In a memo sent to White House Press Secretary Jen Psaki, President Biden’s physician, Dr. Kevin O’Connor, detailed the results of his routine physical and colonoscopy on Friday.

“The President remains fit for duty, and fully executes all of his responsibilities without any exemptions or accommodations,” O’Connor said of the president, who turned 79 on Saturday.

In the six-page document, the doctor noted the “increasing frequency and severity” of Biden’s “’throat clearing’” while speaking. While he said Biden has been doing this for the 13 years he’s been under his care, it has gotten worse in recent months.