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Ensure Consistent and Timely Outcomes for Reserve and Active Duty
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Report to Congressional Committees:
United States Government Accountability Office:
GAO:
March 2006:
Military Disability System:
Improved Oversight Needed to Ensure Consistent and Timely Outcomes for
Reserve and Active Duty Service Members:
GAO-06-362:
GAO Highlights:
Highlights of GAO-06-362, a report to congressional committees:
Why GAO Did This Study:
The House Committee on Armed Services report that accompanies the
National Defense Authorization Act of fiscal year 2006 directs GAO to
review results of the military disability evaluation system. In
response to this mandate, GAO determined: (1) how current DOD policies
and guidance for disability determinations compare for the Army, Navy,
and Air Force, and what policies are specific to reserve component
members of the military; (2) what oversight and quality control
mechanisms are in place at DOD and these three services of the military
to ensure consistent and timely disability decisions for active and
reserve component members; and (3) how disability decisions, ratings,
and processing times compare for active and reserve component members
of the Army, the largest branch of the service, and what factors might
explain any differences.
What GAO Found:
Policies and guidance for military disability determinations differ
somewhat among the Army, Navy, and Air Force. DOD has explicitly given
the services the responsibility to set up their own processes for
certain aspects of the disability evaluation system and has given them
latitude in how they go about this. As a result, each service
implements its system somewhat differently. Further, the laws that
govern military disability and the policies that DOD and the services
have developed to implement these laws have led reservists to have
different experiences in the disability system compared to active duty
members. For example, because reservists are not on active duty at all
times, it takes longer for them to accrue the 20 years of service that
may be needed to earn monthly disability retirement benefits.
While DOD has issued policies and guidance to promote consistent and
timely disability decisions for active duty and reserve disability
cases, DOD is not monitoring compliance. To encourage consistent
decision making, DOD requires all services to use multiple reviewers to
evaluate disability cases. Furthermore, federal law requires that
reviewers use a standardized disability rating system to classify the
severity of the medical impairment. In addition, DOD periodically
convenes the Disability Advisory Council, comprised of DOD and service
officials, to review and update disability policy and to discuss
current issues. However, neither DOD nor the services systematically
determine the consistency of disability decision making. DOD has issued
timeliness goals for processing disability cases, but is not collecting
information to determine compliance. Finally, the consistency and
timeliness of decisions depend, in part, on the training that
disability staff receive. However, DOD is not exercising oversight over
training for staff in the disability system.
While GAO’s review of the military disability evaluation system’s
policies and oversight covered the three services, GAO examined Army
data on disability ratings and benefit decisions from calendar year
2001 through 2005. After controlling for many of the differences
between reserve and active duty soldiers, GAO found that, among
soldiers who received disability ratings, the ratings of reservists
were comparable to those of active duty soldiers with similar
conditions. GAO’s analyses of the military disability benefit decisions
for the soldiers who were determined to be unfit for duty were less
definitive, but suggest that Army reservists were less likely to
receive permanent disability retirement or lump sum disability
severance pay than their active duty counterparts. However, data on
possible reasons for this difference, such as whether the condition
existed prior to service, were not available for our analysis. GAO did
not compare processing times for Army reserve and active duty cases
because GAO found that Army’s data needed to calculate processing times
were unreliable. However, Army statistics based on this data indicate
that from fiscal 2001 through 2005, reservists’ cases took longer to
process than active duty cases.
What GAO Recommends:
GAO recommends the Secretary of Defense improve oversight of the
military disability evaluation system, including providing guidance to
the services to collect reliable data to allow for an adequate
assessment of the system.
In its comments, the Department of Defense agreed with our
recommendations, indicating the department will implement them all.
www.gao.gov/cgi-bin/getrpt?GAO-06-362.
To view the full product, including the scope and methodology, click on
the link above. For more information, contact Robert E. Robertson at
(202) 512-7215 or robertsonr@gao.gov.
[End of section]
Contents:
Letter:
Results in Brief:
Background:
Military Disability Policies Differ among the Services, and Certain
Policies May Result in Different Experiences for Reservists:
DOD Has Guidance in Place to Promote Consistent and Timely Decisions,
but Does Not Adequately Oversee Key Aspects of the Disability System:
Disparities May Exist in Disability Benefits and Processing Times
between Army Reservists and Active Duty Soldiers, but Lack of Data
Prevents More Definitive Conclusions:
Conclusions:
Recommendations for Executive Action:
Response to Agency Comments:
Appendix I: Objective, Scope, and Methodology:
Appendix II: Selected Data from Service Branches on Processing Time,
Dispositions, and Medical Holdover:
Appendix III: Compilation of Differences in Regulations Governing the
Military Disability Evaluation System:
Appendix IV: Characteristics of Army Service Members Entering the DES:
Appendix V: Disability Evaluation Outcomes for Army Active Duty and
Reserve Component Members for 2001 to 2005:
Appendix VI: Comments from the Department of Defense:
Appendix VII: GAO Contact and Staff Acknowledgments:
Related GAO Products:
Tables:
Table 1: Military Disability PEB Caseload, Fiscal Year 2001 to 2005:
Table 2: Military Disability Funding Expenditures for Fiscal Year 2004:
Table 3: Post-PEB Appeals Process across the Services:
Table 4: Estimate of the Relationship between Being a Reservist and the
Final Disability Rating among Soldiers Receiving a Rating:
Table 5: Estimate of the Relationship between Being a Reservist and
Receipt of Benefits before and after Controlling for Other Factors
(among Those Unfit and Assigned a Final Disposition):
Table 6: Army Processing Times for Disability Cases, Including both MEB
and PEB Processing, Fiscal Year 2001 to 2005:
Table 7: Navy Processing Times for Disability Cases, Including Only PEB
Processing, Fiscal Year 2001 to 2005:
Table 8: Air Force Processing Times for Disability Cases, Including
Only PEB Processing, Fiscal Year 2001 to 2005:
Table 9: Final Dispositions Made by Navy PEB for Disability Cases,
Fiscal Year 2001 to 2005:
Table 10: Final Dispositions Made by Air Force PEB for Disability
Cases, Fiscal Year 2001 to 2005:
Table 11: Number of Army Reserve Component Members Entering Medical
Holdover by Year, Calendar Year 2001 to 2005:
Table 12: Occupational Codes for Services Members in Military
Disability Evaluation System, Calendar Years 2001 to 2005:
Table 13: Rank Groups by Component for Services Members in the Military
Disability System, Calendar Years 2001 to 2005:
Table 14: Descriptive Statistics on Disability Evaluation Outcomes for
Active Duty and Reserve Component Members in the Army, Calendar Years
2001 to 2005:
Table 15: Descriptive Statistics on Disability Evaluation Outcomes for
Active Duty and Reserve Component Members in the Army, Calendar Years
2001 to 2005:
Figures:
Figure 1: Decisions Made during the Military Disability Evaluation
Process:
Figure 2: Oversight of the Military Disability Evaluation Process
within the Department of Defense:
Figure 3: Yearly Percentage Change in PEB Caseload for Active Duty and
Reserve Component Soldiers, Calendar Years 2001 to 2005:
Figure 4: Ages of Active Duty and Reserve Component Soldiers Entering
the Disability Evaluation System, Calendar Years 2001 to 2005:
Abbreviations:
CBHCO: Community-Based Health Care Organization: DOD: Department of
Defense:
DES: disability evaluation system: DMDC: Defense Manpower Data Center:
FY: fiscal year:
GAO: Government Accountability Office: LOD: line of duty:
MEB: medical evaluation board: MEBITT: Medical Evaluation Board
Internal Tracking Tool: MMRB: Military Occupational Specialty/Medical
Retention Board: MTF: military treatment facility: OLS: ordinary least
squares: PDCAPS: Physical Disability Computer Assisted Processing
System: PEB: physical evaluation board: PEBLO: Physical Evaluation
Board Liaison Officer: SSA: Social Security Administration: TDRL:
temporary disability retired list: USMC: United States Marine Corps:
VA: Veterans Affairs:
VASRD: Veterans Administration Schedule for Rating Disabilities:
United States Government Accountability Office:
Washington, DC 20548:
March 31, 2006:
The Honorable John Warner:
Chairman:
The Honorable Carl Levin:
Ranking Minority Member:
Committee on Armed Services: United States Senate:
The Honorable Duncan L. Hunter: Chairman:
The Honorable Ike Skelton:
Ranking Minority Member:
Committee on Armed Services: House of Representatives:
In recent years, about 490,000 reserve members of the military have
been called to augment active duty military forces in conflicts and
peace-keeping missions in support of the Global War on Terrorism. About
110,000 mobilized reserve component members were on active duty on
January 31, 2006, down from about 174,000 the prior January. A number
of these service members get injured or develop temporary or permanent
disabilities related to their service, such as head, neck or spinal
injuries and psychological conditions such as post-traumatic stress
disorder.
The Department of Defense (DOD), through its disability evaluation
system, is responsible for determining if active and reserve service
members are unable to perform the military duties of their office,
grade, rank, or rating as a result of a diagnosed medical condition and
compensating those with service-incurred or aggravated injuries or
diseases that render them unfit for continued military service. One of
the primary goals of the military disability system is to ensure that
disability evaluations for all service members are conducted in a
consistent and timely manner. Each of the services administers its own
disability evaluation system and assigns a standardized severity
rating, from 0 to 100 percent, to each disabling condition, which along
with years of service and other factors, determines compensation.
Disability compensation may be in the form of lump sum payments or
monthly benefits, depending on the rating and years of service.
The House Committee on Armed Services report that accompanies the
National Defense Authorization Act of fiscal year 2006 directs GAO to
review results of the military disability evaluation system. In
response to this mandate, GAO determined: (1) how current DOD policies
and guidance for disability determinations compare for the Army, Navy,
and Air Force, and what policies are specific to reserve component
members of the military; (2) what oversight and quality control
mechanisms are in place at DOD and these three services of the military
to ensure consistent and timely disability rating and benefit decisions
for active and reserve component members; and (3) how disability rating
and benefit decisions, and processing times compare for active and
reserve component members of the Army, the largest branch of the
service, and what factors might explain any differences.[Footnote 1]
To address the first two objectives covering DOD and three branches of
the service, we reviewed relevant legislation, policy guidance, and
literature; interviewed officials from DOD, Army, Navy, Air Force,
Reserves, and National Guard; and visited Lackland and Randolph Air
Force Bases, Fort Sam Houston and Walter Reed Army Medical Center,
Washington Navy Yard and Bethesda Naval Hospital and interviewed
relevant officials.[Footnote 2] We chose these sites because the
services conduct physical disability evaluations at these locations. In
addition, we interviewed officials from military treatment facilities
(MTF), including Brooke Army Medical Center and Wilford Hall Medical
Center. We limited the scope of the third objective to the Army because
it currently processes the most military disability cases. To determine
if outcomes for active duty and reserve disability cases were
statistically consistent, we analyzed data provided by the Army. Based
on our assessment of the quality of the Army's data, we concluded that
data on disability determinations and ratings were sufficiently
reliable for our analyses. On the other hand, the Army's data on
processing times were not reliable for our analyses. Except for the
Army data used in our analyses, we did not test the reliability of
other data we received from the services and DOD. While GAO has noted
in its 21st Century Challenges report that eligibility criteria for
disability programs need to be brought into line with the current state
of science, medicine, technology and labor market conditions, this
study does not examine the basic eligibility criteria for military
disability benefits.[Footnote 3] We conducted our review from June 2005
through January 2006 in accordance with generally accepted government
auditing standards. A detailed description of our scope and methodology
is provided in appendix I.
Results in Brief:
There are differences in policies and guidance for disability
determinations, in general, among the Army, Navy, and Air Force. The
services' policies differ, in part because DOD has explicitly given the
services the responsibility to set up their own processes for certain
aspects of the disability evaluation system and has given them latitude
in how they go about this. For example, the services set different
qualifications for members of the medical disability decision making
boards. Further, the laws that govern military disability and the
policies that DOD and the services have developed to implement these
laws have led reservists to have different experiences in the system
compared to the active duty members. For example, because they are not
on active duty at all times, it takes longer for reservists to accrue
the 20 years of service that may be needed to earn monthly disability
retirement benefits. Moreover, unlike full-time active duty soldiers,
many mobilized Army reservists are assigned to special units while
being treated for medically limiting injuries or illnesses.
DOD has issued policies and guidance to promote consistent and timely
disability decisions for active duty and reserve disability cases, but
the agency is not monitoring compliance with these. To encourage
consistent decision making, DOD requires all services to use multiple
reviewers to evaluate disability cases. Furthermore, federal law
requires that the services use a standardized disability rating system
to classify the severity of the medical impairment. In addition, DOD
periodically convenes a Disability Advisory Council comprised of
service officials to review and update disability policy and to discuss
current issues. However, neither DOD nor the services systematically
analyze the consistency of decision making. Such an analysis of data
should be one key component of quality assurance. To ensure timely
disability case processing, DOD has issued timeliness goals for
processing all service members' cases. However, DOD is not collecting
available information on disability evaluation processing times from
the services to determine compliance, nor are the services ensuring
these data are reliable. Moreover, some military officials have
expressed concerns that the current goals may not be appropriate for
all cases. Finally, both the consistency and timeliness of decisions
depend, in part, on the training that disability officials receive.
Despite a regulation requiring DOD's Office of Health Affairs to
develop relevant training for disability staff, DOD is not exercising
oversight over training for staff in the disability system.
