Military Pay: Gaps in Pay and Benefits Create Financial Hardships for Injured Army National Guard and Reserve Soldiers

Highlights

In light of the recent mobilizations associated with the Global War on Terrorism, GAO was asked to determine if the Army's overall environment and controls provided reasonable assurance that soldiers who were injured or became ill in the line of duty were receiving the pay and other benefits to which they were entitled in an accurate and timely manner. GAO's audit used a case study approach to provide perspective on the nature of these pay deficiencies in the key areas of (1) overall environment and management controls, (2) processes, and (3) systems. GAO also assessed whether recent actions the Army has taken to address these problems will offer effective and lasting solutions.

Recommendations

Recommendations for Executive Action

Agency Affected	Recommendation	Status
Department of the Army	The Secretary of the Army should direct the Deputy Chief of Staff, Army G-1 to develop and promulgate--with appropriate input from the Regional Medical Commands, hospital commanders, medical hold unit commanders, and case managers--comprehensive, integrated policies and procedures for managing and treating reserve component soldiers with service-connected injuries or illnesses. At a minimum, standard operating procedures, and guidance should be developed that address specific organizational responsibilities for managing programs that deal with injured or ill reserve component soldiers, including specifying which officials have the ultimate responsibility for the success of these programs.	Closed – Implemented The Department of the Army issued Medical Holdover (MHO) Consolidated Guidance, which includes clear and comprehensive guidance for the installations to utilize in effectively managing the Medical Retention Processing (MRP) program, including specific organizational responsibilities for administering MRP.
Department of the Army	The Secretary of the Army should direct the Deputy Chief of Staff, Army G-1 to develop and promulgate--with appropriate input from the Regional Medical Commands, hospital commanders, medical hold unit commanders, and case managers--comprehensive, integrated policies and procedures for managing and treating reserve component soldiers with service-connected injuries or illnesses. At a minimum, standard operating procedures, and guidance should be developed that address where orders that extend a soldier's active duty status are to be issued, how they are to be distributed, and to whom they are to be distributed--for both command and control purposes and to update the Army's pay, personnel, and medical eligibility systems.	Closed – Implemented The Department of the Army issued Medical Holdover (MHO) Consolidated Guidance, which includes clear and comprehensive guidance for the installations to utilize in effectively managing the Medical Retention Processing (MRP) program, including an Order Distribution List covering the command and control, pay, personnel, and medical eligibility functions.
Department of the Army	The Secretary of the Army should direct the Deputy Chief of Staff, Army G-1 to develop and promulgate--with appropriate input from the Regional Medical Commands, hospital commanders, medical hold unit commanders, and case managers--comprehensive, integrated policies and procedures for managing and treating reserve component soldiers with service-connected injuries or illnesses. At a minimum, standard operating procedures, and guidance should be developed that address standards for being retained on active duty orders, including time frames and criteria for extension or retention beyond one year.	Closed – Implemented The Department of the Army has issued Medical Holdover (MHO) Consolidated Guidance, which includes eligibility criteria for being retained on active duty orders, including guidelines for extension of orders beyond one year.
Department of the Army	The Secretary of the Army should direct the Deputy Chief of Staff, Army G-1 to develop and promulgate--with appropriate input from the Regional Medical Commands, hospital commanders, medical hold unit commanders, and case managers--comprehensive, integrated policies and procedures for managing and treating reserve component soldiers with service-connected injuries or illnesses. At a minimum, standard operating procedures, and guidance should be developed that address criteria that clearly establishes priorities for where a soldier may be attached for medical care (i.e. medical facility has the specialties and the capacity needed to treat the soldier, proximity to soldier's residence).	Closed – Implemented The Department of the Army issued Medical Holdover (MHO) Consolidated Guidance, which includes guidelines for soldiers on Medical Retention Processing (MRP) orders--including both those assigned to an MRP Unit and those assigned to a Community Based Healthcare Organization (CBHCO) location--based on eligibility criteria set forth in the Consolidated Guidance.
