Military Pay
Gaps in Pay and Benefits Create Financial Hardships for Injured Army National Guard and Reserve Soldiers Gao ID: GAO-05-125 February 17, 2005In 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.
Injured and ill reserve component soldiers--who are entitled to extend their active duty service to receive medical treatment--have been inappropriately removed from active duty status in the automated systems that control pay and access to medical care. The Army acknowledges the problem but does not know how many injured soldiers have been affected by it. GAO identified 38 reserve component soldiers who said they had experienced problems with the active duty medical extension order process and subsequently fell off their active duty orders. Of those, 24 experienced gaps in their pay and benefits due to delays in processing extended active duty orders. Many of the case study soldiers incurred severe, permanent injuries fighting for their country including loss of limb, hearing loss, and back injuries. Nonetheless, these soldiers had to navigate the convoluted and poorly defined process for extending active duty service. The Army's process for extending active duty orders for injured soldiers lacks an adequate control environment and management controls--including (1) clear and comprehensive guidance, (2) a system to provide visibility over injured soldiers, and (3) adequate training and education programs. The Army has also not established user-friendly processes--including clear approval criteria and adequate infrastructure and support services. Many Army locations have used ad hoc procedures to keep soldiers in pay status; however, these procedures often circumvent key internal controls and put the Army at risk of making improper and potentially fraudulent payments. Finally, the Army's nonintegrated systems, which require extensive errorprone manual data entry, further delay access to pay and benefits. The Army recently implemented the Medical Retention Processing (MRP) program, which takes the place of the previous process in most cases. MRP, which authorizes an automatic 179 days of pay and benefits, may have resolved many of the processing delays experienced by soldiers. However, MRP has some of the same issues and may also result in overpayments to soldiers who are released early from their MRP orders. Out of 132 soldiers the Army identified as being released from active duty, 15 received pay past their release date--totaling approximately $62,000.
RecommendationsOur recommendations from this work are listed below with a Contact for more information. Status will change from "In process" to "Open," "Closed - implemented," or "Closed - not implemented" based on our follow up work.
Director: Team: Phone:GAO-05-125, Military Pay: Gaps in Pay and Benefits Create Financial Hardships for Injured Army National Guard and Reserve Soldiers
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Report to Congressional Requesters:
February 2005:
MILITARY PAY:
Gaps in Pay and Benefits Create Financial Hardships for Injured Army
National Guard and Reserve Soldiers:
GAO-05-125:
GAO Highlights:
Highlights of GAO-05-125, a report to congressional requesters
Why GAO Did This Study:
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.
What GAO Found:
Injured and ill reserve component soldiers”who are entitled to extend
their active duty service to receive medical treatment”have been
inappropriately removed from active duty status in the automated
systems that control pay and access to medical care. The Army
acknowledges the problem but does not know how many injured soldiers
have been affected by it. GAO identified 38 reserve component soldiers
who said they had experienced problems with the active duty medical
extension order process and subsequently fell off their active duty
orders. Of those, 24 experienced gaps in their pay and benefits due to
delays in processing extended active duty orders. Many of the case
study soldiers incurred severe, permanent injuries fighting for their
country including loss of limb, hearing loss, and back injuries.
Nonetheless, these soldiers had to navigate the convoluted and poorly
defined process for extending active duty service.
Examples of Injured Soldiers with Gaps in Pay and Benefits:
[See PDF for image]
[End of figure]
The Army‘s process for extending active duty orders for injured
soldiers lacks an adequate control environment and management
controls”including (1) clear and comprehensive guidance, (2) a system
to provide visibility over injured soldiers, and (3) adequate training
and education programs. The Army has also not established user-friendly
processes”including clear approval criteria and adequate infrastructure
and support services. Many Army locations have used ad hoc procedures
to keep soldiers in pay status; however, these procedures often
circumvent key internal controls and put the Army at risk of making
improper and potentially fraudulent payments. Finally, the Army‘s
nonintegrated systems, which require extensive error-prone manual data
entry, further delay access to pay and benefits.
The Army recently implemented the Medical Retention Processing (MRP)
program, which takes the place of the previous process in most cases.
MRP, which authorizes an automatic 179 days of pay and benefits, may
have resolved many of the processing delays experienced by soldiers.
However, MRP has some of the same issues and may also result in
overpayments to soldiers who are released early from their MRP orders.
Out of 132 soldiers the Army identified as being released from active
duty, 15 received pay past their release date”totaling approximately
$62,000.
What GAO Recommends:
GAO makes 20 recommendations for immediate actions including
(1) establishing comprehensive policies and procedures, (2) providing
adequate infrastructure and resources, and (3) making process
improvements to compensate for inadequate, stovepiped systems. In
addition, GAO recommends 2 actions, as part of longer term system
improvement initiatives, to integrate the Army‘s order writing, pay,
personnel, and medical eligibility systems. In its written response to
our recommendations, DOD briefly described its completed, ongoing, and
planned actions for each of our 22 recommendations.
www.gao.gov/cgi-bin/getrpt?GAO-05-125.
To view the full product, including the scope and methodology, click on
the link above. For more information, contact Gregory D. Kutz at (202)
512-9095 or kutzg@gao.gov.
[End of section]
Contents:
Letter:
Results In Brief:
Background:
Injured and Ill Reserve Component Soldiers Experience Gaps in Pay and
Benefits, Creating Financial Hardships for Soldiers and Their Families:
The Army Lacks an Effective Control Environment and Management Controls:
Lack of Clear Processes Contributed to Pay Gaps and Loss of Benefits:
Nonintegrated Systems Contribute to Processing Delays:
The Army's New Medical Retention Program Will Not Solve All the
Problems Associated with ADME:
Conclusion:
Recommendations of Executive Action:
Agency Comments and Our Evaluation:
Appendixes:
Appendix I: Objective, Scope, and Methodology:
Appendix II: Comments From the Department of the Army:
GAO Comments:
Appendix III: GAO Contact and Staff Acknowledgments:
GAO Contact:
Acknowledgments:
Table:
Table 1: Audited Installations:
Figures:
Figure 1: Overview of the Army's ADME Application Process--When
Operating as Planned:
Figure 2: Effects of Disruptions in Pay and Benefits:
Figure 3: Illustration of Retroactive Rescission of Orders and
Resulting Impact on Soldiers:
Figure 4: Transaction Flow Between the Army's Order Writing, Pay,
Personnel, and Medical Eligibility Systems:
Letter February 17, 2005:
The Honorable Tom Davis:
Chairman, Committee on Government Reform:
House of Representatives:
The Honorable Christopher Shays:
Chairman, Subcommittee on National Security, Emerging Threats, and
International Relations:
Committee on Government Reform:
House of Representatives:
The Honorable Todd Russell Platts:
Chairman, Subcommittee on Government Management, Finance, and
Accountability:
Committee on Government Reform:
House of Representatives:
In response to the September 11, 2001, terrorist attacks, the Army
National Guard and Army Reserve mobilized and deployed soldiers in
support of Operations Noble Eagle and Enduring Freedom. When mobilized
for up to 2 years at a time,[Footnote 1] these soldiers performed
search and destroy missions against Taliban and al Qaeda members
throughout Asia and Africa, fought on the front lines in Afghanistan
and guarded al Qaeda prisoners held at Guantanamo Bay, Cuba. Similarly,
reserve component soldiers fought on the front lines in Iraq and are
now assisting in peace-keeping and reconstruction operations in Iraq
under Operation Iraqi Freedom. In November 2003 and August 2004, we
reported[Footnote 2] that the existing processes and controls used to
provide pay and allowances to mobilized reserve component soldiers were
so cumbersome and complex that neither DOD nor the mobilized Army Guard
and Reserve soldiers could be reasonably assured of timely and accurate
pay. During the Army National Guard audit, we identified several
instances in which injured Guard soldiers experienced gaps in entitled
active duty pay and associated medical benefits due to problems with
the Army's process for extending their active duty orders. Mobilized
reserve component soldiers who are injured or become ill are released
from active duty and demobilized when their mobilization orders expire
unless the Army takes steps, at the soldier's request, to extend their
active duty service--commonly referred to as an active duty medical
extension (ADME).
Concerned that these soldiers' problems were symptomatic of a broader
problem in providing timely and accurate pay and related health and
other benefits to mobilized reserve component soldiers that were
injured in the line of duty, you asked us to determine if the Army's
ADME process provided reasonable assurance that injured soldiers
returning from operations associated with the Global War on
Terrorism[Footnote 3] were receiving the pay and other benefits to
which they were entitled in an accurate and timely manner. As such, we
are reporting on (1) problems experienced by selected injured or ill
Army Reserve and National Guard soldiers, (2) weaknesses in the overall
control environment and management, (3) the lack of clear processes,
and (4) the lack of integrated pay, personnel, and medical eligibility
systems. During the course of our audit, the Army implemented the
Medical Retention Processing (MRP) program, which takes the place of
ADME for soldiers returning from operations in support of the Global
War on Terrorism.[Footnote 4] Therefore, we also assessed whether the
MRP program had resolved deficiencies associated with ADME and would
provide effective and lasting solutions.
To achieve our objectives, we performed work at 10 Army installations
throughout the country that either mobilized reserve component soldiers
or, according to Army data, had significant injured or ill reserve
component populations. To determine what impact these problems were
having on soldiers and their families and provide perspective on the
nature of pay deficiencies, we interviewed 38 reserve component
soldiers who served in the Global War on Terrorism and had experienced
problems with the active duty medical extension order process at four
military installations. Using Army pay and administrative records, we
corroborated information provided by soldiers about disruptions in pay
and benefits. We were not always able to validate other statements
injured soldiers made about other types of problems they experienced.
We also interviewed and obtained relevant documentation from officials
at the Army Manpower Office[Footnote 5] at the Pentagon, all four of
the Army's Regional Medical Commands (RMC) in the continental United
States, and the Army Human Resource Command (HRC) in Alexandria,
Virginia.
We relied on a case study and selected site visit approach for this
work, principally because the many previously identified flaws in the
existing pay processes had not yet been resolved. Compounding this, the
Army did not maintain reliable, centralized data on the number,
location, and disposition of mobilized reserve component soldiers who
had requested to extend their active duty service because they had been
injured or become ill in the line of duty.[Footnote 6] Therefore, it
was not possible to statistically test controls or the impact control
breakdowns had on soldiers and their families.
We performed this work between February 2004 and October 2004 in
accordance with generally accepted government auditing standards. The
investigative portion of our work was completed in accordance with
investigative standards established by the President's Council on
Integrity and Efficiency. We also reviewed written and technical
comments provided by the Principal Deputy Under Secretary of Defense
for Personnel and Readiness, which we have incorporated as appropriate.
DOD's comments are reprinted in appendix II. Further details on our
scope and methodology are included in appendix I.
Results In Brief:
The Army lacks an effective control environment and the management
controls needed to provide reasonable assurance that injured and ill
reserve component soldiers receive the pay and benefits to which they
are entitled without interruption. For some soldiers, this resulted in
being removed from active duty status in the automated systems that
control pay and access to benefits, including medical care. In
addition, because these soldiers no longer had valid active duty
orders, they did not have access to the post exchange--which allows
soldiers and their families to purchase groceries and other goods at a
discount. While the Army does not know how many soldiers have
experienced problems receiving their pay and benefits, of the 38
reserve component soldiers we interviewed, 24 said that they had
experienced gaps in their pay and benefits due to delays in processing
extended active duty orders. Although we did not verify the claims of
all 24 soldiers, we further developed 10 case studies and verified that
they had indeed experienced problems receiving their pay and benefits.
For example, while attempting to obtain care for injuries sustained
from a helicopter crash in Afghanistan, one Special Forces soldier we
interviewed fell off his active duty orders four times. During the
times he was off-orders, he was not paid and he and his family
experienced delays in receiving medical treatment. In all, he missed 10
pay periods--totaling $11,924. Although the Army eventually paid him,
each time he fell off orders and was not paid, he and his family
struggled financially. Many of the soldiers we interviewed had incurred
severe, permanent injuries fighting for their country including loss of
limb, hearing loss, and ruptured disks. Nonetheless, we found that the
soldier carries a large part of the burden when trying to understand
and successfully navigate the Army's poorly defined requirements and
processes for obtaining extended active duty orders.
The Army lacks an adequate control environment and management controls
over ADME, which is one of the mechanisms[Footnote 7] it uses to
provide medical treatment for injured or ill reserve component soldiers
returning from Iraq and Afghanistan when their mobilization orders had
expired. ADME, as opposed to other means the Army uses to provide
health care, places soldiers on active duty orders, which then entitles
soldiers to pay and other active duty benefits.
* First, the Army's guidance for processing ADME orders does not
clearly define organizational responsibilities or standards for being
retained on active duty orders, how soldiers will be identified as
needing an extension, and how and to whom ADME orders are to be
distributed. Without clear and comprehensive guidance, the Army is
unable to establish straightforward, user-friendly processes that
provide reasonable assurance that injured and ill reserve component
soldiers receive the pay and benefits to which they are entitled
without interruption. In addition, the guidance erroneously requires
the personnel cost associated with soldiers on ADME orders to be
accounted for as a base operating expense, rather than charged to
contingency operations. We believe the cost of treating injured and ill
soldiers--including their pay and benefits--who fought in operations
supporting the Global War on Terrorism should be recorded as an expense
associated with contingency operations to accurately capture the total
cost of these operations.
* Second, the Army lacks an integrated personnel system to provide
visibility over injured or ill reserve component soldiers and as a
result, sometimes loses track of these soldiers. For example, according
to one soldier we interviewed, after he was injured in Iraq by a hand-
detonated land mine and medically evacuated back to the United States
for treatment, the Army called his wife to attempt to locate him.
According to the soldier, the Army apparently had no record of his
injury and transport out of theater and thought he might be absent
without leave, when in fact, he was in an Army hospital in the United
States making appointments with Army physicians.
* Finally, the Army has not adequately educated reserve component
soldiers about ADME or trained Army personnel responsible for helping
soldiers apply for ADME orders. As a result, many of the soldiers we
interviewed said that neither they nor the Army personnel responsible
for helping them clearly understood the process. This confusion
resulted in delays in processing ADME orders and for some, meant that
they fell from their active duty orders and lost pay and medical
benefits for their families.
The Army lacks customer-friendly processes for injured or ill soldiers
who are trying to extend their active duty service through the ADME
process--including clear approval criteria and adequate infrastructure
and support services. Although the Army's procedural guidance,
discussed previously, describes what forms and documents must be
submitted as part of an ADME application, the guidance lacks clear
criteria on the specific information that must be contained in each
document and well-defined procedures for providing feedback on the
status of application packages. As a result, soldiers often had to
submit their applications numerous times before obtaining approval.
This delay, in turn, caused these soldiers to fall off their active
duty orders and, at times, interrupted their pay and benefits. For
example, one Special Forces soldier we interviewed, who lost his leg
when a roadside bomb destroyed the vehicle he was riding in while on
patrol for Taliban fighters in Afghanistan, missed three pay periods
totaling $5,000 because he fell off his active duty orders. Although
this soldier was clearly entitled to a medical extension, according to
approving officials at Army Manpower, his application was not
immediately approved because it did not contain sufficiently current
and detailed information to justify this soldier's qualifications for
an active duty medical extension. In addition, at some installations
the Army did not have adequate support services to help soldiers
complete their ADME applications and obtain the required medical
documentation in an efficient and timely manner. For example, one
injured soldier we interviewed whose original mobilization orders
expired in January 2003 said that he made over 40 trips to various
sites at Fort Bragg during the month of January to complete his ADME
application.