While our review of the military disability evaluation system's
policies and oversight covered three branches of the service, we most
closely examined data from the Army's disability evaluation process to
better understand how disability decisions and processing times compare
for reserve component and active duty soldiers. Our analyses of ratings
from the Army disability evaluation system from calendar year 2001 to
2005 indicated that, after taking into account many of the differences
between reserve and active duty soldiers, among soldiers who received
disability ratings, Army reservists received ratings comparable to
their active duty counterparts. The results of our analyses of military
disability benefit decisions for soldiers were less definitive, but
suggest that Army reservists with impairments that made them unfit for
duty were less likely to receive either permanent disability retirement
or lump sum disability severance pay than their active duty
counterparts. However, data on all possible reasons for this
difference, such as whether the condition existed prior to service,
were not available for our analysis. With regard to disability
evaluation processing times, we did not compare processing times for
Army reserve and active duty cases because we found that the data in
the Army's electronic database needed to calculate processing times
were unreliable. The Army's own statistics indicate that from fiscal
year 2001 through 2005, more than half of all reservists' cases took
longer than 90 days to process as compared to about one third of active
duty soldiers' cases.
We are recommending that the Secretary of Defense improve oversight of
the military disability system, evaluate the appropriateness of
timeliness standards for case processing, and assess the adequacy of
training for disability evaluation staff. DOD agreed with our
recommendations and stated that it is taking steps toward implementing
them.
Background:
As provided by the Career Compensation Act of 1949, as amended, service
members who become physically unfit to perform military duties may
receive military disability compensation under certain
conditions.[Footnote 4]
Compensation for disabilities can be in the form of monthly disability
retirement benefits or a lump sum disability severance payment,
depending on the disability rating and years of creditable
service.[Footnote 5] To qualify for monthly disability retirement
benefits, a service member with a permanent impairment that renders him
or her unfit for duty must have (1) at least 20 years of creditable
service or (2) a disability rating of at least 30 percent.[Footnote 6]
Service members with less than 20 years of creditable service and a
disability rating less than 30 percent receive a lump sum severance
disability payment.
Service members with service connected disabilities may also be
eligible for VA disability compensation. Until recently, this military
benefit was offset by any VA compensation received. However, the fiscal
year 2004 National Defense Authorization Act now allows some military
retirees to concurrently receive VA and military benefits.[Footnote 7]
Generally, military disability retirement pay is taxable. Exceptions
are (1) if the disability pay is for combat-related injuries or (2) if
the service member was in the military, or so obligated, on September
24, 1975.
The Disability Evaluation Process:
Each of the military services administers its own disability evaluation
process. According to DOD regulations, the process should include a
medical evaluation board (MEB), a physical evaluation board (PEB), an
appellate review process, and a final disposition. Each service member
should be assigned a Physical Evaluation Board Liaison Officer (PEBLO),
a counselor to help the service member navigate the system and prepare
documents for the PEB.
As shown in figure 1, there are a number of steps in the disability
evaluation process and several factors that play a role in the
decisions that are made at each step. There are four possible outcomes
in the disability evaluation system. A service member can be:
* found fit for duty;
* separated from the service without benefits--service members whose
disabilities were incurred while not on duty or as a result of
intentional misconduct are discharged from the service without
disability benefits;
* separated from the service with lump sum disability severance pay;
or:
* retired from the service with permanent monthly disability benefits
or placed on the temporary disability retired list (TDRL).
Figure 1: Decisions Made during the Military Disability Evaluation
Process:
[See PDF for image]
[End of figure]
Medical Evaluation Board:
The disability evaluation process begins at a military treatment
facility (MTF), when a physician identifies a condition that may
interfere with a service member's ability to perform his or her
duties.[Footnote 8] The physician prepares a narrative summary
detailing the injury or condition.[Footnote 9] DOD policy establishes
the date of dictation of the narrative summary as the beginning of the
disability evaluation process. This specific type of medical evaluation
is for the purpose of determining if the service member meets the
military's retention standards, according to each service's
regulations.[Footnote 10] This process is often referred to as a
medical evaluation board (MEB). Service members who meet retention
standards are returned to duty, and those who do not are referred to
the physical evaluation board (PEB).
Physical Evaluation Board:
The PEB is responsible for determining whether service members have
lost the ability to perform their assigned military duties due to
injury or illness, which is referred to as being "unfit for duty". If
the member is found unfit, the PEB must then determine whether the
condition was incurred or permanently aggravated as a result of
military service. While the composition of the PEB varies by service,
it is typically composed of one or more physicians and one or more line
officers. Each of the services conducts this process for its service
members. The Army has three PEBs located at Fort Sam Houston, Texas;
Walter Reed Army Medical Center in Washington, D.C; and Fort Lewis,
Washington. The Navy has one located at the Washington Navy Yard in
Washington, D.C. The Air Force has one located in San Antonio, Texas.
The first step in the PEB process is the informal PEB--an
administrative review of the case file without the presence of the
service member. The PEB makes the following findings and
recommendations regarding possible entitlement for disability benefits:
* Fitness for duty--The PEB determines whether or not the service
member "is unable to reasonably perform the duties of his or her
office, grade, rank, or rating," taking into consideration the
requirements of a member's current specialty. Fitness determinations
are made on each medical condition presented. Only those medical
conditions which result in the finding of "unfit for continued military
service" will potentially be compensated. Service members found fit
must return to duty.
* Compensability--The PEB determines if the service member's injuries
or conditions are compensable, considering whether they existed prior
to service (referred to as having a pre-existing condition) and whether
they were incurred or permanently aggravated in the line of
duty.[Footnote 11] Service members found unfit with noncompensable
conditions are separated without disability benefits.
* Disability rating--When the PEB finds the service members unfit and
their disabilities are compensable, it applies the medical criteria
defined in the Veterans Administration Schedule for Rating Disabilities
(VASRD) to assign a disability rating to each compensable condition.
The PEB then determines (or calculates) the service member's overall
degree of service connected disability. Disability ratings range from 0
(least severe) to 100 percent (most severe) in increments of 10
percent.[Footnote 12] Depending on the overall disability rating and
number of years of active duty or equivalent service, the service
member found unfit with compensable conditions is entitled to either
monthly disability retirement benefits or lump sum disability severance
pay.
In disability retirement cases, the PEB considers the stability of the
condition. Unstable conditions are those for which the severity might
change resulting in higher or lower disability ratings. Service members
with unstable conditions are placed on TDRL for periodic PEB
reevaluation at least every 18 months. While on TDRL, members receive
monthly retirement benefits. When members on TDRL are determined to be
fit for duty, they may choose to return to duty or leave the military
at that time. Members who continue to be unfit for duty after 5 years
on TDRL are separated from the military with monthly retirement
benefits, discharged with severance pay, or discharged without
benefits, depending on their condition and years of service.
Service members have the opportunity to review the informal PEB's
findings and may request a formal hearing with the PEB; however, only
those found unfit are guaranteed a formal hearing. The formal PEB
conducts a de novo review of referred cases and renders its own
decisions based upon the evidence. At the formal PEB hearing, service
members can appear before the board, put forth evidence, introduce and
question witnesses, and have legal counsel help prepare their cases and
represent them. The military will provide military counsel or service
members may retain their own representative. If service members
disagree with the formal PEB's findings and recommendations, they can,
under certain conditions, appeal to the reviewing authority of the PEB.
Once the service member either agrees with the PEB's findings and
recommendations or exhausts all available appeals, the reviewing
authority issues a final disability determination concerning fitness
for duty, disability rating, and entitlement to benefits.
Disability Evaluation System Caseloads:
In 2005, over 23,000 U.S. service members with physical injuries or
other conditions went through the military disability evaluation
system, according to DOD. In total, the Army, Navy, and Air Force
report evaluating over 90,000 PEB cases during the fiscal years 2001 to
2005. The Army represents the largest share of disability cases, with
Army reserve component members representing approximately 32 percent of
all Army cases in 2005 (see table 1). PEB disability caseloads for all
services have increased over time from about 15,000 in fiscal year 2002
to about 23,000 in fiscal year 2005.
Table 1: Military Disability PEB Caseload, Fiscal Year 2001 to 2005:
Service: Army: Active duty;
Number of service members: 2001: 6,627; Number of service members:
2002: 6,510; Number of service members: 2003: 6,659; Number of service
members: 2004: 7,694; Number of service members: 2005: 9,322.
Service: Army: Reserve component; Number of service members: 2001: 591;
Number of service members: 2002: 812; Number of service members: 2003:
1,546; Number of service members: 2004: 4,187; Number of service
members: 2005: 4,426.
Service: Navy: Active duty;
Number of service members: 2001: 4,620; Number of service members:
2002: 3,953; Number of service members: 2003: 3,814; Number of service
members: 2004: 4,889; Number of service members: 2005: 4,645.
Service: Navy: Reserve component; Number of service members: 2001: 379;
Number of service members: 2002: 413; Number of service members: 2003:
436; Number of service members: 2004: 543; Number of service members:
2005: 555.
Service: Air Force: Active duty; Number of service members: 2001:
2,376; Number of service members: 2002: 3,251; Number of service
members: 2003: 3,340; Number of service members: 2004: 3,525; Number of
service members: 2005: 3,610.
Service: Air Force: Reserve component; Number of service members: 2001:
441; Number of service members: 2002: 535; Number of service members:
2003: 633; Number of service members: 2004: 719; Number of service
members: 2005: 758.
Services: TOTAL;
Number of service members: 2001: 15,034; Number of service members:
2002: 15,474; Number of service members: 2003: 16,428; Number of
service members: 2004: 21,557; Number of service members: 2005: 23,316.
Source: Departments of the Army, Navy, and Air Force.
[End of table]
Military Disability Retirement Expenditures:
In fiscal year 2004, the military services spent over $1 billion in
disability retirement benefits for over 90,000 service members. See
table 2. This table does not include expenditures for lump sum
disability payments which DOD was unable to provide.
Table 2: Military Disability Funding Expenditures for Fiscal Year 2004:
Service: Army;
Temporary disability retirement: Dollars (in millions): $16.9;
Temporary disability retirement: Number of service members: 2,170;
Permanent disability retirement: Dollars (in millions): $432.3;
Permanent disability retirement: Number of service members: 34,372;
Total: Dollars (in millions): $449.2; Total: Number of service members:
36,542.
Service: Navy;
Temporary disability retirement: Dollars (in millions): $21.4;
Temporary disability retirement: Number of service members: 2,769;
Permanent disability retirement: Dollars (in millions): $379.1;
Permanent disability retirement: Number of service members: 30,831;
Total: Dollars (in millions): $400.5; Total: Number of service members:
33,600.
Service: Air Force;
Temporary disability retirement: Dollars (in millions): $4.1; Temporary
disability retirement: Number of service members: 399; Permanent
disability retirement: Dollars (in millions): $349.6; Permanent
disability retirement: Number of service members: 21,540; Total:
Dollars (in millions): $353.7; Total: Number of service members:
21,939.
Service: DOD (all);
Temporary disability retirement: Dollars (in millions): $42.4;
Temporary disability retirement: Number of service members: 5,338;
Permanent disability retirement: Dollars (in millions): $1,161.0;
Permanent disability retirement: Number of service members: 86,743;
Total: Dollars (in millions): $1,203.4; Total: Number of service
members: 92,081.
Source: DOD Office of the Actuary, Statistical Report FY 2004.
[End of table]
Oversight:
The Secretary of Defense oversees the military disability evaluation
system through the Under Secretary of Defense for Personnel and
Readiness.[Footnote 13] The Surgeons General for each service are
responsible for overseeing their service's MTFs, including the MEBs
conducted at each facility. The Deputy Under Secretary of Defense for
Military Personnel Policy has oversight of the PEBs, and also oversees
the Disability Advisory Council. The council is composed of officials
from DOD's offices of Military Personnel Policy, Health Affairs, and
Reserve Affairs, the services' disability agencies; and the Department
of Veterans Affairs. See fig. 2.
Figure 2: Oversight of the Military Disability Evaluation Process
within the Department of Defense:
[See PDF for image]
[End of figure]
Military Disability Policies Differ among the Services, and Certain
Policies May Result in Different Experiences for Reservists:
The policies and guidance for disability determinations for all service
members are somewhat different among the Army, Navy, and Air Force. DOD
has explicitly given the services the responsibility to set up their
own processes for some aspects of the disability system and has given
the services much room for interpretation. Each service has implemented
its system somewhat differently. For example, the composition of
decision making bodies differs across the services. Additionally, the
laws that govern military disability and the policies that DOD and the
services have developed to implement these laws have led to reserve
members having different experiences with the disability system than
active duty members. Some of these experiences result from the part-
time nature of reserve service while others are the consequence of
policies and laws specific to reservists.
DOD Policies and Guidance Allow Services to Implement the Disability
System Differently:
DOD regulations establish some parameters for the disability system and
provide guidelines to the services, and the services each have their
own regulations in accordance with these. Specifically, the aspects of
the system that differ among the services include: characteristics of
the medical evaluation board (MEB) and physical evaluation board (PEB),
the use of counselors to help service members navigate the system, and
procedures to make line of duty determinations. Appendix III provides a
compilation of these and other differences.
Medical Evaluation Boards:
DOD regulations require that each service set up MEBs to conduct
medical evaluations to determine if the service member meets retention
standards according to each service's regulations. The services carry
out MEB procedures differently. For example, the Air Force MEB convenes
an actual board of physicians who meet regularly and vote to decide
whether a service member meets retention standards. In the Army and
Navy, in contrast, the MEB is an informal procedure. A service member's
case file is passed among the board's members, who separately evaluate
it. In all of the services, the medical commander or his designee may
sign off on the final decision. The services also differ in the
qualifications and requirements for MEB board membership. The Army and
Navy require that at least two physicians serve on an MEB, while the
Air Force requires three.
