This paper examines the command framework and medical care responsibilities outlined in Army Regulation 600-20. It details how commanders authorize and oversee medical treatment, manage soldier refusal of mandatory care through medical board proceedings, and maintain command authority. The paper also explores the foundational principles of military command—including leadership climate, integrity, soldier development, and discipline—that enable commanders to fulfill their statutory responsibilities and maintain unit cohesion and mission readiness.
Soldiers on active duty (AD) or active duty for training (ADT) may be required to submit to medical care when necessary for survival, to reduce excessive suffering, or to preserve the health of others. Commanders may order medical examination of any soldier when deemed necessary. The medical treatment facility (MTF) commander determines whether hospitalization is appropriate. Emergency medical care necessary to save a soldier's life, fitness, or aptness for duty may be executed by the attending physician. If a soldier declines required treatment and the unit commander is not present, the hospital commander may mandate the treatment.
Commanders must ensure that soldiers understand the importance of both routine and theater-specific or threat-specific military immunizations. Immunizations required by Army Regulation (AR) 40-562 or other lawful ordinance may be given mandatorily. This authorization ensures the health and overall effectiveness of the command and protects soldiers who refuse endorsed medical care by placing them under medical review.
If soldiers refuse dental care or X-ray procedures deemed mandatory by the installation dental surgeon for creating dental and panoramic oral records, they may be referred to a medical board (Headquarters & Headquarters, Department of the Army, n.d.). This formal process ensures that refusal is not simply accommodated but rather examined through an official procedure with documented justification and opportunity for appeal.
The medical board proceeding's report must display the requirement and rationale for the suggested medical care that the soldier has refused. The report must show that the soldier was given the opportunity to appear in person and must specify whether the soldier's condition permitted attendance. The report must also demonstrate that the soldier was given the opportunity to submit a written statement explaining the basis for refusal. If any statement was submitted, it must be delivered with the report.
If any soldier is deemed incompetent, they may be assisted by a representative who may appear on their behalf. The representative need not be legally qualified. The soldier must be informed of the board's conclusions and instructed on whether the board has determined that the suggested medical care is required to preserve the soldier's well-being, protect the health of others, or enable the soldier to accomplish his or her duties appropriately (Headquarters & Headquarters, Department of the Army, n.d.).
The board findings must also state whether the suggested care will have a beneficial effect. Soldiers must be given the results of the board proceedings and afforded the opportunity to accept the recommended medical care. If the soldier does not accept, the MTF commander will direct the medical board proceedings to HQDA (DASG-HS-AS), 5109 Leesburg Pike, Falls Church, VA 22041-3258 for review.
When the reason to refuse is based on religion, the Surgeon General (TSG) will refer the proceedings to the Deputy Chief of Staff, G-1 for review and a recommended judgment before taking any action. The TSG will return the proceedings to the MTF commander after accepting or rejecting the medical board findings. If TSG approves the board proceedings, the soldier is again presented the opportunity to accept treatment. If the soldier continues to refuse, the MTF commander mentions the issue to the proper Special Court-Martial Convening Authority, with copies of the medical board proceedings delivered. If the Special Court-Martial Convening Authority orders the soldier to comply with treatment and the soldier does not obey, further military justice action may follow (Headquarters & Headquarters, Department of the Army, n.d.).
Command is exercised by virtue of office and the special obligation of members of the United States Armed Forces who hold the appropriate military grade and are qualified to exercise command. A commander is an appointed officer or warrant officer (WO) who exercises principal command authority over a military unit or approved geographical area designated as a "command" under relevant official directives. The authority to command is not limited by branch of service except as indicated in applicable regulations. Civilians may not exercise any command orders. The basic foundations of command are power and accountability. Formal authority for command originates from the strategies, processes, and standards presented in Army Regulation 600-20 and related directives.
The commander is responsible for establishing the leadership climate of the unit and developing well-organized and cohesive units. This establishes the boundaries within which command will be exercised and lays the foundation for professional and accountability relationships within the command. Professional development of soldiers is the commander's responsibility. Commanders must encourage self-study, professional development, and continued growth of their subordinates' military careers (Headquarters & Headquarters, Department of the Army, n.d.).