The financial hardships experienced by injured or ill reserve component
soldiers would have been more widespread had individuals within the
Army not taken extraordinary steps to keep soldiers in pay status. In
fact, 7 of the 10 Army installations we visited had created their own
ad-hoc procedures or workarounds to keep soldiers in pay status. One
installation we visited issued legitimate, official mobilization orders
locally to keep soldiers in pay status. However, in doing so, they
created additional problems--which ultimately resulted in garnishing
soldiers' pay to straighten out Army accounting and funding issues. In
most other cases, the installations we visited made unauthorized,
unsupported adjustments to a soldier's pay records. While effectively
keeping a soldier in pay status in the pay system, this workaround
circumvented key internal controls--putting the Army at risk of making
improper and, as explained later, potentially fraudulent payments. In
addition, because these soldiers are not on official active duty
orders, they are not eligible to receive other benefits to which they
are entitled, including health coverage for their families. For some of
the soldiers we interviewed, this created significant problems. For
example, according to one soldier we interviewed, when he was off
active duty orders due to delays in processing his extension and
required treatment for nausea and vomiting blood, he was initially
refused treatment because he was not on active duty orders. His wife
also lost access to health care each time he was off his active duty
orders. At the time, his wife was pregnant and was relying on coverage
through the military's dependent care insurance for her prenatal visits.
Manual processes and non-integrated pay and personnel systems affect
the Army's ability to generate timely active duty medical extension
orders and ensure that soldiers are paid correctly. Overall, we found
the current stovepiped, nonintegrated systems were labor intensive and
require extensive error-prone manual data entry and reentry. For
example, the Army's order-writing system does not directly interface
with the personnel, pay, or medical eligibility systems, which all need
to be updated in order for soldiers and their families to receive the
pay and medical benefits to which they are entitled. Instead, once
approved, hard copy or electronic copy ADME orders are distributed and
used to manually update the appropriate systems. However, as discussed
previously, the Army's ADME guidance does not address the distribution
of ADME orders or clearly define who is responsible for ensuring that
the appropriate pay, personnel, and medical eligibility systems are
updated. As a result, ADME orders are not sent directly to the
individuals responsible for data input but instead, are distributed via
e-mail and forwarded throughout the Army and the Department of Defense-
-eventually reaching individuals with access to the pay, personnel, and
medical eligibility systems. For example, once an ADME order is
processed, it is e-mailed to nine different individuals--four at the
National Guard Bureau (NGB), four at the Army Manpower office, and one
HRC in Alexandria Virginia--none of which are responsible for updating
the appropriate pay and benefit systems. Not only is this process
vulnerable to input errors, but not sending a copy of the orders
directly to the individual responsible for input further delays a
soldier's ability to receive the pay and benefits to which he or she is
entitled.
The Army's new MRP program, which went into effect May 1, 2004, and
takes the place of ADME for soldiers returning from operations in
support of the Global War on Terrorism, should resolve many of the
processing delays experienced by soldiers applying for ADME by
simplifying the application process. In addition, unlike ADME, the
personnel costs associated with soldiers on MRP orders are
appropriately linked to the contingency operation for which they
served, and therefore will more appropriately capture these costs
related to the Global War on Terrorism. While the front-end approval
process appears to be operating more efficiently than the ADME approval
process, due to the fact that the first wave of 179-day MRP orders did
not expire until October 27, 2004, after the completion of our work, we
were unable to assess how effectively the Army identified soldiers that
required an additional 179 days of MRP and whether those soldiers will
experience pay problems or difficulty obtaining new MRP orders. In
addition, because the Army does not maintain reliable data on the
current status and disposition of injured soldiers, we could not test
or determine whether all soldiers who should be on MRP orders were
applying and getting into the system. Further, MRP has not resolved the
underlying management control problems that plague ADME--including
problems associated with the lack of guidance, visibility over
soldiers, adequate training and education, and manual processes and non-
integrated pay and personnel systems--and in some respects has worsened
problems associated with the Army's lack of visibility over injured
soldiers. For example, in September and October of 2004 the Army did
not know with any certainty how many soldiers were currently on MRP
orders, how many had returned to active duty, or how many had been
released from active duty early.
In addition, although MRP authorizes 179 days and eliminates the need
to reapply for new orders every 30 days, as was sometimes the case with
ADME, it also presents new challenges. If the Army treats and releases
soldiers from active duty in less than 179 days, our previous work has
shown that weaknesses in the Army's process for releasing soldiers from
active duty and stopping the related pay before their orders have
expired--in this case before their 179 days is up--often resulted in
overpayments to soldiers. Although the Army did not have a complete or
accurate accounting of soldiers who were treated and released from MRP
early, of the 132 soldiers that the Army identified as released from
active duty, we found that 15 received pay past their release date--
totaling approximately $62,000. For example, one soldier who was
released from active duty on July 9, 2004 after 43 days on MRP orders
was overpaid $10,595 between July and November. As of the date of this
report, we are continuing to investigate soldiers who were overpaid by
the Army. Finally, because ADME will continue to be used for soldiers
who are not activated or mobilized as part of the Global War of
Terrorism--such as soldiers injured in Bosnia or Kosovo or during
training exercises--it is still important that the ADME problems we
identified are resolved.
We are making 20 recommendations for immediate actions including (1)
establishing comprehensive policies and procedures for managing
programs for treating reserve component soldiers with service-connected
injuries or illnesses--including MRP and ADME, (2) providing adequate
infrastructure and resources, and (3) making process improvements to
compensate for inadequate, stove-piped systems. In addition, GAO
recommends 2 actions, as part of longer term system improvement
initiatives, to integrate the Army's order writing, pay, personnel, and
medical eligibility systems.
We are encouraged that the Army has begun to take action to address the
problems we identified and are hopeful that it will continue to work
toward comprehensive, effective solutions for addressing the
recommendations in this report dealing with reserve component soldiers
with service-connected injuries or illnesses.
Background:
The Army has several mechanisms for providing needed health care
services for reserve component soldiers who become injured or ill while
mobilized on active duty or during military training. Some soldiers
choose to be released from duty and seek care through their private
insurers. Eligible soldiers may also seek care through the Veterans
Administration (VA) or the military's transitional medical assistance
program.[Footnote 8] Finally, soldiers may also request to remain on
active duty for medical evaluation, treatment, and/or processing
through the Army disability evaluation system. Remaining on active duty
entitles soldiers to continue receiving full pay and allowances as well
as health care without charge to the soldiers and their dependents.
Until recently, mobilized reserve component soldiers who were receiving
medical treatment or evaluations for conditions that made them unfit
for duty have fallen into two groups. The first comprises soldiers who
are being treated on mobilization orders and is referred to as "medical
holdover" soldiers. The second group comprises soldiers whose
mobilization orders have expired and who have applied and been approved
to be extended on active duty for medical treatment or evaluation
through ADME orders. Regardless of the classification, the Army's goals
are the same--to ensure that the soldier attains the optimal level of
physical or mental condition and to determine whether he or she can be
returned to duty, released from active duty, or released from military
service. To facilitate this process the Army relies on (1) case
managers located at Army Military Treatment Facilities (MTF) who are
responsible for helping both active and reserve component soldiers
schedule medical appointments and understand what steps he or she needs
to take to progress through the treatment or evaluation process (for
reserve component soldiers this might include applying for ADME) and
(2) garrison support units and medical hold units located at each
installation that are responsible for, among other things, helping
soldiers apply for ADME.
* Medical holdover. This group comprises two categories: ( 1) soldiers
who were mobilized to active duty, but who for medical reasons were non-
deployable[Footnote 9] and (2) soldiers who were mobilized and deployed
but sustained line of duty injuries, which make them not fit to return
to duty. These soldiers are being medically treated while on their
original mobilization orders. If treatment is not completed and
soldiers have not been returned to duty or released from duty at the
end of their orders, these soldiers may apply for an ADME order.
* Active duty medical extension. This group comprises three categories:
(1) soldiers who were previously in medical holdover, either because
they were medically non-deployable or had sustained line of duty
injuries, but whose medical treatment was not completed before their
mobilization orders expired, (2) soldiers identified during
demobilization as being not fit for duty due to illnesses or injuries
sustained or aggravated while on active duty, and (3) soldiers who
sustained injuries during annual training, weekend drills, or other
activities associated with their Army National Guard or Army Reserve
duties. This third group of soldiers, however, falls outside the scope
of our audit.
Mobilized reserve component soldiers who are in medical holdover are
attached to a medical hold unit[Footnote 10] and would typically apply
for ADME orders through that unit.[Footnote 11] If identified during
demobilization, injured or ill soldiers would typically apply for ADME
orders through the garrison support unit, which handles the
mobilization and demobilization of reserve component soldiers. However,
similar to soldiers injured during weekend drills or annual training,
mobilized soldiers may also apply for ADME orders through their reserve
component home state units.
As shown in figure 1, reserve component soldiers wishing to be extended
on active duty for medical treatment or evaluation are to submit an
active duty medical extension order application packet to Army Manpower.
Figure 1: Overview of the Army's ADME Application Process--When
Operating as Planned:
[See PDF for image]
[A] Soldiers are identified as needing medical treatment through (1)
mobilization, (2) demobilization, or (3) when the soldier is medically
evacuated out of theater.
[B] Army Manpower will not begin processing a medical extension order
request packet until it deems that the packet is complete. Army
Manpower does not give notice to the requesting installation if more
detailed information is required to begin the evaluation and approval
process.
[End of figure]
Officials in that office evaluate the application packet and make a
determination of (1) whether the soldier will be approved for medical
extension orders, (2) the length of medical extension orders, if
approved, and (3) the military medical treatment facility to which the
soldier will be attached. The officials make these determinations based
on the data included in the application packets. According to the
medical extension procedural guidance, all application packets are to
include:
* An application form that includes demographic information about the
soldier and identifies the closest military medical treatment facility
to the soldiers home to which the soldier will be attached for
treatment;[Footnote 12]
* A physician's statement describing the soldier's diagnosis,
prognosis, and care needed, including length of care needed;[Footnote
13]
* A physical profile, if available;[Footnote 14]
* A commander's statement that the soldier's illness or injury was
incurred or aggravated in the line of duty; and:
* A letter of consent to remain on active duty.
Army Manpower officials also told us that soldiers must submit a copy
of their original orders, although we did not find that to be
explicitly stated in the Procedural Guidance or the Field Operating
Guide. Figure 1 depicts the design of the ADME process as it was
intended to be implemented. As discussed later in this report, we found
numerous breakdowns in the process.
As shown in figure 1, all medical extension application packets were to
be transmitted to Army Manpower officials in the Pentagon. If a
soldier's application is not approved, the soldier was to be released
from active duty and, as discussed previously, was eligible for the
Army's transitional medical assistance program or possibly VA benefits.
Once Army Manpower officials approve an ADME application, they e-mail a
memorandum requesting the extension to the HRC location in St. Louis,
Missouri, which processes the ADME orders. HRC-St. Louis, the entity
that ultimately forwards copies of the orders to personnel responsible
for updating the Army's pay, personnel, and medical eligibility
systems, then transmits, via e-mail, a copy of the order back to Army
Manpower and the Army National Guard. Army Manpower distributes copies
to the medical hold unit, the regional medical command and the soldier.
This process, as described by Army Manpower officials, was not set
forth in either the ADME Procedural Guidance or the MEDCOM Field
Operating Guide.
According to DOD directive, if a soldier--active duty or reserve
component, including reserve component soldiers mobilized to active
duty--remains medically unfit for duty for a year, the Army is to
examine whether the soldier can be returned to duty (RTD), released
from active duty (REFRAD), or put before a medical evaluation board and
entered into the physical disability evaluation process to determine
the likelihood of return to duty.[Footnote 15] The exceptions are
soldiers who have not yet reached an optimal level of medical care and
for whom the possibility of return to duty may still be realistic.
The procedural guidance and the field operating guide for ADME do not
limit the number of times or the number of total days that soldiers may
be on medical extension orders for the purpose of medical treatment or
evaluation. Individual medical extension orders can be written for up
to 179 days or for shorter periods, as appropriate. They may also be
extended beyond the original end date by providing an updated
physician's statement detailing the revised healing plan and associated
timeframe.
Effective May 1, 2004, the Army implemented its new MRP program, which
takes the place of ADME for soldiers returning from operations in
support of the Global War on Terrorism, and transferred the approval
process from the Army Manpower office to HRC - Alexandria. ADME will
still exist, but only for Army reserve component soldiers who become
injured or ill during annual training, weekend drills, other activities
associated with Army National Guard or Army Reserve duty, and military
operations not associated with the Global War on Terrorism. Eligible
soldiers who were on ADME orders when MRP was implemented were not
transferred to MRP orders but if necessary, can apply for MRP when
their ADME orders expire. Soldiers eligible for MRP are also eligible
to participate in the Army's new Community Based Health Care Initiative
(CBHCI) pilot program. The purpose of the initiative is to allow
selected reserve component soldiers to return to their homes and
receive medical care in their community rather than remaining at the
demobilization site. To be selected for the program, soldiers must
volunteer to remain on active duty, reside in a state participating in
the pilot program, and reside in a community where appropriate medical
care is available.
MRP is for soldiers who become injured or ill while on mobilization
orders in support of the Global War on Terrorism. Soldiers who are
identified within the first 25 days of mobilization as being medically
non-deployable for non-service-connected medical conditions will be
released from active duty. Soldiers who are injured in the line of duty
or become ill during pre-deployment training or while deployed may
apply for MRP once the Army has established that (1) the soldier will
not return to duty within 60 days or (2) the soldier could return to
duty within 60 days, but will not have at least 120 days remaining on
his mobilization orders. Soldiers meeting these criteria will be
reassigned to the installation Medical Retention Processing Unit
(MRPU). Soldiers are to remain assigned to the MRPU until a medical
determination is made concerning whether they will return to duty,
enter the CBHCI program, be released from active duty, retire, or be
discharged. All MRP orders are cut for 179 days, and the Army's
implementing instructions state that soldiers will not be extended past
365 days without being entered into the physical disability evaluation
process. Further, MRP orders state that separation or REFRAD is
required upon completion of medical evaluation or treatment, or for
disability separation.
Injured and Ill Reserve Component Soldiers Experience Gaps in Pay and
Benefits, Creating Financial Hardships for Soldiers and Their Families:
Poorly defined requirements and processes for extending injured and ill
reserve component soldiers on active duty have caused soldiers to be
inappropriately dropped from their active duty orders. For some, this
has led to significant gaps in pay and health insurance, which has
created financial hardships for these soldiers and their families.
Based on our analysis of Army Manpower data during the period from
February 2004 through April 7, 2004, almost 34 percent of the 867
soldiers who applied to be extended on active duty orders fell off
their orders before their extension requests were granted. This placed
them at risk of being removed from active duty status in the automated
systems that control pay and access to benefits, including medical care
and access to the post exchange--which allows soldiers and their
families to purchase groceries and other goods at a discount.