Physical Evaluation Boards:
In accordance with DOD regulations, the military services have set up
PEBs to evaluate whether service members are fit for duty. DOD
regulations provide no guidance concerning how much time a service
member has to decide whether to accept the disability decision of his
or her informal PEB. Army provides service members 10 calendar days;
Navy provides 15 calendar days; and Air Force provides 3 duty days,
according to their regulations. Additionally, DOD regulations provide
that service members found unfit for duty by an informal PEB are
guaranteed the right to appeal to a formal PEB. However, service
members found fit are not guaranteed the right to appear before a
formal PEB.
While DOD regulations state that a service member has the right to
appeal the decision of a formal PEB, they do not state what this appeal
process should look like. The services differ in how many appeal
opportunities they offer service members after the formal PEB. For
example, the Navy and Air Force offer two opportunities for appeal
after the formal PEB. The Army also has two opportunities for appeal.
However, it also has the Army Physical Disability Appeal Board, which
provides appeal for only certain cases, for example, if the Army
Physical Disability Agency revises the finding of the PEB during a
quality or mandatory review and the soldier disagrees with the change
(see table 3).
Table 3: Post-PEB Appeals Process across the Services:
Military service: Army: 1st appeal; Appellate authority: Army Physical
Disability Agency.
Military service: Army: Additional appeal[A]; Appellate authority: Army
Physical Disability Appeal Board.
Military service: Army: Final appeal; Appellate authority: Army Board
for the Correction of Military Records.
Military service: Navy: 1st appeal; Appellate authority: Secretary of
the Navy Council of Review Boards.
Military service: Navy: Final appeal; Appellate authority: Board for
the Correction of Naval Records.
Military service: Air Force: 1st appeal; Appellate authority: Air Force
Secretary of the Air Force Personnel Council.
Military service: Air Force: Final appeal; Appellate authority: Air
Force Board of Correction of Military Records.
Source: DOD documents.
[A] Note: Applicable only to cases in which Army Physical Disability
Agency revises the PEB findings as part of a quality or mandatory
review and the soldier does not concur with the revised finding.
[End of table]
Further, the services also differ on whether they permit the same
members to sit on the informal and formal PEB of the same case. The
Army allows PEB members to do this while the Air Force only allows this
under certain circumstances. The Navy has no written policy on the
matter, although one official from the Navy PEB indicated that the
members of the two boards were often the same for a case.
Physical Evaluation Board Liaison Officers:
The point at which PEBLOs become involved in the disability evaluation
system and the training PEBLOs receive differ between the services. DOD
regulations require that each service provide members counseling during
the disability evaluation process and outline the responsibilities of
these counselors. For example, they are expected to discuss with
service members their rights, the effects of MEB and PEB decisions, and
available benefits.
Each service has created PEBLOs in accordance with these rules, but the
services have placed the PEBLOs under different commands. In the Army
and Air Force, PEBLOs are the responsibility of the medical command. In
the Navy, in contrast, the PEBLO responsibility is shared by the PEB
and MTF. Further, the services involve PEBLOs at different points in
the disability process. In the Army and Air Force, PEBLOs begin
counseling the service member at the MEB level of the disability
process. However, while Navy, officials told us that PEBLOs provide
counseling at the MEB level, some PEBLOs we interviewed told us that
they begin counseling members after the informal PEB has issued its
decision. At some MTFs, case managers provide counseling for service
members going through the disability evaluation process. The services
also differ in their training of PEBLOs. The Army holds an annual
conference for PEBLOs and provides on-the-job training. The Navy relies
primarily on on-the-job training and also offers quarterly and annual
training. The Air Force also relies heavily on on-the-job training and,
until recently, held regular training for PEBLOs.
Line of Duty Determinations:
As required by law, a service member may receive disability
compensation for an injury or illness that was incurred or permanently
aggravated while in the line of duty. Generally, the military services
document that an injury occurred in the line of duty by filling out a
form or noting it in the service member's health record. Typically, a
service member's commanding officer is responsible for this action,
according to the service's policies. Unlike the Army and Navy, the Air
Force always requires a line of duty determination for reservists.
DOD regulations state that an injury is presumed to have been in the
line of duty when it clearly resulted from enemy or terrorist attack,
regardless of whether the member is a reserve or active duty member.
However, if the injury may have resulted from misconduct or willful
negligence, DOD requires the military services to investigate and
determine whether the injury did, in fact, occur in the line of duty.
The line of duty determination is a complicated process involving a
number of people, such as the examining medical official and higher
commands. DOD gives the services responsibility for creating the
procedures for conducting line of duty determinations, and there are
some technical differences in the processes among the services. For
example, the services have different rules regarding how long this
process should take. The Army and the Air Force place time frames on
the process, while the Navy does not.
DOD and the Services Have Established Policies That Result in Different
Experiences with the Disability System for Reservists:
The laws that govern the military disability system and the policies
and guidance that DOD and the services have developed to implement the
laws can result in different experiences with the disability system for
reservists. Some of these differences are due to the part-time nature
of reserve service, while others result from laws and policies specific
to reservists.
Twenty Years of Service Requirement for Disability Retirement:
Because they are not on duty at all times, reservists take longer to
accrue the 20 years of service that may be needed to earn the monthly
disability retirement benefit when the disability rating is less than
30 percent. For example, an active duty service member who enlisted in
the Army in 1985 and stayed on continuous active duty would have 20
years toward disability retirement by 2005. An Army reservist who
enlisted at the same time, met his training obligations, and had been
activated for 1 year would have roughly 5 years and 9 months toward
disability retirement by 2005, according to the formula the Army uses
to determine years of service toward disability retirement benefits.
All three services use the same formula when calculating the 20 years
of service requirement for disability retirement benefits.
Eight Years of Service Requirement for Compensation for Preexisting
Conditions:
The part-time status of reservists also makes it more difficult for
reservists with preexisting conditions to be covered by the 8-year rule
and therefore eligible for compensation. By law, service members with
at least 8 years of active duty service are entitled to compensation
even if their conditions existed before the beginning of their military
service or were not service aggravated. This entitlement only applies
to reservists when they are on ordered active duty of more than 30 days
at the time of PEB adjudication. For reservists, accruing the 8 years
necessary for a condition to be covered by this rule can be more
difficult than for active duty service members. For example, an active
duty service member who enlisted in the Army in 1997 and stayed on
continuous active duty would have 8 years toward disability retirement
by 2005. A reservist who enlisted at the same time, met his training
obligations, and has been activated for 1 year would have roughly 1
year and 3 months of service, according to the Army's 8-year rule
formula and would not be eligible for compensation for a preexisting
condition. Further, the services differ slightly in how they calculate
the 8 years for reservists. The Army and Navy calculate the 8 years
differently from the 20 year requirement, but the Air Force uses the
same formula for both. The Army and Navy count only active duty time,
while the Air Force also counts time spent in other activities, such as
continuing education.[Footnote 14]
Line of Duty Determinations:
Officials reported that commanders and others responsible for
completing line of duty determinations were often uncertain as to when
line of duty determinations were necessary for reservists and active
duty members. Moreover, these officials noted that in some cases, the
necessary line of duty determinations were not made, resulting in
delays for service members. For example, Air Force officials we spoke
with had different impressions as to whether line of duty
determinations were always required for reservists, even though Air
Force regulations state they are. Officials from the Army and Army
National Guard similarly offered different perspectives on the need for
line of duty determinations for reservists.
Medical Holdover:
In the Army, deployed active duty soldiers return to their unit in a
back up capacity when they are injured or ill. However, mobilized
injured or ill Army reservists have no similar unit to return to.
Consequently, they may be removed from their mobilization orders and
retained on active duty in "medical holdover status" and assigned to a
unit, such as a medical retention processing unit.[Footnote 15] While
in medical holdover status, reservists may live on base, at a military
treatment facility, at home or other locations. After their
mobilization orders expire, they can elect to continue on active duty
through a program such as medical retention processing, which allows
them to continue receiving pay and benefits. Between 2003 and 2005 the
Army reports that about 26,000 reservists entered medical holdover
status (see appendix II).
Unlike most injured active duty soldiers, reservists in medical
holdover generally live farther from their families than active duty
members because the units at military medical facilities are often far
from where their families live. In certain cases reservists in medical
holdover may receive treatment and recuperate at home. The Army's
Community-Based Health Care Organizations (CBHCOs) provide medical and
case management for these reservists living at home as they receive
medical care in their communities. As of December 2005, about 35
percent of the reservists in medical holdover were being cared for in
the CBHCO program. In order to be assigned to the CBHCO program,
reservists must meet a number of criteria. For example, reservists must
live in communities where they can get appropriate care, and they must
also be reliable in keeping medical appointments.
DOD Has Guidance in Place to Promote Consistent and Timely Decisions,
but Does Not Adequately Oversee Key Aspects of the Disability System:
DOD has policies and guidance to promote consistent and timely
disability decisions, but is not monitoring whether the services are
compliant. Neither DOD nor the services systematically determine the
consistency of decision making, which would be a key component of
quality assurance. With regard to timeliness, DOD has issued goals for
processing service members' cases but is not collecting available
information from the services, and military officials have expressed
concerns that the goals may not be realistic. Finally, DOD is not
exercising any oversight over training for staff in the disability
system, despite being required to do so.
DOD Requires All Services to Use a Common Ratings System and Multiple
Reviewers and Convenes a Disability Council:
To encourage consistent decision making, DOD policies require that
service members' case files undergo multiple reviews and federal law
requires that disability ratings be based on a common schedule. During
both the MEB and PEB stages of the disability process, a service
member's case must be reviewed and approved by several officials with
different roles. When rating the severity of a service member's
impairment, all services are required to use a common schedule, VA's
Schedule for Rating Disabilities (VASRD), in accordance with federal
law. The VASRD is a descriptive list of medical conditions along with
associated disability ratings. For example, if a service member has x-
ray evidence of degenerative arthritis affecting two or more joints,
"with occasional incapacitating exacerbations," he or she should
receive a rating of 20 percent according to the VASRD.
DOD also convenes the Disability Advisory Council, which DOD officials
told us is the primary oversight body of the disability system. The
disability council is composed of key officials from the three
disability agencies of the services, the VA, and relevant DOD officials
from the health affairs, reserve affairs, and personnel departments.
The council's mission is to monitor the administration of the
disability system and, according to DOD officials, the council serves
as a forum to discuss issues such as rules changes and increasing
coordination among the services. Currently, the disability council is
facilitating a review and revision of all DOD regulations pertaining to
the disability system. Military officials view the council as a group
that aims to meet quarterly to discuss issues raised by the services.
By having these meetings, DOD hopes to bring all of the services "on
the same page" when it comes to the disability system. However,
military officials reported that the council has not met quarterly in
the past year and generally does not produce formal reports for the DOD
chain of command. Furthermore, the disability council is staffed by one
person at DOD who has additional responsibilities.
Military officials also regard the appeals process as helping to ensure
the consistency of disability evaluation decision making. However, not
all service members appeal. In addition, during the appeals process
additional evidence may be presented that may result in a different
outcome for the same case. Furthermore, the appeals process is designed
to determine whether the correct decision was made, rather than whether
consistent decisions were made across comparable cases.
Lack of Oversight by DOD and the Services Provides Little Assurance
Decisions Are Consistent:
Despite this policy guidance and the presence of the disability
council, both DOD and the three services lack quality assurance
mechanisms to ensure that decisions are consistent. Given that one of
the primary goals of the disability system is that disability
evaluations take place in a consistent manner, collecting and analyzing
the service members' final disability determinations are critical for
ensuring that decisions are consistent. DOD regulations recognize this
and require that the agency establish necessary reporting requirements
to monitor and assess the performance of the disability system and
compliance with relevant DOD regulations. Yet, DOD does not collect
information from the services on the final disability determinations
and personal characteristics of service members going through the
disability system.
In addition, DOD has not established quality parameters for the
services to follow to evaluate the consistency of decision making. As a
result, the services generally lack a robust quality assurance process.
In our past work on federal disability programs, we have recommended
that quality assurance have two components: (1) the use of multivariate
regression analysis examining disability decisions along with
controlling factors to determine whether the decisions are consistent
and (2) an in depth independent review of a statistically valid group
of case files to determine what factors may contribute to
inconsistencies. However, the services were unable to provide any
evidence that they are conducting statistical reviews - such as
multivariate regression analysis - on their data to determine the
consistency of decision making for service members with similar
characteristics. Furthermore, while we found that the Army is
conducting independent reviews of 25 to 30 percent of its PEB cases,
the Navy and Air Force conduct these reviews only when a service member
appeals the PEB's decision. Additionally, these reviews reflect how a
single case's medical evidence supports the dispositions made
(accuracy) rather than the degree to which decisions in cases, in
general, with similar impairments and characteristics compare
(consistency). Without such an analysis the services are unable to
assure that adjudicators are making consistent decisions in reservist
and active duty cases with similar characteristics.
Officials from the services said that it was very difficult to examine
outcomes for consistency because each disability decision is unique and
there are a multitude of factors considered when rendering a disability
decision, some of which could not be captured in a database. For
example, individuals' pain tolerance varies, along with their
motivation to adhere to treatment programs. Nonetheless, other federal
disability programs face the same challenges, have acknowledged the
importance of determining consistency of decision making, and have
taken some initial steps to develop quality assurance systems. For
example, the VA selects a random sample of files for independent review
using a standard methodology and compiles the results of these
reviews.[Footnote 16]
DOD Has Instituted Timeliness Goals for Processing Service Members'
Cases, but Does Not Oversee Compliance with Them:
DOD regulations set forth timeliness goals for the two major processes
of the disability system. According to DOD, the first stage of the
process--the MEB--should normally be completed in 30 days or less. The
second stage of the process--the PEB--should normally take 40 days or
less. Despite establishing these timeliness goals for the services, DOD
is not ensuring compliance with them. DOD does not regularly collect
available timeliness data from the services, a necessary first step for
determining compliance.
