Officials: Corps behind on health screenings
By Michael Hoffman - Staff writer
Posted : Sunday Jul 22, 2007 9:16:02 EDT

A year after launching a program to reassess the mental and physical health of Marines 90 days after they return from a deployment, less than a third of post-deployment Marines have taken the assessment, said a Navy mental health professional.

Now, Corps officials are hustling to boost the number who actually participate after multiple reports have proven the screening’s effectiveness, said Navy Capt. Amy Lindberg, director of the Post-Deployment Health Reassessment program for the Marine Corps.

Military medical officials say the reassessment is even more important than the initial Post-Deployment Health Assessment, since the later screening can catch long-term health problems such as post-traumatic stress disorder or chemical exposures to a Marine’s skin or lungs. The initial assessments are typically done within the first month after returning.

But two-thirds of Marines returning from deployment still haven’t received the reassessment, and Marine officials have taken notice, making it a priority by transferring the program’s office from the Navy Bureau of Medicine and Surgery to Marine Corps headquarters. The service also plans to send teams of health care professionals to units throughout the Corps by October to get as many active-duty leathernecks to take the reassessment as they can, Lindberg said.

“I think it’s a case where Marines just don’t know about it,” said Paul Bennett, the director of Marine Corps Manpower Information Systems, who oversees the program. “We’re just getting the word out now. Commanders were just not aware of the requirement.”

The Marine Corps launched the reassessment program — a medical screening done three to six months after a service member returns from a deployment — in accordance with a Defense Department directive in June 2006.

Since its inception, results from the 8,558 active-duty and 4,557 Reserve Marines who have taken the reassessment show the program is catching a number of medical problems that either were missed in the initial health screening or cropped up after it occurred.

After filling out the four-page survey and speaking with a health professional, 13 percent of active-duty and 49 percent of Reserve Marines received referrals for further medical attention, according to the Defense Medical Surveillance System report published July 9.

The survey said 30 percent of active-duty respondents and 40 percent of Reserve Marines reported concerns with their mental health. It also showed 14 percent of active Marines and 26 percent of reservists said they thought they were exposed to a harmful substance; while 26 percent of active and 46 percent of Reserve Marines reported injuries suffered during, or caused by the deployment.

Compared to the rest of the Defense Department, Marines received a smaller percentage of referrals; the other services averaged a 19 percent referral rate for active-duty troops and a 49 percent rate for reservists.

“We’re finding that the referral rate for further medical workup is twice as high as the first assessment,” said Dr. Michael Kilpatrick, the Defense Department’s deputy director for force health protection and readiness programs.

As more screenings are done in the coming months, Marine officials said they are anticipating a strain on medical resources with a rise on the number of referrals for ailments ranging from sore backs to PTSD cases. But Lindberg said she was confident the Corps has made the proper investment to handle it.

The Marine Corps got off to a slow start after the program launched when only 10 to 20 percent of leathernecks took part in the reassessment. This has brought down the current percentage of compliance “much like how a batting average for a baseball player suffers if he goes through a slump at the start of the season,” Kilpatrick said.

“While the Marine Corps has been closer to an 80 percent compliance rate recently, the slow start has kept the overall percentage low,” he said.

The Marine Corps is currently behind both the Army and Air Force when it comes to complying with the reassessment program. The Army does have a much larger force, but 121,157 soldiers have taken the reassessment thus far, according to the July report. The Air Force, which has a smaller force and deploys its people for shorter tours, has screened 37,983 airmen, according to the report. Only 13,115 Marines have completed the reassessment.

“It’s frustrating to see [the Army’s] perceived success,” Lindberg said. “We just didn’t have the tools, but now we have the resources to go along with the task.”

At first, the Marine Corps and Navy combined programs at BuMed like most of their health affairs. The Corps also didn’t have the computers and funding it has now for the teams of contracted medical personnel to ensure active-duty troops are taking part in the medical screening, Lindberg said.

“It was at the wrong office,” she said. “If it started where it is today under [Marine Corps Manpower and Reserve Affairs], we would have had better success. It was more clinically focused than operationally focused back then.”

Maj. Gen. Ronald Coleman, commander of Manpower and Reserve Affairs, has made this a priority for the Corps and will throw in any resources necessary to accomplish it, Bennett said. Coleman, however, could not be reached for comment by press time.

“If we cannot take care of the mental and physical side of a Marine, we can’t use them down the road,” Bennett said.

The reassessment is especially important for Reserve Marines who lose their full Tricare medical benefits six months after returning from deployment, said Col. Eric Peterson, who oversees the program for Marine Forces Reserve.

After the six-month window, reservists must depend on the Department of Veterans Affairs for their medical needs if they don’t use private medical insurance. Therefore, it’s important to have all medical claims documented by a health professional during these reassessments, Peterson said.

Medical officials across the board said reservists have a harder time readapting to “normal” life in the civilian world after a deployment.

“Reservists are isolated,” Lindberg said. “They don’t come back to a group of comrades that they can share their experiences with. Active duty returns to an environment that has constant health care and prevention.”

The active-duty plan was partially modeled after the way the Reserve pushes Marines through the screening process, she said.

Three months after a deployment, Reserve units fill out the reassessment survey and either make a team of contracted medical personnel available, or set up a call center that Marines use to go through the screening, Peterson said.

Once contracted teams of five medical personnel are dispersed through the Corps armed with computers to allow Marines to fill out the survey, Lindberg estimates it will take a six-month surge before it can catch up with the backlog of Marines who haven’t taken the reassessment. Kilpatrick pointed to the Army, which he said needed three months using these traveling medical teams to deal with its backlog.

“By this time next year, we hope to be at a steady state,” Lindberg said. “Once Marines realize that there is a difference between the [reassessment] and the [initial assessment], I think we’ll be OK.”

Ellie