While the Army Manpower office began tracking the number of soldiers
who have applied for ADME and fell off their active duty orders during
that process, the Army does not keep track of the number or soldiers
who have lost pay or other benefits as a result. Although, logically, a
soldier who is not on active duty orders would also not be paid, as
discussed later, many of the Army installations we visited had
developed ad hoc procedures to keep these soldiers in pay status even
though they were not on official, approved orders. However, many of the
ad hoc procedures used to keep soldiers in pay status circumvented key
internal controls in the army payroll system--exposing the Army to the
risk of significant overpayment, did not provide for medical and other
benefits for the soldiers dependents, and sometimes caused additional
financial problems for the soldier.
Further, because the Army did not maintain any centralized data on the
number, location, and disposition of mobilized reserve component
soldiers who had requested ADME orders but had not yet received them,
we were unable to perform statistical sampling techniques that would
allow us to estimate the number of soldiers affected. However, through
our case study work, we identified 38 reserve component soldiers who
said they had experienced problems with the active duty medical
extension order process and subsequently fell off their active duty
orders. Of those, 24 said that they had experienced gaps in their pay
and benefits. We did not verify the claims of all 24 soldiers; however,
based on the information that we obtained from these soldiers, we
further developed 10 case studies and verified that they had indeed
experienced problems receiving their pay and benefits.
Figure 2 provides an overview of the pay problems experienced by the 10
case study soldiers we interviewed and the resulting impact the
disruptions in pay and benefits had on the soldiers and their families.
According to the soldiers we interviewed, many were living paycheck to
paycheck, therefore, missing pay for even one pay period created a
financial hardship for these soldiers and their families.
Figure 2: Effects of Disruptions in Pay and Benefits:
[See PDF for image]
[A] Missed pay only includes base pay, however, depending on the
soldiers location and circumstances, they may be entitled to more than
base pay. There is not a direct correlation between the number of days
off orders and the amount of pay missed. This occurs for a variety of
reasons, including differences in soldier rank and pay structure.
[End of figure]
During our fieldwork, the 10 soldiers described in figure 2 experienced
pay problems. While the Army ultimately addressed these soldiers'
problems, absent our efforts and consistent pressure from the
requesters of the report, it would likely have taken longer for the
Army to address these soldiers' problems. To illustrate the tremendous
hardships faced by injured and ill reserve component soldiers applying
for active duty medical extensions, we have chronicled the experiences
of three soldiers who were mobilized to active duty for military
operations in Afghanistan and Iraq. Each of these soldiers had an
illness and/or injury that was incurred or aggravated while mobilized.
* Case Study #1. As a Staff Sergeant with the Virginia Army National
Guard, B Company, 3rd Battalion, 20th Special Forces, this soldier was
called to active duty in January 2002 for a 1 year tour of duty in
Afghanistan, including search and destroy missions seeking Taliban
organizations and operatives. In July 2002, while in combat in
Afghanistan, he was injured in a helicopter crash and sustained
injuries to both knees and suffered kidney problems. He returned to
Fort Bragg in October 2002 with his unit to demobilize. As part of this
process, he first applied for an active duty medical extension in
November--hoping that his orders would be approved before his original
mobilization orders expired on January 3, 2003. However, the order to
extend him on active duty was not approved until approximately a month
after his original mobilization orders expired, resulting in two missed
pay periods. Although the nature and extent of his injuries required
months of treatment, his original medical extension was only approved
for 90 days. As a result, he had to apply for three additional
extensions. Each time, delays in processing caused him to fall off
orders--during which time he missed an additional 8 pay periods. In
all, he missed 10 pay periods totaling approximately $12,000. Although
the Army eventually paid him, each time he fell off orders and was not
paid, he and his family struggled financially. According to the
soldier, the late pay caused his credit to be negatively affected. He
was delinquent on 10 payments with four creditors, all coinciding with
missed pay periods. In addition, because he was often in between
orders, on several occasions the soldier's medical treatment was
delayed. For example, according to the soldier, he went to an Army
medical treatment facility after experiencing nausea and vomiting
blood, but because he was off orders and his identification card was
not active, he was initially refused medical treatment. His family also
suffered each time he fell off orders. Specifically, his wife lost
access to her dependent insurance benefits from the Army's health care
contractors. At the time, his wife was pregnant and was relying on the
dependent insurance coverage for her prenatal visits. According to the
soldier, the stress caused by these circumstances created so much
anxiety that he ultimately sought counseling to help him cope with the
strain. This soldier's ADME problems were resolved as of April 2004.
* Case Study #2: As a Sergeant with the Army National Guard, 72nd
Military Police Company in Las Vegas, Nevada, this soldier was
mobilized and deployed with his unit in February 2003 for Operation
Iraqi Freedom. While in Iraq, he and his unit were responsible for
guarding and transporting prisoners to and from Baghdad and Abu Ghraib
prison, securing the courthouse and the surrounding perimeter during
trials, and suppressing prison riots. In June 2003, during a prison
riot, he severely injured his left knee and later sustained a head
injury and had to be medically evacuated for treatment. When he arrived
at Madigan Army Medical Center at Fort Lewis, Washington, he had
surgery on his knee and cervical disk. Because his injuries required
treatment beyond February 2004, the date his mobilization orders would
expire, he applied for an active duty medical extension in December
2003. However, his application was not approved until April 2004.
During most of the time he was off orders, the medical hold unit
personnel at Fort Lewis were able to keep him in pay status by working
with the local finance staff to manipulate key fields in the Army's pay
system. Nonetheless, these ad-hoc workarounds were not always
effective, and he missed about three pay periods totaling almost
$3,900. In addition, because he did not have official active duty
orders, he and his family did not have access to military base benefits
such as the Post Exchange, precluding them from buying groceries and
other necessities at a discount, and he was unable to show proof of
employment in order to receive a home loan or even rent a house for his
family. As a result, the soldier said that he and his wife and three
daughters lived in the basement of his father-in-law's house and
borrowed $10,000 from his mother for living expenses. This soldier's
ADME problems were resolved as of April 2004. Case Study #10. As a
Specialist with the Army National Guard, 306 Engineers, located in
Amityville, New York, this soldier was activated in January 2002 as
part of Operation Noble Eagle. She initially reported to Fort Dix, New
Jersey, to be mobilized and deployed but was later sent to Fort
Stewart, Georgia, to assist that installation's engineering unit with
vehicle repairs. In April 2002, while at Fort Stewart, she injured her
left foot during training exercises. While still on her original
mobilization orders, she had surgery on her foot. However, a year
later, in January 2003, her original mobilization orders were about to
expire but she was still having problems walking so she applied for an
active duty medical extension. Although her original request was
approved on January 18, 2003, for 30 days, her subsequent request was
not approved. According to the soldier, she had to reapply for
extensions numerous times before finally being approved. During this
time she was off orders for a total of 101 days, totaling $13,475 in
late pay. According to the soldier, she depleted her savings and had to
use money saved for her retirement to pay her bills. According to the
soldier, the 14 pay periods she missed while applying for active duty
medical extension orders caused her to pay many of her bills late. This
soldier's ADME problems were resolved as of April 2004.
The Army Lacks an Effective Control Environment and Management Controls:
The Army lacks an effective control environment and the management
controls needed to provide reasonable assurance that injured and ill
reserve component soldiers receive the pay and benefits to which they
are entitled without interruption. Specifically, the Army has not
provided (1) clear and comprehensive guidance needed to develop
effective processes to manage and treat injured and ill reserve
component soldiers, (2) an effective means of tracking the location and
disposition of injured and ill soldiers, and (3) adequate training and
education programs for Army officials and injured and ill soldiers
trying to navigate their way through the ADME process.
Clear and Complete Guidance Lacking:
The Army's implementing guidance related to the extension of active
duty orders is sometimes unclear or contradictory--creating confusion
and contributing to delays in processing ADME orders. For example, the
guidance states that the Army Manpower Office is responsible for
approving extensions beyond 179 days but does not say what organization
is responsible for approving extensions that are less than 179 days. In
practice, we found that all applications were submitted to Army
Manpower for approval regardless of number of days requested. At times,
this created a significant backlog at the Army Manpower Office and
resulted in processing delays. The guidance also is confusing regarding
where applications for extensions are to be forwarded. It specifies
sending them to either the National Guard Bureau or the Army Manpower
office but provides no further explanation for why an application would
be sent to one organization versus the other.
The Army's regulations[Footnote 16]for addressing the needs of injured
and ill active component soldiers are intended to also address the
needs of mobilized injured and ill reserve component soldiers because
once a reserve component soldier has been on active duty orders in
excess of 30 days, he or she is entitled to the same health and other
benefits as active component soldiers. Army regulations[Footnote 17]
also state that for soldiers on active duty orders for 30 consecutive
days or more, their active duty orders may be extended for the purpose
of receiving medical treatment. However, the Army's implementing
guidance does not clearly define organizational responsibilities, how
soldiers will be identified as needing an extension, how ADME orders
are to be distributed, and to whom they are to be distributed. As
discussed later, the lack of clear guidance has contributed to the
Army's difficulties in (1) maintaining visibility over the status of
these soldiers and their applications, (2) training and educating
soldiers and Army personnel on the procedures for applying for
extensions, and (3) efficiently updating the appropriate pay,
personnel, and medical eligibility systems. In addition, according to
the guidance, the personnel costs associated with soldiers on ADME
orders should be tracked as a base operating cost. However, we believe
the cost of treating injured and ill soldiers--including their pay and
benefits--who fought in operations supporting the Global War on
Terrorism should be accounted for as part of the contingency operation
for which the soldier was originally mobilized. This would more
accurately capture the total cost of these wartime operations.[Footnote
18]
The Army Lacks an Effective Means of Tracking the Location and
Disposition of Injured and Ill Soldiers:
As we have reported in the past, the Army's visibility over mobilized
reserve component soldiers is jeopardized by stovepiped systems serving
active and reserve component personnel.[Footnote 19] Therefore, the
Army has had difficulty determining which soldiers are mobilized and/or
deployed, where they are physically located, and when their active duty
orders expire. In the absence of an integrated personnel system that
provides visibility when a soldier is transferred from one location to
another, the Army has general personnel regulations that are intended
to provide some limited visibility over the movement of soldiers.
However, when a soldier is on ADME orders, the Army does not follow
these or any other written procedures to document the transfer of
soldiers from one location to another--thereby losing even the limited
visibility that might otherwise be achievable. Further, although the
Army has a medical tracking system, the Medical Operational Data System
(MODS) that could be used to track the whereabouts and status of
injured and ill reserve component soldiers, we found that, for the most
part, the installations we visited did not use or update that system.
Instead, each of the installations we visited had developed its own
stovepiped tracking system and databases.
According to Army officials, when a soldier departs from one unit or
installation to another, the Army requires the losing unit to notify
the gaining unit about the transfer and provide the gaining unit with a
copy of the soldier's orders. However, these procedures are not
followed when ADME orders are used to attach a soldier to an MTF for
treatment. As a result, the receiving MTF is routinely not notified
about the transfer and therefore, has no knowledge that it is now
responsible for the injured soldier. Such knowledge is necessary to
ensure that the soldier is assigned a case manager and receives the
needed medical attention.
Instead, Army Manpower sends a copy of the soldier's ADME orders to the
RMC and, according to Army Manpower officials, they expect the RMC to
forward a copy of the orders to the gaining MTF. However, as discussed
previously, the Army's procedural guidance does not clearly define how
ADME orders are to be distributed and does not direct the RMC to
further distribute the orders. Further, according to officials at Army
RMCs, they are often inundated with e-mails containing multiple ADME
order attachments, making it impractical for them to sort through and
distribute all of them. As a result, we found that ADME orders did not
routinely make it to the gaining MTF. According to Army officials at
some of the MTFs we visited, this, combined with the fact that some
soldiers on ADME orders never report to their new unit, make it
difficult to ensure that these soldiers get the treatment they need. As
discussed later, nonintegrated systems and a lack of clear guidance on
how, to whom, and for what purpose ADME orders are to be distributed
have also created delays in updating the Army's pay, personnel, and
medical eligibility systems once a soldier's ADME order is approved.
Case Study Illustration: Army Loses Track of Wounded National Guard
Soldier:
A Specialist with the Nevada Army National Guard, 72nd MP Company, was
mobilized on February 10, 2003, to active duty as part of Operation
Iraqi Freedom. He and his unit were mobilized through Fort Lewis,
Washington, and sent to Iraq. His unit provided security for Abu Ghraib
prison, including reopening the prison and securing Iraqi detainees;
On June 27, 2003, while on duty outside the prison near Baghdad, the
vehicle in which the soldier was riding was struck by a hand-detonated
land mine. The soldier and others in his vehicle were injured. He was
medically evacuated from the scene of the attack for treatment of
multiple injuries including a blown ear drum with complete hearing loss
in his right ear and partial hearing loss in the left, large cuts and
bruises over his left eye and forehead, fracture to the left elbow and
left wrist, crushed (deformed) right index finger, and shrapnel on the
left side of his upper body;
He was flown from Iraq to Kuwait and then to Lundsthul Hospital in
Germany for additional care. After a week or so at the hospital in
Germany, the soldier was cleared to go back to the United States to
continue his medical care. According to the soldier, he was told that
he must have "closed toe shoes" in order to take the flight home or he
would be strapped down to a gurney the entire flight. The soldier only
had flip-flops since at the time of the attack, it was necessary to cut
off his clothing and shoes to care for his wounds;
After being told by the hospital chaplain that shoes were not
available, he was given permission to leave the hospital to obtain
shoes and clothing. He proceeded to take the hospital shuttle bus to
Ramstien Air Base, approximately 15 minutes away. The soldier told us
that he walked approximately 2 miles to the Post Exchange, wearing flip-
flops and torn clothing from the attack, along with stitches and
slings. Further, he was severely hearing impaired and in pain. After
purchasing shoes and toiletry items, at his own expense, he took a cab
back to Lundstuhl Hospital;
Once he got to Fort Lewis, Washington, he was transported by bus to
Madigan Army Hospital. On or about July 7, 2003, the soldier's wife
told us that personnel from Fort Lewis contacted her at their home in
Las Vegas. The Army could not locate the soldier and wanted to know if
his spouse knew his location. Personnel from Fort Lewis thought he
might be AWOL. He was in fact at the Army hospital at Fort Lewis making
medical appointments with physicians. Eventually he was placed on
remote care at Nellis Air Force base located near his home in Las
Vegas;
On or about July 25, 2003 while on convalescent leave in Las Vegas the
family was contacted by a member of the U.S. Army stating that the
soldier had been injured in Baghdad and was in a hospital in Germany.
The soldier had been in the States for 20 days.
Although MODS, if used and updated appropriately, could provide some
visibility over injured and ill active and reserve component soldiers-
-including soldiers who are on ADME orders, 8 of the 10 installations
we visited did not routinely use MODS. MODS is an Army Medical
Department (AMEDD) system that consolidates data from over 15 different
major Army and Department of Defense data bases. The information
contained in MODS is accessible at all Army MTFs and is intended to
help Army medical personnel administer patient care. For example, as
soldiers are approved for ADME orders, the Army Manpower office enters
data indicating where the soldier is to receive treatment, to which
unit he or she will be attached, and when the soldier's ADME orders
will expire. However, as discussed previously, the Army has not
established written standard operating procedures on the transfer and
tracking of soldiers on ADME orders. Therefore, the installations we
visited were not routinely looking to MODS to determine which soldiers
were attached to them through ADME orders. When officials at one
installation did access MODS, the data in MODS indicated that the
installation had at least 105 soldiers on ADME orders. However,
installation officials were only aware of 55 soldiers who were on ADME
orders. According to installation officials, the missing soldiers never
reported for duty and the installation had no idea that they were
responsible for these soldiers.
