ABERDEEN PROVING GROUND, Md. -- To ensure a healthy force, Army leaders need to know what ongoing health conditions are posing the greatest threat to their troops’ non-readiness.
In its last Health of the Force publication, the Army Public Health Center found that 15.8 million limited duty days were recommended for more than 188,000 active duty Soldiers in 2019. The medical restrictions resulting in limited duty may render Soldiers not ready to deploy.
“Leaders need to know not only what types of health conditions are experienced by the largest number of their Soldiers, but how many days Soldiers are typically out of commission or have duty restrictions,” says Matt Inscore, a senior epidemiologist for APHC’s Injury Prevention Branch.
To assess health care providers’ duty restriction recommendations for Soldiers with medical or behavioral conditions, Inscore and other epidemiologists at APHC use a software application within the Medical Operational Data System that gives electronic information on profiles.
Profiles are generated by medical and behavioral health providers to notify leaders of a Soldier's functional limitations. The profiles can be either temporary or permanent, and a Soldier can have multiple profiles for different conditions at the same time. Profiles are recommendations, and the ultimate decision as to a Soldier’s duties during any medically-recommended recovery period are determined by a commander.
The recent HoF report indicates that physical injuries and behavioral health conditions were the leading reasons for Soldier profiles. Together they resulted in almost 12 million limited duty days. All other causes, including pregnancy, eye, skin and pulmonary conditions, resulted in approximately 4 million limited duty days.
“Injuries were, far and away, the leading cause, affecting over 154,000 Soldiers and resulting in over 10.1 million limited duty days over the course of the year, which was 64 percent of all Army active duty limited duty days,” says Inscore.
The HoF report indicates an average injured Soldier’s experience is 66 limited duty days. The recovery period typically involves medical costs as well as lost training time and either temporary duty reassignment or physical restriction. The APHC has started to look at these costs as well. An article published in the June 2021 Medical Surveillance Monthly Report indicated that, for lower extremity fractures that occurred in 2017, total estimated costs were $116 million. Estimated costs of lost and limited duty time were four times greater than the medical care costs for these injuries.
Injuries affecting bones, muscles, tendons, and ligaments, referred to as musculoskeletal injuries, were the most common cause of active-duty Army injury profiles. Musculoskeletal injuries among Army Soldiers are primarily due to the cumulative damage caused by repetitive strain on tissues during activities such as running and long distance marches.
The HoF reported that among men, knee injuries accounted for the greatest proportion of Soldiers’ injury-related limited duty days. This was followed by injuries to the lower back, ankle, shoulder, and hip. Among women, hip injuries accounted for the most LDDs, followed by injuries of the lower back, knee, ankle, and shoulder. Together, injuries to these sites resulted in more than 6.1 million limited duty days.
Although fewer Soldiers received a profile for behavioral health conditions than for other injuries, the HoF reported that providers recommended an average of 87 limited days for those with a behavioral health profile. Annual medical reporting shows that BH conditions account for more inpatient treatment days than do other injuries, which are predominantly treated through outpatient visits. Adjustment disorders were the most common BH profile, followed by depressive disorders, substance use and treatment, PTSD, and anxiety disorders.
“We also know that people with chronic or severe injuries may be at higher risk for depression or other behavorial health conditions,” Inscore says.
In order to make the best decisions about their troops’ mission capabilities, leaders need to know not just the number of Soldiers on profile, but also the types of conditions, limitations, and expected recovery times, says Inscore.
To keep abreast of this information, commanders have access to the Commander's Dashboard and the Medical Protection System as well as the e-Profile system.
With their local medical support, such as a battalion physician assistant, leaders are responsible for e-Profile tracking. Ideally, leaders meet with the physician assistant monthly to discuss profile data and trends, specific Soldier profiles and mitigation strategies to reduce the impact of injury and behavioral health conditions among unit soldiers.
Inscore said that leaders should consider recommendations from their medical support to balance projected recovery times against mission requirements.
“In most cases, ‘limited duty’ doesn’t mean ’no duty,’ which is an important point,” says Inscore.
Inscore poses an example of a Soldier with a torn anterior cruciate ligament. An infantryman with this knee injury would not be able to participate in many of the physical training duties required for the Soldier’s military occupational specialty until fully rehabilitated. However, the same injury experienced by a Soldier assigned to duties behind a desk might only have 5 to 10 percent of duties temporarily limited. Then again, it doesn’t mean either would be deployable.
Inscore and other APHC experts recognize the significant impact temporary medical profiles have on readiness and offer subject matter expertise to help interpret eProfile data to provide leaders with the tools they need to effectively care for Soldiers and anticipate recovery needs in order to mitigate the impact of limited duty assignments.
The Army Public Health Center enhances Army readiness by identifying and assessing current and emerging health threats, developing and communicating public health solutions, and assuring the quality and effectiveness of the Army’s Public Health Enterprise.