Previous CSG South Policy Analysts Present on Felony Murder Statutes to Tennessee Senate Judiciary Committee
Military 101: The U.S. Public Health Service Commissioned Corps
USPHS Commissioned Corps provides medical services at Task Force Holloman [Image 2 of 2]
HOLLOMAN AIR FORCE BASE, NEW MEXICO, UNITED STATES
10.07.2021
Photo by Pfc. Anthony Sanchez
By Morgan Thomas, Policy Analyst
When people think of the U.S. Military, they often consider the U.S. Armed Forces, which consists of the U.S. Air Force, U.S. Army, U.S. Marine Corps, U.S. Navy, U.S. Space Force and the U.S. Coast Guard . However, armed forces are only one component of the U.S. Uniformed Services.
In total, there are eight U.S. Uniformed Services, including six branches of the U.S. Armed Forces, the U.S. Public Health Service (USPHS) Commissioned Corps and the National Oceanic and Atmospheric Administration (NOAA) Commissioned Officer Corps.
In contrast to the armed forces, the USPHS Commissioned Corps is an all-commissioned officer corps, meaning that there are no enlisted or warrant officer personnel, and every service member has at least a bachelor’s degree. Officers of the USPHS Commissioned Corps are uniformed service members commissioned by the President of the United States and supervised and directed by the Secretary of Health and Human Services. Their aim is to protect citizens domestically and abroad.
Mission
The mission of the USPHS Commissioned Corps is to “protect, promote, and advance the health and safety of our Nation.” The USPHS Commissioned Corps achieves this through rapid and effective response to public health needs, leadership and excellence in public health practices, and advancement of public health science. The USPHS Commissioned Corps provides essential healthcare services, leads public health programs and deploys during public health emergencies.
History
The U.S. Public Health Service Corps’ origins date back to 1798, when Congress passed the Act for the Relief of Sick and Disabled Seamen, which established hospitals for civilian merchant sailors. In 1871, locally controlled marine hospitals were placed under the control of a newly established Marine Hospital Service headquarters in Washington, D.C, led by the Supervising Surgeon (later known as the Surgeon General), Dr. John Maynard Woodworth. The newly centralized Marine Hospital Service fell under the Department of the Treasury and began to expand to include collecting health statistics and researching infectious diseases. In 1889, a law created a commissioned officer corps in the Marine Hospital Service. This law established a mobile corps subject to duty anywhere upon assignment, codifying a policy that had been in effect in the Marine Hospital Service since Dr. Woodworth’s appointment.
In 1902, the Service’s scope expanded, and its name changed to the Public Health and Marine Hospital Service, with officers serving as physicians, administrators and other medical professionals in the Public Health Service (PHS) hospitals and performing immigrant screenings at ports of entry, such as Ellis Island.
The USPHS Commissioned Corps was designed to be a cadre of medical officers who would serve as the primary personnel to carry out the PHS’s health and medical missions. In 1912, legislation changed the name of the Public Health and Marine Hospital Service to the Public Health Service and broadened the PHS research program to include “diseases of man,” including contagious diseases like tuberculosis and influenza, and contributing factors such as pollution of navigable streams. A reserve corps was created in 1918 in response to the influenza pandemic. Additionally, officers of the USPHS Commissioned Corps became responsible for serving veterans until the creation of the Veterans’ (VA) Hospital system in 1922, as the PHS hospitals were the predecessors of the VA hospitals. The Public Health Service Act of 1944 consolidated many existing health services under the Federal Security Agency, a predecessor to the Department of Health and Human Services. Further, the act expanded the role of the USPHS Commissioned Corps in various health-related areas, such as medical research, health education and environmental health protection, which also authorized a broader subset of medical and public health disciplines to be commissioned in the Service.
By the late 20th century, the USPHS Commissioned Corps had extended its work internationally, dealing with public health challenges like smallpox, HIV/AIDS, malaria, Ebola and other emerging infectious diseases. USPHS Commissioned Corps epidemiologist and physician, Joseph Goldberger, was famously credited for discovering the link between pellagra and dietary deficiencies. Public Health Service officers also deployed alongside Department of Defense personnel in Iraq and Afghanistan to assist with quarantine and infrastructure needs, in addition to assisting with humanitarian missions on the USNS Mercy and USNS Comfort. Today, the USPHS Commissioned Corps serves more than 800 locations in over 20 federal departments globally and is trained to respond to urgent public health crises. The USPHS Commissioned Corps works closely with agencies such as the Centers for Disease Control and Prevention, National Institutes of Health, and the Food and Drug Administration and even assists with humanitarian missions for the Red Cross and the Department of Defense.
In 2019, the USPHS Commissioned Corps developed a working relationship with the National Guard. The symbiotic relationship of the USPHS Commissioned Corps and the National Guard Bureau is designed to provide training and technical assistance across all 50 states to enhance disaster preparedness during a domestic emergency, such as hurricanes and wildfires.
Structure
The USPHS Commissioned Corps does not have the same structure as the other uniformed services. Instead, the USPHS Commissioned Corps is comprised of public health professionals and is organized to align with its public health mission. While it is a uniformed service, its structure focuses on functional and administrative roles within the Department of Health and Human Services and other public health agencies. Some of the main agencies under the Department of Health and Human Services that the USPHS Commissioned Corps serve in are the:
- Centers for Disease Control and Prevention
- National Institutes of Health
- Food and Drug Administration
- Health Resources and Services Administration
- Indian Health Service
- Substance Abuse and Mental Health Services Administration
- Administration for Children and Families
- Center for Medicare & Medicaid Services
- Administration for Strategic Preparedness and Response
- Advanced Research Projects Agency for Health
The Assistant Secretary for Health administers the USPHS Commissioned Corps, under the supervision of the Health and Human Services Secretary. The Assistant Secretary for Health serves as the highest-ranking officer in the USPHS Commissioned Corps and reports directly to the Health and Human Services Secretary. The Surgeon General, the second highest ranking officer, is responsible for the supervision of activities relating to the day-to-day operations of the USPHS Commissioned Corps. The Surgeon General serves as “America’s Doctor,” who is responsible for public health leadership, communication and advises the President and other government officials on matters of public health.