Further, although MODS will generate reports that show when a reserve
component soldier's orders are within 30, 60, or 90 days of expiration,
only two of the locations we visited said that they used MODS for this
purpose--noting that they used other local systems in conjunction with
MODS. Officials at the other installations discounted the utility of
MODS for managing soldiers on ADME orders because the data were often
inaccurate or incomplete. Further, MODS does not contain information on
who has applied for ADME or the status of ADME applications. Therefore,
all of the installations we visited used their own local systems and/or
spreadsheets to track the status of soldiers who were nearing the end
of their mobilization orders, were applying for ADME, and were on ADME
orders.
The Army Lacks Adequate Training and Education Programs:
The Army has not adequately trained or educated Army staff or reserve
component soldiers about ADME. The Army personnel responsible for
preparing and processing ADME applications at the 10 installations we
visited received no formal training on the ADME process. Instead, these
officials were expected to understand their responsibilities through on-
the-job training. However, the high turnover caused by the rotational
nature of military personnel, and especially reserve component
personnel who make up much of the garrison support units that are
responsible for processing ADME applications, limits the effectiveness
of on-the-job training. Once these soldiers have learned the
intricacies of the ADME process, their mobilization is over and their
replacements must go through the same on-the-job learning process. For
example, 9 of the 10 medical hold units at the locations we visited
were staffed with reserve component soldiers.
In addition, the Army has not developed nor implemented any ADME
training or education for soldiers and their commanders. In the absence
of education programs based on sound policy and clear guidance,
soldiers have established their own informal methods--using Internet
chat rooms and word-of-mouth--to educate one another on the ADME
process. Unfortunately, the information they receive from one another
is often inaccurate and instead of being helpful, further complicates
the process. For example, one soldier was told by his unit commander
that he did not need to report to his new medical hold unit after
receiving his ADME order. While this may have been welcome news at the
time, the soldier could have been considered absent without leave.
Instead, the soldier decided to follow his ADME order and reported to
his assigned case manager at the installation.
Case Study Illustration: Guard Soldier Loses Pay and Medical Benefits:
A Sergeant First Class mobilized on June 23, 2002, under Operation
Enduring Freedom orders and was deployed to Afghanistan in August 2002.
On September 17, 2002, he was injured and suffered a torn rotator cuff,
broken shoulder blade, and torn ligaments in his shoulder. He was
medically evacuated back to Fort Bragg and assigned to the 2125th
Garrison Support Unit while he was on his original set of mobilization
orders. The Sergeant told us that he received very little support from
unit officials and had great difficulty getting appointments to see a
doctor to get the proper medical forms completed. For example, he did
not get to see a doctor for 6 months after surgery to repair his
shoulder. He was given guidelines by the unit to use in preparing his
ADME packet, but the unit rejected his packet and he was told he used
the wrong form--even though he had used the request form included in
their own guidelines. The Sergeant indicated that the civilian in
charge of the ADME process at the Fort Bragg medical holding unit did
not have a real understanding of the process. Further, the soldier
stated that the commander of the medical holding company was also
unfamiliar with the process;
As a result of these problems, the Sergeant's orders lapsed and he
missed one pay period before he was granted ADME. Further, because his
active duty orders had expired, according to the soldier, he was not
admitted to the base and missed several medical appointments. He also
said that, because he was off his active duty orders, his wife had to
pay for treatment for an illness out of her own pocket.
Lack of Clear Processes Contributed to Pay Gaps and Loss of Benefits:
The Army lacks customer-friendly processes for injured and ill soldiers
who are trying to extend their active duty orders so that they can
continue to receive medical care. Specifically, the Army lacks clear
criteria for approving ADME orders, which may require applicants to
resubmit paperwork multiple times before their application is approved.
This, combined with inadequate infrastructure for efficiently
addressing the soldiers' needs, has resulted in significant processing
delays. Finally, while most of the installations we reviewed took
extraordinary steps to keep soldiers in pay status, these steps often
involved overriding required internal controls in one or more systems.
In some cases, the stop gap measures ultimately caused additional
financial hardships for soldiers or put the Army at risk of
significantly overpaying soldiers in the long run.
The Army Lacks Criteria for Approving ADME Orders:
Although the Army Manpower office issued procedural guidance in July of
2000 for ADME and the Army Office of the Surgeon General issued a field
operating guide in early 2003, neither provides adequate criteria for
what constitutes a complete ADME application package. The procedural
guidance lists the documents that must be submitted before an ADME
application package is approved; however, the criteria for what
information is to be included in each document is not specified. In the
absence of clear criteria, officials at both Army Manpower and the
installations we visited blamed each other for the breakdowns and
delays in the process.
Soldiers applying for ADME orders are required to submit an application
package to the Army Manpower office that includes, among other things,
(1) evidence that the soldier's injury was sustained in the line of
duty and (2) a physician's statement outlining the diagnosis,
prognosis, and treatment plan. Officials at the Army Manpower office
and many of the Army installations we visited agree that problems with
this documentation create one of the greatest barriers to processing
ADME orders in a timely manner and ensuring that soldiers do not fall
off their active duty orders. However, this is where their agreement
ends.
According to Army Manpower officials, delays in processing have
resulted for two reasons: (1) soldiers do not apply for ADME until
their orders have expired or are about to expire and (2) soldiers do
not submit complete application packages. According to Army Manpower
statistics, in February 2004, the first month they began tracking
application statistics, 34 percent of the applications submitted were
received after the soldier's active duty orders had expired and another
47 percent were received within 30 days of expiration. In addition,
they claimed that 87 percent of ADME applications they reviewed were
incomplete and therefore could not be processed without additional
information.
In contrast, according to officials at the 10 installations we visited,
soldiers applying for ADME fall off their active duty orders because
(1) Army Manpower does not begin processing application packages until
a soldier's active duty orders are set to expire and (2) it is not
clear exactly what medical documentation is required for approval and
the requirements often change without notice. Officials at the 10
installations we visited said that, generally, they could compile the
information needed for an ADME application packet in about a week, but
it typically took the Army Manpower office 60 to 90 days to process the
application. Further, once the package was submitted, they would
receive nothing from Army Manpower indicating that the packet had been
received or was being evaluated. Instead, installations would
periodically inquire as to the status of the application. It was often
only upon inquiry that installation officials would learn that the
medical documentation provided was inadequate or that the package was
never received.
Case Study Illustration: ADME Extension Denied to Soldier who Lost Leg
in Roadside Attack:
A Sergeant First Class with B Company, 20th Special Forces, Alabama,
was deployed to Afghanistan in September 2002. On February 19, 2003,
while on patrol for Taliban fighters, the soldier's vehicle was
destroyed by a roadside bomb. He and other members of his unit suffered
serious injuries. He lost a leg and was immediately transferred to
Germany and then on to Walter Reed Army Medial Center. He had about 15
surgeries on his leg and was receiving physical therapy for his
prosthetic leg. When his mobilization orders expired on January 3,
2004, he had to apply for ADME. As with many of the soldiers we
interviewed, the Sergeant had difficulty navigating the ADME process,
despite the assistance of the Special Forces Liaison. After missing
three pay periods and over $5,000 in pay, ADME was approved through May
31, 2004. While waiting for his medical examination board, which had
been cancelled four times, the Sergeant applied for an ADME extension.
On June 2, 2004, an e-mail was received from Army Manpower stating that
"current and more detailed medical documents were needed to evaluate
this soldier's qualifications for ADME." As a result, according to this
soldier, who incurred a grave injury in service to his country, he was
denied health insurance for his family for over 1 month and had to
borrow money from his brother to pay his mortgage. According to the
soldier, in July 2004, he completed the medical board process to
receive his disability pay, was released from active duty, and returned
home.
According to installation officials, the Army Manpower office will not
accept ADME requests that contain documentation older than 30 days.
However, because it often took Army Manpower more than 30 days to
process ADME applications, the documentation for some applications
expired before approving officials had the opportunity to review it.
Consequently, applications were rejected and soldiers had to start the
process all over again. Although officials at the Army Manpower office
denied these assertions, the office did not have policies or procedures
in place to ensure that installations were notified regarding the
status of soldiers' applications or clear criteria on the sufficiency
of medical documentation. For example, one soldier we interviewed at
Fort Lewis had to resubmit his ADME applications three times over a 3-
month period--each time not knowing whether the package was received
and contained the appropriate information. According to the soldier,
weeks would go by before someone from Fort Lewis was able to reach the
Army Manpower office to determine the status of his application and
when they did, he was told each time that he needed more current or
more detailed medical documentation. Consequently, it took over 3
months to process his orders during which time he fell off his active
duty orders and missed 3 pay periods totaling nearly $4,000.
In an environment that lacks clear criteria on what constitutes a
complete application package and well-defined processes for providing
feedback on the status of application packages, it is not surprising
that soldiers have fallen out of pay status because their current
orders--mobilization or ADME--expired before their ADME orders or ADME
extensions came through.
The Army Has Not Consistently Provided the Infrastructure Needed to
Support Injured and Ill Soldiers:
The Army has not consistently provided the infrastructure needed--
including convenient support services--to accommodate the needs of
soldiers trying to navigate their way through the ADME process. This,
combined with the lack of clear guidance discussed previously and the
high turnover of the personnel who are responsible for helping injured
and ill solders through the ADME process, has resulted in injured and
ill soldiers carrying a disproportionate share of the burden for
ensuring that they do not fall off their active duty orders to thereby
receive the pay and benefits to which they are entitled. This has left
many soldiers disgruntled and feeling like they have had to fend for
themselves.
As the mobilization orders for the first wave of injured and ill
reserve component soldiers coming back from Iraq and Afghanistan began
to expire in 2003, according to Army officials, the Army was not
prepared and lacked the infrastructure to process their ADME
applications. For instance, case managers now play an important role in
ensuring that both reserve component and active Army soldiers receive
the medical care they need so that they can return to duty, be released
from active duty, or separate from military service. However, in
January 2003, the Army had very few case managers to deal with the
thousands of injured and ill soldiers--both active duty and reserve
component--returning to the Army's 14 demobilization sites. This
mirrors the comments of some of the soldiers we interviewed, who found
the ADME application process in disarray and not organized in a fashion
that made it easy for soldiers to obtain all the appropriate documents
and medical appointments needed to successfully apply for and obtain
ADME orders. For example, one injured soldier we interviewed whose
original mobilization orders expired in January 2003 recalls making
over 40 trips to various sites at Fort Bragg during the month of
January to complete his ADME application.
Case Study Illustration: Army Reserve and National Guard Liaisons
Assume Responsibility for ADME in the Absence of an Established
Infrastructure:
In July 2002, one Army Reserve National Guard liaison at Walter Reed
Medical Center observed that numerous injured and ill soldiers were
falling off orders and were losing pay and benefits. He advised his
commander of the problem and unofficially began assisting soldiers with
ADME issues;
There wasn't any funding or furniture for work space because this was
not an official office. Therefore, he and a couple of other soldiers
rummaged through the trash and found some old office furniture, which
they used to establish an operating base from which to work. Since that
time, these soldiers have used their own money and own time--making
frequent trips to local office supply stores to purchase supplies and
keep the office running. According to the soldier who started the
office, they have spent about three hundred dollars out of pocket for
office supplies;
The soldier who started the office had received some information on the
process in a related workshop he had taken but no formal training was
provided to any of the soldiers working in the office as to how the
ADME process worked. Instead, they learned through trial and error.
Further, in 2002, there were no case managers at Walter Reed.
Consequently, soldiers were responsible for making medical appointments
and managing their own care. If soldiers were severely injured they
were not capable of preparing an ADME packet and there was no one
assigned to assist them. The case manager system, which was established
in May of 2004, has helped considerably in this regard. However, the
process, and the amount of time it takes to process ADME orders have
not improved.
At the time of our site visits some installations were still
experiencing difficulties, particularly those that handle mobilization
and demobilization of soldiers. For instance, at Fort Lewis, one of the
Army's largest mobilization/demobilization sites, the medical hold unit
to which ADME soldiers are attached has had to move its soldiers on
three occasions to different barracks to make room for demobilizing
soldiers.
Case Study Illustration: Injured Guard Soldier Sent to Two Bases Where
No Medical Treatment Was Available:
A Sergeant with G Company, 140th Aviation unit, California, was
deployed to Iraq on March 6, 2003. On or about March 27, 2003, the
soldier injured his back when he was thrown to the ground during a
sandstorm. He re-injured his back in April 2003 loading a helicopter.
He was diagnosed with two bulging discs and curvature of the spine. The
soldier was medically evacuated to Andrews Air Force Base, Maryland,
for medical treatment. While being transported, his stretcher was
dropped, further compounding his injuries. After 2 weeks at Andrews,
the soldier told us that he received pain medication but no medical
treatment. He was then transported to Travis Air Force Base in
California to continue his treatment. In October 2003, because he was
an Army soldier being treated at an Air Force facility, he was ordered
to report to the Army hospital at Fort Lewis, Washington, for further
treatment. Upon arrival, he turned over his medical records to Fort
Lewis personnel. The records were lost and never found. According to
the soldier, he was housed in World War II era barracks. The mess hall
was about a one-half mile walk from the barracks--difficult for him to
navigate with a cane and even harder for other soldiers with more
severe injuries. The barracks were not wheelchair accessible and the
more able-bodied soldiers eventually built a wheelchair ramp. During
his 3 weeks at Fort Lewis, the soldier received pain medication but no
medical treatment. The doctors at Fort Lewis determined that it would
be in his best interest to return to Travis for treatment and he was
reassigned there. Although this ordeal took place while the soldier was
on his original mobilization orders, it illustrates the inadequacies of
the infrastructure used to house and treat injured soldiers and the
difficulty faced by injured soldiers when they are transferred from one
location to another.
Over time, the Army has begun to make some progress in addressing its
infrastructure issues. At the time of our visit, we found that some
installations had added new living space or upgraded existing space to
house returning soldiers. For example, Walter Reed has contracted for
additional quarters off base for ambulatory soldiers to alleviate the
overcrowding pressure and Fort Lewis had upgraded its barracks to
include, among other things, wheelchair accessible quarters. Also,
installations have been adding additional case managers to handle their
workload. Case managers are responsible for both active and reserve
component soldiers, including injured and ill active duty soldiers,
reserve component soldiers still on mobilization orders, reserve
component soldiers on ADME orders, and reserve component soldiers who
have inappropriately fallen off active duty orders. As of June 2004,
according to the Army, it had 105 case managers, and maintained a
soldier-to-case-manager-ratio of about 50-to-1 at 8 of the 10 locations
we visited while conducting fieldwork. Finally, to the extent possible,
several of the sites we visited co-located administrative functions
that soldiers would need--including command and control functions, case
management, ADME application packet preparation, and medical treatment.