Department of the Army	The Secretary of the Army should direct the Deputy Chief of Staff, Army G-1 to develop and promulgate--with appropriate input from the Regional Medical Commands, hospital commanders, medical hold unit commanders, and case managers--comprehensive, integrated policies and procedures for managing and treating reserve component soldiers with service-connected injuries or illnesses. At a minimum, standard operating procedures, and guidance should be developed that address minimum eligibility criteria for soldiers applying for such programs as Active Duty Medical Extension (ADME) and MRP.	Closed – Implemented The Department of the Army issued Medical Holdover (MHO) Consolidated Guidance, which includes minimum eligibility criteria for soldiers applying for the Medical Retention processing (MRP) and Active Duty Medical Extension (ADME) programs.
Department of the Army	The Secretary of the Army should direct the Deputy Chief of Staff, Army G-1 to develop and promulgate--with appropriate input from the Regional Medical Commands, hospital commanders, medical hold unit commanders, and case managers--comprehensive, integrated policies and procedures for managing and treating reserve component soldiers with service-connected injuries or illnesses. At a minimum, standard operating procedures, and guidance should be developed that address avenues through which soldiers may apply for such programsas ADME and MRP.	Closed – Implemented The Department of the Army issued Medical Holdover (MHO) Consolidated Guidance, which includes guidance on the avenues through which eligible soldier may apply for MRP and ADME.
Department of the Army	The Secretary of the Army should direct the Deputy Chief of Staff, Army G-1 to develop and promulgate--with appropriate input from the Regional Medical Commands, hospital commanders, medical hold unit commanders, and case managers--comprehensive, integrated policies and procedures for managing and treating reserve component soldiers with service-connected injuries or illnesses. At a minimum, standard operating procedures, and guidance should be developed that address specific documentation required to retain or extend active duty orders for medical treatment or evaluation.	Closed – Implemented The Department of the Army has issued Medical Holdover (MHO) Consolidated Guidance, which includes a list and examples of the specific documentation required to retain or extend active duty orders for the purpose of medical treatment or evaluation.
Department of the Army	The Secretary of the Army should direct the Deputy Chief of Staff, Army G-1 to develop and promulgate--with appropriate input from the Regional Medical Commands, hospital commanders, medical hold unit commanders, and case managers--comprehensive, integrated policies and procedures for managing and treating reserve component soldiers with service-connected injuries or illnesses. At a minimum, standard operating procedures, and guidance should be developed that address entitlements of eavh program for both the soldier and his/her dependents.	Closed – Implemented The Department of the Army has issued Medical Holdover (MHO) Consolidated Guidance, which includes a list of the entitlements available for injured reserve component soldiers and their dependents.
Department of the Army	The Secretary of the Army should direct the Deputy Chief of Staff, Army G-1 to develop and promulgate--with appropriate input from the Regional Medical Commands, hospital commanders, medical hold unit commanders, and case managers--comprehensive, integrated policies and procedures for managing and treating reserve component soldiers with service-connected injuries or illnesses. At a minimum, standard operating procedures, and guidance should be developed that address correctly linking the cost of these programs to the mission or operation in which the soldier was involved.	Closed – Implemented The Medical Retention Processing (MRP) program replaced the Active Duty Medical Extension (ADME) process for treating mobilized reserve component soldiers with service-related injuries or illnesses incurred as part of the Global War on Terror (GWOT). Under the new MRP program, the costs associated with providing medical care to these soldiers are correctly linked to GWOT funds.
Department of the Army	The Secretary of the Army should direct the Deputy Chief of Staff, Army G-1 to require that the officials designated with the responsibility for managing these programs develop performance measures to evaluate the program's success. Such performance measures should be sufficient to enable the Army to evaluate the efficiency and effectiveness of these programs--including timeliness of application processing, soldier satisfaction, and the length of time soldiers are in the program.	Closed – Implemented Since we lat reported, the Army's Office of the Surgeon General (OTSG) has developed metrics track the timeliness of application processing, conducted and reported on a soldiers satisfaction survey, and begun to track the amount of time injured or ill reserve component soldiers have spent on MRP orders.
