Military Disability Evaluation
Ensuring Consistent and Timely Outcomes for Reserve and Active Duty Service Members Gao ID: GAO-06-561T April 6, 2006The House Subcommittee on Military Personnel asked GAO to discuss the results of its recent study on the Military Disability Evaluation System. In this study, GAO determined (1) how current DOD policies and guidance for disability determinations compare for the Army, Navy, and Air Force, and what policies are specific to reserve component members of the military; (2) what oversight and quality control mechanisms are in place at DOD and these three services of the military to ensure consistent and timely disability decisions for active and reserve component members; and (3) how disability decisions, ratings, and processing times compare for active and reserve component members of the Army, the largest branch of the service, and what factors might explain any differences.
In March 2006, GAO reported that policies and guidance for military disability determinations differ somewhat among the Army, Navy, and Air Force. DOD has explicitly given the services the responsibility to set up their own processes for certain aspects of the disability evaluation system and has given them latitude in how they go about this. As a result, each service implements its system somewhat differently. Further, the laws that govern military disability and the policies that the Department of Defense (DOD) and the services have developed to implement these laws have led reservists to have different experiences in the disability system compared to active duty members. For example, because they are not on active duty at all times, it takes longer for reservists to accrue the 20 years of service that may be needed to earn monthly disability retirement benefits. While DOD has issued policies and guidance to promote consistent and timely disability decisions for active duty and reserve disability cases, DOD is not monitoring compliance. To encourage consistent decision-making, DOD requires all services to use multiple reviewers to evaluate disability cases. Furthermore, federal law requires that they use a standardized disability rating system to classify the severity of the medical impairment. In addition, DOD periodically convenes the Disability Advisory Council, comprised of DOD and service officials, to review and update disability policy and to discuss current issues. However, neither DOD nor the services systematically determine the consistency of disability decision-making. DOD has issued timeliness goals for processing disability cases, but is not collecting information to determine compliance. Finally, the consistency and timeliness of decisions depend, in part, on the training that disability staff receive. However, DOD is not exercising oversight over training for staff in the disability system. While GAO's review of the military disability evaluation system's policies and oversight covered the three services, GAO examined Army data on disability ratings and benefit decisions from 2001 to 2005. After controlling for many of the differences between reserve and active duty soldiers, GAO found that among soldiers who received disability ratings, the ratings of reservists were comparable to those of active duty soldiers with similar conditions. GAO's analyses of the military disability benefit decisions for the soldiers who were determined to be unfit for duty were less definitive, but suggest that Army reservists were less likely to receive permanent disability retirement or lump sum disability severance pay than their active duty counterparts. However, data on possible reasons for this difference, such as whether the condition existed prior to service, were not available for our analysis. GAO did not compare processing times for Army reserve and active duty cases because we found that Army's data needed to calculate processing times were unreliable. However, Army statistics based on this data indicate that from fiscal year 2001 through 2005, reservists' cases took longer to process than active duty cases.
GAO-06-561T, Military Disability Evaluation: Ensuring Consistent and Timely Outcomes for Reserve and Active Duty Service Members
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Testimony before the Subcommittee on Military Personnel, Committee on
Armed Services, House of Representatives:
United States Government Accountability Office:
GAO:
For Release on Delivery Expected at 9:00 a.m. EDT:
Thursday, April 6, 2006:
Military Disability Evaluation:
Ensuring Consistent and Timely Outcomes for Reserve and Active Duty
Service Members:
Statement of Robert E. Robertson, Director, Education, Workforce, and
Income Security Issues:
GAO-06-561T:
GAO Highlights:
Highlights of GAO-06-561T, a testimony to the Subcommittee on Military
Personnel, House Committee on Armed Services:
Why GAO Did This Study:
The House Subcommittee on Military Personnel asked GAO to discuss the
results of its recent study on the Military Disability Evaluation
System. In this study, GAO determined (1) how current DOD policies and
guidance for disability determinations compare for the Army, Navy, and
Air Force, and what policies are specific to reserve component members
of the military; (2) what oversight and quality control mechanisms are
in place at DOD and these three services of the military to ensure
consistent and timely disability decisions for active and reserve
component members; and (3) how disability decisions, ratings, and
processing times compare for active and reserve component members of
the Army, the largest branch of the service, and what factors might
explain any differences.