An optimistic command atmosphere is stimulated by commanders and other leaders who are sincere to the professional Army ethic. The loyalty of soldiers is earned by leaders who demonstrate loyalty toward the Army, the nation, and their soldiers. An energetic and positive command climate is produced when leaders consider soldiers' needs, show genuine concern for their well-being, and display authentic care for them. Soldiers who are responsible fulfill assigned tasks, seek opportunities to improve themselves, and accept responsibility from their leaders.
Soldiers—leaders and enlisted alike—work collaboratively to accomplish the mission rather than pursue self-interest (Headquarters & Headquarters, Department of the Army, n.d.). Truthfulness is a way of life. Established integrity is the foundation for reliable, consistent evidence, judgment, and delegation of authority.
Competent leaders will earn respect for their authority by working to develop, sustain, and employ the full range of human potential in their organization. This potential is essential to ensure that the organization is proficient to accomplish its mission. Leaders must provide soldiers with beneficial information on the requirements for and resolution of military discipline. Articles in the Uniform Code of Military Justice (UCMJ) requiring explanation should be presented so that soldiers are fully aware of the duties imposed on them by military service. Commanders must ensure proper training of soldiers and that both soldiers and equipment remain ready at all times. The command climate should be tested by commanders to assess the human dimension of battle readiness. The healthy leadership climate developed by commanders must help soldiers accomplish their mission through unit cohesion. Individual readiness is enhanced as leaders develop competence and confidence in subordinates. Soldiers must have confidence in themselves, their equipment, their peers, and their leaders, while remaining mentally, physically, tactically, and technically competent. A leadership climate where all soldiers are treated with fairness and equality is essential for developing soldier confidence. It is the commander's responsibility to develop well-organized and cohesive units maintained at the highest readiness level possible (Headquarters & Headquarters, Department of the Army, n.d.).
All commanding officers and others in authority in the Army must demonstrate high standards of character, integrity, loyalty, and duty; be alert in observing the conduct of all persons under their command; guard against and eliminate all immoral and corrupt practices; and correct, according to Army law and regulations, all persons who fall short of these standards. Commanders must take all necessary and appropriate actions under Army law, regulations, and values, and must stimulate and maintain the confidence, physical well-being, and general safety of the officers and enlisted personnel under their command or charge. Soldiers are assigned to stations or units where their services are needed. The commanding officer then allocates suitable duties (Headquarters & Headquarters, Department of the Army, n.d.).
Army and Marine Corps military police, Air Force security police, as well as members of the Navy and Coast Guard shore patrols are authorized and directed to arrest Armed Forces members who commit crimes punishable under the UCMJ. Warrant officers, officers, noncommissioned officers (NCOs), and petty officers of the Armed Forces are authorized and directed to suppress all disputes, fights, and disturbances among persons subject to military law and to detain participants. Those exercising this authority must do so with fairness and discretion. Personnel so arrested will be returned to the authority of their respective service as soon as possible. Confinement of females will comply with AR 190-47.
Commanders must ensure that there is a reasonable basis to believe that a felony has been committed and that the person identified committed it. Examples of proper grounds for action include recommendation of charges, imposition of non-judicial punishment, endorsement of separation from service, and judgment by a civilian court. When commanders receive legal evaluation of an investigation or inquiry and decide to take action against an offender regarding an incident, they will complete a DA Form 4833. The completed and signed form, along with supporting documents (such as records of the commander's inquiry, Article 15 proceedings, or court-martial paperwork), should be emailed to the supporting provost marshal office or defense examination section (PMO/DES). For commands not located on an installation or commands on a joint base, the supporting PMO/DES can be identified in AR 190-45 (Headquarters & Headquarters, Department of the Army, n.d.).
Participation in terrorist organizations and activities by Army personnel is incompatible with the responsibilities of military service. It is the policy of the United States Army to facilitate equal opportunity and fair treatment for all soldiers without regard to race, color, religion, gender, or national origin. It is the command's responsibility to enforce this policy, which is essential for unit cohesion and morale and is necessary for the Army to accomplish its mission.
It is the commander's duty to uphold good order and discipline in the unit. Every commander possesses the inherent authority to take appropriate actions to achieve this objective (Headquarters & Headquarters, Department of the Army, n.d.).
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