They also made sure that Army administrative staff, familiar with the
paperwork requirements, filled out all the required paperwork for the
soldier. Centralizing document preparation reduces the risk of
miscommunication between the soldier and unit officials, case managers,
and medical staff. It also seemed to reduce the frustration that
soldiers would feel when trying to prepare unfamiliar documents in an
unfamiliar environment.
Ad Hoc Procedures to Keep Soldiers in Pay Status Circumvented Key
Internal Controls and Created Additional Problems for Soldiers:
The financial hardships discussed previously that were experienced by
some soldiers would have been more widespread had individuals within
the Army not taken it upon themselves to develop ad hoc procedures to
keep these soldiers in pay status. In fact, 7 of the 10 Army
installations we visited had created their own ad-hoc procedures or
workarounds to (1) keep soldiers in pay status and (2) provide soldiers
with access to medical care when soldiers fell off active duty orders.
In many cases, the installations we visited made adjustments to a
soldiers pay records. While effectively keeping a soldier in pay
status, this work-around circumvented key internal controls--putting
the Army at risk of making improper and potentially fraudulent
payments. In addition, because these soldiers are not on official
active duty orders they are not eligible to receive other benefits to
which they are entitled, including health coverage for their families.
Conversely, one installation we visited issued official orders locally
to keep soldiers in pay status. However, in doing so, they created a
series of accounting problems that resulted in additional pay problems
for soldiers when the Army attempted to straighten out its accounting.
Many of the installations we visited made informal agreements with
staff at the installation's payroll office to keep solders in pay
status until their ADME orders could be approved. When a soldier's ADME
packet was submitted to Army Manpower, the case manager or medical hold
unit commander would ask a trusted coworker at the installation's
payroll department to extend the soldier's orders. Installation payroll
personnel, who have authorized access to the Army's payroll system,
then enter an unauthorized transaction. Specifically, payroll personnel
manually adjust the soldier's original mobilization order end date and,
in effect, circumvented key controls which are intended to ensure that
only valid transactions supported by valid active duty orders are
entered into the pay system. While these soldiers are technically not
on active duty orders, they continue to be paid as if they were.
Subsequently, when the ADME order was issued and sent to the soldier,
it was backdated to the original mobilization order end date.
Backdating the ADME order makes it appear as if the soldier has been on
orders the entire time. This ad-hoc workaround has three drawbacks.
First, the practice of routinely altering pay records without support
creates an environment that increases the risk of improper or
fraudulent payments. For example, in such an environment, payroll
personnel could arrange to extend the order end dates for numerous
soldiers, allowing them to receive pay after they have been released
from active duty, and, in return, ask for a portion of the fraudulent
payment. Second, although soldiers have rarely been denied ADME, if
this were to happen, the soldier would then be responsible for repaying
the amounts received after the mobilization orders expired--assuming
that the case manager or medical hold unit commander tells the finance
office that a soldier's ADME packet was denied. Finally, while the
soldier has access to medical care on the installation, his family
would not be able to use civilian providers under the Army's contractor
health provider network. For example, if a soldier's family relies on
TRICARE-Remote--DOD's health care plan intended to treat eligible
beneficiaries through private sector health care providers--as their
primary health insurance, the family's benefits cannot be extended
without a copy of valid active duty orders. Similarly, without valid
active duty orders the family would not have access to other benefits
such as the Post Exchange for reduced price groceries.
According to Army officials at the installations we reviewed, they
understood that exploiting the weaknesses in the Army's payroll systems
was not in line with Army procedures, but, understandably, told us that
they were not left with many choices. According to these officials,
they were motivated, in part, because it was the right thing to do for
the soldier, and, in part, because they feared retribution. They noted
that soldiers who fell out of pay status frequently complained to their
congressmen or the Inspector General or the installation commander.
Such complaints could result in an investigation where installation
officials, who were the ones with the most direct contact with the
disgruntled soldiers, would be called on to explain the reasons for
soldiers' orders not being processed. Since order processing and
approval are actions over which the installation officials had no
control, but which they feared they would have to explain, medical hold
unit commanders began keeping logs of what specific information was
sent to Army Manpower and when it was sent. They also began looking for
ways to keep soldiers from falling out of pay status, even if those
actions involved circumventing internal controls, in an attempt to
forestall the possibility of undergoing an investigation if someone
fell off orders.
In contrast, the installation commander at one installation was
unwilling to override key controls in the pay system and instead issued
new orders locally to extend the soldiers' mobilization. While this
kept the soldier in active duty pay status, it created accounting
problems for the installation finance office that ultimately caused pay
problems for soldiers. As injured and ill reserve component soldiers
requiring ADME neared the end of their original mobilization order end
date, the installation's Adjutant General's office would issue new
orders to extend soldiers' mobilization. The extension was typically 90
days long, the average amount of time based on their experience that it
took to receive ADME orders. However, as discussed previously, the
personnel costs associated with soldiers on mobilization orders are
recorded in accounts related to contingency operations, whereas, the
personnel costs for soldiers on ADME orders are recorded in accounts
related to base operations costs. Therefore, when soldiers received
their backdated ADME orders, installation payroll and accounting
personnel would reallocate costs previously charged to a contingency
operations account to the base operating account.
To do this, as shown in figure 3, the payroll office retroactively
rescinded the local order used to keep the soldier in pay status, which
created a debt in the amount of pay that the soldier received while on
that order. Because the soldier then owed the government money, albeit
from a contrived debt, a significant portion of the soldier's wages
were garnished to pay back the debt as he or she began receiving ADME
paychecks, which are accounted for as a base operations expense.
Figure 3: Illustration of Retroactive Rescission of Orders and
Resulting Impact on Soldiers:
[See PDF for image]
[End of figure]
Figure 3 shows that 66 percent of this soldier's paycheck was garnished
until the monies owed from pay received and accounted for as a
contingency operations expense were repaid in full. For example, one
soldier's paycheck suddenly dropped to $1,550 from $3,625 without
explanation. Upon repayment, the soldier then began receiving 166
percent of his pay until he was compensated for the amount previously
garnished. As he later found out, the Army was garnishing his pay to
reimburse the contingency operations account. Not surprisingly, this
creates serious confusion and a significant cash flow problem for most
soldiers until the Army reconciles the two amounts. In addition, the
effort required to correct the Army's accounting creates an
administrative burden that could have been avoided had the Army
adequately addressed its processes to efficiently process soldiers'
ADME orders. Finally, as discussed previously, we believe that the cost
of treating and paying soldiers whose injuries resulted in support of
the Global War on Terrorism should be linked to the contingency
operation for which the soldier was originally mobilized. This would
more accurately capture the total cost of the operation.
Nonintegrated Systems Contribute to Processing Delays:
Manual processes and nonintegrated order writing, pay, personnel, and
medical eligibility systems also contribute to processing delays which
affect the Army's ability to update these systems and ensure that
soldiers on ADME orders are paid in an accurate and timely manner.
Overall, we found that the current stove-piped, nonintegrated systems
were labor-intensive and require extensive error-prone manual data
entry and re-entry. Therefore, once Army Manpower approves a soldiers
ADME application and the ADME order is issued, the ADME order does not
automatically update the systems that control a soldier's access to pay
and medical benefits. In addition, as discussed previously, the Army's
ADME guidance does not address the distribution of ADME orders or
clearly define who is responsible for ensuring that the appropriate
pay, personnel, and medical eligibility systems are updated, so
soldiers and their families receive the pay and medical benefits to
which they are entitled. As a result, ADME orders were sent to multiple
individuals at multiple locations before finally reaching individuals
who have the access and authority to update the pay and benefits
systems, which further delays processing.
As shown in figure 4, once Army Manpower officials approve a soldier's
ADME application, they e-mail a memorandum to HRC-St. Louis authorizing
the ADME order. The Automated Order Resource System (AORS), which is
used to write the order, does not directly interface nor automatically
update the personnel, pay, or medical eligibility systems. Instead,
once HRC-St. Louis cuts the ADME order it e-mails a copy of the order
to nine different individuals--four at the Army Manpower office, four
at the NGB headquarters, and one at the HRC in Alexandria Virginia--
none of which are responsible for updating the pay, personnel, or
medical eligibility systems.
Figure 4: Transaction Flow Between the Army's Order Writing, Pay,
Personnel, and Medical Eligibility Systems:
[See PDF for image]
[End of figure]
As shown in figure 4, Army Manpower, upon receipt of ADME orders, e-
mails copies to the soldier, the medical hold unit to which the soldier
is attached, and the RMC. Again, none of these organizations has access
to the pay, personnel, or medical eligibility systems. Finally, NGB
officials e-mail copies of National Guard ADME orders to one of 54
state-level Army National Guard personnel offices and HRC-Alexandria e-
mails copies of Reserve ADME orders to the Army Reserve's regional
personnel offices. HRC-Alexandria also sends all Reserve orders to the
medical hold unit at Walter Reed Army Hospital. When asked, the
representative at HRC-Alexandria who forwards the orders did not know
why orders were sent to Walter Reed when many of the soldiers on ADME
orders were not attached or going to be attached to Walter Reed. The
medical hold unit at Walter Reed that received the orders did not know
why they were receiving them and told us that they filed them.
At this point in the process, of the eight organizations that receive
copies of ADME orders, only two--the ANG personnel office and the Army
Reserve personnel office--use the information to initiate a pay or
benefit-related transaction. Specifically, the Guard and Reserve
personnel offices initiate a transaction that should ultimately update
the Army's medical eligibility system, Defense Enrollment Eligibility
System (DEERS). To do this, the Army National Guard personnel office
manually inputs a new active duty order end date into the Army National
Guard personnel system, Standard Installation Division Personnel
Reporting System (SIDPERS). In turn, the data from SIDPERS are batch
processed into the Total Army Personnel Database-Guard (TAPDB-G), and
then batch processed to the Reserve Components Common Personnel Data
System (RCCPDS). The data from RCCPDS are then batch processed into
DEERS--updating the soldier's active duty status and active duty order
end-date. Once the new date is posted to DEERS, soldiers and family
members can get a new ID card at any DOD ID Card issuance
facility.[Footnote 20] The Army Reserve finance office initiates a
similar transaction by entering a new active duty order end date into
the Regional Level Application System (RLAS), which updates Total Army
Personnel Database-Reserve (TAPDB-R), RCCPDS, and DEERS through the
same batch process used by the Guard.
As discussed previously, the Army does not have an integrated pay and
personnel system. Therefore, information entered into the personnel
system (TAPDB) is not automatically updated in the Army's pay system,
Defense Joint Military Pay System-Reserve Component (DJMS-RC).
Instead, as shown in figure 4, after receiving a copy of the ADME
orders from Army Manpower, the medical hold unit and/or the soldier
provide a hard copy of the orders to their local finance. Using the
Active Army pay input system, Defense Military Pay Office system (DMO),
installation finance office personnel update DJMS-RC. Not only is this
process vulnerable to input errors, but also, not sending a copy of the
orders directly to the individual responsible for input further delays
a soldier's ability to receive the pay and benefits to which the
soldier is entitled.
The Army's New Medical Retention Program Will Not Solve All the
Problems Associated with ADME:
The Army's new MRP program, which went into effect May 1, 2004, and
takes the place of ADME for soldiers returning from operations in
support of the Global War on Terrorism, has resolved many of the
processing delays experienced by soldiers applying for ADME by
simplifying the application process. In addition, unlike ADME, the
personnel costs associated with soldiers on MRP orders are
appropriately linked to the contingency operation for which they
served, and, therefore, will more appropriately capture the costs
related to the Global War on Terrorism. While the front-end approval
process appears to be operating more efficiently than the ADME approval
process, due to the fact that the first wave of 179-day MRP orders did
not expire until October 27, 2004, after we completed our work, we were
unable to assess how effectively the Army identified soldiers that
required an additional 179 days of MRP and whether those soldiers will
experience pay problems or difficulty obtaining new MRP orders. In
addition, the Army has no way of knowing whether all soldiers that
should be on MRP orders are actually applying and getting into the
system. Further, MRP has not resolved the underlying management control
problems that plagued ADME, and, in some respects, has worsened
problems associated with the Army's lack of visibility over injured
soldiers. Finally, because the MRP program is designed such that
soldiers may be treated and released from active duty before their MRP
orders expire, weaknesses in the Army's processes for updating its pay
system to reflect an early release date have resulted in overpayments
to soldiers.
According to Army officials at each of the 10 installations we visited,
unlike ADME, they have not experienced problems or delays in obtaining
MRP orders for soldiers in their units. In fact some installation
officials have said that the process now takes 1 or 2 days instead of 1
or 2 months. Because there is no mechanism in place to track
application processing times, we have no way of substantiating these
assertions. Conversely, we are not aware of any soldier complaints
regarding the process, which were commonplace with ADME.
The MRP application and approval process, which rests with HRC-
Alexandria, instead of the Army Manpower office, is a simplified
version of the ADME process. As with ADME orders, the soldier must
request that this process be initiated and voluntarily request an
extension on active duty orders. Both the MRP and ADME request packets
include the soldier's request form, a physician's statement, and a copy
of the soldier's original mobilization orders. However, with MRP, the
physician's statement need only state that the soldier needs to be
treated for a service-connected-injury or illness and does not require
detailed information about the diagnosis, prognosis, and medical
treatment plan as it does with ADME. As discussed previously,
assembling this documentation was one of the primary reasons ADME
orders were not processed in a timely manner. In addition, because all
MRP orders are issued for 179 days, MRP has alleviated some of the
workload on officials who were processing AMDE orders and who were
helping soldiers prepare application packets by eliminating the need
for a soldier to reapply every 30, 60, or 90 days as was the case with
ADME.
While MRP has expedited the application process, MRP guidance, like
that of ADME, does not address how soldiers who require MRP will be
identified in a timely manner, how soldiers requiring an additional 179
days of MRP will be identified in a timely manner, or how soldiers and
Army staff will be trained and educated about the new process. Further,
because the Army does not maintain reliable data on the current status
and disposition of injured soldiers, we could not test or determine
whether all soldiers that should be on MRP orders are actually applying
and getting into the system. In addition, because MRP authorizes 179
days of pay and benefits regardless of the severity of the injury, the
Army faces a new challenge--to ensure that soldiers are promptly
released from active duty or placed in a medical evaluation board
process upon completion of medical care or treatment and avoid
needlessly retaining and paying these soldiers for the full 179 days.
However, MRP guidance does not address how the Army will provide
reasonable assurance that upon completion of medical care or treatment
soldiers are promptly released from active duty or placed in a medical
evaluation board process.
MRP has also contributed to the Army's difficulty maintaining
visibility over injured reserve component soldiers. Although the Army's
MRP implementation guidance requires that installations provide a
weekly report to HRC-Alexandria that includes the name, rank, and
component of each soldier currently on MRP orders, according to HRC
officials, they are not consistently receiving these reports.
Consequently, the Army cannot say with certainty how many soldiers are
currently on MRP orders, how many have been returned to active duty, or
how many soldiers have been released from active duty before their 179-
day MRP orders expired. As discussed previously, if the Army used and
appropriately updated the agency's medical tracking system, MODS, the
system could provide some visibility over injured and ill active and
reserve component soldiers--including soldiers on ADME or MRP orders.
However, the Army MRP implementation guidance is silent on the use of
MODS and does not define responsibilities for updating the system.