The services generally are using their databases to track the
timeliness of decisions, but military officials cited confusion
regarding the start date for the process. Both the Army and Navy are
tracking processing times for both the MEB and PEB using their
databases. The Air Force lacks a centralized database to track its MEB
cases and therefore can only track PEB timeliness. However, we found
that the usefulness of these timeliness data may be undermined by
confusion among military officials and data entry staff regarding the
starting dates for the disability process. We compared original Army
PEB case files to Army electronic data from both its MEB and PEB
databases, and found that the date a physician dictates a narrative
summary, the beginning of the disability process and a critical data
point for timeliness calculations, was frequently entered incorrectly
into the Army's databases. When we asked about these errors, Army
officials said that increased training of data entry staff would help
with these problems. Navy officials also said that there was some
confusion about how to record starting dates for cases when additional
medical information was needed to make a disability decision for a
service member.
Data reported by the services on the timeliness of cases generally show
that the services are not meeting DOD timeliness goals (see appendix
II). Military officials said that these results stemmed in part from
the unrealistic nature of the goals themselves. Navy officials told us
that they do not consider the 30-day goal as a performance standard for
MEB processing to be held accountable for. They said that the 30-day
goal is also unrealistic, especially in certain cases when there were
addendums to the narrative summary. Army officials also said that it
was unrealistic for all MEB cases to be processed in 30 days because
certain cases take longer. For example, cases when a line of duty
determination is needed or when certain medical tests are required to
diagnose some orthopedic or psychiatric conditions.
DOD's Delegation of Training to the Services and Staff Turnover
Presents Additional Challenges for the Disability System:
While DOD regulations require that the agency develop and maintain
training for key participants in the disability system, DOD officials
told us that they had given this responsibility to the services. The
Assistant Secretary of Defense for Health Affairs is given explicit
instructions to develop and maintain a training program for MEB and PEB
staff, but officials from the Office of Health Affairs indicated they
were unaware that they had the responsibility to develop a training
program. In addition, despite high turnover among military disability
evaluation staff, the services do not have a system to ensure that all
staff are properly trained. This turnover stems, in part, from the
military requirement that personnel rotate to different positions in
order to be promoted. Depending on the positions involved, military
officials told us that some staff remain in their positions from 1 to 6
years, with most remaining about 3 years. This turnover and the
resulting loss of institutional knowledge require that the services
systematically track who has been properly trained. However, all of the
services lack data systems that would allow them to do so, an issue
that was highlighted in a previous report by the RAND
Corporation.[Footnote 17]
Disparities May Exist in Disability Benefits and Processing Times
between Army Reservists and Active Duty Soldiers, but Lack of Data
Prevents More Definitive Conclusions:
Our analysis of Army disability data from calendar years 2001 to 2005
indicated that after controlling for many of the differences we found
between reservists and active duty soldiers, Army reservists received
similar disability ratings to their active duty counterparts. We also
found that reservists may be less likely to receive military disability
benefits. Data on years of service and preexisting conditions were not
available for this analysis, however, factors that influence disability
benefit decisions. Finally, we were unable to compare processing times
for reserve and active duty disability cases because we found that Army
data on processing times were not reliable. However, based on these
data, some Army officials conclude that reservists' cases often take
longer to process through the disability evaluation system than the
cases of active duty soldiers.
Army Reservists and Active Duty Soldiers in the Disability Evaluation
System Had Different Characteristics:
From 2001 through 2005, the characteristics of Army reservists and
active duty soldiers in the disability evaluation system differed in a
number of ways. Specifically, reservists tended to have more
impairments than active duty soldiers; they were more likely than
active duty soldiers to have three or four impairments. Reservists also
experienced higher rates of impairments affecting the cardiovascular
and endocrine systems, while active duty soldiers experienced a higher
rate of impairments affecting the musculoskeletal system. Reservists
were more often classified in higher pay grades and more often worked
as functional support and administration, crafts workers, and service
and supply handlers. See appendix IV. Active component soldiers worked
more often as infantry and gun crews; electronic equipment repairers;
and communications and intelligence specialists.[Footnote 18] In
addition, compared to the number of active duty disability cases from
2001 through 2005, which remained relatively constant, the proportion
of reservists going through the PEB process rose dramatically through
2004. See figure 3.
Figure 3: Yearly Percentage Change in PEB Caseload for Active Duty and
Reserve Component Soldiers, Calendar Years 2001 to 2005:
[See PDF for image]
Note: The 2005 numbers represent annual projections based on data
collected through Aug 2005.
[End of figure]
Finally, the demographic characteristics of Army reservists and active
duty soldiers in the disability evaluation system also differed. Eighty
percent of reservists were male, compared to 76 percent of active duty
soldiers, while, on average, reservists were 11 years older than active
duty soldiers.[Footnote 19] See figure 4.
Figure 4: Ages of Active Duty and Reserve Component Soldiers Entering
the Disability Evaluation System, Calendar Years 2001 to 2005:
[See PDF for image]
Note: The 2005 numbers represent annual projections based on data
collected through August 2005.
[End of figure]
Army Reservists Received Disability Ratings Similar to Their Active
Duty Counterparts, but Reservists May Be Less Likely to Receive
Benefits:
Before controlling for factors that could account for differences in
the outcomes of the Army disability evaluation system for reserve and
active duty soldiers, our analysis of Army data indicates that, from
2001 through 2005, reservists were assigned slightly higher disability
ratings, but received benefits less often than active duty soldiers.
See appendix V. When we controlled for many of the characteristics of
reserve and active duty soldiers that could account for their
difference in ratings, we found that, among soldiers who received
ratings, the ratings assigned to Army reservists were comparable to
those assigned to their active duty counterparts. When we controlled
for a more limited number of factors, Army reservists who were
determined to be unfit for duty appeared less likely to receive
benefits (either monthly disability payments or severance pay). See
appendix I. This analysis of benefit outcomes for Army reserve and
active duty disability cases could not account for the influence that
preexisting conditions and years of service can have on disability
decisions.[Footnote 20] These factors are key in determining whether an
injured or ill service member qualify for disability benefits.[Footnote
21] Because we could not test the effect of these factors empirically,
we cannot rule out the possibility that one or the other may account
for the differences we found.
Poor Quality Data Precluded GAO Analysis, but the Army Reports
Reservists' Cases Can Take Longer:
While, according to the Army's own statistics, the PEB process can take
longer for reservists than active duty soldiers, we found the Army data
used to calculate processing times not of sufficient quality to warrant
its use in our analysis. Specifically, the dates in Army's electronic
database often did not correspond with the dates recorded in paper
files. See appendix I. Nonetheless, the statistics the Army provided
indicate that disability cases reviewed between fiscal years 2001 and
2005 took consistently longer than those of active duty soldiers. Over
half (54 percent) of reserve soldiers took longer than 90 days while
over one-third (35 percent) of active duty soldiers exceed this
threshold. See appendix II for more detail.
There are several possible explanations for the differences in
processing times between reservists and active duty members, according
to the Army. For example, the Army officials reported that MEBs often
must request medical records from private medical practitioners for
reservists' cases, which can involve considerable delays. In addition,
the personnel documents for reservists are stored in facilities around
the U.S., and therefore they may take longer to obtain than records for
centrally located active duty soldiers. Due to the lack of data on
these issues as well as the problems we encountered with the data
provided by the Army we were not able to measure the differences or
empirically test possible explanations for differences the Army
reported in the timeliness of disability case processing for Army
reservists and active duty soldiers.
Conclusions:
The military disability system's outcomes can greatly impact the future
of service members, including reservists, injured in service to their
country. Given the significance of these decisions as well as the
latitude that services have to implement the system, it is important
that DOD exercise proper oversight to make sure the system meets the
needs of service members today and in the future. However, DOD is not
adequately monitoring the outcomes for active duty and reservist cases
in the disability evaluation system. DOD and the services do not have
complete and reliable data for all aspects of the disability system.
Further, neither DOD nor the services are systematically evaluating
consistency and timeliness of decision making in the system.
Military officials recognize that in many cases, service members' cases
are not determined within timeliness goals and have suggested that the
goals may not be appropriate in many cases. In addition, it may take
longer for reservist cases to go through the system. If a goal does not
reflect appropriate processing times, it may not be useful as a program
management tool. Furthermore, both consistency and timeliness of
decisions depend on the adequate training and experience of all
participants in the disability system. Yet we found that DOD had little
assurance that staff at all levels are properly trained.
Recommendations for Executive Action:
To ensure that all service members--both active duty and reserves--
receive consistent and timely treatment within the disability
evaluation process, we recommend that the Secretary of Defense take the
following five actions:
* require the Army, Navy, and Air Force to take action to ensure that
data needed to assess consistency and timeliness of military disability
rating and benefit decisions are reliable;
* require these services to track and regularly report these data--
including comparisons of processing times, ratings and benefit
decisions for reservists and active duty members--to the Under
Secretary of Personnel and Readiness and the Surgeons General;
* determine, based on these reports, if ratings and benefit decisions
are consistent and timely across the services and between reservists
and active duty members and institute improvements to address any
deficiencies that might be found;
* evaluate the appropriateness of current timeliness goals for the
disability process and make any necessary changes; and:
* assess the adequacy of training for MEB and PEB disability evaluation
staff.
Response to Agency Comments:
We provided a draft of this report to the Department of Defense for its
review. DOD agreed with our recommendations, indicating the Department
will implement all of them and listing a number of steps it will take
to do so. DOD also provided technical comments, which we incorporated
into the report as appropriate.
We are sending copies of this report to the Secretary of Defense,
relevant congressional committees, and others who are interested.
Copies will also be made available to others upon request. The report
is also available at no charge on GAO's Web site at http://www.gao.gov.
Please contact me on (202) 512-7215 if you or your staff have any
questions about this report. Contact points for our Offices of
Congressional Relations and Public Affairs can be found on the last
page of this report. Other major contributors to this report are listed
in appendix VII.
Signed by:
Robert E. Robertson:
Director Education, Workforce, and Income Security:
[End of section]
Appendix I: Objective, Scope, and Methodology:
The objectives of our report were to determine: (1) how current DOD
policies and guidance for disability determinations compare for the
Army, Navy, and Air Force, and what policies are specific to reserve
component members of the military; (2) what oversight and quality
control mechanisms are in place at DOD and these three services of the
military to ensure consistent and timely disability rating and benefit
decisions for active and reserve component members, and (3) how
disability rating and benefit decisions, and processing times compare
for active and reserve component members of the Army, the largest
branch of the service, and what factors might explain any differences.
To address objectives 1 and 2, we reviewed relevant legislation, policy
guidance, and literature; interviewed officials from DOD, Army, Navy,
Air Force, Reserves, and National Guard; and visited Lackland and
Randolph Air Force Bases, Fort Sam Houston and Walter Reed Army Medical
Center; Washington Navy Yard and Bethesda Naval Hospital; and
interviewed relevant officials. In addition, we interviewed officials
from military treatment facilities.
To determine if outcomes for active duty and reserve service members'
disability cases were statistically consistent, we analyzed data
provided by the physical evaluation board (PEB) of the Army. We also
obtained summary information on total caseloads and processing times
from the services and from the Department of Defense. Based on our
assessment of the quality of the Army's data, we concluded that data on
disability determinations and ratings made by the Army's PEB were
sufficiently reliable for our analysis. On the other hand, the Army's
data on processing times were not reliable for our analysis. We did not
test the reliability of statistical data provided by DOD and the
services.
This appendix is organized into two sections: Section 1 describes the
analyses related to our tests of data quality and reliability. Section
2 describes the empirical analyses that were used to determine if
outcomes for active duty and reserve disability cases were
statistically consistent.
Section 1: Data Reliability Tests:
To ensure that the Army data were sufficiently reliable for our
analyses, we conducted detailed data reliability assessments of the
data sets that we used. We restricted these assessments, however, to
the specific variables that were pertinent to our analyses. We found
that all of the data sets used in this report were sufficiently
reliable for use in our analyses.
To allow us to analyze the outcomes of the disability evaluation
process and determine whether decisions were made in a timely fashion,
we requested that the Army share data from both the Medical Evaluation
Board and the Physical Evaluation Board for our review. The Army
provided extracts from both the Medical Evaluation Board Internal
Tracking Tool (MEBITT), used by the Medical Evaluation Board and the
Physical Disability Computer Assisted Processing System (PDCAPS), used
by the PEB.
During interviews with the database managers responsible for MEBITT and
PDCAPS, we learned that the Army has few internal controls to ensure
that the data are complete and accurate. Consequently, we conducted a
trace-to-file process to determine whether the data in the electronic
systems were an accurate reflection of what was recorded in the paper
files. We requested that the Army provide us with the paper files for a
sample of 130 cases that completed the Army's disability evaluation
process between 2000 and August, 2005. Army officials provided 93 paper
files for our review. The remaining files were archived or were not
found.
We checked the data in files provided against the electronic records in
MEBITT and PDCAPS. We determined that the MEBITT data were not
sufficiently reliable for our use. We also determined that in the
PDCAPS, there was a high degree of accuracy in the data fields related
to: rank, component (active duty versus reserve component), date of
entry into military service, primary military occupational specialty,
disposition of disability case, percentage rating for disability,
location of PEB, and illness/diagnosis codes. These fields were deemed
reliable for use in our report.[Footnote 22] However, this review also
revealed that the data in the date fields, such as the narrative
summary dates and the final decision dates, were often inaccurate and
were therefore determined to be of insufficient quality for use in our
report.
Section 2: Statistical Analyses:
To determine if outcomes for active duty and reserve disability cases
were statistically consistent, we conducted extensive statistical
analyses including cross tabulations and econometric modeling. This was
important because active and reserve component soldiers being evaluated
differ greatly in demographic characteristics and in administrative
characteristics, such as pay grade and occupational specialty.
