MILITARY 

DISABILITY SYSTEM

Improved Monitoring 

Needed to Better 

Track and Manage 

Performance

Report to Congressional Committees

August 2012

GAO-12-676

United States Government Accountability Office

GAO
United States Government Accountability Office

Highlights of GAO-12-676, a report to 

congressional committees

August 2012

MILITARY DISABILITY SYSTEM

Improved Monitoring Needed to Better Track and 

Manage Performance

Why GAO Did This Study

Since 2007, DOD and VA have jointly 

operated IDES—which is intended to 

expedite benefits for injured 

servicemembers. IDES replaced the 

departments’ separate processes for 

evaluating servicemembers for fitness 

and disability. Initially a pilot at 3 

military treatment facilities, IDES is 

now in place at military treatment 

facilities worldwide. In previous reports, 

GAO identified a number of challenges 

as IDES expanded to more facilities, 

including staffing shortages and 

difficultly meeting timeliness goals.

In light of IDES’ expansion, GAO was 

asked to examine: (1) the extent to 

which DOD and VA are meeting IDES 

timeliness and servicemember 

satisfaction performance goals, and 

(2) steps the agencies are taking to 

improve IDES performance. GAO 

analyzed IDES timeliness and 

customer satisfaction data, visited six 

IDES sites with varying performance, 

and interviewed DOD and VA officials.

What GAO Recommends

To improve monitoring of IDES 

timeliness and satisfaction, GAO 

recommends that DOD and VA work 

together to (1) develop plans for 

completing the ongoing business 

process review and implementing any 

resulting recommendations and 

(2) improve the accuracy of case 

information at the point of data entry; 

and that (3) DOD consider alternative 

approaches to measuring satisfaction. 

DOD and VA concurred with GAO’s 

recommendations.

What GAO Found

Case processing times under the Integrated Disability Evaluation System (IDES) 

have increased over time, and measures of servicemember satisfaction have 

shortcomings. Since 2008, annual average processing times for IDES cases 

have steadily climbed, while the percentage of cases meeting established 

timeliness goals declined. Average case processing times reached 394 and 420 

days for active and reserve component members in fiscal year 2011—compared 

to goals of 295 and 305 days, respectively, and just 19 percent of active duty and 

18 percent of guard or reserve servicemembers completed the process and 

received benefits within established goals. Of the four phases comprising IDES, 

the medical evaluation board phase increasingly fell short of timeliness goals, 

while the physical evaluation board phase, although meeting goals, was taking 

increasingly more time to complete. With respect to servicemember satisfaction 

with the IDES process, GAO found shortcomings in how these data are collected 

and reported, such as unduly limiting who is eligible to receive a survey and 

computing average satisfaction scores in a manner that may overstate them. 

Department of Defense (DOD) officials told GAO they are considering 

alternatives for gauging satisfaction with the process. 

Timeliness for IDES Cases Resulting in VA Benefits (by year case completed)

DOD and Veterans Affairs (VA) are taking steps to improve IDES performance, 

but progress to date is uneven and it is too early to assess their overall impact. 

For example, VA increased resources for completing exams and disability ratings

while the Army is hiring additional staff for its medical evaluation boards. VA has 

met exam timeliness goals in the past several months, but other resources have 

yet to translate into lower processing times. DOD and VA are pursuing system 

upgrades so that staff and managers at IDES facilities can better track and 

manage the progress of servicemembers’ cases. IDES officials have been 

working with the military services to correct case data that were inaccurately 

entered into VA’s IDES tracking system, but have not yet identified a permanent 

solution to improve the accuracy of data input. Finally, DOD, with VA’s 

assistance, is in the early stages of an in-depth review of the entire IDES process 

and its supporting IT systems. This effort is intended to improve understanding of 

how each step contributes to overall processing times and identify opportunities 

to streamline the process and supporting systems. However, timeframes for 

completing the review or issuing recommendations have yet to be established.