What GAO Found:
In March 2006, GAO reported that policies and guidance for military
disability determinations differ somewhat among the Army, Navy, and Air
Force. DOD has explicitly given the services the responsibility to set
up their own processes for certain aspects of the disability evaluation
system and has given them latitude in how they go about this. As a
result, each service implements its system somewhat differently.
Further, the laws that govern military disability and the policies that
the Department of Defense (DOD) and the services have developed to
implement these laws have led reservists to have different experiences
in the disability system compared to active duty members. For example,
because they are not on active duty at all times, it takes longer for
reservists to accrue the 20 years of service that may be needed to earn
monthly disability retirement benefits.
While DOD has issued policies and guidance to promote consistent and
timely disability decisions for active duty and reserve disability
cases, DOD is not monitoring compliance. To encourage consistent
decision-making, DOD requires all services to use multiple reviewers to
evaluate disability cases. Furthermore, federal law requires that they
use a standardized disability rating system to classify the severity of
the medical impairment. In addition, DOD periodically convenes the
Disability Advisory Council, comprised of DOD and service officials, to
review and update disability policy and to discuss current issues.
However, neither DOD nor the services systematically determine the
consistency of disability decision-making. DOD has issued timeliness
goals for processing disability cases, but is not collecting
information to determine compliance. Finally, the consistency and
timeliness of decisions depend, in part, on the training that
disability staff receive. However, DOD is not exercising oversight over
training for staff in the disability system.
While GAO‘s review of the military disability evaluation system‘s
policies and oversight covered the three services, GAO examined Army
data on disability ratings and benefit decisions from 2001 to 2005.
After controlling for many of the differences between reserve and
active duty soldiers, GAO found that among soldiers who received
disability ratings, the ratings of reservists were comparable to those
of active duty soldiers with similar conditions. GAO‘s analyses of the
military disability benefit decisions for the soldiers who were
determined to be unfit for duty were less definitive, but suggest that
Army reservists were less likely to receive permanent disability
retirement or lump sum disability severance pay than their active duty
counterparts. However, data on possible reasons for this difference,
such as whether the condition existed prior to service, were not
available for our analysis. GAO did not compare processing times for
Army reserve and active duty cases because we found that Army‘s data
needed to calculate processing times were unreliable. However, Army
statistics based on this data indicate that from fiscal year 2001
through 2005, reservists‘ cases took longer to process than active duty
cases.
What GAO Recommends:
In this report, GAO recommended that the Secretary of Defense take
certain steps to improve DOD oversight of the military disability
evaluation system, including evaluating the appropriateness of
timeliness standards for case processing, and assessing the adequacy of
training for disability evaluation staff.
The Secretary concurred and indicated that our recommendations would be
implemented.
www.gao.gov/cgi-bin/getrpt?GAO-06-561T.
To view the full product, including the scope and methodology, click on
the link above. For more information, contact Robert E. Robertson at
(202) 512-7215 or robertsonr@gao.gov.
[End of section]
Mr. Chairman and Members of the Subcommittee:
Thank you for inviting me to present the results of our work in
response to this committee's mandate to review the Department of
Defense (DOD) disability evaluation system, in particular how the
system ensures that decisions in reserve and active duty cases are
consistent and timely. Under certain circumstances, both active duty
and reserve component members of the military are entitled to receive
compensation for service-incurred or -aggravated injuries or illnesses
that render them unfit for continued military service. According to DOD
regulations, a primary goal of the military disability evaluation
system is to ensure consistent and timely decisions for active duty and
reserve component members.
Over the past 5 years, nearly half a million reserve component members
across all services have been mobilized to augment active duty military
forces in conflicts and peacekeeping missions worldwide.[Footnote 1] In
total, the Army, Navy, and Air Force evaluated 23,316 disability cases
in fiscal year 2005. One in four of these was a reservist's case.
Because reserve component members represent a substantial proportion of
the mobilized military force, it is incumbent on DOD and the military
to ensure that disability decisions made in their cases are consistent
with those made in the cases of active duty members, and as timely.