Recognizing the potential of these characteristics to influence final
outcomes and disability ratings, we developed econometric models to
assess whether the observed differences between active and reserve
component soldiers persist after controlling for these factors.
We began with a series of bivariate cross tabulations and then expanded
these cross-classifications and examined three-way and four-way tables.
These allowed us to compare large groups of active and reserve
soldiers, as well as to compare soldiers in specific sets of
categories--such as active and reserve soldiers of different grades
being evaluated at different PEBs. To control for additional factors,
we supplemented the cross-tabulations with ordinary least squares (OLS)
and multivariate logistic regressions. Our analyses considered both the
size and significance of the relationships of interest, using means,
percentages, and odds and odds ratios to assess magnitude, and f-tests,
chi-square tests and Wald statistics to assess the significance of the
differences.
The analyses are limited due to our inability to control for several
important factors in the disability evaluation process. For example, no
reliable electronic data existed to indicate whether an injury existed
prior to service or was incurred outside of the line of duty, both
primary reasons for separating a soldier without benefits. Similarly,
Army officials told us that data on years of service for reservists in
the electronic data the Army provided were unreliable. Additionally,
soldiers declared fit or separated without benefits do not receive
percentage disability ratings, and the Army reports no impairment codes
for soldiers declared fit. As such, we could not determine whether
active and reserve component soldiers were similarly likely to be
declared fit controlling for impairment or percentage rating. Given
these difficulties, we restricted our multivariate analyses to soldiers
rated unfit.
Multivariate regression analysis:
To assess factors contributing to the final rating among those members
declared unfit and receiving a percentage rating (that is, excluding
those separated without benefits), we ran a series of multivariate
models. Army data systems report up to four impairments.[Footnote 23]
Their final percentage disability rating is determined by a composite
of ratings for individual impairments, the system(s) affected and how
the specific impairment relates to the soldier's ability to perform his
or her duties.[Footnote 24] Regression analysis allows us to assess
whether the observed differences between reserve and active soldiers'
final ratings persist controlling for factors that enter the decision
process, such as military occupational specialty[Footnote 25] and
system of impairment, as well as other factors such as demographic
differences between the reserve component and active duty soldiers.
We began by estimating a "gross effects" (or unadjusted) model, which
considers the gross difference in mean disability ratings between
active and reserve component soldiers ignoring other factors. The model
confirms descriptive statistics showing that reserve component members'
ratings average approximately 4 points higher than those of active
component members.
We next estimated a series of alternative "net effects" (or adjusted)
models to account for other factors that influence the decision
process; these models estimate the impact of being a reservist on
rating "net" of other factors. Our first model included number of
reported impairments, physical system affected and occupational
specialty; a second model added year of decision, age, race, sex, pay
grade, and PEB to control for forces that may influence the decision
process unofficially and certain demographic differences between
components. Additionally, we ran a variety of alternative
specifications to ensure the stability and robustness of the results;
this included, for example, a model testing the interaction between
system affected and occupational specialty[Footnote 26] and a model to
account for the clustering (and potential "nonindependence") of cases
within each PEB.[Footnote 27]
Table 4 presents the coefficient representing the relationship between
being a reservist on final disability ratings in models that control
for a limited set of controls both relevant and external to the formal
decision process. What appears to be a small difference in ratings
between reserve and active component members diminishes controlling for
other factors. Overall, results of our OLS regression analyses suggest
that active and reserve component members receive similar disability
ratings controlling for factors that enter the formal decision process
formally and indirectly.
Table 4: Estimate of the Relationship between Being a Reservist and the
Final Disability Rating among Soldiers Receiving a Rating:
Effect of Being a Reservist on Disability Ratings: Gross effects model
(no controls);
Unstandardized coefficient (standard error): 3.8[A](0.25);
Interpretation: Reserve component soldiers receive ratings
approximately 4 percentage points higher than active component
soldiers.
Effect of Being a Reservist on Disability Ratings: Net effects model,
limited controls (number of impairments, main body system affected, and
occupational specialty);
Unstandardized coefficient (standard error): 1.9[A](0.22);
Interpretation: Reserve component soldiers receive ratings
approximately 2 percentage points higher than active component
soldiers.
Effect of Being a Reservist on Disability Ratings: Net effects model,
expanded controls (year of decision, controls above plus age, race,
sex, pay grade, PEB and PEB cluster adjustment); Unstandardized
coefficient (standard error): -1.1[B](0.40); Interpretation: Reserve
component soldiers receive disability ratings approximately 1
percentage point lower than active duty soldiers, but this result is
not statistically significant at conventional levels after adjusting
for clustering within each PEB.
Source: GAO analysis of Army PDCAPS data.
[A] Coefficients statistically significant at the 99 percent level.
[B] Standard errors in the final model presented here account for PEB
clustering and reduce the statistical significance of the estimate to
just below the 90 percent confidence level based on three independent
clusters; the coefficient is significant at the 99 percent level in an
identical model that does not adjust standard errors for clustering.
[End of table]
Multinomial Logistic Analysis:
To assess receipt of benefits, we estimated a multinomial logistic
model, a technique that allows us to estimate the likelihood of
placement in one of several categories controlling for additional
factors. The model produces relative risk ratios that compare the
relative odds of reserve component soldiers and active duty soldiers
determined unfit for duty being placed into either one of two
categories (severance pay or permanent disability retirement) rather
than the base or referant category (separated without benefits). With
controls, the relative risk ratio compares the odds of placement in the
given category for similarly situated active and reserve component
soldiers.
A relative risk ratio of 1 indicates that reserve and active component
members have equal odds of being placed in one category rather than the
base category. A relative risk ratio of less than 1 for reserve
soldiers indicates that reservists have lower odds than active members
of placement in the category rather than in the base category, and a
relative risk ratio of greater than 1 indicates that reservists have
higher odds than active duty members of being placed in that category
rather than in the base category. Because soldiers placed on the
temporary disability retired list (TDRL) have not received a final
benefits determination, they are excluded from the model.
The relative risk ratios in table 5 demonstrate that among those
declared unfit, reserve component soldiers have significantly lower
odds than active component soldiers of receiving either permanent
disability retirement or lump sum disability severance pay. Prior to
controlling for other factors (our "gross effects" model), reserve
soldiers have significantly lower odds than active component members of
receiving either permanent disability retirement or severance pay
rather than being separated without benefits--the relative risk ratios
of 0.5 and 0.4 in the first row of the table respectively demonstrate
reservists are only half or less than half as likely to receive
permanent disability retirement or severance pay, respectively.
Table 5: Estimate of the Relationship between Being a Reservist and
Receipt of Benefits before and after Controlling for Other Factors
(among Those Unfit and Assigned a Final Disposition):
Effect of Being a Reservist on odds of receiving (relative risk ratio):
Gross effects model (no controls, base category is separation without
benefits);
Permanent disability retirement: 0.5; Severance pay: 0.4;
Interpretation: The odds of receiving permanent disability retirement
or severance pay are lower for reservists.
Effect of Being a Reservist on odds of receiving (relative risk ratio):
Net effects model, limited controls (number of impairments, main body
system affected, occupational specialty); Permanent disability
retirement: 0.4; Severance pay: 0.4;
Interpretation: The odds of receiving permanent disability retirement
or severance pay are lower for reservists.
Effect of Being a Reservist on odds of receiving (relative risk ratio):
Net effects model, expanded controls (year of decision, controls above
plus age, race, sex, pay, and PEB; Permanent disability retirement:
0.1; Severance pay: 0.3;
Interpretation: The odds of receiving permanent disability retirement
or severance pay are lower for reservists.
Source: GAO analysis of Army PDCAPS data.
Note: This analysis compared relative risk ratios of those who were
granted permanent disability retirement and severance pay with those
who were separated without benefits. Relative risk ratios are
statistically significant at the 99 percent level.
[End of table]
This relationship persists after controlling for limited factors both
relevant to[Footnote 28] and external to[Footnote 29] the official
decision making process ("net effects" models), and in fact the
estimated difference between reservists and active duty soldiers is in
fact increased by the inclusion of variables such as race, sex and PEB
location. While these additional factors do not directly enter the
decision making process, they control for some of the administrative
and demographic differences we observe between active and reserve
component members. The relationship differs for the odds of receiving
severance pay, where reserve soldiers have less than one third the odds
of active soldiers, and the odds of receiving permanent disability
retirement, where the odds of reservists' receiving this type of
benefit rather than separation without benefits is about one-tenth that
of active component members.
We lacked reliable electronic data on two potentially important
factors. This inability to control for length of service and injuries
existing prior to service prevents us from determining whether the
differences presented above are warranted or defensible:
[End of section]
Appendix II: Selected Data from Service Branches on Processing Time,
Dispositions, and Medical Holdover:
Table 6: Army Processing Times for Disability Cases, Including both MEB
and PEB Processing, Fiscal Year 2001 to 2005:
FY2001:
Active duty;
Total Number of Cases: 6,627; Percentage of cases processed in: 30
days: 1.6;
31-60 days: 13.6;
61-90 days: 41.3;
91-120 days: 20.1;
>120 days: 23.4.
Reserve component;
Total Number of Cases: 591;
Percentage of cases processed in: 30 days: 4.1;
31-60 days: 14.5;
61-90 days: 24.2;
91-120 days: 15.9;
>120 days: 41.3.
FY2002:
Active duty;
Total Number of Cases: 6,510; Percentage of cases processed in: 30
days: 1.7;
31-60 days: 10.9;
61-90 days: 36.6;
91-120 days: 22.6;
>120 days: 28.2.
Reserve component;
Total Number of Cases: 812;
Percentage of cases processed in: 30 days: 3.6;
31-60 days: 10.5;
61-90 days: 24.9;
91-120 days: 20.2;
>120 days: 40.9.
FY2003:
Active duty;
Total Number of Cases: 6,659; Percentage of cases processed in: 30
days: 7.4;
31-60 days: 31.9;
61-90 days: 28.9;
91-120 days: 14.7;
>120 days: 17.1.
Reserve component;
Total Number of Cases: 1,546; Percentage of cases processed in: 30
days: 6.5;
31-60 days: 25.5;
61-90 days: 23.9;
91-120 days: 17.7;
>120 days: 26.3.
FY2004:
Active duty;
Total Number of Cases: 7,694; Percentage of cases processed in: 30
days: 5.5;
31-60 days: 35.9;
61-90 days: 27.9;
91-120 days: 13.9;
>120 days: 16.8.
Reserve component;
Total Number of Cases: 4,187; Percentage of cases processed in: 30
days: 2.0;
31-60 days: 18.7;
61-90 days: 22.3;
91-120 days: 19.6;
>120 days: 37.2.
FY2005:
Active duty;
Total Number of Cases: 9,322; Percentage of cases processed in: 30
days: 16.0;
31-60 days: 37.1;
61-90 days: 21.3;
91-120 days: 12.3;
>120 days: 13.2.
Reserve component;
Total Number of Cases: 4,426; Percentage of cases processed in: 30
days: 5.5;
31-60 days: 21.8;
61-90 days: 20.3;
91-120 days: 16.3;
>120 days: 36.0.
Source: Department of the Army.
Note: Percentages may not total 100 due to rounding.
[End of table]
Table 7: Navy Processing Times for Disability Cases, Including Only PEB
Processing, Fiscal Year 2001 to 2005:
FY 2001:
Active duty;
Total Number of Cases: 4,620; Percentage of cases processed in: 30
days: 24;
31-60 days: 41;
61-90 days: 16;
91-120 days: 6;
>120 days: 13.
Reserve component;
Total Number of Cases: 379;
Percentage of cases processed in: 30 days: 7;
31-60 days: 39;
61-90 days: 19;
91-120 days: 9;
>120 days: 26.
FY2002:
Active duty;
Total Number of Cases: 3,953; Percentage of cases processed in: 30
days: 26;
31-60 days: 43;
61-90 days: 15;
91-120 days: 6;
>120 days: 9.
Reserve component;
Total Number of Cases: 413;
Percentage of cases processed in: 30 days: 9;
31-60 days: 41;
61-90 days: 24;
91-120 days: 6;
>120 days: 20.
FY2003:
Active duty;
Total Number of Cases: 3,814; Percentage of cases processed in: 30
days: 23;
31-60 days: 39;
61-90 days: 21;
91-120 days: 7;
>120 days: 10.
Reserve component;
Total Number of Cases: 436;
Percentage of cases processed in: 30 days: 11;
31-60 days: 38;
61-90 days: 24;
91-120 days: 10;
>120 days: 17.
FY2004:
Active duty;
Total Number of Cases: 4,889; Percentage of cases processed in: 30
days: 31;
31-60 days: 35;
61-90 days: 18;
91-120 days: 7;
>120 days: 9.
Reserve component;
Total Number of Cases: 543;
Percentage of cases processed in: 30 days: 19;
31-60 days: 40;
61-90 days: 17;
91-120 days: 7;
>120 days: 17.
FY2005:
Active duty;
Total Number of Cases: 4,645; Percentage of cases processed in: 30
days: 61;
31-60 days: 24;
61-90 days: 5;
91-120 days: 3;
>120 days: 5.
Reserve component;
Total Number of Cases: 555;
Percentage of cases processed in: 30 days: 30;
31-60 days: 39;
61-90 days: 12;
91-120 days: 6;
>120 days: 14.
Source: Department of the Navy.
[End of table]
Table 8: Air Force Processing Times for Disability Cases, Including
Only PEB Processing, Fiscal Year 2001 to 2005:
FY2001:
Active duty;
Total Number of Cases: 2,376; Percentage of cases processed in: 30
days: 89;
31-60 days: 7;
61-90 days: 3;
91-120 days: 1;
>120 days: 0.
Reserve component;
Total Number of Cases: 441;
Percentage of cases processed in: 30 days: 85;
31-60 days: 9;
61-90 days: 5;
91-120 days: 2;
>120 days: 0.
