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Aligning Recruiting Standards with Evolving Health Trends

By Master Sgt. Robert E. Eichelberger

Class 74, Sergeants Major Course

April 15, 2024

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Manhattan recruiters talk with a potential recruit on the streets of New York City

In 2023, Secretary of the Army Christine Wormuth said, “The number one priority, in my mind, for [2023] ... is fixing our recruiting problem” (Ware, 2023, p. 1). In a 2022 statement to the 117th U.S. Congress, Army strategic leadership stressed a need to adapt to recruiting efforts to posture for emerging societal shifts (McConville, 2022)

Two examples of American societal shifts are the expansion of attention-deficit/hyperactivity disorder (ADHD) cases and marijuana legalization at the state level (Asch et al., 2021).

"Army standards continue to stipulate that applicants who test positive for marijuana require a waiver to be eligible for enlistment, and applicants with a history of ADHD ... will not meet enlistment standards and might not even qualify for a waiver, depending on their specific case” (Asch et al., 2021, p. 219)

The Army requires applicants to meet medical fitness standards and complete a physical exam before enlisting. It must preserve force quality and exacting standards amid increased strategic recruiting emphasis. In the 2022 Call to Service to Overcome Recruiting Challenges, Army senior leadership said, “We will not lower our standards” (McConville & Wormuth, 2022, p. 2).

The Department of Defense (DOD) requires Secretary of the Army to ensure successful recruiting without lowering enlistment standards or recruit quality. The Army can improve recruiting performance without lowering standards by aligning medical fitness standards with societal health trends, specifically regarding ADHD and marijuana use. This practical solution provides a broader pool of qualified applicants without compromising force quality.


“The All-Volunteer Force is in a competition for talent” (McConville, 2022, p. 11).

The Army is losing the talent competition. It missed the 2022 fiscal year (FY) assigned mission by 20,844 enlistments (Department of Defense, 2022a). It is expected to miss the FY 23 assigned mission by approximately 25,000 enlistments (Department of Defense, 2023).

A multitude of factors impact the Army recruiting mission. Recruiting faces labor market, lack of awareness, and societal disconnect challenges (U.S. Army Recruiting Command [USAREC], 2023). Senior leadership is attacking recruiting challenges with innovative marketing strategies, recruiter incentives, and virtual recruiting efforts (McConville & Wormuth, 2022), but medical fitness policies remain unchanged.

The DOD provides service components with medical standards for military service in DOD Instruction 6130.03 (Department of Defense, 2022b). The volume assigns responsibility to service components to determine juvenile mental health and marijuana use (Department of Defense, 2022b).

54th Security Forces Assistance Brigade Soldiers use their operational experience to prepare a simulated casualty for medical evacuation during field operations

Army Regulation 40-501 is the primary U.S. Army medical fitness policy and covers medical background screening and Military Entrance Processing Station (MEPS) physical examinations (Department of the Army, 2019). The Secretary of the Army has approval authority for all updates to medical fitness standards when problems arise (Department of the Army, 2019).


The 2020 Army Vision guidance calls for the Regular Army to grow by 500,000 Soldiers by 2028 (Department of the Army, 2020a). However, it is on pace to fail the 2023 recruiting mission by 25,000 Soldiers and finish with an end strength of 473,000.

This downward recruiting trend requires a comprehensive review of recruiting operations and policies. A 2020 Pentagon Qualified Military Available Study reported 77% of Americans do not qualify for service (Novelly, 2022). The U.S. Office of People Analytics (OPA) further reports 60% of 17- to 24-year-old males do not meet medical fitness standards (Joint Advertising Market Research & Studies [JAMRS], 2023).

The U.S. Army’s medical fitness standards for enlistment effectively prevent more than two-thirds of Americans from enlisting. The critical areas of consideration for the medical fitness standards enlistment problem are efficient background screening, juvenile mental health history, and marijuana legalization.

Efficient Background Screening

Efficient medical background screening is essential to ensure recruit quality. The Military Health System Genesis (MHSG) became mandatory for MEPS background screening in February 2022 (MEPCOM, 2023). MHSG now provides potential recruits’ entire medical history, allowing for health-based enlistment decision-making.

The prevalence of ADHD diagnoses and marijuana use in recruit medical histories dramatically impacts medical processing. The Pentagon reported 17% of 2022 enlistments required waivers, an increase of six percent and 8,000 waivers overall from 2021 (Cohen, 2023).

The MHSG was an outstanding update to medical background screening. It effectively screens life-threatening health conditions such as heart disease and Human Immunodeficiency Virus (HIV). MHSG electronic health records also reflect juvenile mental health and marijuana legalization societal shifts.

Juvenile Mental Health

The recruitment target population ranges are from 17 to 24 (JAMRS, 2023).

Today, more than one out of every 10 American youths in that age range are diagnosed with ADHD (Bitsko et al., 2022). The U.S. Centers for Disease Control (CDC) report that 6.6 million American youths have ADHD (CDC, 2023).

A potential applicant gets drug tested through a urinalysis test

Army Regulation 40-501 states, “Current or history of attention deficit hyperactivity disorder is disqualifying” (Department of the Army, 2019, p. 50). However, many serving Soldiers seek treatment for ADHD and do not get medically separated. The most recent estimate of ADHD prevalence in the active component is 1.7 to 3.7 percent, a high end of 17,501 service members (Sayers et al., 2021).

The estimate was compiled before MHSG implementation and may logically increase parallels to medical waiver increases. The medical fitness standard for ADHD disqualifies an American population that shifted toward juvenile mental health treatment. The societal shift toward marijuana legalization is equally detrimental to the Army recruiting mission.

Marijuana Legalization

Marijuana is the most used federally illegal drug in the U.S. (CDC, 2023).