The information I'm providing today is based on work we reported on
March 31, 2006, which was completed in accordance with generally
accepted government auditing standards.[Footnote 2] I will be
discussing (1) how current DOD policies and guidance for disability
determinations compare for the Army, Navy, and Air Force, and what
policies are specific to reserve component members of the military; (2)
what oversight and quality control mechanisms are in place at DOD and
these three services to ensure consistent and timely disability
decisions for active and reserve component members; and (3) how
disability decisions, ratings and processing times compare for active
and reserve component members of the Army, the largest branch of the
military, and what factors might explain any differences.
In summary, GAO found that DOD has explicitly given the services the
responsibility to set up their own processes for certain aspects of the
disability evaluation system and has given them latitude in how they go
about this. As a result, each service implements its system somewhat
differently. Further, the laws that govern military disability and DOD
and service policies implementing these laws have led reservists to
have different experiences in the disability system compared to active
duty members. While DOD has issued policies and guidance to promote
consistent and timely disability decisions for active duty and reserve
disability cases, DOD is not monitoring compliance, and neither DOD nor
the services systematically determine the consistency of disability
decision making. With regard to ensuring the timeliness of disability
case processing, DOD has issued processing time goals but is not
collecting information to determine compliance. Our own statistical
analysis found that Army reservists received similar disability ratings
as their active duty counterparts, but reservists may be less likely to
receive military disability benefits than their active duty
counterparts. Data available from the Army were not reliable enough for
our analysis. However, Army statistics indicate that from 2001 through
2005 reservists' cases took longer to process than active duty
soldiers' cases.
Background:
Service members who become physically unfit to perform military duties
due to service-incurred or -aggravated injuries or illnesses may
receive military disability compensation under certain conditions. Each
of the services administers its own disability evaluation process.
According to DOD regulations, the process should include a medical
evaluation board (MEB), a physical evaluation board (PEB), an appellate
review process, and a final disposition. Each service member who goes
through the system should be assigned a Physical Evaluation Board
Liaison Officer (PEBLO) to help the service member navigate the system
and prepare documents for the PEB.
There are a number of steps in the disability evaluation process and
several factors play a role in the decisions that are made at each
step. See fig. 1.
Figure 1: Decisions Made During the Military Disability Evaluation
Process:
[See PDF for image]
[End of figure]
The disability evaluation process has four possible outcomes. A service
member can be:
1. Found fit for duty;
2. Separated from the service without benefits--service members whose
disabilities were incurred while not on duty or as a result of
intentional misconduct are discharged from the service without
disability benefits;
3. Separated from the service with lump sum disability severance pay;
or:
4. Retired from the service with permanent monthly disability benefits
or placed on the temporary disability retirement list (TDRL).
The disability evaluation process begins at a military treatment
facility (MTF) when a physician medically evaluates a service member's
injury or condition to determine if the service member meets the
military's retention standards, and prepares a narrative summary
describing the findings. This process is referred to as a medical
evaluation board (MEB). Service members who meet retention standards
are returned to duty. Those who do not are referred to the physical
evaluation board (PEB).
The first step in the PEB stage of the process is the informal PEB--an
administrative review of the case file without the presence of the
service member. To arrive at its findings and recommendations regarding
eligibility for disability benefits, the PEB determines if service
members are fit for duty and their injuries or conditions are
compensable, and what disability rating their injuries or conditions
should be assigned. The PEB also considers the stability of the
condition in cases eligible for monthly disability retirement benefits.
Service members with conditions that might improve or worsen are placed
on TDRL and reevaluated by the PEB at least every 18 months to
determine if their condition has stabilized. Those who continue to be
unfit for duty after 5 years on TDRL are separated from the military
with monthly retirement benefits, discharged with severance pay, or
discharged without benefits, depending on their condition and years of
service.
Service members have the opportunity to review the informal PEB's
findings and may request a formal hearing with the PEB. However, only
those found unfit are guaranteed a formal hearing. If service members
disagree with a formal PEB's findings and recommendations, they can,
under certain circumstances, appeal to the reviewing authority of the
PEB. Once the service member either agrees with the PEB's findings and
recommendations or exhausts all available appeals, the reviewing
authority issues the final disposition in the case.