FY2002:
Active duty;
Total Number of Cases: 3,251; Percentage of cases processed in: 30
days: 86;
31-60 days: 8;
61-90 days: 4;
91-120 days: 2;
>120 days: 0.
Reserve component;
Total Number of Cases: 535;
Percentage of cases processed in: 30 days: 86;
31-60 days: 4;
61-90 days: 5;
91-120 days: 3;
>120 days: 1.
FY2003:
Active duty;
Total Number of Cases: 3,340; Percentage of cases processed in: 30
days: 82;
31-60 days: 5;
61-90 days: 6;
91-120 days: 4;
>120 days: 3.
Reserve component;
Total Number of Cases: 633;
Percentage of cases processed in: 30 days: 77;
31-60 days: 4;
61-90 days: 6;
91-120 days: 6;
>120 days: 6.
FY2004:
Active duty;
Total Number of Cases: 3,525; Percentage of cases processed in: 30
days: 70;
31-60 days: 11;
61-90 days: 7;
91-120 days: 5;
>120 days: 7.
Reserve component;
Total Number of Cases: 719;
Percentage of cases processed in: 30 days: 67;
31-60 days: 8;
61-90 days: 5;
91-120 days: 7;
>120 days: 13.
FY2005:
Active duty;
Total Number of Cases: 3,610; Percentage of cases processed in: 30
days: 55;
31-60 days: 23;
61-90 days: 9;
91-120 days: 5;
>120 days: 8.
Reserve component;
Total Number of Cases: 758;
Percentage of cases processed in: 30 days: 44;
31-60 days: 20;
61-90 days: 12;
91-120 days: 8;
>120 days: 16.
Source: Department of the Air Force.
[End of table]
Table 9: Final Dispositions Made by Navy PEB for Disability Cases,
Fiscal Year 2001 to 2005:
Total Number of Cases:
Active duty;
FY2001: 4,620;
FY2002: 3,952;
FY2003: 3,813;
FY2004: 4,889;
FY2005: 4,645.
Reserve component;
FY2001: 380;
FY2002: 414;
FY2003: 436;
FY2004: 543;
FY2005: 557.
Disposition: Fit/Returned to Duty[A]:
Active duty;
FY2001: 1,164;
FY2002: 926;
FY2003: 820;
FY2004: 1,213;
FY2005: 1,297.
Reserve component;
FY2001: 176;
FY2002: 193;
FY2003: 180;
FY2004: 200;
FY2005: 183.
Disposition: Separated with Severance Pay:
Active duty;
FY2001: 1,998;
FY2002: 1,667;
FY2003: 1,688;
FY2004: 1,991;
FY2005: 1,649.
Reserve component;
FY2001: 130;
FY2002: 144;
FY2003: 130;
FY2004: 197;
FY2005: 196.
Disposition: Separated without Benefits:
Active duty;
FY2001: 288;
FY2002: 225;
FY2003: 272;
FY2004: 362;
FY2005: 269.
Reserve component;
FY2001: 9;
FY2002: 11;
FY2003: 30;
FY2004: 24;
FY2005: 26.
Disposition: Permanent Disability Retirement:
Active duty;
FY2001: 130;
FY2002: 171;
FY2003: 114;
FY2004: 141;
FY2005: 126.
Reserve component;
FY2001: 5;
FY2002: 10;
FY2003: 7;
FY2004: 9;
FY2005: 13.
Disposition: Temporary Disability Retired List:
Active duty;
FY2001: 1,040;
FY2002: 963;
FY2003: 919;
FY2004: 1,182;
FY2005: 1,304.
Reserve component;
FY2001: 60;
FY2002: 56;
FY2003: 89;
FY2004: 113;
FY2005: 139.
Source: Department of the Navy.
[A] Includes "presumed fit" cases.
[End of table]
Table 10: Final Dispositions Made by Air Force PEB for Disability
Cases, Fiscal Year 2001 to 2005:
Total Number of Cases:
Active duty;
FY2001: 2,376;
FY2002: 3,251;
FY2003: 3,340;
FY2004: 3,525;
FY2005: 3,610.
Reserve component;
FY2001: 441;
FY2002: 535;
FY2003: 633;
FY2004: 719;
FY2005: 758.
Disposition: Fit/Returned to Duty:
Active duty;
FY2001: 1,406;
FY2002: 1,797;
FY2003: 1,730;
FY2004: 1,492;
FY2005: 1,503.
Reserve component;
FY2001: 294;
FY2002: 365;
FY2003: 427;
FY2004: 441;
FY2005: 387.
Disposition: Separated with Severance Pay:
Active duty;
FY2001: 311;
FY2002: 691;
FY2003: 773;
FY2004: 1,040;
FY2005: 1,273.
Reserve component;
FY2001: 44;
FY2002: 40;
FY2003: 79;
FY2004: 106;
FY2005: 156.
Disposition: Separated without Benefits:
Active duty;
FY2001: 101;
FY2002: 273;
FY2003: 425;
FY2004: 429;
FY2005: 273.
Reserve component;
FY2001: 5;
FY2002: 22;
FY2003: 37;
FY2004: 49;
FY2005: 30.
Disposition: Permanent Disability Retirement:
Active duty;
FY2001: 169;
FY2002: 162;
FY2003: 144;
FY2004: 146;
FY2005: 228.
Reserve component;
FY2001: 25;
FY2002: 36;
FY2003: 32;
FY2004: 56;
FY2005: 93.
Disposition: Temporary Disability Retired List:
Active duty;
FY2001: 389;
FY2002: 328;
FY2003: 268;
FY2004: 258;
FY2005: 333.
Reserve component;
FY2001: 73;
FY2002: 72;
FY2003: 58;
FY2004: 67;
FY2005: 92.
Source: Departments of the Air Force.
[End of table]
Table 11: Number of Army Reserve Component Members Entering Medical
Holdover by Year, Calendar Years 2001 to 2005:
Year of Entry: 2001;
Number Entered: 175.
Year of Entry: 2002;
Number Entered: 560.
Year of Entry: 2003;
Number Entered: 7,865.
Year of Entry: 2004;
Number Entered: 9,850.
Year of Entry: 2005;
Number Entered: 8,729.
Year of Entry: TOTAL;
Number Entered: 27,181.
Source: Department of the Army.
[End of table]
[End of section]
Appendix III: Compilation of Differences in Regulations Governing the
Military Disability Evaluation System:
Aspect: Line of Duty Determinations: 1. Time frames for processing for
active component members;
Army: Time limits are placed on each participant in the process; Navy:
No stated policy;
Air Force: Time limits for completing LOD determinations are placed on
each participant in the process.
Aspect: Line of Duty Determinations: 2. Time frames for processing for
reserve component members;
Army: Time limits are placed on each participant in the process; Navy:
No stated policy;
Air Force: Line of duty determinations must be completed "promptly".
Aspect: Line of Duty Determinations: 3. Required for reserve component
members;
Army: Required[A];
Navy: Required[A];
Air Force: Always required.
Aspect: Line of Duty Determinations: 4. Responsible for doing line of
duty determination;
Army: Unit commander;
Navy: Line commander;
Air Force: Commander.
Aspect: Line of Duty Determinations: 5. MEB/PEB options for missing or
incomplete line of duty determinations; Army: If line of duty
determination is required by regulations and is not in the case file,
the case will be returned to the MTF for completion of LOD process. PEB
does not have the authority to make LOD determinations;
Navy: MEB reviews case records to ensure line of duty determination is
done. Under some circumstances, case can be forwarded without one; Air
Force: If necessary for adjudication, the MEB/PEB will request a
missing LOD be accomplished and incomplete LODs to be completed.
Aspect: MEB: 1. Means of referral to MEB; Army: Physician, unit
commander, higher command, or the Military Occupational
Specialty/Medical Retention Board (MMRB).[B]; Navy: Physician, unit
commander, or higher command; Air Force: Physician and/or unit
commander with physician input.
Aspect: MEB: 2. Composition; Army: Two or more physicians. If MEB
contains a mental condition, one must be a psychiatrist. If dental
condition, one must be a dentist. When adjudicating mental
incapacitation, three required (one must be psychiatrist);
Navy: Minimum of two physicians. When adjudicating mental
incapacitation, three required, one must be a psychiatrist; Air Force:
Three physicians. When adjudicating mental incapacitation, one must be
a psychiatrist.
Aspect: MEB: 3. Type of process; Army: Informal process in which at
least two physicians compile and evaluate a service member's medical
history and his or her current medical status;
Navy: MEB members pass files among themselves and review them
independently;
Air Force: Formal process in which board meets to discuss the case.
Aspect: MEB: 4. MEB has option to place member on limited duty[C];
Army: Yes;
Navy: Yes;
Air Force: No.
Aspect: MEB: 5. Service member can appeal MEB decision; Army: Yes;
Navy: Service member has option of submitting a written rebuttal or
addendum. Physician must address the service member's specific issues;
Air Force: No.
Aspect: PEBLOs: 1. Command with responsibility for PEBLO; Army:
Medical;
Navy: Medical and PEB;
Air Force: Medical.
Aspect: PEBLOs: 2. Training; Army: Primarily on-the-job training and
annual conference; Navy: Primarily on-the-job training, plus quarterly
and annual training;
Air Force: Primarily on-the-job training, PEBLO Guide, and planned
annual training.
Aspect: PEBLOs: 3. Point in process PEBLO begins counseling service
member;
Army: MEB;
Navy: Regulations indicate this is done upon referral of MEB. However,
Navy officials interviewed said it was done after the PEB decision; Air
Force: MEB.
Aspect: PEB: 1. Overall PEB process: a. Number of PEBs nationwide;
Army: Three, plus "mobile PEB"[D]; Navy: One;
Air Force: One.
Aspect: PEB: 1. Overall PEB process: b. Reserve component board member
required on for reserve component cases; Army: Yes;
Navy: Yes;
Air Force: Yes.
Aspect: PEB: 1. Overall PEB process: c. Active component board member
required on case for active component cases; Army: No stated policy;
Navy: No stated policy;
Air Force: Yes.
Aspect: 2. Informal PEB: a. Composition; Army: At least three members;
Navy: Three members;
Air Force: Three members.
Aspect: 2. Informal PEB: b. Amount of time service member has to
concur/nonconcur with findings; Army: Ten calendar days;
Navy: Fifteen calendar days; Air Force: Three duty days.
Aspect: 2. Informal PEB: c. Informal PEB can reconsider findings under
some circumstances;
Army: Yes;
Navy: Yes;
Air Force: Yes.
Aspect: PEB: 3. Formal PEB: a. Composition; Army: At least three
members; Navy: Three members;
Air Force: Three members.
Aspect: PEB: 3. Formal PEB: b. Members of informal and formal PEB can
be the same for a case;
Army: Normally will be;
Navy: No stated policy;
Air Force: Normally will not be.
Aspect: PEB: 3. Formal PEB: c. Amount of time given to a service member
to prepare for the formal PEB; Army: Minimum of three workings days;
Navy: A "reasonable period"; Air Force: Up to three duty days after
arrival at formal PEB.[E].
Aspect: PEB: 3. Formal PEB: d. When service member is notified of
Formal PEB decision;
Army: At conclusion of proceedings; Navy: Two to three weeks after
proceedings; Air Force: At conclusion of proceedings.
Aspect: PEB: 3. Formal PEB: e. Amount of time service member has to
concur/nonconcur with findings; Army: Ten calendar days from receipt of
findings letter; Navy: Fifteen calendar days from receipt of findings
letter; Air Force: Service member has 24 hours to concur or nonconcur
with the findings. If service member does not concur he has 10 duty
days to submit a rebuttal if desired.[F].
Aspect: PEB: 3. Formal PEB: f. Formal PEB can reconsider findings under
some circumstances;
Army: Yes;
Navy: No;
Air Force: No.
Aspect: Appeals: 1. Appeal opportunities beyond the formal PEB; Army:
Army Physical Disability Agency; Navy: Petition for Relief to the
Secretary of the Navy Council of Review Boards;
Air Force: Secretary of the Air Force Personnel Council.
Army: Appeals: Army Physical Disability Appeal Board[G]; Navy: Board
for the Correction of Naval Records; Air Force: Air Force Board for the
Correction of Military Records.
Army: Army Board for the Correction of Military Records.
Source: GAO analysis, review of relevant regulations and interviews
with military officials.
[A] "Required" includes a general authority that includes reserve
members.]
[B] The Military Occupational Specialty/Medical Retention Board (MMRB)
is an administrative board that evaluates the ability of a service
member with a permanent profile of 3 or 4 (which indicates a physical
limitation) to meet the responsibilities of his military occupational
specialty in a worldwide field environment.
[C] Limited duty is a temporary period in which a service member's
responsibilities are restricted.
[D] The "mobile PEB" is a group of three adjudicators who travel and
provide additional manpower to the PEBs when needed.
[E] An Air Force official stated that members can begin their
preparations once they non-concur with the informal PEB findings and
request a formal PEB.
[F] A February 2006 policy revision allows the formal PEB president to
approve written requests for additional time to allow the member to
obtain medical documentation or consult with legal counsel.
[G] Applicable only to cases in which Army Physical Disability Agency
revises the PEB findings as part of a quality or mandatory review and
the soldier does not concur with the revised finding.
