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Table 1. FY2025 NDAA Legislative Proposals

House-passed H.R. 8070

Senate Armed Services Committee-reported S.

4638

No similar provision. Section 597 would require the Under Secretary of Defense for Personnel and Readiness to implement a two-year pilot program that utilizes reserve component medical personnel to support the United States Medical Entrance Processing Command (USMEPCOM) to accelerate medical record reviews.

No similar provision. Section 597A would direct the Secretary of Defense to provide the congressional defense committees a review of military accession standards and ongoing plans to modify those standards. The provision would also require, among other items, the review to describe modifications made by the Medical Accession Records Pilot (MARP) and a plan to expand the MARP to review other medical accession standards.

No similar provision. Section 726 would require the Secretary of Defense to submit to Congress a plan to reduce recruitment processing delays associated with DOD’s electronic health record systems. The provision would also establish accessions time processing requirements.

No similar provision. Section 745 would require the Secretary of Defense to implement a two-year pilot program and issue policy guidance directing the secretaries of the military departments to delegate medical waiver authority to USMEPCOM for certain disqualifying medical conditions.

Source: CRS analysis of legislation on Congress.gov.

Discussion

Since 1973, the U.S. military has been an all-volunteer force, requiring each service to actively recruit and retain servicemembers to meet annual end-strength goals. Over the past five years, the services have experienced “complex and multifaceted” challenges with meeting these goals resulting from

• strong economic conditions,

• a smaller pool of eligible individuals,

• generational shifts in perspective on traditional life and career paths and trust in government institutions, and

• decreased desire to serve.

In a December 2023 House Armed Services Committee (HASC), Subcommittee on Military Personnel hearing, a DOD official stated that the services missed their “recruiting goals by approximately 41,000 recruits ... in part because of the difficult recruiting environment.” The services have implemented certain mitigation strategies to improve recruitment, including changes to aptitude score thresholds, initial drug testing procedures, preparatory training, and recruiting workforce.

Some observers contend that changes to the medical accession standards could also help mitigate existing recruitment challenges. For example, some observers have proposed relaxing certain standards to reflect “societal health trends” or to tailor standards to certain occupational requirements. On the other hand,

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some research has shown “reduced rates of medical discharge when policies are tightened and corresponding cost savings to DoD in the millions of dollars.”

Some Members of Congress have expressed concern with the medical screening process and the length of time to adjudicate medical waivers. According to DOD data provided to CRS, as of January 2024, the services reported the following average processing times for medical waivers:

• Army: 83 days.

• Navy: 5-6 days.

• Marine Corps: 12 days.

• Air Force: 95 days.

In 2023, the DOD Inspector General found that the services “could improve the medical waiver process by tracking data,” update relevant policies to reflect implementation and use of DOD’s new electronic health record (i.e., MHS Genesis), and enhance communication and training on medical screening processes with the military recruiters.

Medical Screening and Waivers

Military Entrance Processing Stations (MEPS) screen and determine fitness for service based on DOD and service-specific standards. This process includes a medical prescreening, accession medical examination, and medical qualification determination. Based on this determination, applicants may be deemed medically qualified or disqualified to be enlisted or appointed into military service. Medically disqualified applicants may end their pursuit to join the military, or submit a request to waive the medical standards to a Service Medical Waiver Review Authority. The applicant’s military recruiter normally facilitates the request, which may require an applicant to submit additional information and medical documentation.

DOD’s Accession Medical Standards Analysis and Research Activity (AMSARA) reported that between FY2016 and FY2020, 1.35 million applicants received a MEPS medical examination. Figure 1 shows the proportion of those applicants who were medically disqualified, requested a medical waiver, and subsequently received a medical waiver.

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IN12428 · VERSION 1 · NEW

Author Information

Bryce H. P. Mendez Specialist in Defense Health Care Policy

Disclaimer

This document was prepared by the Congressional Research Service (CRS). CRS serves as nonpartisan shared staff to congressional committees and Members of Congress. It operates solely at the behest of and under the direction of Congress. Information in a CRS Report should not be relied upon for purposes other than public understanding of information that has been provided by CRS to Members of Congress in connection with CRS’s institutional role. CRS Reports, as a work of the United States Government, are not subject to copyright protection in the United States. Any CRS Report may be reproduced and distributed in its entirety without permission from CRS. However, as a CRS Report may include copyrighted images or material from a third party, you may need to obtain the permission of the copyright holder if you wish to copy or otherwise use copyrighted material.