Risk factors for medical disability in U.S. enlisted marines: Fiscal years 2001 to 2009

Objective: To assess factors associated with medical disability in the U.S. Marine Corps. Methods: Case-control study enrolling 11,554 medical disability cases of U.S. enlisted Marines referred to the Physical Evaluation Board fiscal year 2001 to 2009 and 42,216 controls frequency matched to cases in a 4:1 ratio on year of accession into the service were analyzed utilizing bivariate and multivariate logistic regression analysis. Results: Increased age and body mass index at accession were associated with higher odds of medical disability. Females (odds ratio adjusted [OR^adj] = 1.3, 95% confidence interval [CI] = 1.2-1.3) have higher odds of disability than males. "Healthy Warrior Effect" was observed in that those who deployed (OR^adj = 0.48, 95% CI = 0.46-0.50) had decreased odds of medical disability than those who did not deploy. Medical waivers at accession (OR^adj = 1.12, 95% CI = 1.01-1.23) increased the odds of medical disability. Conclusions: Continued surveillance of the disability evaluation system is needed to help develop preventive measures and to help policy makers establish evidence-based policies on accession, deployment, and retention standards over the lifecycle of service members.