[End of table]
Disability Evaluation Related Regulations:
Federal Code:
38 CFR Part 4: Veterans Affairs Schedule for Rating Disabilities;
Department of Defense:
DODD 1332.18 "Separation or Retirement for Physical Disability"
DODI 1332.38 "Physical Disability Evaluation"
DODI 1332.39 "Application of the Veterans Administration Schedule for
Rating Disabilities"
Army:
AR 40-400 "Patient Administration"
AR 40-501 "Standards of Medical Fitness"
AR 600-8-4 "Line of Duty Policy, Procedures, and Investigations"
AR 600-60 "Physical Performance Evaluation System"
AR 635-40 "Physical Evaluation for Retention, Retirement, or
Separation"
Navy:
SECNAV 1850.4E "Department of the Navy Disability Evaluation Manual"
JAGINST 5800.7D "Manual of the Judge Advocate General"
NAVMED P-117 "Manual of the Medical Department"
Air Force:
AFI 36-2910 "Line of Duty (Misconduct) Determinations"
AFI 36-3212 "Physical Evaluation for Retention, Retirement and
Separation"
AFI 41-210 "Patient Administration Functions"
AFI 44-157 "Medical Evaluation Boards and Continued Military Service"
AFI 48-123 "Medical Examination and Standards"
[End of section]
Appendix IV: Characteristics of Army Service Members Entering the DES:
Table 12: Occupational Codes for Services Members in Military
Disability Evaluation System, Calendar Years 2001 to 2005:
Enlisted Occupation Codes: 10 Infantry, Gun Crews, and Seamanship
Specialists;
Active duty: Frequency: 7,112; Active duty: Percent: 21.2;
Reserve Component: Frequency: 1,330; Reserve Component: Percent: 14.4;
Total: Frequency: 8,442;
Total: Percent: 19.8.
Enlisted Occupation Codes: 11 Electronic Equipment Repairers; Active
duty: Frequency: 2,029; Active duty: Percent: 6.1;
Reserve Component: Frequency: 210; Reserve Component: Percent: 2.3;
Total: Frequency: 2,239;
Total: Percent: 5.2.
Enlisted Occupation Codes: 12 Communications and Intelligence
Specialists;
Active duty: Frequency: 3,673; Active duty: Percent: 11.0;
Reserve Component: Frequency: 361; Reserve Component: Percent: 3.9;
Total: Frequency: 4,034;
Total: Percent: 9.4.
Enlisted Occupation Codes: 13 Health Care Specialists; Active duty:
Frequency: 2,930; Active duty: Percent: 8.8;
Reserve Component: Frequency: 534; Reserve Component: Percent: 5.8;
Total: Frequency: 3,464;
Total: Percent: 8.1.
Enlisted Occupation Codes: 14 Other Technical and Allied Specialists;
Active duty: Frequency: 945; Active duty: Percent: 2.8;
Reserve Component: Frequency: 222; Reserve Component: Percent: 2.4;
Total: Frequency: 1,167;
Total: Percent: 2.7.
Enlisted Occupation Codes: 15 Functional Support and Administration;
Active duty: Frequency: 4,749; Active duty: Percent: 14.2;
Reserve Component: Frequency: 1,826; Reserve Component: Percent: 19.8;
Total: Frequency: 6,575;
Total: Percent: 15.4.
Enlisted Occupation Codes: 16 Electrical/Mechanical Equipment
Repairers;
Active duty: Frequency: 4,539; Active duty: Percent: 13.6;
Reserve Component: Frequency: 1,084; Reserve Component: Percent: 11.8;
Total: Frequency: 5,623;
Total: Percent: 13.2.
Enlisted Occupation Codes: 17 - Crafts Workers; Active duty: Frequency:
649; Active duty: Percent: 1.9;
Reserve Component: Frequency: 557; Reserve Component: Percent: 6.1;
Total: Frequency: 1,206;
Total: Percent: 2.8.
Enlisted Occupation Codes: 18 Service and Supply Handlers; Active duty:
Frequency: 4,872; Active duty: Percent: 14.5;
Reserve Component: Frequency: 2,447; Reserve Component: Percent: 26.6;
Total: Frequency: 7,319;
Total: Percent: 17.1.
Enlisted Occupation Codes: 19 Non-Occupational; Active duty: Frequency:
281; Active duty: Percent: 0.8;
Reserve Component: Frequency: 17; Reserve Component: Percent: 0.2;
Total: Frequency: 298;
Total: Percent: 0.7.
Officer Occupation Codes: 21 General Officers and Executives, N.E.C;
Active duty: Frequency: 0;
Active duty: Percent: 0.0;
Reserve Component: Frequency: 2; Reserve Component: Percent: 0.0;
Total: Frequency: 2;
Total: Percent: 0.0.
Officer Occupation Codes: 22 Tactical Operations Officers; Active duty:
Frequency: 535; Active duty: Percent: 1.6;
Reserve Component: Frequency: 151; Reserve Component: Percent: 1.6;
Total: Frequency: 686;
Total: Percent: 1.6.
Officer Occupation Codes: 23 Intelligence Officers; Active duty:
Frequency: 136; Active duty: Percent: 0.4;
Reserve Component: Frequency: 39; Reserve Component: Percent: 0.4;
Total: Frequency: 175;
Total: Percent: 0.4.
Officer Occupation Codes: 24 Engineering and Maintenance Officers;
Active duty: Frequency: 247; Active duty: Percent: 0.7;
Reserve Component: Frequency: 66; Reserve Component: Percent: 0.7;
Total: Frequency: 313;
Total: Percent: 0.7.
Officer Occupation Codes: 25 Scientists and Professionals; Active duty:
Frequency: 81;
Active duty: Percent: 0.2;
Reserve Component: Frequency: 43; Reserve Component: Percent: 0.5;
Total: Frequency: 124;
Total: Percent: 0.3.
Officer Occupation Codes: 26 Health Care Officers; Active duty:
Frequency: 424; Active duty: Percent: 1.3;
Reserve Component: Frequency: 131; Reserve Component: Percent: 1.4;
Total: Frequency: 555;
Total: Percent: 1.3.
Officer Occupation Codes: 27 Administrators; Active duty: Frequency:
115; Active duty: Percent: 0.3;
Reserve Component: Frequency: 94; Reserve Component: Percent: 1.0;
Total: Frequency: 209;
Total: Percent: 0.5.
Officer Occupation Codes: 28 Supply, Procurement and Allied Officers;
Active duty: Frequency: 163; Active duty: Percent: 0.5;
Reserve Component: Frequency: 94; Reserve Component: Percent: 1.0;
Total: Frequency: 257;
Total: Percent: 0.6.
Officer Occupation Codes: 29 Non-Occupational; Active duty: Frequency:
19;
Active duty: Percent: 0.1;
Reserve Component: Frequency: 6; Reserve Component: Percent: 0.1;
Total: Frequency: 25;
Total: Percent: 0.1.
Enlisted Occupation Codes: Total; Active duty: Frequency: 33,499;
Active duty: Percent: 78.4;
Reserve Component: Frequency: 9,214; Reserve Component: Percent: 21.6;
Total: Frequency: 42,713;
Total: Percent: 100.
Source: Based on conversion of military occupational specialty codes
into DOD standard occupational codes.
[End of table]
Table 13: Rank Groups by Component for Services Members in the Military
Disability System, Calendar Years 2001 to 2005:
Rank group: Junior. Enlisted (E1-E4); Active duty: Frequency: 22,460;
Active duty: Percent: 66.8;
Reserve Component: Frequency: 3,771; Reserve Component: Percent: 40.7;
Total: Frequency: 26,231;
Total: Percent: 61.1.
Rank group: Non-Commissioned Officer (E5-E9); Active duty: Frequency:
9,403; Active duty: Percent: 28.0;
Reserve Component: Frequency: 4,862; Reserve Component: Percent: 52.4;
Total: Frequency: 14,265;
Total: Percent: 33.3.
Rank group: Company grade officer (01-03); Active duty: Frequency:
1,018; Active duty: Percent: 3.0;
Reserve Component: Frequency: 205; Reserve Component: Percent: 2.2;
Total: Frequency: 1,223;
Total: Percent: 2.9.
Rank group: Field grade and general officer (04-010); Active duty:
Frequency: 447; Active duty: Percent: 1.3;
Reserve Component: Frequency: 311; Reserve Component: Percent: 3.4;
Total: Frequency: 758;
Total: Percent: 1.8.
Rank group: Warrant officer (W01-CW5); Active duty: Frequency: 302;
Active duty: Percent: 0.9;
Reserve Component: Frequency: 128; Reserve Component: Percent: 1.4;
Total: Frequency: 430;
Total: Percent: 1.0.
Rank group: Total;
Active duty: Frequency: 33,630; Active duty: Percent: 74.8;
Reserve Component: Frequency: 9,277; Reserve Component: Percent: 21.6;
Total: Frequency: 42,907;
Total: Percent: 74.8.
Source: Department of the Army.
[End of table]
[End of section]
Appendix V: Disability Evaluation Outcomes for Army Active Duty and
Reserve Component Members for 2001 to 2005:
This appendix compares Army disability evaluation outcomes in effect
for active duty and reserve component service members as of August
2005. For the purpose of our analysis, we counted only final
dispositions for service members initially placed on the temporary
disability retired list (TDRL) and subsequently taken off that list
when a final disposition was made by the Army’s Physical Evaluation
Board (PEB).1 In these cases, we counted the final disposition in the
year the initial TDRL decision was made. As a result, the tables in
this appendix show fewer TDRL dispositions than the number issued by
the PEB annually, according to the Army. The tables also show greater
numbers of permanent disability retirement and other dispositions than
the numbers reported by the Army PEB annually for the years 2001
through 2004. In each case, the differences are more pronounced in
earlier years. Therefore, data in these tables do not represent the
number of each type of disability disposition issued by the Army PEB
annually.
Table 14: Descriptive Statistics on Disability Evaluation Outcomes for
Active Duty and Reserve Component Members in the Army, Calendar Years
2001 to 2005:
Active duty:
Year: 2001;
Fit: 504;
Separation without benefits: 526;
Permanent disability retirement: 642;
Severance pay: 4,541;
Temporary disability: retired list[A]: 165;
Total: 6,378.
Year: 2002;
Fit: 462;
Separation without benefits: 541;
Permanent disability retirement: 517;
Severance pay: 4,866;
Temporary disability: retired list[A]: 246;
Total: 6,632.
Year: 2003;
Fit: 366;
Separation without benefits: 555;
Permanent disability retirement: 435;
Severance pay: 4,390;
Temporary disability: retired list[A]: 427;
Total: 6,173.
Year: 2004;
Fit: 407;
Separation without benefits: 666;
ermanent disability retirement: 362;
Severance pay: 5,495;
Temporary disability: retired list[A]: 1,050;
Total: 7,980.
Year: 2005[B];
Fit: 445;
Separation without benefits: 506;
Permanent disability retirement: 209;
Severance pay: 4,468;
Temporary disability: retired list[A]: 837;
Total: 6,465.
Reserve Component:
Year: 2001;
Fit: 105;
Separation without benefits: 24;
Permanent disability retirement: 87;
Severance pay: 311;
Temporary disability: retired list[A]: 20;
Total: 547.
Year: 2002;
Fit: 141;
Separation without benefits: 73;
Permanent disability retirement: 112;
Severance pay: 370;
Temporary disability: retired list[A]: 32;
Total: 728.
Year: 2003;
Fit: 223;
Separation without benefits: 472;
Permanent disability retirement: 126;
Severance pay: 796;
Temporary disability: retired list[A]: 91;
Total: 1,708.
Year: 2004;
Fit: 328;
Separation without benefits: 782;
Permanent disability retirement: 177;
Severance pay: 2,345;
Temporary disability: retired list[A]: 439;
Total: 4,071.
Year: 2005[B];
Fit: 248;
Separation without benefits: 338;
Permanent disability retirement: 102;
Severance pay: 1,220;
Temporary disability: retired list[A]: 315;
Total: 2,223.
Source: GAO analysis of Army PDCAPS data.
[A] Contains only cases in which temporary disability status was
assigned and continued to be in effect through August 2005.
[B] Contains decisions made by the Army PEB only through August 2005.
[End of table]
Table 15: Descriptive Statistics on Disability Evaluation Outcomes for
Active Duty and Reserve Component Members in the Army, Calendar Years
2001 to 2005:
Active duty:
Year: 2001;
Fit: 7.9;
Separation without benefits: 8.2;
Permanent disability retirement: 10.1;
Severance pay: 71.2;
Temporary disability: retired list[A]: 2.6;
Total: 100.
Year: 2002;
Fit: 7;
Separation without benefits: 8.2;
Permanent disability retirement: 7.8;
Severance pay: 73.4;
Temporary disability: retired list[A]: 3.7;
Total: 100.
Year: 2003;
Fit: 5.9;
Separation without benefits: 9;
Permanent disability retirement: 7;
Severance pay: 71.1;
Temporary disability: retired list[A]: 6.9;
Total: 100.
Year: 2004;
Fit: 5.1;
Separation without benefits: 8.3;
Permanent disability retirement: 4.5;
Severance pay: 68.9;
Temporary disability: retired list[A]: 13.2;
Total: 100.
Year: 2005[B];
Fit: 6.9;
Separation without benefits: 7.8;
Permanent disability retirement: 3.2;
Severance pay: 69.1;
Temporary disability: retired list[A]: 12.9;
Total: 100.
Reserve Component:
Year: 2001;
Fit: 19.2;
Separation without benefits: 4.4;
Permanent disability retirement: 15.9;
Severance pay: 56.9;
Temporary disability: retired list[A]: 3.7;
Total: 100.
Year: 2002;
Fit: 19.4;
Separation without benefits: 10;
Permanent disability retirement: 15.4;
Severance pay: 50.8;
Temporary disability: retired list[A]: 4.4;
Total: 100.
Year: 2003;
Fit: 13.1;
Separation without benefits: 27.6;
Permanent disability retirement: 7.4;
Severance pay: 46.6;
Temporary disability: retired list[A]: 5.3;
Total: 100.
Year: 2004;
Fit: 8.1;
Separation without benefits: 19.2;
Permanent disability retirement: 4.3;
Severance pay: 57.6;
Temporary disability: retired list[A]: 10.8;
Total: 100.