Department of the Army	The Secretary of the Army should direct the Deputy Chief of Staff, Army G-1 to require that the officials designated with the responsibility for managing these programs develop performance measures to evaluate the program's success. Such performance measures should be sufficient to enable the Army to take any corrective actions needed to address documented shortcomings in program performance.	Closed – Implemented The Army Office of the Surgeon General (OTSG) has developed metrics that illustrates the percent of the monthly population that was dispositioned, or released from the MRP program, referred to as throughput. This is a percent of total population per month, broken out by CBHCO and MTF. Through this metric, the Army can determine how efficiently the CBHCO program is operating and can identify any program shortfalls and address them appropriately.
Department of the Army	The Secretary of the Army should direct the Deputy Chief of Staff, Army G-1 to provide the infrastructure and resources needed to support these programs and make needed process improvements to provide reasonable assurance that officials responsible for managing and treating injured and ill reserve component soldiers are adequately trained on program requirements, benefits, and processes.	Closed – Implemented We found that although the Army has provided more training and education opportunities under the new MRP program than were offered under ADME, additional actions are needed to provide mandatory, formalized training and education for those officials responsible for managing and treating injured or ill reserve component soldiers.
Department of the Army	The Secretary of the Army should direct the Deputy Chief of Staff, Army G-1 to provide the infrastructure and resources needed to support these programs and make needed process improvements to provide reasonable assurance that reserve component soldiers and unit commanders will be educated on these programs, their requirements, and their benefits.	Closed – Implemented Although the Army has provided more training and education opportunities under the new MRP program than were offered under ADME, additional actions to provide mandatory, formalized training and education for reserve component soldiers are still needed.
Department of the Army	The Secretary of the Army should direct the Deputy Chief of Staff, Army G-1 to provide the infrastructure and resources needed to support these programs and make needed process improvements to provide reasonable assurance that the administrative burden on the soldier is alleviated through coordinated, customer-friendly processes and easy access to staff responsible for both the administrative and medical treatment aspects of the programs.	Closed – Implemented The Medical Retention Processing (MRP) program, which replaced the Active Duty Medical Extension (ADME) process for reserve component soldiers mobilized as part of the Global War on Terror, has dramatically reduced the administrative burden on soldiers by improving the soldier-to-case manager ratio. Army case managers are now better able to assist soldiers navigate the administrative process associated with the MRP program.
Department of the Army	The Secretary of the Army should direct the Deputy Chief of Staff, Army G-1 to provide the infrastructure and resources needed to support these programs and make needed process improvements to provide reasonable assurance that paper-intensive application processes are replaced with user-friendly automated processes, to the extent possible, through which soldiers are notified or have easy access to the current status of their application.	Closed – Implemented The Medical Retention Processing (MRP) program, which replaced the Active Duty Medical Extension (ADME) process for reserve component soldiers mobilized as part of the Global War on Terror, is more user-friendly than the ADME program. Because MRP applications are approved in two to three days instead of two or three weeks, which was the case under ADME, the need for automated processes to track the status of applications is less important. Also, the Department of the Army has issued Medical Holdover (MHO) Consolidated Guidance, which includes an initial packet checklist, extension packet checklist, and an administrative function checklist for all soldiers to use who are applying for MRP.
Department of the Army	The Secretary of the Army should direct the Deputy Chief of Staff, Army G-1 to provide the infrastructure and resources needed to support these programs and make needed process improvements to provide reasonable assurance that the practice of garnishing soldiers' wages to resolve accounting problems created by the use of retroactive rescissions of soldiers' orders is ended.	Closed – Implemented The Medical Retention Processing (MRP) program, which replaced the Active Duty Medical Extension (ADME) process for reserve component soldiers mobilized as part of the Global War on Terror, uses a more streamlined application process than that used by the ADME program. Therefore, soldiers' active duty orders do not expire before new orders are issued, which was the case with ADME. As a result, Army installations no longer need to garnish soldiers' wages to resolve accounting problems created by the use of ad hoc procedures used to keep soldiers in pay status.