View GAO-12-676. For more information, 

contact Daniel Bertoni at (202) 512-7215 or 

bertonid@gao.gov.
Page i GAO-12-676 Military Disability Evaluation

Letter 1 

Background 2

IDES Processing Times Increased Over Time, While Measures of 

Servicemember Satisfaction Have Shortcomings 8

Recent Actions and Ongoing Initiatives May Improve IDES 

Performance, but It Is Too Early to Assess Their Overall Impact 23

Conclusions 31

Recommendations for Executive Action 32

Agency Comments and Our Evaluation 33

Appendix I Objectives, Scope, and Methodology 35

Appendix II Additional Timeliness and Satisfaction Analyses 40

Appendix III Monthly DOD Timeliness Data for Active Duty Cases in Fiscal Year 

2012 69

Appendix IV Comments from the Department of Defense 70

Appendix V Comments from the Department of Veterans Affairs 72

Appendix VI GAO Contact and Staff Acknowledgments 74

Related GAO Products 75

Tables

Table 1: Average Processing Times for MEB Phase for Completed 

Cases by Fiscal Year of Completion (in days) 11

Contents
Page ii GAO-12-676 Military Disability Evaluation

Table 2: Average Processing Time in PEB Phase of IDES for 

Completed Cases (in days) 16

Table 3: Average Processing Time for PEB Stages of IDES for 

Completed Cases (in days) 16

Table 4: Average Processing Time in Transition Phase of IDES for 

Completed Cases (in days) 17

Table 5: Average Processing Time in Benefits Phase of IDES for 

Completed Cases (in days) 18

Table 6: Survey Response and Coverage Rates 20

Table 7: Selected Characteristics of IDES Pilot Sites Visited as of 

May 2011 39

Table 8: Survey phase response and coverage rates 52

Table 9: Selected Servicemember Characteristics of Respondents 

and Nonrespondents to the MEB, PEB and Transition 

Surveys 53

Table 10: Questions Used in DOD Indices of Overall 

Servicemember Satisfaction 56

Table 11: Overall IDES Satisfaction by Subgroups 59

Table 12: Perceived Timeliness of IDES by Actual Processing 

Times 65

Table 13: DOD Reported Monthly Average Processing Times for 

Active Component Servicemembers in Fiscal Year 2012 (in 

days) 69

Figures

Figure 1: Steps of the IDES Process and Timeliness Goals 5

Figure 2: IDES Cases Enrolled and Completed by Fiscal Year 7

Figure 3: Distribution of New IDES Cases Each Year by Military 

Service and Status 8

Figure 4: Average Processing Times and Number of Completed 

Cases Resulting in Benefits by Fiscal Year of IDES 

Completion 9

Figure 5: Percentage of Cases Resulting in Benefits Meeting and 

Not Meeting Overall Processing Time Goals by Fiscal Year 

of IDES Completion 10

Figure 6: Percent of Cases Meeting Timeliness Goals for each 

Phase of IDES by Fiscal Year of Completion 11

Figure 7: Percent of Cases Completing MEB Within or in Excess of 

Goals All Fiscal Years Combined 13

Figure 8: Timeliness of Cases Enrolled in MEB Stage as of 

December 2011 14
Page iii GAO-12-676 Military Disability Evaluation

Figure 9: Comparison of Percent of Servicemembers Satisfied 

Using GAO and DOD Calculations for Overall Satisfaction 21

Figure 10: Average IDES Processing Times by Year of Completion, 

for Completed Cases Resulting in Benefits 42

Figure 11: Average IDES Processing Times by Fiscal Year of 

Enrollment for Completed Cases Resulting in Benefits 43

Figure 12: Average IDES Processing Times by Year of Completion, 

for All Completed Cases Regardless of Outcome 44

Figure 13: Average IDES Processing Times by Fiscal Year of 

Enrollment for All Completed Cases Regardless of 

Outcome 45

Figure 14: Percentage of Completed Cases Meeting and Missing the 

Overall Processing Time Goals, by Fiscal Year of IDES 

Completion, for Servicemembers Receiving Benefits 46

Figure 15: Percentage of Completed Cases Meeting and Missing the 

Overall Processing Time Goals, by Fiscal Year of IDES 

Enrollment, for Servicemembers Receiving Benefits 47

Figure 16: Average Processing Time for Each IDES Phase, by Fiscal 

Year in Which the Phase Was Completed 48

Figure 17: Average Processing Time for Each IDES Phase, by Fiscal 

Year of Enrollment in Each Phase 49

Figure 18: Percent of Cases Meeting Timeliness Goals for each 

Phase of IDES, by Fiscal Year in Which the Phase Was 

Completed 50

Figure 19: Percent of Cases Meeting Timeliness Goals for each 

Phase of IDES, by Fiscal Year of Enrollment in Each 

Phase 51
Page iv GAO-12-676 Military Disability Evaluation

Abbreviations

DOD Department of Defense