According to officials at HRC-Alexandria, they do not update MODS or
any other database when they issue MRP orders. They also acknowledged
that the 1,800 soldiers reflected as being on MRP orders in MODS, as of
September 2004, was probably understated given that, between May 2004
and September 2004, HRC-Alexandria processed approximately 3,300 MRP
orders. Further, as was the case with ADME, 8 of the 10 installations
we visited did not routinely use or update MODS but instead maintained
their own local tracking systems to monitor soldiers on MRP orders.
Not surprisingly, the Army does not know how many soldiers have been
released from active duty before their 179-day MRP orders had expired.
This is important because our previous work has shown that weaknesses
in the Army's process for releasing soldiers from active duty and
stopping the related pay before their orders have expired--in this case
before their 179 days is up--often resulted in overpayments to
soldiers. According to HRC-Alexandria officials, as of October 2004, a
total of 51 soldiers had been released from active duty before their
179-day MRP orders expired. At the same time, Fort Knox, one of the few
installations that tracked these data, reported it had released 81
soldiers from active duty who were previously on MRP orders--none of
whom were included in the list of 51 soldiers provided by HRC-
Alexandria. Concerned that some of these soldiers may have
inappropriately continued to receive pay after they were released from
active duty, we verified each soldier's pay status in DJMS-RC and found
that 15 soldiers were paid past their release date--totaling
approximately $62,000. For example, one soldier was released from
active duty on July 9, 2004, after 43 days on MRP orders but, as of
November 5, 2004, the soldier was still being paid as if he were on
active duty. Between July and November he was overpaid $10,595.
Further, if we had not alerted the Army, he may have continued to be
paid until November 21, 2004--the date his 179-day MRP orders would
have expired--an additional $1,246, for a total of $11,841. According
to Army finance officials, they rely on the soldier to bring them a
copy of their Certificate of Discharge or Release from Active Duty (DD
form 214) so that they can change the order end date in the pay system
and stop the soldier's pay. However, when the installation finance
personnel do not receive a soldier's DD214, the soldier will continue
to be paid until the order end date recorded in the pay system--in this
case, the original date on the soldier's MRP orders. In another
example, a soldier who was released from active duty on October 7,
2004, continued to receive active duty pay and may have continued to
receive pay until January 10, 2005, if we had not brought the issue to
the Army's attention--for a total of $4,500.
Finally, because ADME will still exist for soldiers who are not
mobilized in support of the Global War on Terrorism--such as soldiers
injured in Bosnia or Kosovo or during annual training exercises--it is
still important that the problems we identified related to it are
resolved.
Conclusion:
The recent mobilization and deployment of Army National Guard and
Reserve soldiers in connection with the Global War on Terrorism is the
largest activation of reserve component troops since World War II. As
such, in recent years, the Army's ability to take care of these
soldiers when they are injured or ill has not been tested to the degree
that it is being tested now. Unfortunately, the Army has failed this
test and the brave soldiers fighting to defend our nation have paid the
price. The personal toll that the pay problems experienced by these
soldiers and their families and what they have endured cannot be
readily measured. But clearly, the hardships they have endured are
unacceptable given the substantial sacrifices they have made and the
injuries they have sustained. To its credit, the Army's new streamlined
medical retention application process has alleviated many of the
immediate problems experienced by soldiers under ADME but it also has
many of the same limitations. A complete and lasting solution to the
pay problems and overall poor treatment of injured soldiers that we
identified will require that the Army address the underlying problems
associated with its all around control environment for managing and
treating reserve component soldiers with service-connected injuries or
illnesses and deficiencies associated with its automated systems.
Recommendations of Executive Action:
We recommend that the Secretary of the Army direct the Deputy Chief of
Staff, Army G-1 to take the following 22 actions:
Control Environment and Management Controls. 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.
* 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.
* Standards for being retained on active duty orders, including time
frames and criteria for extension or retention beyond one year.
* 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).
* Minimum eligibility criteria for soldiers applying for such programs
as ADME and MRP.
* Avenues through which soldiers may apply for such programs.
* Specific documentation required to retain or extend active duty
orders for medical treatment or evaluation.
* Entitlements of each program for both the soldier and his/her
dependents.
* Correctly link the cost of these programs to the mission or operation
in which the soldier was involved.
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.
* Take any corrective actions needed to address documented shortcomings
in program performance.
Infrastructure, resources, and process improvement. 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.
* Reserve component soldiers and unit commanders will be educated on
these programs, their requirements, and their benefits.
* 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.
* 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.
* The practice of garnishing soldiers' wages to resolve accounting
problems created by the use of retroactive rescissions of soldiers'
orders is ended.
Automated systems. In the near term, require that:
* The gaining MTF is notified and receives a copy of the solder's
orders when a soldier is transferred from one MTF to another for
treatment.
* The information in MODS is routinely updated and utilized to the
maximum extent possible to provide visibility over and manage injured
and ill reserve component soldiers.
* 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.
* 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.
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.
* Ensures that the order writing system automatically updates the pay,
personnel, and medical eligibility systems.
Agency Comments and Our Evaluation:
In its written response to a draft of this report, DOD briefly
described its completed, ongoing, and planned actions to implement all
22 of our recommendations.
We are encouraged that the Army has begun to take action to address the
problems we identified and are hopeful that it will continue to work
toward comprehensive, effective solutions for addressing the
recommendations in this report dealing with reserve component soldiers
with service-connected injuries or illnesses.
Separately in its technical comments, reprinted in appendix II, DOD
disagreed with several of the facts and circumstances presented in the
report related to non-pay issues and challenged our use of certain case
studies. We continue to believe that the information we presented
offers valid perspective on the Army's management and treatment of
injured reserve component soldiers.
As agreed with your offices, unless you announce its contents earlier,
we will not distribute this report further until 30 days from its date.
At that time, we will send copies to interested congressional
committees, the Secretary of the Army, and the Director of the Office
of Management and Budget. We will make copies available to others upon
request. In addition, the report will be available at no charge on the
GAO Web site at [Hyperlink, http://www.gao.gov].
If you or your staffs have any questions concerning this report, please
contact me at (202) 512-9095 or [Hyperlink, kutzg@gao.gov], or Diane
Handley at (404) 679-1986 or [Hyperlink, handleyd@gao.gov]. Key
contributors to this report are acknowledged in appendix III.
Signed by:
Gregory D. Kutz:
Director:
Financial Management and Assurance:
Signed by:
Robert J. Cramer:
Managing Director:
Office of Special Investigation:
[End of section]
Appendixes:
Appendix I: Objective, Scope, and Methodology:
We relied on a case study and selected the site visit approach for this
work, principally because the many previously identified flaws in the
existing pay processes had not yet been resolved and the Army did not
maintain reliable, centralized data on the number, location, and
disposition of mobilized reserve component soldiers who had requested
to extend their active duty service because they had been injured or
become ill in the line of duty. Therefore, it was not possible to
statistically test controls or the impact control breakdowns had on
soldiers and their families.
To obtain an understanding and assess the adequacy of the processes,
personnel (human capital), and systems used to provide assurance that
mobilized Army Guard and Army Reserve soldiers received entitled pays
and associated medical benefits, we reviewed applicable policies,
procedures, and program guidance; observed active duty medical
extension processing operations; and interviewed cognizant agency
officials. With respect to applicable policies and procedures, we
obtained and reviewed procedural guidance for reserve component
soldiers on active duty medical extension, the U.S. Army Medical
Command field operating guide for reserve component soldiers on active
duty medical extension, and other pertinent sections of Title 10 USC
and DOD and Army regulations. We also used the internal controls
standards provided in the Standards for Internal Control in Federal
Government.[Footnote 21]
We applied the policies and procedures prescribed in these documents to
the observed and documented procedures and practices followed by the
key DOD components involved in providing active duty pays and medical
benefits to reserve component soldiers. We also interviewed officials
from the National Guard Bureau, Army Reserve, Army and DOD military pay
offices, Army Manpower office, and regional medical commands, as well
as installation and military treatment facility commanders to obtain an
understanding of their experiences in applying these policies and
procedures.
With respect to the Army's automated systems, we assessed whether they
provided reasonable assurance that once an ADME order was issued, the
appropriate pay, personnel, and medical eligibility systems are updated
in an accurate and timely manner. To accomplish this, we interviewed
and obtained available documentation from individuals responsible for
entering ADME order transactions into the Army's order writing, pay,
personnel, and medical eligibility systems. Although we requested the
written policies and procedures used to update each of these systems,
none had been established. We also relied on the extensive work
recently performed on related GAO military pay engagements.[Footnote
22] We did not test computer security or access controls or test
individual transactions.
Because our preliminary assessment determined that the design of
current operations used to route soldiers through the active duty
medical extension process relied solely on error-prone manual documents
and transactions and multiple, nonintegrated systems, we did not
statistically test current processes or controls. We selected
installations for review based on the reported populations of active
duty medical extension and medical holdover soldiers, as well as other
specialized traits, including presence of regional medical command. The
installations we selected for review were: 6 of the top 7 installations
with large active duty medical extension and medical holdover
populations; the 4 installations with co-located Regional Medical
Commands in the continental United States; 6 of the 15 Army Power
Projection Platforms, which mobilize and deploy high priority reserve
component in both of the continental armies in the United States (1st
U.S. Army is east of the Mississippi River, 5th U.S. Army is west of
the Mississippi River, excluding Minnesota); and a reserve training
base that has the largest deployments of reserve component soldiers,
and which also does not have a medical treatment facility. The
installations we visited are listed in table 1.
Table 1: Audited Installations:
Installation: Fort Lewis, Washington;
Characteristics: large active duty medical extension and medical
holdover populations; Western Regional Medical Command; Power
Projection Platform-5th U.S. Army.
Installation: Fort Knox, Tennessee;
Characteristics: large active duty medical extension and medical
holdover populations -1st U.S. Army.
Installation: Fort Benning, Georgia;
Characteristics: large active duty medical extension and medical
holdover populations; Power Projection Platform-1st U.S. Army.
Installation: Fort Campbell, Kentucky;
Characteristics: large active duty medical extension and medical
holdover populations; Power Projection Platform-1st U.S. Army.
Installation: Fort Dix, New Jersey;
Characteristics: large active duty medical extension and medical
holdover populations; Power Projection Platform-1st U.S. Army;
reserve only.
Installation: Fort Bragg, North Carolina;
Characteristics: large active duty medical extension and medical
holdover populations; Power Projection Platform-1st U.S. Army.
Installation: Fort Carson, Colorado;
Characteristics: Power Projection Platform-5th U.S. Army.
Installation: Fort Sam Houston, Texas;
Characteristics: Great Plains Regional Medical Command.
Installation: Fort Gordon, Georgia;
Characteristics: Southeast Regional Medical Command.
Installation: Walter Reed;
Characteristics: North Atlantic Regional Medical Command.
Source: GAO.
[End of table]
At all the installations, we interviewed officials who were responsible
for counseling soldiers on the active duty medical extension process,
officials who prepared and submitted the medical extension application
packets, case managers, primary care managers, medical hold unit
commanders, and installation payroll personnel. We obtained
documentation on and performed walkthroughs of the process to request
an active duty medical extension for a reserve component soldier, the
command and control structure of medical hold units, the case
management function, installation medical extension tracking systems,
and the medical-extension-to-pay system interface. We held interviews
with officials from the Army National Guard Bureau, Army Reserve, Army
Military Pay Operations, and Army Human Resource Command to augment our
documentation and walkthroughs.
In addition, we interviewed officials who process and approve
applications for active duty medical extensions at the Army Manpower
Office in the Pentagon. We performed interviews and walkthroughs that
depict how an application is processed once received by the office.
Specifically, we gained an understanding of how an application is
transmitted to the office, what standards were in use to review the
approval for sufficiency of documentation, what standards were in use
related to the timeliness of the documentation, and how the request is
entered into the Army's Medical Operational Data System (MODS) for
tracking. We obtained data from that office on the orders processed at
the time our fieldwork began in February 2004 and updated data as of
October 2004.
Further, we interviewed and discussed active duty medical extension
issues with officials from the following offices or commands:
* National Guard Bureau (NGB), Arlington, Virginia:
* Army Reserve Affairs Office, Arlington, Virginia:
* U.S. Army Reserve Command (USARC), Fort McPherson, Georgia:
* 1ST U.S. First Army, Fort Gillem, Georgia:
* 5TH U.S. Army, Fort Sam Houston, Texas:
* U.S. Army Forces Command (FORSCOM), Fort McPherson, Georgia:
When the Army initiated the new medical retention order process during
our fieldwork, we met with officials from the Army Human Resources
Command in Alexandria, Virginia, who are responsible for processing
those orders and obtained and analyzed copies of their implementing
instructions. We discussed these instructions and the medical retention
order request process with officials at each of the installations we
reviewed. We also requested statistics, as of September 2004, from HRC-
Alexandria regarding the number of soldiers currently on MRP orders,
returned to active duty, and released from active duty before their 179-
day MRP orders expired.
After determining that the HRC-Alexandria data were incomplete, we also
requested data from each of the installations we audited on soldiers
who were released from active duty before their 179-day MRP orders
expired to determine whether the Army continued to pay them after they
were released from active duty. For the 132 soldiers identified by the
Army, as of the date of this report, as released from active duty, we
determined their pay status in DJMS-RC and obtained pay and personnel
records for those soldiers who inappropriately remained in pay status.
As of the date of this report, we are continuing to investigate
soldiers who were overpaid by the Army. Due to the timing of this
report and the fact that the first wave of 179-day MRP orders did not
expire until October 27, 2004, we were unable to assess how effectively
the Army identified soldiers who required an additional 179 days of MRP
and whether those soldiers will experience pay problems or difficulty
obtaining new MRP orders. In addition, because the Army does not
maintain reliable data on the current status and disposition of injured
soldiers we could not test or determine whether all soldiers who should
be on MRP orders are actually applying and getting into the system.
During the course of our investigation we identified sources at various
forts and facilities, who were familiar with the ADME process. These
individuals provided us with the names and contact information of
soldiers who were having trouble with the ADME process. To obtain a
more detailed understanding of the ADME process challenges associated
with it, and problems soldiers faced, we visited four forts and
interviewed 38 soldiers at the forts. Based on the information that we
obtained at the forts, we further developed 10 case studies. To
corroborate the information provided by our 10 case study solders, we
obtained and reviewed soldiers' official military pay records,
mobilization and ADME orders, bank statements, and credit records.
Although the information obtained is limited to the 10 soldiers, the
soldiers that were chosen highlight a variety of problems that soldiers
experienced with the ADME process. As for soldiers' statements
regarding non-pay issues, when possible, we corroborated soldiers'
statements with Army officials familiar with the soldiers. When we
could not readily corroborate their statements by other evidence, we
have taken great care to attribute the information to the soldiers we
interviewed.
We briefed DOD, Army, and National Guard Bureau officials from the
selected sites on the details of our audit, including our findings and
their implications. We conducted our fieldwork from February 2004
through October 2004 in accordance with U.S. generally accepted
government auditing standards. We requested and received written
comments on a draft of this report from the Department of the Army.
These comments are presented and evaluated in the "Agency Comments and
Our Evaluation" section of this report and are reprinted in appendix II.
