Returning to duty from temporary disability in the U.S. Army: observational data and commentary for commanders, providers, and soldiers.

Before 2011, Army commanders were unable to achieve complete visibility of soldiers possessing temporary medical limitations. The creation of time-limited definitions and technical categorization of this group, now known as the medically not ready (MNR) population, eventually allowed its quantification. With heightened visibility of the group, leaders in the Fort Stewart community facilitated its management through soldier medical readiness councils. In this commentary, we introduce a project that identified and tracked a cohort of 2,490 MNR soldiers for a 1-year period until they either recovered or entered the medical separation process. We identified that musculoskeletal injuries accounted for a heretofore unrecognized 87.4% majority of the MNR population. Prognosis of the MNR population was generally good. Fifty percent of the population returned to duty within 90 days of illness/injury. Seventy-seven percent returned to duty during the follow-up period. Although low back and knee/leg injuries were the largest contributors to the MNR population, low back issues were more likely to result in medical separation. Traumatic brain injury and post-traumatic stress disorder did not contribute significantly to the MNR population. This article seeks to describe the natural history of the MNR category of temporary disability for commanders, providers, and soldiers alike.

The effectiveness of Soldier Medical Readiness Councils in reducing and shaping the population of soldiers not medically deployable.

The population of Soldiers not medically fit for deployment has created readiness problems for the U.S. Army in recent years. To address this issue, the 3rd Infantry Division created councils of experts to address the size of its medically nondeployable population. Our results demonstrate success in effectively reducing the subpopulation of Soldiers who have been medically nondeployable for long periods of time by enforcing their return to duty or medical retirement. This study also demonstrates that council-based management affects the composition of the medically-not-ready population. Traditional approaches allow a minority subpopulation of Soldiers with poor prognoses to dwell within the nondeployable population for long periods of time (6-18+ months), whereas the healthier majority recovers within the first 6 months. This creates a dynamic in which remaining in the population for longer time periods increases the probability of being medically retired. Our study demonstrates that councils consistently and actively shape the character of the group such that those remaining in the medically-not-ready population for longer periods of time do not have an increased risk of medical retirement. Soldier Medical Readiness Councils have already been adopted by the Army. This article provides evidence to support their efficacy.