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Physical Standards

Annual Report of the Surgeon General United States Army Fiscal Year 1961

PHYSICAL STANDARDS

Army Regulations No. 40-501, a regulation pertaining to medical fitness standards, was published as a result of a project that was designed to consolidate the many regulations concerning medical standards into one single document. Originally, the project envisioned the publication of two separate volumes, to be known as AR 40-501A and AR 40-501B However, since both A and B regulations apply to all levels of medical examining facilities, two separate suffixes were not necessary. AR 40-501 will cover the full extent of medical examinations with separate chapters covering specific areas. Chapters 1, 3, and 8 were published in the first increment and became effective on 10 January 1961.


34-35

TABLE 6.—Patient census, admissions, and bed occupancy, U.S. Army fixed hospitals, fiscal years 1961 and (in part) 1960


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TABLE 7.—Outpatient visits, by category of patient, U.S. Army medical treatment facilities, worldwide, fiscal years 1959, 1960, and 1961

Chapter 1 introduces the new regulation; chapter 3 sets forth the conditions which render an individual unfit for retention and also singles out those conditions which, although unfitting for retention can be considered for continuance on active service under the provisions of AR 616-41; and chapter 8 incorporates numerous directives which are used to establish medical fitness standards for special registrants.

Chapters 2, 4, 5, 6, and 7 became effective on 1 April 1961. Chapter 2 replaces that portion of AR 40-503 which contained medical fitness standards for procurement of personnel in peacetime; chapter 6


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contains medical standards for procurement of personnel during partial or total mobilization; chapter 4 determines medical fitness standards for flying and other related aviation positions. It does not, however, incorporate the scope or techniques for such examinations. These will be covered in future chapters of the regulations; chapter 5 sets forth standards of fitness for admission to the USMA; and chapter 7 contains miscellaneous standards which are applicable to airborne, ranger, and special forces training and duty, and all other standards not covered in other chapters. This chapter also sets forth medical fitness limitations for assignments in certain geographic areas. Fort Churchill in Canada and military missions are examples of assignments for which specific standards are announced. Chapter 9, which is being staffed with The Adjutant General and DCSPER (Deputy Chief of Staff for Personnel), will supersede AR 40-503 and will announce a revised physical profile system. The most meaningful change from the old system is the adaptation of a one-letter coding system to be used in ADPS (automatic data processing system). This coding system will supersede the categories A, B, C, and E, as currently used. The PULHES factors will be retained as will the numerical designators 1, 2, 3, and 4, although their meanings will be changed. Of special interest, too, is the fact that this chapter officially recognizes the popular conception of the meaning of the designator “4.” Although this designation was intended to identify individuals who did not meet procurement standards, it has commonly been used to identify individuals who possess medical conditions or physical defects which render them unfit for retention in the military service, and will be so employed when this chapter is published.

During fiscal year 1961, 16,306 separation and retirement cases were reviewed. Approximately 10 percent of such cases had to be returned for more complete documentation. An incidental, but important, result of reviewing separation and retirement medical examinations was new appreciation of the quality of medical examinations conducted at U.S. Army medical treatment facilities. In those instances where the quality was not considered as meeting the required standard, corrective measures were taken through direct communication with surgeons of major commands and commanders of class II activities.

A special research project was conducted for the Physical Standards Division, OTSG, by the Surveys and Research Corporation, Washington, D.C. This project on “Effectiveness of Discharged-to-Duty Patients in Selected Diagnoses” presented valuable data regarding the performance of men returned to duty after observation and treatment for conditions such as diabetes mellitus, peptic ulcer, otitis media, and


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epilepsy. The study is particularly meaningful in terms of retention or separation of individuals who have been determined to possess any of the conditions which were studied.

Representatives of the Physical Standards Division participated in a meeting of an interservice committee established by the Secretary of Defense to establish uniform disability separation procedures for the armed services. Although all three services operate their disability separations under the Career Compensation Act of 1949, the implementing regulations and directives are not uniform, especially as pertains to procedure. The committee made specific recommendations to the Assistant Secretary of Defense (Manpower, Procurement, and Reserve) which would make uniform the procedures for all three military services. It also proposed that a pilot study be undertaken in order to evaluate more fully the recommended procedures. As of this report, no final action has been taken by DOD (Department of Defense).