[End of section]
Appendix II: Comments From the Department of the Army:
OFFICE OF THE UNDER SECRETARY OF DEFENSE:
PERSONNEL AND READINESS:
4000 DEFENSE PENTAGON:
WASHINGTON, D.C. 20301-4000:
JAN 24 2005:
Mr. Gregory D. Kutz:
Director, Financial Management and Assurance:
U.S. Government Accountability Office:
Washington, D.C. 20548:
Dear Mr. Kutz:
This is the Department of Defense response to the GAO draft report,
"MILITARY PAY: Gaps in Pay and Benefits Create Financial Hardships for
Injured Army National Guard and Reserve Soldiers," dated November 5,
2004 (GAO Code 192115/GAO-05-125). The response is provided in two
sections: 1) Responses to the GAO's 22 recommendations for executive
action and 2) Other relevant comments on portions of the report.
My point of contact is Norma St. Claire, who can be reached at 703-696-
8710 or via email at norma.stclaire@osd.pentagon.mil.
Sincerely,
Signed by:
Charles S. Abell:
Principal Deputy:
Enclosure As stated:
GAO DRAFT REPORT DATED NOVEMBER 5, 2004 GAO-05-125 (GAO CODE 192115)
"MILITARY PAY: GAPS IN PAY AND BENEFITS CREATE FINANCIAL HARDSHIPS FOR
INJURED ARMY NATIONAL GUARD AND RESERVE SOLDIERS"
DEPARTMENT OF DEFENSE COMMENTS TO THE GAO RECOMMENDATIONS:
RECOMMENDATION 1: The GAO recommended that the Secretary of the Army
direct the Deputy Chief of Staff (DCS), Army G-1 to develop and
promulgate comprehensive, integrated policies and procedures for
managing and treating reserve component soldiers with service-connected
injuries or illnesses that address specific organizational
responsibilities for managing programs that deal with injured or ill
reserve component soldiers, including which officials have the ultimate
responsibility for the success of these programs. (p. 31/GAO Draft
Report)
DoD RESPONSE: The Department has initiated corrective action.
Currently, the G-1 is working with the U.S. Army Forces Command in
developing an Army Regulation on all Medical holdovers.
RECOMMENDATION 2: The GAO recommended that the Secretary of the Army
direct the Deputy Chief of Staff, Army G-1 to develop and promulgate
comprehensive, integrated policies and procedures for managing and
treating reserve component soldiers with service-connected injuries or
illnesses that address where orders that extend a soldier's active duty
status are to be cut, 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. (p.
31 /GAO Draft Report)
DoD RESPONSE: Headquarters, Department of the Army (HQDA), G-1 will
work with the Human Resources Command (HRC), the Office of the Chief
Army Reserve, the National Guard Bureau, the Defense Finance and
Accounting System (DFAS), the Office of the Assistant Secretary of
Defense for Reserve Affairs (OASD/RA), and the Defense Manpower Data
Center to develop an integrated policy, which will be incorporated into
the guidance and implementation of the Army regulation.
RECOMMENDATION 3: The GAO recommended that the Secretary of the Army
direct the Deputy Chief of Staff, Army G-1 to develop and promulgate
comprehensive, integrated policies and procedures for managing and
treating reserve component soldiers with service-connected injuries or
illnesses that address standards for being retained on active duty
orders, including timeframes and criteria for extension or retention
beyond one year. (p. 31/GAO Draft Report)
DoD RESPONSE: The Department has initiated corrective action. The G-1
is working with the Office of the Surgeon General of the Army and the
Physical Disability Agency to develop an integrated policy.
RECOMMENDATION 4: The GAO recommended that the Secretary of the Army
direct the Deputy Chief of Staff, Army G-1 to develop and promulgate
comprehensive, integrated policies and procedures for managing and
treating reserve component soldiers with service-connected injuries or
illnesses 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 soldiers residence). (p. 32/GAO Draft Report)
DoD RESPONSE: HQDA G-1 will work with the Office of the Surgeon General
(OTSG)/Medical Command (MEDCOM) on policy and procedural development
for medical issues.
RECOMMENDATION 5: The GAO recommended that the Secretary of the Army
direct the Deputy Chief of Staff, Army G-1 to develop and promulgate
comprehensive, integrated policies and procedures for managing and
treating reserve component soldiers with service-connected injuries or
illnesses that address minimum eligibility criteria for soldiers
applying for such programs as Active Duty Medical Extensions (ADME) and
Medical Retention Processing (MRP). (p. 32/GAO Draft Report)
DoD RESPONSE: HQDA, G-1, in conjunction with the OTSG, has already
established minimum eligibility. The ADME is in the Procedural Guidance
on the HQDA, G-1 Website. MRP has been established by the OTSG.
RECOMMENDATION 6: The GAO recommended that the Secretary of the Army
direct the Deputy Chief of Staff, Army G-1 to develop and promulgate
comprehensive, integrated policies and procedures for managing and
treating reserve component soldiers with service-connected injuries or
illnesses that address avenues through which soldiers may apply for
programs such as ADME or MRP. (p. 32/GAO Draft Report)
DoD RESPONSE: This action is almost complete. The ADME process has been
posted on the Website since inception July 2000. The MRP is for
mobilized RC Soldiers who no longer can meet the deployable standards
within the 60 days allowed. MRP is now posted on the HRC website.
RECOMMENDATION 7: The GAO recommended that the Secretary of the Army
direct the Deputy Chief of Staff, Army G-1 to develop and promulgate
comprehensive, integrated policies and procedures for managing and
treating reserve component soldiers with service-connected injuries or
illnesses that address specific documentation required to be retained
or extended on active duty orders for medical treatment or evaluation.
(p. 32/GAO Draft Report)
DoD RESPONSE: The Army has completed this action. The ADME program has
established specific documentation. The MRP implementation guidance
lists specific documents required to be retained or extended on active
duty for medical treatment or evaluation.
RECOMMENDATION 8: The GAO recommended that the Secretary of the Army
direct the Deputy Chief of Staff, Army G-1 to develop and promulgate
comprehensive, integrated policies and procedures for managing and
treating reserve component soldiers with service-connected injuries or
illnesses that address entitlements of each program for both the
soldier and his/her dependents. (p. 32/GAO Draft Report)
DoD RESPONSE: HQDA, G-1 will take the necessary action to develop
methods to inform Service members of their entitlements.
RECOMMENDATION 9: The GAO recommended that the Secretary of the Army
direct the Deputy Chief of Staff, Army G-1 to develop and promulgate
comprehensive, integrated policies and procedures for managing and
treating reserve component soldiers with service-connected injuries or
illnesses that address correctly linking of the cost of programs such
as ADME and MRP to the mission or operation in which the soldier was
involved. (p. 32/GAO Draft Report)
DoD RESPONSE: Establishing the MRP will link all Soldiers to the Global
War on Terrorism (GWOT) mission. The HQDA G-1 will work with the
Assistant Secretary of the Army, Manpower and Reserve Affairs (Force
Management, Manpower and Resources) (ASA(M&RA)FM) and the DFAS to
follow through on this recommendation.
RECOMMENDATION 10: The GAO recommended that the Secretary of the Army
direct the Deputy Chief of Staff, Army G-1 to require that officials
designated with the responsibility for managing these programs develop
performance measures to evaluate the efficiency and effectiveness of
the programs - including timeliness of application processing, soldier
satisfaction, and the length of time soldiers are in the program. (p.
32/Draft Report)
DoD RESPONSE: First, concerning the timeliness of the application - the
ADME has a tracking system where the Army can track all applications.
The MRP is in the process of establishing a tracking system. Secondly,
concerning soldier satisfaction - the ASA (M&RA) and Forces Command
(FORSCOM) are conducting periodic site visits and performing sensing
sessions with the soldiers. Finally, concerning the length of time
soldiers are in the program - this data is tracked through the Medical
Operational Data System (MODS) Medical holdover (MHO) Module and the
Army will enforce utilization of this feature.
RECOMMENDATION 11: The GAO recommended that the Secretary of the Army
direct the Deputy Chief of Staff, Army G-1 to require that officials
designated with the responsibility for managing these programs develop
performance measures to evaluate the program's success and enable the
Army to take any corrective actions needed to address documented
shortcomings in program performance. (p. 32/Draft Report)
DoD RESPONSE: The ASA (M&RA) and FORSCOM are addressing this
recommendation for the MRP. The HQDA, G-1 is addressing this for the
ADME with an internal tracking tool designed to assist in developing
program performance measures.
RECOMMENDATION 12: The GAO recommended that the Secretary of the Army
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 their processes. (p. 32/Draft Report)
DoD RESPONSE: The Army is already engaged in process improvements and
will continue to refine the programs and processes.
RECOMMENDATION 13: The GAO recommended that the Secretary of the Army
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. (p. 32/Draft
Report)
DoD RESPONSE: The HQDA, G-1 will work with the Office of the Chief Army
Reserve and the National Guard Bureau to accomplish this task.
RECOMMENDATION 14: The GAO recommended that the Secretary of the Army
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 administrative and medical treatment aspects of the programs. (p.
32/Draft Report)
DoD RESPONSE: The HQDA, G-1 will work with the appropriate
organizations accordingly to accomplish this tasking.
RECOMMENDATION 15: The GAO recommended that the Secretary of the Army
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, in which soldiers are
notified or have easy access to the current status of their
application. (p. 32/Draft Report)
DoD RESPONSE: The HQDA, G-1 will work with the appropriate
organizations to provide easy access to the soldiers on the current
status of their medical extension or retention processing requests.
RECOMMENDATION 16: The GAO recommended that the Secretary of the Army
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. (p. 32/Draft Report)
DoD RESPONSE: The Army will work with the DFAS to implement necessary
process improvements.
RECOMMENDATION 17: The GAO recommended that the Secretary of the Army
direct the Deputy Chief of Staff, Army G-1 to require that the gaining
MTF be notified and receive a copy of the soldier's orders when a
soldier is transferred from one MTF to another for treatment. (p. 32/
Draft Report)
DoD RESPONSE: The HQDA, G-1 will work with the OTSG to implement this
recommendation.
RECOMMENDATION 18: The GAO recommended that the Secretary of the Army
direct the Deputy Chief of Staff, Army G-1 to require that the
information in MODS is routinely updated and utilized to the maximum
extent possible to provide visibility over and manage injured and ill
reserve component soldiers. (p. 32/Draft Report)
DoD RESPONSE: This recommendation has already been implemented.
RECOMMENDATION 19: The GAO recommended that the Secretary of the Army
direct the Deputy Chief of Staff, Army G-1 to 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. (p. 33/Draft Report)
DoD RESPONSE: For the ADME, the current distribution includes both the
Army Reserve and NGB, and a DFAS representative. A Command and Control
element will be added to the distribution. The MRP distributes to the
Medical Retention Processing Unit's (MRPU's), the Installations, and to
the DFAS. The servicing demobilization installation is providing
support to the soldier will also be added to the distribution.
RECOMMENDATION 20: The GAO recommended that the Secretary of the Army
direct the Deputy Chief of Staff, Army G-1 to 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. (p. 33/Draft Report)
DoD RESPONSE: The HQDA, G-1 will work with the appropriate
organizations to implement this recommendation.
RECOMMENDATION 21: The GAO recommended that the Secretary of the Army
direct the Deputy Chief of Staff, Army G-1 to design and implement
integrated order writing, pay, personnel, and medical eligibility
systems that provide visibility over injured and ill reserve component
soldiers. (p. 33/Draft Report)
DoD RESPONSE: The Department's long-term solution is the implementation
of the Defense Integrated Military Human Resource System (DIMHRS). Many
of the current administrative problems the Army faces today, whether it
is with financial records, personnel accountability, medical records,
or orders production, directly or indirectly stem from incompatible
data systems. To be effective, data must be able to accurately flow
among all Army components, and between the Services. This is one of
DIMHRS major intents.
RECOMMENDATION 22: The GAO recommended that the Secretary of the Army
direct the Deputy Chief of Staff, Army G-1 to design and implement
integrated order writing, pay, personnel, and medical eligibility
systems that ensure the order writing system automatically updates the
pay, personnel, and medical eligibility systems. (p. 33/Draft Report)
DoD RESPONSE: The Department's long-term solution is the implementation
of the DIMHRS.
GAO DRAFT REPORT DATED NOVEMBER 5, 2004:
GAO-05-125 (GAO CODE 192115)
"MILITARY PAY: GAPS IN PAY AND BENEFITS CREATE FINANCIAL HARDSHIPS FOR
INJURED ARMY NATIONAL GUARD AND RESERVE SOLDIERS"
DEPARTMENT OF DEFENSE COMMENTS OTHER:
GAO document (pages 3,11,13, and 24) The report contains incorrect
information regarding pay and benefits, specifically in regards to Post
Exchange (PX) and Defense Commissary Agency commissary access.
DoD comment: The report repeatedly refers to Soldiers and/or family
members losing their PX and/or commissary benefits if the Soldier was
dropped from an active duty status. This information is incorrect. All
Soldiers and/or family members in possession of a valid identification
card (regardless of active, reserve, or guard status) are entitled to
unlimited use of PX facilities at any time. Access to the PX is not
limited only to Soldiers on active duty status. In the matter of
commissary benefits, prior to November 2003, non-active status Army
Reserve and National Guard soldiers assigned to units were authorized
24 visits per year to the commissary. Beginning in November 2003, the
Defense Commissary Agency implemented the provisions of the 2004
National Defense Authorization Act, which eliminated restrictions
previously in place for Army Reserve and National Guard Soldiers and
their families. Recommend revision of the report to remove these
incorrect and misleading statements.
GAO document (page 7 - V bullet) Defines medical holdover (MHO).
DoD comment: The definition of "medical holdover" is incorrect. MHO is
a generic, broad-based term used to describe mobilized Reserve
Component (RC) soldiers in support of the GWOT who were unable to
deploy due to pre-existing or new medical conditions, or who developed
new medical conditions or aggravated pre-existing medical conditions
during deployment. These soldiers are currently non-deployable.
Mobilized GWOT soldiers, who were extended under ADME or are now
extended under MRP programs, are also MHO soldiers. RC soldiers on ADME
from weekend drill, annual training, etc., are not MHO soldiers.
GAO document (page 7 - 2nd paragraph) States that mobilized RC soldiers
who are in MHO are attached to a medical hold unit and would typically
apply for ADME orders through that unit.
DoD comment: MHO soldiers are not assigned nor attached to medical
treatment facility (MTF) medical holding units (MHU). It is true some
MHO soldiers are assigned to MTF MHUs, but these are normally active
compo soldiers who are unable to perform their military operational
skill even within the confines of a limited duty profile. Although a
few installations, such as Ft. Bragg, did assign their MHO soldiers to
the MTF MHU, the Army policy is that MHO soldiers belong to the
garrison commander and are assigned to some type of garrison holding
unit. Most "holding units" were created out of the Garrison Support
Units (GSU) or other garrison units. The implementation of the MRP
program created specific derivative unit identification codes (DUIC)
for medical retention processing units (MRPU) to which MRP/MHO soldiers
are now assigned. The MRPUs, which fall under garrison commander and
IMAs, are staffed by mobilized soldiers requested by the IMAs to
provide command and control to MHOS on the garrison. Non-mobilized ADME
soldiers (who are not MHOS) are assigned or attached to the MTF MHUs
for medical management.