IDES integrated disability evaluation system

MEB medical evaluation board

PEB physical evaluation board

VA Department of Veterans Affairs

VTA Veterans Tracking Application

WCP Office of Warrior Care Policy 

WWCTP Office of Wounded Warrior Care & Transition Policy

This is a work of the U.S. government and is not subject to copyright protection in the 

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Page 1 GAO-12-676 Military Disability Evaluation

United States Government Accountability Office

Washington, DC 20548

August 28, 2012

The Honorable Patty Murray

Chairman

The Honorable Richard Burr

Ranking Member

Committee on Veterans’ Affairs

United States Senate

The Honorable Joseph I. Lieberman

Chairman

The Honorable Susan M. Collins

Ranking Member

Committee on Homeland Security and Governmental Affairs

United States Senate

Servicemembers who are injured in war or as the result of accidents and 

illnesses may face a difficult transition as they leave the military and 

become veterans. In response to concerns that wounded, ill, or injured 

servicemembers had to undergo two complex disability evaluations—first 

by the Department of Defense (DOD) then by the Department of Veterans 

Affairs (VA)—DOD and VA jointly designed a new integrated disability 

evaluation process to expedite the delivery of benefits to 

servicemembers. In November 2007, DOD and VA began pilot testing the

integrated disability evaluation system (IDES) at three military treatment 

facilities in the Washington, D.C. area, and expanded the number of sites 

over time. As of October 1, 2011, IDES had replaced the military services’ 

existing—or “legacy”—disability evaluation systems for almost all new 

disability cases.

Past GAO work highlighted challenges DOD and VA experienced while 

piloting the IDES and recommended a number of improvements. For 

instance, we reported in December 20101

 

1 GAO, Military and Veterans Disability System: Pilot Has Achieved Some Goals, but 

Further Planning and Monitoring Needed, 

that insufficient staff and 

logistical challenges contributed to delays in completing IDES cases and 

recommended the agencies take steps to ensure adequate staffing levels 

and develop a systematic process for monitoring caseloads. In response 

GAO-11-69 (Washington, D.C.: Dec. 6, 2010). 

 
 

Page 2 GAO-12-676 Military Disability Evaluation

to ongoing concerns with IDES performance, this report provides 

information on (1) the extent to which DOD and VA are meeting IDES 

performance goals, and (2) steps DOD and VA are taking to improve 

IDES performance.

In conducting our work, we obtained DOD timeliness and customer 

satisfaction data from the inception of IDES in 2007 to December 2011. 

We assessed the reliability of these data and analyzed them to look for 

changes in performance over time; factors that may help or hinder 

performance; and relationships between servicemember satisfaction and 

case outcomes and timeliness. We supplemented these analyses with 

site visits to six military treatment facilities, where we spoke with DOD 

and VA staff as well as some servicemembers involved in the IDES 

process.2 We selected these facilities to obtain perspectives from sites in 

different military services and geographical regions and with varying 

caseloads and performance outcomes. For both research objectives, we 

interviewed key officials involved with IDES at DOD, VA, and each of the 

military services, and reviewed pertinent reports, guidance, plans, 

relevant federal laws, regulations, directives, and other documents. We 

conducted this performance audit from May 2011 to August 2012, in 

accordance with generally accepted government auditing standards.

These standards require that we plan and perform the audit to obtain 

sufficient, appropriate evidence to provide a reasonable basis for our 

findings and conclusions based on our audit objectives. We believe the 

evidence obtained provides a reasonable basis for our findings and 

conclusions based on our audit objectives.

The IDES process begins at a military treatment facility when a physician 

identifies one or more conditions that may interfere with a 

servicemember’s ability to perform his or her duties.3

 

2 We visited the facilities at Joint Base Andrews and Fort Meade, Maryland; Naval 

Hospital Bremerton and Joint Base Lewis-McChord (Madigan Army Medical Center), 

Washington; and Forts Hood and Sam Houston, Texas.

