Military Disability System:

Increased Supports for Servicemembers and Better Pilot Planning Could Improve the Disability Evaluation Process

GAO-08-1137: Published: Sep 24, 2008. Publicly Released: Sep 24, 2008.

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In February 2007, a series of articles in The Washington Post about conditions at Walter Reed Army Medical Center highlighted problems in the military's disability evaluation system. Subsequently, the Department of the Army, Department of Defense (DOD), and Department of Veterans Affairs (VA) undertook initiatives to address concerns with the disability evaluation process. In 2007, the Army took steps to streamline its process, and DOD and VA began piloting a joint evaluation system to address systemic concerns about timeliness and the potential inefficiency of having separate disability evaluation systems. GAO was asked to examine (1) recent actions by the Army to help servicemembers navigate its disability evaluation process and (2) the status, plans, and challenges of DOD and VA's efforts to pilot and implement a joint disability evaluation system. GAO interviewed Army, DOD, and VA officials; visited Army treatment facilities; and reviewed data from these sources.

The Army has taken a number of steps to help servicemembers navigate the disability evaluation process through additional support mechanisms and streamlining efforts, but faces challenges in meeting internal goals and demonstrating impact. Most significantly, the Army has begun hiring more staff to facilitate the process for servicemembers, such as legal personnel, and setting staffing goals for key positions, such as for board liaisons and physicians. However, the Army has not met its internal staffing goals for board liaisons and physicians, and continues to face shortages in legal personnel. The Army has also struggled to meet timeliness goals for case processing and has even experienced negative trends over the last year, despite streamlining initiatives. Furthermore, the Army faces particular challenges in meeting timeliness goals for completing reservists' evaluations, due in part to the challenge of obtaining complete personnel and medical documents from nonmilitary sources. Besides staffing initiatives, the Army has also taken steps to help servicemembers better understand and navigate the process. However, we found that these efforts varied by location, and that many servicemembers we spoke with were unaware of the availability of expert legal counsel. To increase transparency of the disability process, one location we visited afforded servicemembers the opportunity to have the written summary of their medical conditions explained to them, but not all Army locations have adopted this practice. In general, the Army faces challenges in demonstrating that its efforts to date have had an overall positive impact on servicemembers' satisfaction, because it has not implemented a survey that adequately targets and queries servicemembers who are undergoing disability evaluations. Under direction from the agencies' joint Senior Oversight Committee, DOD and VA moved quickly to design and pilot a joint disability evaluation process, but gaps remain in their plans to evaluate the pilot and potentially implement a joint process on a larger scale. DOD and VA have established a comprehensive mechanism for measuring key aspects of the pilot. However, they have not yet decided on criteria for determining whether the joint process is worthy of widespread implementation. In addition, although DOD and VA are in the process of developing surveys to measure servicemember and stakeholder satisfaction, sufficient comparative data on servicemember satisfaction may not be available when the pilot is scheduled to end. DOD and VA are also in the process of tracking challenges that have arisen in implementing the pilot, but they have not yet resolved several challenges associated with expanding the joint process if the pilot is deemed successful. Such challenges include determining who will perform the single physical examination when a VA medical center is not nearby. Beyond these concerns, DOD and VA may ultimately need to prepare for challenges that come with implementing large-scale system changes--such as those envisioned by the pilot. These challenges include sustaining management attention to ensure that the changes are implemented well and are producing the intended results. However, the Senior Oversight Committee's planned January 2009 end raises questions about whether management attention will be maintained over the long term.

Status Legend:

More Info
  • Review Pending-GAO has not yet assessed implementation status.
  • Open-Actions to satisfy the intent of the recommendation have not been taken or are being planned, or actions that partially satisfy the intent of the recommendation have been taken.
  • Closed-implemented-Actions that satisfy the intent of the recommendation have been taken.
  • Closed-not implemented-While the intent of the recommendation has not been satisfied, time or circumstances have rendered the recommendation invalid.
    • Review Pending
    • Open
    • Closed - implemented
    • Closed - not implemented

    Recommendations for Executive Action

    Recommendation: To ensure that pilot evaluation and any large-scale implementation of the joint disability process is done successfully, DOD and VA should sustain collaborative executive focus on the pilot and retain knowledgeable staff by, for example, continuing the agencies' joint Senior Oversight Committee or transferring the responsibilities to an equally staffed structure with the same level of executive commitment.

    Agency Affected: Department of Veterans Affairs

    Status: Closed - Implemented

    Comments: DOD and VA have sustained joint, executive level focus on the disability evaluation system through its Senior Oversight Committee, which is chaired by the Deputy Secretary of VA and the Deputy Secretary of DOD, and meets regularly to review performance metrics of the joint disability evaluation system.

    Recommendation: To help reduce delays in medical evaluation board (MEB) case processing due to shortages of board physicians and caseload surges at particular treatment facilities, the Secretary of Defense should direct the Secretary of the Army to consider developing more mobile units of medical board staff, including physicians who could be flexibly deployed to treatment facilities where servicemembers are experiencing case processing delays.