Department of the Army	The Secretary of the Army should direct the Deputy Chief of Staff, Army G-1 to, in the near term, require that the gaining Military Treatment Facility (MTF) is notified and receives a copy of the soldier's orders when a soldier is transferred from one MTF to another for treatment.	Closed – Implemented The Department of the Army issued Medical Holdover (MHO) Consolidated Guidance, which contains guidelines requiring the losing MTF to notify and provide a copy of the soldier's orders to the gaining MTF when a soldier is transferred from one MTF to another for treatment. Based on our ongoing work in this area, all of the installations we visited were routinely following this guidance.
Department of the Army	The Secretary of the Army should direct the Deputy Chief of Staff, Army G-1 to, in the near term, require that the information in the Medical Operational Data System is routinely updated and utilized to the maximum extent possible to provide visibility over and manage injured and ill reserve component soldiers.	Closed – Implemented Officials at each of the installations we visited told us that MODS was reliable, accurate, complete, and useful in managing soldiers on Medical Retention Processing (MRP) orders. Our follow up data reliability assessments at these installations confirmed that data in MODS were reasonably accurate and complete. In addition, we found Army officials were routinely using MODS to track and manage soldiers on MRP orders, as instructed in Army's guidance on the program.
Department of the Army	The Secretary of the Army should direct the Deputy Chief of Staff, Army G-1 to, in the near term, require that new orders extending active duty for injured or ill soldiers are sent directly to the staff responsible for updating the appropriate pay, personnel, and medical eligibility systems.	Closed – Implemented The Department of the Army has issued Medical Holdover (MHO) Consolidated Guidance, which includes an Order Distribution List and requires that new orders be sent directly to the organizations responsible for updating the pay, personnel, and medical eligibility systems.
Department of the Army	The Secretary of the Army should direct the Deputy Chief of Staff, Army G-1 to, in the near term, require that controls are put in place to provide assurance that the order end date in the pay system is changed to reflect the actual date the soldier was released from active duty when soldiers are released from active duty before their orders expire.	Closed – Implemented The Army has not put additional controls in place to provide assurance that the order end date in the pay system is changed to reflect the actual date the soldier was released from active duty when soldiers are released from active duty before their orders expire. As a result, the Army risks overpaying these soldiers.
Department of the Army	The Secretary of the Army should direct the Deputy Chief of Staff, Army G-1 to, in the long term, design and implement integrated order writing, pay, personnel, and medical eligibility systems that provide visibility over injured and ill reserve component soldiers.	Closed – Not Implemented Manual processes and nonintegrated order writing, pay, personnel, and medical eligibility systems at the Army are labor intensive, require extensive error-prone manual data entry and reentry, and continue to contribute to processing delays that affect the visibility over reserve component soldiers in the MRP program.
Department of the Army	The Secretary of the Army should direct the Deputy Chief of Staff, Army G-1 to, in the long term, design and implement integrated order writing, pay, personnel, and medical eligibility systems that ensure that the order writing system automatically updates the pay, personnel, and medical eligibility systems.	Closed – Not Implemented The Army has not created an order writing system that automatically updates the pay, personnel, and medical eligibility systems. Manual processes and nonintegrated order writing, pay, personnel, and medical eligibility systems at the Army are labor intensive, require extensive error-prone manual data entry and reentry, and continue to contribute to processing delays that affect the Army's ability to ensure efficient visibility and accountability over reserve component soldiers.

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National Defense

Armed forces reservesHealth care programsHealth care servicesInternal controlsMilitary payMilitary reserve personnelMobilizationNational GuardManagement information systemsArmy personnelFringe benefitsTimeliness