DOD Policies and Guidance Allow the Services to Implement the
Disability Evaluation System Differently:
DOD explicitly gives the services responsibility for administering the
military disability evaluation system. While DOD regulations establish
some parameters and guidelines for this system, the services have
considerable latitude in how they interpret them. Consequently, across
the services there are differences in MEB and PEB procedures and the
use of counselors to help service members navigate the system.
With regard to the MEB, the medical evaluation of a service member's
ability to meet military retention standards, the Air Force convenes an
actual board of physicians who meet regularly and vote on whether
service members meet retention standards. In contrast, the Army and
Navy MEBs are informal procedures during which case files are
separately reviewed by board members. Each branch of the service has
established PEB to determine whether service members who do not meet
medical retention standards are entitled to disability compensation.
Makeup of the board differs by service. The Army allows the same
individuals to sit on both the informal and formal PEB in the same
case. The Air Force allows this only under certain circumstances. The
Navy has no written policy on the matter, and one Navy PEB official
indicated that the same individuals often served on both informal and
formal PEBs in a case.
DOD regulations require that each service assign a Physical Evaluation
Board Liaison Officer to service members whose disability cases are
being evaluated. According to these regulations, PEBLOs are expected to
counsel these service members on their rights, the effects of MEB and
PEB decisions, and available disability benefits. Each service employs
PEBLO counselors in accordance with these rules, but has placed them
under different commands, begins the counseling process at different
points in the disability evaluation process, and provides PEBLOS with
different levels of training.
DOD and the Services Have Established Policies That Result in Different
Experiences with the Disability System for Reservists:
Due to the part-time nature of reserve service, some laws governing
military disability compensation result in different experiences with
the disability system for reservists. Under the law, to receive monthly
disability retirement benefits, a service member determined unfit for
duty must have at least 20 years of active duty service or a disability
rated at least 30 percent. Because reservists are not on duty at all
times, it takes longer for them to accrue the 20 years of service
needed to qualify for monthly disability retirement benefits when their
disability rating is less than 30 percent.
Part-time status also makes it more difficult for reservists with
preexisting conditions to be covered by the 8-year rule and therefore
eligible for disability compensation of any kind. By law, service
members determined to be unfit for duty are automatically eligible for
disability compensation if they have at least 8 years of active duty
service, even if their conditions existed prior to entry into the
military or were not aggravated by their military service. However,
this entitlement only applies to reservists when they are on ordered
active duty of more than 30 days at the time their case is before a
PEB. For reservists, accruing these 8 years can be more difficult than
for active duty service members.
Questions About Line of Duty Determinations:
Officials reported that commanders and others responsible for
completing line of duty determinations were often uncertain as to when
line of duty determinations were necessary for reservists and active
duty members. Moreover, these officials noted that in some cases, the
necessary line of duty determinations were not made, resulting in
delays for service members. For example, Air Force officials we spoke
with had different impressions as to whether line of duty
determinations were always required for reservists, even though Air
Force regulations state they are. Officials from the Army and Army
National Guard similarly offered different perspectives on the need for
line of duty determinations for reservists.
Army Reservists Often Are Not Returned Home for Medical Treatment:
In the Army, deployed active duty soldiers return to their unit for
service in a back up capacity when they are injured or ill and require
medical treatment. Mobilized injured or ill Army reservists have no
similar unit to return to. Consequently, their mobilization orders are
often suspended; they are retained on active duty in "medical holdover
status" and often assigned to a medical retention processing unit while
they receive medical treatment. While in medical holdover status,
reservists may live on base, at a military treatment facility, at home
or at other locations. After their mobilization orders expire, they can
elect to continue on active duty through a program such as medical
retention processing, which allows them to continue receiving pay and
benefits. According to the Army, about 26,000 reservists entered
medical holdover status between 2003 and 2005.
Unlike most injured active duty soldiers, reservists in medical
holdover generally must live away from their families while receiving
medical treatment. In certain cases reservists in medical holdover may
receive treatment and recuperate at home. The Army's Community Based
Health Care Organizations (CBHCO) provide medical and case management
for these reservists. As of December 2005, about 35 percent of the
reservists in medical holdover were being cared for in the CBHCO
program. In order to be assigned to this program, reservists must meet
a number of criteria. For example, reservists must live in communities
where they can get appropriate care, and they must also be reliable in
keeping medical appointments.