Rank
The USPHS Commissioned Corps is a sea service and thus follows the same rank structure as the U.S. Navy, the U.S. Coast Guard and the NOAA Commissioned Officer Corps. The rank structure for sea service officers is as follows:
Officer Ranks:
Ensign (O-1) – gold bar
Lieutenant Junior Grade (O-2) – silver bar
Lieutenant (O-3) – two silver bars
Lieutenant Commander (O-4) – gold oak leaf
Commander (O-5) – silver oak leaf
Captain (O-6) – silver eagle
Rear Admiral Lower Half (O-7) – silver star
Rear Admiral Upper Half (O-8) – 2 silver stars
Vice Admiral (O-9) – 3 silver stars
Admiral (O-10) – 4 silver stars
The Assistant Secretary for Health holds the rank of Admiral, while the Surgeon General holds the rank of Vice Admiral
Statutory Obligations
As prescribed by statute, the USPHS Commissioned Corps has statutory obligations to serve:
The U.S. Coast Guard (provide medical care)
42 U.S. Code § 253
NOAA Commissioned Corps (provide medical care)
42 U.S. Code § 253
Immigrants/Aliens (Disease mitigation)
42 U.S. Code § 252
The Federal Bureau of Prisons (provide medical care)
42 U.S. Code § 250
Quarantined Individuals (Disease mitigation)
42 U.S. Code § 249
Additionally, the Health and Human Services Secretary is statutorily mandated to provide health promotion and disease prevention services to American Indian/Alaska Native Tribes and Tribal organizations to achieve their health status objectives.
Indian Health Service
25 U.S. Code § 1621b
Lastly, in 2003, the Indian Health Service and VA began sharing medical facilities and services as part of an agreement required by the Indian Health Care Improvement Act (IHCIA). The Patient Protection and Affordable Care Act of 2010 permanently authorized the arrangement, allowing IHS to share facilities with American Indian/Alaska Native Tribes and Tribal organizations and the VA, thus prompting the USPHS Commissioned Corps to serve within the VA.
Veterans Health Administration
IHCIA (Public Law 94-437)
Jobs
Career paths in the USPHS Commissioned Corps are assigned differently than in other uniformed services. Since every member of the USPHS Commissioned Corps holds at least a bachelor’s degree, they are directly commissioned as officers upon joining. Unlike members of the armed forces, who take the Armed Services Vocational Aptitude Battery, USPHS officers are assigned jobs based on their professional education, training and experience in a relevant medical field. Job placements depend on the individual’s professional background and current organizational vacancies.
After successfully completing screening at the Military Entrance Processing Station, new officers attend an Officer Basic Training Course in the Greater Washington, D.C., area. Assignments are typically within one of the 13 operating divisions of the Department of Health and Human Services, with positions available for a wide range of public health professionals, including physicians, dentists, nurses, pharmacists, dietitians, engineers, environmental health officers, scientists, veterinarians and more. These roles exist as both active duty and reserve positions. Due to USPHS officers’ unique public health and disaster care capabilities for vulnerable and underserved populations, there is a growing number of USPHS officers who are detailed to the Department of Defense, the Department of Homeland Security and NOAA Commissioned Officer Corps.
Challenges in Accessing State Benefits and Protections
The USPHS Commissioned Corps is a federally recognized uniformed service, which entitles them to federal benefits, including Department of Veterans Affairs benefits and voting protections under the Uniformed and Overseas Citizens Absentee Voting Act. However, the USPHS Commissioned Corps and the NOAA Commissioned Officer Corps are often overlooked in policy discussions regarding military and veterans’ affairs among states. This is primarily due to the common use of terms like military or armed forces in state legislation, which can unintentionally exclude members of these two uniformed services from accessing state benefits and protections. To address this, state statutes should consider using the term uniformed services or expanding the definition of armed forces within their state to recognize all uniformed service personnel as veterans and extend state-level benefits to them. In 2014, Ohio updated its definition of the armed forces to include officers of the USPHS Commissioned Corps. Maryland also updated its definition of a veteran to entitle any member of the USPHS Commissioned Corps to access state veterans’ programs.
Historically, some states’ administrative processes prevented members of the uniformed services from accessing VA benefits. While Title 10 and Title 38 section 101 use the term uniformed services, which includes the USPHS Commissioned Corps and NOAA Commissioned Officer Corps, to define and grant federal statutory veterans’ rights, many state-level veteran benefits are out of reach due to antiquated definitions of “veteran” within state laws. Additionally, some states require a DD-214 form as proof of active-duty service to entitle them to state veterans’ benefits. Historically, USPHS Commissioned Corps officers did not receive a DD-214. However, as of 2021, officers are receiving a DD-214, replacing the previously used Statement of Service (Form PHS-1867 or Form PHS 2893), which helps them qualify for state and federal VA benefits. This move has allowed greater access to VA benefits such as healthcare, mental health services, education benefits and more.
Each uniformed service brings unique expertise to the collective defense of the Nation, and the USPHS Commissioned Corps plays a critical role through its leadership in medical and scientific response. Using a broader term, such as uniformed services or explicitly expanding the state’s definition of armed forces in state legislation, helps ensure that state benefits and protections extend to all service members.