In a 2021 Monitoring the Future Survey, more than 30% of American high school students reported using marijuana in the past 12 months (Miech et al., 2023). Army Regulation 600-85 prohibits service member marijuana use (Department of the Army, 2020b).

Medical fitness standards apply to applicants before they enlist, and legal marijuana use routinely disqualifies law-abiding citizens. During initial screening by recruiters, marijuana use in the last 30 days temporarily disqualifies applicants.

Applicants must later undergo drug testing for marijuana metabolites per the DOD Drug Testing System. In California, for instance, potential recruits face disqualification when the MEPS-administered drug and alcohol test detects previous legal marijuana use. 74 percent of Americans live in an area with state-legalized marijuana (Schaeffer, 2023). The societal shift toward marijuana use creates a disconnect with Army medical fitness standards for enlistment.


U.S. Army strategic change leverages Doctrine, Organizations, Training, Materiel, Leader Development and Education, Personnel, Facilities, and Policy (DOTMLPF-P) integration (Department of the Army, 2021).

A review of medical fitness standards displays an opportunity to implement changes in the doctrine, training, and policy elements. The U.S. Army can feasibly align medical fitness policy with juvenile mental health and marijuana legalization without lowering standards using DOTMLPF-P.

Attention-Deficit/Hyperactivity Disorder

The Secretary of the Army can change Army Regulation 40-501 to allow applicants with a history of ADHD to complete successful academic or employment experience 12 months before enlisting.

The MHSG background screening process would find ADHD diagnoses and juvenile mental health issues. Each potential recruit would need to provide examples of successful experience, such as high school transcripts and work references. Recruiters could then make qualification determinations without disqualifying potential recruits during the initial screening process.

Removing ADHD disqualifications would immediately broaden the qualified pool of recruits, increase processing efficiency by removing waivers, and provide positive gains toward removing the stigma of mental health treatment in the Army. The Army can achieve these benefits without lowering standards or force quality.

Recent studies show people with ADHD typically thrive in the heavily structured and directive military environment (Bahn et al., 2018). Force resilience may improve as people with ADHD tend to show increased mindfulness and self-regulation compared to control populations (Asherson et al., 2018).

A medical fitness policy change as it pertains to legalized marijuana provides added opportunity for Army accessions.

Marijuana Legalization

Applicants who used marijuana 30 days before beginning the enlistment process are disqualified from enlistment (USAREC, 2022). The USAREC commander approves changes to USAREC doctrine and could remove this disqualification criteria for instances of legal marijuana use.

54th Security Forces Assistance Brigade Soldiers confronted multiple challenges to test their problem-solving abilities during a 48-hour field training exercise in Fort Moore, Georgia

The DOD drug testing program would test for illegal and illicit substances at MEPS, but with a policy adjustment that prevents legal marijuana use from disqualifying applicants. Once enlisted, Soldiers would still be required to adhere to Army Substance Abuse Program guidelines. Marijuana use in the Army is unauthorized, and violations are punishable under the Uniformed Code of Military Justice (UCMJ).

The National Center for Studies for Education Statistics (NCES) reports 15.4 million students attended public high school in 2021 (NCES, 2023). A medical fitness marijuana policy alignment would qualify approximately 30 percent of them, a total of 4,620,000 potential recruits. The U.S. Army can avoid lowering standards by allowing only legal marijuana use.

Recent studies show “recruits with a history of marijuana use were just as likely to complete their first term and make Sergeant, and less likely to leave the Army for health or performance reasons” (Asch et al., 2021, p. 1). The Army may also benefit from improved tracking and statistics reporting by incentivizing applicant transparency for those who used marijuana.

DOTMLPF-P Implementation

The proposed medical fitness policy change requires doctrine, training, and policy element integration. USAREC doctrine may support medical fitness policy changes by removing USAREC Manual 3-32 guidance to disqualify for marijuana use and ADHD diagnoses during initial screening.

USAREC makes rapid doctrine revisions by email, using the USAREC Message Portal. A USAREC message outlining policy changes and processing instructions may be issued instantly to the recruiting force, ensuring instant implementation.

Army doctrine and policy changes require training to ensure compliance and competence. Army recruiting leaders would be required to train the recruiting force on doctrinal changes as prescribed in training and leader development program regulations. Newly assigned recruiters would complete updated applicant screening training in the Army Recruiter Course.

The costs associated with medical fitness policy change are minimal due to current organizational and training infrastructure. The USAREC and MEPS facilities would not need to change during implementation. Army doctrine, training, and policy element integration would ensure successful medical fitness policy change implementation.


U.S. Army recruiting faces complex challenges in the talent competition. Senior leaders prioritize and tackle these challenges comprehensively. Recent annual recruiting shortcomings indicate the need to adjust and improve the strategic approach.

American society is consistently evolving, and the U.S. Army must remain flexible. It must exploit emerging trends to achieve mission accomplishment. By aligning medical fitness policies with the realities of ADHD diagnoses and marijuana legalization, the Army can broaden its recruit base without compromising force quality. The Army would improve recruiting performance without lowering standards by aligning medical fitness standards with societal health trends.

This proactive approach not only addresses ongoing recruiting shortfalls but also ensures the Army remains resilient and adaptable in the face of future societal shifts. As the Army navigates the complex recruiting landscape, embracing change in medical fitness standards stands as a testament to its ability to evolve with the times while safeguarding the nation’s defense and enhancing its national security capabilities.


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Master Sgt. Robert Eichelberger III is a Class 74 student at the Sergeant Majors Course, Fort Bliss, Texas. He has served in a variety of leadership assignments and positions over the past 18 years, ranging from team leader to company first sergeant. Eichelberger holds a master’s degree in human resources organizational development from the University of Louisville and is a Society for Human Resource Management Certified Professional.

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