Several Features of the Disability Evaluation System Are Intended to
Help Ensure Consistent Decision Making:
To help ensure consistent decision making in disability cases, all
services must use a common rating schedule, multiple reviews are
required, and a disability advisory council was created to oversee
administration of the system. The law requires all services to assign
ratings to disabilities based on a common schedule--the Department of
Veterans Affairs Schedule for Rating Disabilities (VASRD). The VASRD is
a descriptive list of medical conditions associated with disability
ratings. DOD regulations require each service to review service
members' case files multiple times during the disability evaluation
process by a number of officials with different roles. Military
officials also regard the appeals process required by DOD as helping to
ensure the consistency of disability evaluation decision making.
According to DOD officials, primary oversight of the disability
evaluation system currently rests with the DOD Disability Advisory
Council. The council is composed of officials from each of the three
services' disability agency; DOD health affairs, reserve affairs, and
personnel officials; and representatives from the Department of
Veterans Affairs. According to DOD officials, the council serves as a
forum to discuss issues such as changing rules and increasing
coordination among the services. The council generally does not
formally report on its activities and accomplishments to higher
officials in the DOD chain of command nor has it met on a regular basis
during the last year.
Lack of Oversight by DOD and the Services Provides Little Assurance
Decisions Are Consistent:
Despite this policy guidance and the presence of the disability
council, both DOD and the three services lack quality assurance
mechanisms to ensure that decisions are consistent. Given that one of
the primary goals of the disability system is that disability
evaluations take place in a consistent manner, collecting and analyzing
the service member's final disability determinations are critical for
ensuring that decisions are consistent. DOD regulations recognize this
and require that the agency establish necessary reporting requirements
to monitor and assess the performance of the disability system and
compliance with relevant DOD regulations. Yet DOD does not collect and
analyze information from the services on the final disability
determinations and personal characteristics of service members going
through the disability system.
DOD Has Instituted Timeliness Goals for Processing Disability Cases but
Does Not Oversee Compliance with Them:
To help ensure timely disability decisions, DOD regulations indicate
that MEBs should normally be completed in 30 days or less; PEBs should
normally be completed in 40 days or less. DOD does not regularly
collect available data from the services on their MEB and PEB
processing times, however, so it does not monitor compliance with its
goals.
The Army and Navy generally use the data they compile on their
disability cases to track the timeliness of both MEB and PEB decisions.
The Air Force only tracks processing times for PEB cases because it has
no centralized database containing information from all its MEB cases.
Data reported by the services show disability case processing time
goals are not being met. Some of the military officials we spoke with
believe this is because the goals themselves are unrealistic,
particularly when addendums to the MEB's findings are required, such as
in orthopedic or psychiatric cases requiring certain medical tests.
The usefulness of data of disability case processing times may also be
undermined by confusion among military officials and data entry staff
regarding when the disability evaluation process begins. According to
DOD, the process begins on the date a physician dictates the narrative
summary for an MEB. When we compared original Army PEB case files to
Army electronic data from both its MEB and PEB databases, for example,
we found that the date entered in the electronic file was often not the
date on the narrative summary. When we asked about these errors, Army
officials said that increased training of data entry staff would help
resolve this problem. Navy officials also noted that there was some
confusion about when case processing begins if additional medical
information is needed to make a disability decision for a service
member.
DOD's Delegation of Training to the Services and Staff Turnover Present
Additional Challenges for the Disability System:
According to DOD regulations, the Assistant Secretary of Defense for
Health Affairs is given explicit instructions to develop and maintain a
training program for MEB and PEB staff. When we spoke with officials
from the Office of Health Affairs, however, they indicated they were
unaware that they had the responsibility to develop such a training
program. In addition, despite high turnover among military disability
evaluation staff, the services do not have a system to ensure that all
staff are properly trained. This turnover stems, in part, from the
military requirement that personnel rotate to different positions in
order to be promoted. Military officials told us that depending on the
positions involved, some staff remain in their positions from 1 to 6
years, with most remaining about 3 years. This turnover and the
resulting loss of institutional knowledge require that the services
systematically track who has been properly trained. However, all of the
services lack data systems that would allow them to do so, an issue
that was highlighted in a recent RAND report.[Footnote 3]
Some Inconsistencies May Exist in Disability Decisions for Army Reserve
and Active Duty Service Members:
Our analyses of Army data from calendar years 2001 to 2005 indicated
that after taking into account many of the differences between reserve
and active duty soldiers, Army reservists and their active duty
counterparts received similar disability ratings. The results of our
analyses of military disability benefit decisions for soldiers suggest
that Army reservists with impairments that made them unfit for duty
were less likely to receive either permanent disability retirement or
lump sum disability severance pay than their active duty counterparts.