GAO document (page 10 - 3 rd paragraph) States MRP is for soldiers who
become injured or ill while on mobilization orders in support of the
Global War on Terrorism.
DoD comment: MHO/MRP also includes soldiers with pre-existing
conditions that were not identified within 25 days of mobilization or
that were aggravated after mobilization. Soldiers with identified pre-
existing conditions during the first 25 days are released from active
duty. Soldiers who incur new injuries during the first 25 days may
remain on active duty as a MHO.
GAO document (page 22) The report contains contradictory and misleading
statements regarding issues with billeting conditions.
DoD comment: The report refers to medical hold Soldiers at Fort Lewis
having to make three separate moves to make room for demobilizing
units. While one move has been made recently to free up barracks for
returning units, these barracks were only occupied on a temporary
basis. Initial medical holdover billets at Fort Lewis were located in
World War II era billets located on North Fort Lewis, primarily in the
7C block of buildings. As part of an effort to improve living
conditions for medical holdover soldiers, they were relocated to newly
renovated permanent barracks on the main post in late CY 2003. These
barracks had been made available by the deployment of the 3rd Brigade,
2nd Infantry Division (Stryker Brigade Combat Team) to Iraq, and were
expected to be vacated upon the Brigade's return. This move was
accomplished in the Fall of 2004 to barracks vacated by the 1st
Brigade,
25th Infantry Division (Stryker Brigade Combat Team). Due to re-
stationing actions, a final move to new, modular barracks facilities is
planned for the March 2005 timeframe. These new facilities will provide
a permanent home for those medical holdover soldiers retained at Fort
Lewis for their medical care and treatment. Also, the unqualified
anecdote contained in the case study on page 23 alleges that handicap
accessible facilities were not emplaced until built by soldiers in the
Holding company in October 2003. This statement is incorrect. As early
as June 2003, barracks utilized by the Garrison medical holdover
company were modified by the installation Directorate of Public Works
with external ramps to first floor doorways, adaptive equipment in
bathrooms (floor mats, grab rails, and flexible shower heads), and
wider step platforms. These modifications have been made in all
subsequently occupied barracks for soldiers with mobility issues.
GAO document (case studies) The report contains two case studies that
appear to not have been validated with Fort Lewis.
DoD comment: While the report is clear regarding validation of pay
issues presented by soldiers, there appears to have been no validation
of the soldier comments regarding accessibility of the barracks at the
time of their stay. The presentation of such unqualified statements in
a report implies that they are true and correct statements of fact,
which in this case is both untrue and misleading. While not
specifically identified in the case studies, an initial review
indicates additional information is appropriate with regard to certain
aspects of the case studies.
In the example of the Sergeant from G Company, 140TH Aviation Regiment,
the implication is that the soldier was ordered to return to Fort Lewis
simply because he was receiving care through an Air Force hospital. In
this case, the soldier was identified as an individual who had not
properly been recovered into the Army's accountability system and
assigned/attached to a unit for management of required personnel and
medical actions. While delays in returning the soldier to California to
complete his treatment were unfortunate, the soldier was placed on a
remote medical treatment program, which both established proper
accountability and allowed him to reside at his home of record while
his treatment was completed.
In the other two case studies, additional research would be required to
properly identify and document their case histories.
GAO document (page 30 - 2nd paragraph) States that the Army does not
know how many soldiers have been released from active duty before their
179-day MRP order had expired.
DoD comment: Content is incorrect. The Army MRP guidance specifies the
use of MODS as the primary data source for MHO/MRP information. The
guidance further specifies that case managers are responsible for the
accuracy, timeliness and comprehensive entry of data into MODS.
[Guidance: Annex Q (MEDICAL HOLDOVER OPERATIONS) to HQDA OPORD 04-01
and FORSCOM Implementing Instructions].
GAO document (page 32 - 2nd, 3rd and 4th bullets at the top of the
page)
States that the minimum eligibility criteria for soldiers applying for
such programs as ADME and MRP, avenues through which soldiers may apply
for such programs, and specific documentation required to be retained
or extended on active duty orders for medical treatment or evaluation.
DoD comment: These statements are not consistent with DoD policy (DoD
1241.2, "Reserve Component Incapacitation System Management," sections
6.6.3, 6.6.3.2, and 6.6.3.3) concerning retention on active duty until
found fit or processed through the DES. It is not the soldier's
responsibility to ensure he or she is retained on active duty when
injured or ill. It is the service responsibility to ensure the injured
or ill RC member is retained on active duty (unless the member requests
otherwise) until he or she is either medically cleared or processed
through the DES. A more appropriate description of the process is as
follows:
- The service should establish criteria to determine at what point the
member should continue treatment or proceed through the DES.
- If the member is approaching the expiration of his or her orders and
has not been found fit for duty or is still being processed through the
DES, then the service shall initiate action to retain the member on
active duty unless the member requests to be released from active duty.
GAO document (page 32 - 4th bullet of paragraph 2) States that paper-
intensive application processes are replaced with user-friendly
automated processes, to the extent possible, in which soldiers are
notified or have easy access to the current status of their application.
DoD comment: Content is incorrect. There is not an application process,
or at least one submitted by the member. Recommend removing reference
to an application. A more appropriate approach would be:
- User-friendly systems will be in place that would allow the soldier
to review the status of their extension on active duty.
GAO Comments:
1. See the "Agency Comments and Our Evaluation" section of this report.
2. DOD correctly points out that reserve component soldiers and their
families--regardless of their active duty status--are entitled to Post
Exchange and commissary benefits, however, the reality is that these
soldiers could no longer gain access to the Post Exchange and
commissary because they no longer had valid military identification.
When a reserve component soldier's active duty orders expire before new
orders are approved, the soldier's active duty military identification
is no longer valid. Similarly, the soldier no longer has a valid
reserve duty military identification card because this card was
replaced with an active duty identification card upon mobilization.
Therefore, when reserve component soldiers are dropped from active duty
status before they are officially released from active duty, they have
no means of producing valid military identification and gaining access
to these facilities.
3. The written comments provided by DOD attempt to clarify the
definition of MHO soldiers and the Medical Hold Unit as well as which
soldiers are included in MRP. However, DOD's definition does not differ
from our understanding or what we have described in our report. As
discussed previously in our report, soldiers who sustained injuries
during annual training, weekend drills, or other activities associated
with their Army National Guard or Army Reserve duties are eligible for
ADME but are not MHO soldiers. Further, these soldiers fall outside the
scope of our audit because our report specifically focused on soldiers
who were activated for operations in support of the Global War on
Terrorism.
4. We agree that Medical Hold units are not typically part of the MTF
organization but are extensions of a Garrison Support Unit and that the
Installation Management Command has command and control over Medical
Hold units. However, we note in a footnote in the draft report on which
DOD commented that these units may sometimes be found at Army military
medical treatment facilities.
5. We do not believe our report is in conflict with DOD's comment that
MRP units include soldiers with preexisting conditions that were not
identified within 25 days of mobilization or who had injuries that were
aggravated after mobilization.
6. DOD commented that our reference to medical hold soldiers at Fort
Lewis having to make three separate moves to make room for demobilizing
units is contradictory and misleading. According to DOD, not all of the
moves were made to make room for demobilizing units. Some of the moves
were made to improve the quality of the housing provided. We did not
attempt to determine the validity or the necessity of any of the moves,
however, the inconvenience to the injured soldiers of moving from
location to location is the same regardless of the reason.
7. We corroborated the information provided by our 10 case study
soldiers with the soldiers' official military pay records, mobilization
and ADME orders, bank statements, and credit records. In no case did
the statements made by a soldier about gaps in pay differ significantly
from the evidence we obtained. As for statements made about
infrastructure, accommodations, and other qualitative factors, we
attempted to and when possible, we did corroborate soldiers' statements
with Army officials familiar with the soldiers. When we could not
readily corroborate their statements by other evidence, we have taken
great care to attribute the information to the soldiers we interviewed.
Testimonial information that we could not corroborate by other evidence
was not used as the basis for our conclusions and recommendations.
8. We reaffirm our conclusion that the Army does not know how many
soldiers have been released from active duty before their 179-day MRP
orders had expired. According to DOD, the Army MRP guidance specifies
the use of MODS as the primary data source for MHO/MRP information. The
guidance further specifies that case managers are responsible for the
accuracy, timeliness and comprehensive entry of data into MODS. The MRP
implementing instructions are not sufficiently explicit to
satisfactorily deal with the issue of MODS or tracking the status of
injured or ill reserve component soldiers. We believe that implementing
instructions should contain clear, complete, and comprehensive
information needed to carry out Army polices and regulations--instead
of providing references to other policies, procedures, and
instructions, which can create confusion. More importantly, the Army
does not track soldiers that are released from MRP orders before their
179-day orders expire. As discussed in the report previously, HRC-
Alexandria officials asserted that, as of October 2004, a total of 51
soldiers had been released from active duty before their 179-day MRP
orders expired. At the same time, Fort Knox, one of the few
installations that tracked these data, reported it had released 81
soldiers from active duty who were previously on MRP orders--none of
whom were included in the list of 51 soldiers provided by HRC-
Alexandria. Thus it is clear that the Army does not know how many
soldiers have been released from MRP orders. Further, as stated in the
report, the soldiers that were released early from their orders were
improperly paid over $ 62,000, which the Army and DFAS were unaware of
until we notified them.
9. As discussed previously in this report, we found that the soldier
carries a large part of the burden when trying to understand and
successfully navigate the Army's poorly defined requirements and
processes for obtaining extended active duty orders. Therefore, we
continue to believe that the Army needs (1) policies and procedures
that establish minimum eligibility criteria for programs such as ADME
and MRP and avenues through which soldiers may apply with Army
assistance for such programs and (2) user-friendly processes in which
soldiers are notified or have easy access to the status of their active
duty extension.
[End of section]
Appendix III: GAO Contact and Staff Acknowledgments:
GAO Contact:
Diane Handley (404) 679-1986;
John Ryan (202) 512-9587:
Acknowledgments:
Staff members who made key contributions to this report were Gary
Bianchi, Francine DelVecchio, Carmen Harris, Jamie Haynes, Kristen
Plungas, Maria Storts, and Truc Vo.
(192115):
FOOTNOTES
[1] For the purpose of this report, the term mobilized includes all
Army reserve component soldiers called to perform active service.
[2] GAO, Military Pay: Army National Guard Personnel Mobilized to
Active Duty Experienced Significant Pay Problems, GAO-04-89
(Washington, D.C.: Nov. 13, 2003); GAO, Military Pay: Army Reserve
Soldiers Mobilized to Active Duty Experienced Significant Pay Problems,
GAO-04-911 (Washington, D.C.: Aug. 20, 2004).
[3] DOD includes Operations Enduring Freedom, Operation Nobel Eagle,
and Operation Iraqi Freedom as part of the Global War on Terrorism.
[4] ADME will still exist for soldiers who are not mobilized as part of
the Global War on Terrorism--such as soldiers injured in Bosnia or
Kosovo or during annual training exercises.
[5] Army Manpower is an organization within the Army Deputy Chief of
Staff, G-1, formerly the Army Deputy Chief of Staff for Personnel. The
G-1 is the Army's human resource provider, handling human resource
programs, policies, and systems. The Army Human Resources Command is a
field operating activity that reports directly to the G-1.
[6] The Army maintained data on soldiers who were currently on ADME
orders but did not track soldiers who were applying for ADME or who had
been dropped from their active duty orders.
[7] Some soldiers also elect to be released from duty and choose to
seek care through their private insurers or utilize government-provided
transitional assistance. Eligible soldiers may also seek care through
the Veterans Administration.
[8] Under the transitional assistance management program, prior to
October 2004, service members with fewer than 6 years of active service
are eligible for health care benefits for 60 days. With 6 years or more
of active service, eligibility increases to 120 days. In November 2003,
the Congress increased this time period to 180 days through the end of
September 2004. Emergency Supplemental Appropriations Act for Defense
and for the Reconstruction of Iraq and Afghanistan, 2004, Pub. L. No.
108-106, § 1117, 117 Stat. 1209, 1218 (Nov. 3, 2003). In October 2004,
Congress permanently extended the period of eligibility to 180 days for
all categories of service members.
[9] While soldiers in medical holdover status may not have had service-
connected injuries or illnesses, they would be eligible to apply for an
active duty medical extension by virtue of the fact that they have a
medical condition that necessitates treatment for more than 30 days
beyond the end of their existing active duty orders.
[10] Medical hold units handle command and control for active duty and
mobilized reserve component soldiers who are not medically fit for
duty. These units may sometimes be found at Army military medical
treatment facilities, including Army hospitals.
[11] According to Procedural Guidance for Reserve Component Soldiers on
Active Duty Medical Extension, Section 8b, the soldier's ADME request
is required to be submitted through "whoever has command and control
over the soldier at the time of request". Some installations chose to
have the garrison support unit (GSU) remain as the soldiers command and
control authority until their original mobilization orders expired.
Therefore, the initial ADME request would be submitted through the GSU
instead of the medical hold unit.
[12] Department of the Army Form 4187, Personnel Action.
[13] According to the procedural guidance, this is to be a formal
memorandum (on letterhead) from the attending physician, which states
the current diagnosis; current treatment plan; prognosis; date the
soldier is expected to be returned to full duty; and full name, grade,
and office telephone number of physician. If available, a physical
profile should accompany this statement.
[14] Department of the Army Form 3349, Physical Profile.
[15] Soldiers who do not meet medical military retention standards may
be placed on the temporary disability retired list, the permanent
disabled retired list, may be separated from service with severance,
or, in rare cases, be retained with a disability if the soldier is
still needed by the military. Department of Defense Directive 1332.18,
Separation or Retirement for Physical Disability (Nov. 4, 1996);
Department of Defense Instruction 1332.38, Physical Disability
Evaluation; (Nov. 14, 1996), See Army Regulation 635-40, Physical
Evaluation for Retention, Retirement, or Separation (Aug. 15,1990).
[16] Army Regulation 40-400, Patient Administration, paragraph 3-2,
(Mar. 12, 2001) and Army Regulation 135-381, Incapacitation of Reserve
Component Soldiers, paragraph 2-1 (June 1, 1990).
[17] Army Regulation 135-381, Incapacitation of Reserve Component
Soldiers, paragraph 7-2 (June 1, 1990).
[18] We did not audit these costs for the purpose of determining if the
Army properly recorded them against available funding sources. Instead,
we applied DOD's criteria for contingency operations cost accounting in
DOD's Financial Management Regulation, Vol. 12, Chapter 23 (February
2001).
[19] GAO, Military Personnel: DOD Actions Needed to Improve the
Efficiency of Mobilizations for Reserve Forces, GAO-03-921 (Washington,
D.C.: Aug. 21, 2003)
[20] There are over 800 DOD card issuance facilities located in the
U.S. on Army installations and with Army National Guard and Reserve
units.
[21] GAO, Standards for Internal Control in Federal Government, GAO/
AIMD-00-21.3.1 (Washington D.C.: November 1999). These standards
provide the overall framework for establishing and maintaining
effective internal control and for identifying and addressing areas of
greatest risk of fraud, waste, abuse, and mismanagement.
[22] GAO, Military Pay: Army Reserve Soldiers Mobilized to Active Duty
Experienced Significant Pay Problems, GAO-04-911 (Washington, D.C.:
Aug. 20, 2004).
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