    Agency Affected: Department of Defense

    Status: Closed - Implemented

    Comments: Identification of and development of a management plan for potential surges is part of the certification process that Military Treatment Facilities and their VA counterparts complete for IDES. (August 2011)

    Recommendation: To address the disparity in timeliness of MEB and physical evaluation board (PEB) case processing for reservists compared with active-duty servicemembers, the Secretary of Defense should direct the Secretary of the Army to explore approaches to improving reservists' case development, such as ensuring adequate documentation of their military duties and medical conditions.

    Agency Affected: Department of Defense

    Status: Closed - Implemented

    Comments: The Army is exploring the effectiveness of new entities to improve the provision of required documentation for reservists' disability evaluations.

    Recommendation: To further reduce servicemember confusion about and distrust of the disability evaluation process, the Secretary of Defense should direct the Secretary of the Army to explore more widespread implementation of promising practices for ensuring that servicemembers understand their rights to and are aware of the availability of legal counsel during the disability evaluation process, such as having legal counsel present at in-briefings where feasible.

    Agency Affected: Department of Defense

    Status: Closed - Implemented

    Comments: In 2010, the Army developed a policy to require legal counseling so that service members understand their rights to and are aware of the availability of legal counsel throughout the disability evaluation process.

    Recommendation: To further reduce servicemember confusion about and distrust of the disability evaluation process, the Secretary of Defense should direct the Secretary of the Army to explore more widespread implementation of promising practices for improving each servicemember's understanding and acceptance of the written summary of medical conditions that underlies his or her disability evaluation, such as affording servicemembers an opportunity to review the summary with the physician who prepared it before the summary is finalized.

    Agency Affected: Department of Defense

    Status: Closed - Implemented

    Comments: The Army developed policy such that all narrative summaries are reviewed by a physician with the service member and/or service member's family member. During the review, participants' questions or concerns are addressed. The Warrior Transition Command has been conducting inspections to ensure that the policy is being consistently met.

    Recommendation: To help the Army assess the effectiveness of its outreach and supports available to servicemembers undergoing disability evaluations, the Secretary of Defense should direct the Secretary of the Army to administer existing surveys to a representative sample of servicemembers undergoing the MEB and PEB processes, and consider developing additional questions to better assess outreach and support provided by Army legal staff throughout the process.

    Agency Affected: Department of Defense

    Status: Closed - Implemented

    Comments: The Army has included questions regarding the effectiveness and usage of legal supports in its new Integrated Disability Evaluation System (IDES) survey. The survey is given to all service members who are going through the IDES.

    Recommendation: To ensure that the evaluation of the DOD-VA pilot process is sound, and that any decisions on large-scale implementation of it are well-founded, DOD and VA should develop complete plans to evaluate the pilot's success and guide potential large-scale expansion decisions. Such plans should include criteria for determining how much improvement should be achieved under the pilot on various performance measures--such as decision timeliness and servicemember satisfaction--to merit implementing the joint process throughout DOD and VA.

    Agency Affected: Department of Defense

    Status: Closed - Not Implemented

    Comments: DOD and VA have moved beyond piloting a joint disability evaluation system. A joint system now exists throughout DOD and VA. However, DOD and VA did not develop complete plans to evaluate the pilot's success and guide expansion decisions. According to DOD and VA's July 2009 updates, the agencies were using a balanced score card approach to measure the effectiveness of the pilot. However, the balanced score card did not indicate how the agencies planned to apply the various performance measures to determine whether the pilot was worthy of widespread implementation throughout DOD and VA. For example, it was unclear if all performance measures had to demonstrate positive change (i.e., be green) for the pilot process to be implemented throughout the agencies.

    Recommendation: To ensure that the evaluation of the DOD-VA pilot process is sound, and that any decisions on large-scale implementation of it are well-founded, DOD and VA should develop complete plans to evaluate the pilot's success and guide potential large-scale expansion decisions. Such plans should include criteria for determining how much improvement should be achieved under the pilot on various performance measures--such as decision timeliness and servicemember satisfaction--to merit implementing the joint process throughout DOD and VA.

    Agency Affected: Department of Veterans Affairs

    Status: Closed - Not Implemented

    Comments: According to DOD's July 2009 update, sufficient plans exist through DOD and VA's Line of Action 1 balanced score card which includes criteria for determining the worthiness of the pilot. According to VA's July 2009 update, the agencies "continue to use the balanced scorecard methodology and surveys to measure the effectiveness of the Pilot." However, the balanced score card does not indicate how the agencies plan to apply the various performance measures to determine whether the pilot is worthy of widespread implementation throughout DOD and VA. For example, it is unclear if all performance measures have to demonstrate positive change (i.e., be green) for the pilot process to be implemented throughout DOD and VA.

    Recommendation: To ensure that pilot evaluation and any large-scale implementation of the joint disability process is done successfully, DOD and VA should sustain collaborative executive focus on the pilot and retain knowledgeable staff by, for example, continuing the agencies' joint Senior Oversight Committee or transferring the responsibilities to an equally staffed structure with the same level of executive commitment.

    Agency Affected: Department of Defense

    Status: Closed - Implemented

    Comments: DOD and VA have sustained joint, executive level focus on the disability evaluation system through its Senior Oversight Committee, which is chaired by the Deputy Secretary of VA and the Deputy Secretary of DOD, and meets regularly to review performance metrics of the joint disability evaluation system.

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