Members of the Physical Standards Division visited AFES’s in each of the six CONUS Army areas during the year. These visits have proved of considerable value to The Surgeon General as they serve as a direct contact between the individuals of OTSG, who prepare staff directives pertaining to the conduct of medical examinations at AFES’s, and those individuals in the field, who carry out the directives. “After Action” study of the problems generated in the field which have come to light as a result of these visits has resulted in both improvement in the conduct of medical examinations and substantial monetary savings to the Government. This has been particularly true in that the numbers of separations from the service for conditions which existed prior to service have been markedly reduced.

One additional factor which is expected to save the Government substantial amounts of money, eventually measured in millions of dollars per year, is the requirement, within the new medical fitness standards, that audiometric readings be obtained in connection with medical examinations prior to initial entry into the service. Heretofore, no audiometric tests were routinely done on all service candidates, and thus the Government’s position, was jeopardized in the adjudication of claims for hearing loss. A level of hearing taken at the time of entry into service has the double effect of protecting the individual and the Government in hearing loss claims.

Preinduction Examination Results

There was no change during this fiscal year in the medical, mental, or moral standards applied to the examination of selective service


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registrants for military service. The more rigid interpretation of medical standards instituted in 1959 continued. Despite this, however, current standards are more liberal, in certain respects, than those of

World War II. Specifically, maximum weight requirements have been liberalized, uncorrected distant visual acuity has been increased from a definite standard to any degree of uncorrected vision, and the standards for accepting psychoneurotics have been lowered. The underlying rationale regarding this latter category of individuals is that greater proficiency can be accomplished in appraising the fitness of these persons for military service if they are observed under military conditions.

Some 255,000 selective service registrants, sent by the local boards to AFES’s, were given a preinduction examination during the fiscal year—to determine their fitness for military service (table 8). This number exceeds by far the number of registrants processed for preinduction in the preceding (1960) fiscal year, though the number called for induction was lower in 1961 than in 1960 (table 9). This, seemingly, stems from a standing policy of the Selective Service System to build up and maintain a sufficient manpower pool of class I-A registrants examined and acceptable.

Of these examinees, 45.7 percent were determined unfit for military service. This disqualification rate is somewhat higher than in fiscal year 1960 (45.7 percent in 1961 versus 44.7 percent in 1960), due to the increase in disqualifications for mental reasons. Disqualification for medical reasons were lower in 1961 than in 1960 (20.8 percent in 1961 versus 22.9 percent in 1960).

There has been much misinterpretation of the disqualification data. These disqualification rates on preinduction examinations present, of course, only a partial picture, inasmuch as a certain proportion of those who qualify on preinduction examination are rejected for military service at the time of induction. When these additional disqualifications are taken into account, the total disqualification rate of registrants in fiscal year 1961 becomes 52.0 percent. Registrants processed for induction (draftees), however, represent only a segment of the total liable manpower pool. Many of those liable for military service fulfill their liability either by enlisting or by joining a Reserve program. A total of 359,524 individuals without prior military service enlisted in the Armed Forces in fiscal year 1961. These totals exclude individuals fulfilling their military obligation through some Reserve program (that is, National Guard, ROTC, and other Reserve programs). DOD has estimated that, by taking into account all segments of the manpower pool liable for military service, about one-third of this manpower


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TABLE 8.—Results of preinduction examinations of selective service registrants processed for military service, fiscal years 1958 through 1961


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TABLE 9.—Total calls for inductees, fiscal years 1958 through 1961

Month

1961

1960

1959

1958

July

6.000

8,000

10,000

13,000

August

7,000

7,000

10,000

11,000

September

8,000

7,000

11,000

8,000

October

9,000

9,000

11,000

7,000

November

7,000

9,000

11,000

7,000

December

8,000

9,000

11,000

7,000

January

6,000

7,000

9,000

10,000

February

3,000

6,000

9,000

13,000

March

2,500

6,000

8,000

13,000

April

1,500

6,000

7,000

13,000

May

---

6,000

6,000

13,000

June

---

5,500

6,000

10,000

    

Total

58,000

85,500

109,000

125,000

Source:  Annual Reports of the Director of Selective Service.

reservoir would currently be found disqualified for such service, including those in the manpower pool who are disqualified by the local boards.

During the fiscal year, DOD issued calls amounting to 58,000 inductees. A total of 60,293 registrants were actually inducted; practically all were assigned to the Army. The Navy, Marine Corps, and Air Force procured their manpower through enlistments alone. The 359,524 new enlistees were distributed as follows by Armed Forces: Army, 116,129; Navy, 94,178; Marine Corps, 30,454; and Air Force, 118,763.