The results of our analysis of benefits are less definitive than those
from our analysis of ratings, however, because data on all possible
reasons for the difference in receipt of benefits, such as years of
service and whether the condition existed prior to service, were not
available for our analysis.
Poor Quality Data Precluded GAO Analysis, but the Army Reports
Reservists' Cases Can Take Longer to Process:
We did not conduct our own statistical analysis to determine if
processing times for Army reserve and active duty soldiers' cases were
comparable. The electronic data needed to calculate these times were
unreliable, so not of sufficient quality to warrant their use in our
analysis. Nonetheless, the statistics the Army provided on PEB
disability case processing times indicate that reservists' cases
reviewed between fiscal years 2001 and 2005 took consistently longer
than those of active duty soldiers. Over half (54 percent) of reserve
soldiers' cases took longer than 90 days, while over one-third (35
percent) of active duty soldiers' cases exceeded 90 days.
According to Army officials, there are a number of possible
explanations for the differences in processing times in reservist and
active duty cases. In reservists' cases, the MEB often must request
medical records from private medical practitioners, which can cause
considerable delays in the process. In addition, the personnel
documents for reservists are stored in facilities around the United
States, and may take longer to retrieve than records for active duty
soldiers.
Conclusions:
Decisions affecting eligibility for military disability benefits have a
significant impact on the future of service members dedicated to
serving their country. Given the importance of these decisions and the
complexity of the evaluation process and rules governing eligibility
for benefits, it is essential that the services take adequate steps to
ensure that decisions in reserve and active duty cases are consistent
and timely. It is also incumbent on DOD to adequately oversee
administration of its disability evaluation system and the fairness of
the system's outcomes for both reserve and active duty members of the
military across all the services.
DOD is not adequately monitoring disability evaluation outcomes in
reserve and active duty disability cases. The services are not
systematically evaluating the consistency and timeliness of disability
decisions, or compiling reliable data on all aspects of the system
needed to statistically analyze disability evaluation outcomes. With
regard to the timeliness of disability case processing, military
officials recognize that not all disability cases are processed within
the time frames set by DOD and that reservist cases take longer to
process than those of active duty members. They have suggested that the
goals may not be appropriate in many cases. If timeliness goals do not
reflect appropriate processing times, they may not be a useful program
management tool. Finally, while the consistency and timeliness of
decisions depend on the adequate training and experience of all those
involved in evaluating disability cases, we found that DOD had little
assurance that staff at all levels in the process are properly trained.
Based on these findings and conclusions, we recommended in our recent
report that the Secretary of Defense take certain steps to improve DOD
oversight of the military disability system, including evaluating the
appropriateness of timeliness standards for case processing and
assessing the adequacy of training for disability evaluation staff. The
Secretary concurred with our recommendations and indicated our
recommendations would be implemented.
Mr. Chairman, this concludes my remarks. I would be happy to answer any
questions you or the other members of the committee may have.
GAO Contact:
Robert E. Robertson (202)512-7215 or robertsonr@gao.gov:
Staff Acknowledgments:
The following individuals have made major contributions to this
statement--Jason Barnosky, Erin Godtland, Scott Heacock, Anna Kelley,
and Clarita Mrena.
FOOTNOTES
[1] In this testimony, the word "reservist" refers to a reserve
component member.
[2] GAO, Military Disability System: Improved Oversight Needed to
Ensure Consistent and Timely Outcomes for Reserve and Active Duty
Service Members, GAO-06-362 (Washington, D.C.: Mar. 31, 2006).
[3] Cheryl Y. Marcum, Robert M. Emmerichs, Jennifer S. Sloan, and Harry
J. Thie, Methods and Actions for Improving Performance of the
Department of Defense Disability Evaluation System. MR-1228-OSD (Santa
Monica, Californi[A]: the Rand Corporation, 2002).
