider for Tailoring Medical Standards

  • Appendix A

    Medical Standards for Air Force Cyber, Maintenance, and Remotely Piloted Aircraft

  • Appendix B

    Subject-Matter Expert Question Guide

  • Appendix C

    Hearing Condition Survey: Respondents Provided with Questions About an Airman with Below Standard Hearing

  • Appendix D

    Additional Information on Survey Methodology and Results

Research conducted by

The research reported here was commissioned by Major General Robert I. Miller and conducted by the Manpower, Personnel, and Training Program within RAND Project AIR FORCE.

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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