Year: 2005[B];
Fit: 11.2;
Separation without benefits: 15.2;
Permanent disability retirement: 4.6;
Severance pay: 54.9;
Temporary disability: retired list[A]: 14.2;
Total: 100.
Source: GAO analysis of Army PDCAPS data.
[A] Contains only cases in which temporary disability status was
assigned and continued to be in effect through August 2005.
[B] Contains decisions made by the Army PEB only through August 2005.
[End of table]
[End of section]
Appendix VI: Comments from the Department of Defense:
Office Of The Under Secretary Of Defense: 4000 Defense Pentagon:
Personnel And Readiness:
Washington, D.C. 20301-4000:
MAR 9 2006:
Mr. Robert E. Robertson:
Director:
Education, Workforce, and Income Security: U.S. Government
Accountability Office: 441 G Street N.W.
Washington, DC 20548:
Dear Mr. Robertson:
This letter constitutes the Department of Defense (DoD) response to GAO
draft report, "MILITARY DISABILITY SYSTEM: Improved Oversight Needed to
Ensure Consistent and Timely Outcomes for Reserve and Active Duty
Service Members," dated February 27, 2006 (GAO CODE 130501/GAO-06-362).
We fully concur with the recommendations and note one administrative
recommendation to the report. The Department is implementing all
recommendations.
* Plan and execute Disability Advisory Council (DAC) meetings on a
quarterly basis (April, July, October, and January) in order to
facilitate oversight of the disability evaluation system and advise
DOD. As a point of information, DOD has already convened its first DAC
meeting (January 31, 2006) since the GAO pre-brief in January 2006.
* Establishing ways and means to convene ad hoc working groups to
address the specific recommendations of the report and provide DOD with
a detailed "glideslope" to success.
* Revise, extend and republish guidance contained in DoD issuances so
that these are even more relevant to advances in medical science,
practices, patient management and realities of the Global War on
Terrorism.
* Robust the DoD disability management section (to include letting a
contract) to assist with policy formulation, promulgation, and
management.
Enclosed to this letter are DoD's responses to the GAO recommendations
and technical comments regarding the report. The Department appreciates
the opportunity to comment on the draft report. The DoD point of
contact is Lt Col Al Bruner, DUSD (MPP) OEPM, 703-614-2798, e-mail
al.bruner@osd.mil.
Sincerely,
Signed by:
William J. Carr:
Acting Deputy Under Secretary (Military Personnel Policy):
Enclosure: As stated:
GAO DRAFT REPORT - DATED FEBRUARY 27, 2006:
GAO CODE 130501/GAO-06-362:
"MILITARY DISABILITY SYSTEM: Improved Oversight Needed to Ensure
Consistent and Timely Outcomes for Reserve and Active Duty Service
Members"
DEPARTMENT OF DEFENSE COMMENTS TO THE RECOMMENDATIONS:
RECOMMENDATION 1: The GAO recommended that the Secretary of Defense
require the Army, Navy, and Air Force to take action to ensure that
data needed to assess consistency and timeliness of military disability
rating and benefit decisions are reliable. (p. 26/GAO Draft Report):
DOD RESPONSE: Concur.
RECOMMENDATION 2: The GAO recommended that the Secretary of Defense
require the services to track and regularly report these data,
including comparisons of processing times, ratings and benefit
decisions for reservists and active duty members, to the Undersecretary
of Personnel and Readiness and the Surgeons General. (p. 26/GAO Draft
Report):
DOD RESPONSE: Concur with administrative comment: In addition to the
Service Surgeons General, Service Assistant Secretary for Manpower and
Reserve Affairs (M&RAs) should also be included in the reports. The
Physical Disability Evaluation System portion of the Disability
Evaluation System includes a personnel and medical component. The M&RAs
ultimately oversee both the medical and personnel components.
RECOMMENDATION 3: The GAO recommended that the Secretary of Defense
determine, based on these reports, if ratings and benefit decisions are
consistent and timely across the services and between reservists and
active duty members, and institute improvements to address any
deficiencies that might be found. (p. 26/GAO Draft Report):
DOD RESPONSE: Concur.
RECOMMENDATION 4: The GAO recommended that the Secretary of Defense
evaluate the appropriateness of current timeliness goals for the
disability process and make any necessary changes. (p. 26/GAO Draft
Report):
DOD RESPONSE: Concur.
RECOMMENDATION 5: The GAO recommended that the Secretary of Defense
assess the adequacy of training of Medical Evaluation Board and
Physical Evaluation Board disability evaluation staff. (p. 26-27/GAO
Draft Report):
DOD RESPONSE: Concur.
[End of section]
Appendix VII: GAO Contact and Staff Acknowledgments:
GAO Contact:
Robert E. Robertson (202) 512-7215 or robertsonr@gao.gov:
Staff Acknowledgments:
In addition to the contact named above, Clarita A. Mrena, Assistant
Director; and Anna M. Kelley made major contributions to this report.
In addition, Jason Barnosky, Melinda Cordero, Erin Godtland, and Scott
Heacock served as team members; Lynn Milan, Anna Maria Ortiz, Doug
Sloane, Mitch Karpman, and Wil Holloway provided guidance and
assistance with design and analysis; Rachel Valliere advised on report
preparation; and Roger Thomas provided legal advice.
[End of section]
Related GAO Products:
Veterans' Disability Benefits: Claims Processing Challenges and
Opportunities for Improvements. GAO-06-283T. Washington, D.C.: December
7, 2005.
Military Personnel: Top Management Attention Is Needed to Address Long-
standing Problems with Determining Medical and Physical Fitness of the
Reserve Force. GAO-06-105. Washington, D.C.: October 27, 2005.
Military Personnel: DOD Needs to Improve the Transparency and Reassess
the Reasonableness, Appropriateness, Affordability, and Sustainability
of Its Military Compensation System. GAO-05-798. Washington, D.C.: July
19, 2005.
Federal Disability Assistance: Wide Array of Programs Needs to be
Examined in Light of 21st Century Challenges. GAO-05-626. Washington,
D.C.: June 2, 2005.
Veterans' Disability Benefits: Claims Processing Problems Persist and
Major Performance Improvements May Be Difficult. GAO-05-749T.
Washington, D.C.: May 26, 2005.
21st Century Challenges: Reexamining the Base of the Federal
Government. GAO-05-325SP Washington, D.C.: March 4, 2005.
Military Pay: Gaps in Pay and Benefits Create Financial Hardships for
Injured Army National Guard and Reserve Soldiers. GAO-05-125 and
related testimony GAO-05-322T. Washington, D.C.: February 17, 2005.
High-Risk Series: An Update. GAO-05-207. Washington, D.C.: January 1,
2005.
SSA's Disability Programs: Improvements Could Increase the Usefulness
of Electronic Data for Program Oversight. GAO-05-100R. Washington,
D.C.: December 10, 2004.
Veterans Benefits: VA Needs Plan for Assessing Consistency of
Decisions. GAO-05-99. Washington, D.C.: November 19, 2004 and related
testimony GAO-06-120T.
Military Personnel: DOD Needs to Address Long-term Reserve Force
Availability and Related Mobilization and Demobilization Issues. GAO-
04- 1031. Washington, D.C.: September 15, 2004.
Social Security Administration: More Effort Needed to Assess
Consistency of Disability Decisions. GAO-04-656. Washington, D.C.: July
2, 2004.
SSA Disability Decision Making: Additional Steps Needed to Ensure
Accuracy and Fairness of Decisions at the Hearing Level. GAO-04-14.
Washington, D.C.: November 12, 2003.
Defense Health Care: Army Needs to Assess the Health Status of All
Early-Deploying Reservists. GAO-03-437. April 15, 2003 and related
testimony GAO-03-997T Washington, D.C.: July 9, 2003.
Veterans' Benefits: Quality Assurance for Disability Claims and Appeals
Processing Can Be Further Improved. GAO-02-806. August 16, 2002 and
related testimony GAO-05-655T. Washington, D.C.: May 5, 2005.
Defense Health Care: Disability Programs Need Improvement and Face
Challenges. GAO-02-73. Washington, D.C.: October 12, 2001.
DOD Disability: Overview of Compensation Program for Service Members
Unfit for Duty. GAO-01-622. Washington, D.C.: April 27, 2001.
Disability Benefits: Selected Data on Military and VA Recipients. HRD-
92-106. Washington, D.C.: August 13, 1992.
FOOTNOTES
[1] The word reservist in this report refers to reserve component
members.
[2] This report addresses the military disability systems for three
branches of the service: the Army, Navy (including Marines), and Air
Force. This report does not address the Coast Guard or Coast Guard
Reserve.
[3] GAO, 21st Century Challenges: Reexamining the Base of the Federal
Government, GAO-05-325SP (Washington, D.C.: March 4, 2005).
[4] Pub. L. No. 81-351(1949).
[5] Creditable years are computed according to 10 U.S.C. § 1208. To
meet the 20-year threshold, reserve component members must have at
least 7,200 points of combined active duty points, membership points,
and inactive duty points.
[6] To qualify for monthly disability retirement payments, service
members with ratings of 30 percent or higher must have a disability
incurred or aggravated in the line of duty. For members on ordered
active duty of greater than 30 days, a non-aggravated pre-existing
condition is awarded disability compensation under 10 U.S.C. § 1207a if
the member has a total of 8 years of active service (active duty).
[7] For more information about concurrent receipt of military
retirement and VA benefits see Military Retirement: Major Legislative
Issues, Congressional Research Service, updated January 3, 2006.
[8] A physician is required to identify a condition that may cause the
member to fall below retention standards after the member has received
the maximum benefit of medical care.
[9] In addition, there are specific conditions listed in DOD
regulations that require a service member to be referred to the
disability evaluation system.
[10] According to DODI 1332.38, retention standards are the physical
standards or guidelines that establish those medical conditions or
physical defects that may render a member unfit for further military
service and are therefore cause for referral of the member into the
disability evaluation system.
[11] According to 10 U.S.C. § 1201, a service member is ineligible if
1) the disease or injury was incurred while not entitled to receive
basic pay (i.e., the condition existed prior to service and is not
service aggravated) and the member does not fall under the 8-year
provision of 10 U.S.C. § 1207a; 2) the disease or injury was incurred
while not in the line of duty; 3) the disease or injury was incurred
during a period of unauthorized absence; or 4) the disease or injury
resulted from intentional misconduct or willful neglect.
[12] For more information on the VA rating schedule, see DODI 1332.39,
November 14, 1996.
[13] The Under Secretary of Defense for Personnel and Readiness also
oversees the Defense Health Program, Defense Commissaries and
Exchanges, the Defense Education Activity, and the Defense Equal
Opportunity Management Institute.
[14] Army and Navy officials offered different views on the
requirements of DOD regulations, disagreeing on whether they were
obligated to count time spent through the appeals process toward the 8
years or not. However, this difference applied to both active duty and
reserve component members alike.
[15] Medical holdover status provides for the command and control of
mobilized reserve component members.
[16] Although VA compiles this data, it does not systematically assess
decision-making consistency. In a past report, we recommended that the
VA use its data to identify possible inconsistencies. VA officials
concurred with this recommendation and indicated they were implementing
a nationwide information system which they would use to determine
consistency of their disability decisions. See GAO, Veterans Benefits:
VA Needs Plan for Assessing Consistency of Decisions, GAO-05-99
(Washington, D.C.: Nov. 19, 2004) and GAO, VA Disability Benefits:
Routine Monitoring of Disability Decisions Could Improve Consistency,
GAO-06-120T (Washington, D.C.: Oct. 20, 2005).
[17] Cheryl Y. Marcum, Robert M. Emmerichs, Jennifer S. Sloan, and
Harry J. Thie, Methods and Actions for Improving Performance of the
Department of Defense Disability Evaluation System. MR-1228-OSD (Santa
Monica, Calif.: the Rand Corporation, 2002).
[18] Army military occupational specialty data were translated into DOD
occupation categories, as derived by the Defense Manpower Data Center.
[19] The average reservist was 38 years old, while the average active
duty soldier was 27 years old.
[20] If an impairment that renders a member of the military unfit for
duty existed prior to service, it is only compensable when the member
has 8 or more years of service.
[21] Prior GAO research found that, in recent years, reserve members
were deployed with preexisting medical conditions. In addition, because
reservists are not on duty fulltime (except when mobilized/activated),
their injuries are more likely to occur while not in the line of duty.
Both explanations could result in reserves having a higher likelihood
to be separated without benefits.
[22] We concluded that data for a particular variable was sufficiently
reliable for use in our analyses if entries in the electronic system
and the paper record matched in at least 99 percent of the cases
reviewed.
[23] According to the Army their databases list impairments in order of
severity. While some soldiers with multiple impairments might have
consecutive impairments of equal severity, we only included the first
impairment listed in models presented here. Alternative models with the
full set of potential impairments did not alter the substantive
interpretation of being a reservist on final ratings.
[24] As the final disability rating is measured in increments of 10,
some might question our choice of OLS rather than a categorical
analysis or a count model (e.g., Poisson). We believe that the data
represent an underlying continuous distribution between zero and 100,
and are thus appropriately modeled using OLS regression.
[25] Our measure of occupation converts military occupational specialty
codes into DOD standard occupational codes.
[26] As this more complicated model produced nearly identical estimates
of the effect of being a reservist on ratings, we present only the
results of the simpler models without interactions here.
[27] Standard error estimates are usually calculated under the
assumption of independent observations. A control for clustering
adjusts the standard errors to account for the possibility of non-
independence of observations within each cluster (here, PEB).
[28] These "relevant" factors include number of reported impairments,
body system affected, and occupation.
[29] This analysis adds age, race, sex, pay grade, PEB location, and
year the decision was reported.
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