One of our attendings, now out of the Navy, allegedly deliberately failed 3 consecutive PRTs to see what would happen (specifically, would they kick him out despite his ADSO). To hear his description, other than some mandatory remedial group PT, which he was rapidly excused from when it was obvious he was not really out of standards, there were no repercussions.
When I was promoted to O4, the silly command checklist signature scavenger hunt paper I had to get checked off included a stop at command fitness. Presumably if I'd failed the most recent PRT it could have affected my promotion. I'm not sure how - I'd already retaken the oath of office, picked up a new ID card, and the DFAS/pay changes were automatic. I'm skeptical that the command CO has veto authority over the selection board and the United States Congress. No doubt he could hold up an E3's promotion to E4 over a PRT, but I've never heard of an officer having a promotion rescinded because of a failure.
Fitrep bullets are mostly fluff. The O4 promotion is automatic, provided you've got a pulse and haven't been convicted of any felonies. I know lots of physicians have failed PRTs, but nearly everyone gets selected to O4. If you're up for O5, fitreps matter, and I guess a fail could hold things up, but I doubt that a good vs weak passing PRT score would affect selection.
My impression is that for physicians a failed PRT is more of a beaurocratic hassle involving scolding emails than a career problem.