The process 

3 A physician is required to identify a condition that may cause the member to fall below 

retention standards after the member has received the maximum benefit of medical care.

Background 

The Disability Evaluation 

Process
 

Page 3 GAO-12-676 Military Disability Evaluation

involves four main phases: the Medical Evaluation Board (MEB), the 

Physical Evaluation Board (PEB), transition out of military service 

(transition), and VA benefits.

MEB phase: In this phase, medical examinations are conducted and 

decisions are made by the MEB regarding a servicemember’s ability to 

continue to serve in the military. This phase involves four stages: (1) the 

servicemember is counseled by a DOD board liaison on what to expect 

during the IDES process; (2) the servicemember is counseled by a VA 

case manager on what to expect during the IDES process and medical 

exams are scheduled;4 (3) medical exams are conducted according to VA 

standards for exams for disability compensation by VA, DOD, or 

contractor physicians, and (4) exam results are used by the MEB to 

identify conditions that limit the servicemember’s ability to serve in the 

military.5

PEB phase: In this subsequent phase, decisions are made about the 

servicemember’s fitness for duty, disability rating and DOD and VA 

disability benefits, and the servicemember has opportunities to appeal 

those decisions. This includes: (1) the informal PEB stage, an 

administrative review of the case file by the relevant military branch’s PEB 

without the presence of the servicemember; (2) VA rating stage, where a 

VA rating specialist prepares a rating that covers the conditions that DOD 

determined made a servicemember unfit for duty and any other conditions 

claimed by the servicemember to VA.

Also during this stage, a servicemember can seek a rebuttal, or 

an impartial medical review by a physician not on the MEB, or both.

6

 

4 In this report, “DOD board liaisons” refers to DOD Physical Evaluation Board Liaison 

Officers, while “VA case managers” refers to VA Military Service Coordinators.

This rating is prepared for use by 

both agencies in determining disability benefits. In addition, 

servicemembers have several opportunities to appeal different aspects of 

their disability evaluations: a servicemember dissatisfied with the decision 

on whether he or she is fit for duty may request a hearing with a “formal” 

PEB; a servicemember who disagrees with the formal PEB fitness 

5 This evaluation is based on the results of the medical exams, the member’s medical 

records, and input from the member’s commanding officer.

6 VA determines the degree to which veterans are disabled in 10 percent increments on a 

scale of 0 to 100 percent. If VA finds that a veteran has one or more service-connected 

disabilities with a combined rating of at least 10 percent, the agency will pay monthly 

compensation.
 

Page 4 GAO-12-676 Military Disability Evaluation

decision can, under certain conditions, appeal to the reviewing authority 

of the PEB;7

Transition phase: If the servicemember is found unfit to serve, he or she 

enters the transition phase and begins the process of separating from the 

military. During this time, the servicemember may take accrued leave. 

Also, DOD board liaisons and VA case managers provide counseling on 

available benefits and services, such as job assistance.

and a servicemember can ask for VA to reconsider its rating, 

but only for conditions found unfitting by the PEB.

VA benefits phase: A servicemember found unfit and separated from 

service becomes a veteran and enters the VA benefits phase. VA 

finalizes its disability rating after receiving evidence of the 

servicemember’s separation from military service. VA then starts to award 

monthly disability compensation to the veteran.

DOD and VA established timeliness goals for the IDES process to provide 

VA benefits to active duty servicemembers within 295 days of being 

referred into the process, and to reserve component members within 305 

days (see fig. 1). DOD and VA also established interim timeliness goals 

for each phase and stage of the IDES process. The overall timeframes 

are intended to represent an improvement over the legacy disability 

evaluation system, which was estimated to take 540 days to complete.

 

7 The reviewing authorities of PEBs in the respective services are the Air Force Personnel 

Council, the Army Physical Disability Agency, and the Navy Council of Review Boards.
 

Page 5 GAO-12-676 Military Disability Evaluation

Figure 1: Steps of the IDES Process and Timeliness Goals

a

Not all reservists complete the VA benefit phase and thus DOD does not apply the 30-day goal for 

this phase to reservists. For those reservists who do go through the VA benefits phase, this time is 

reflected in the overall time in IDES.
 

Page 6 GAO-12-676 Military Disability Evaluation

b

DOD guidance allows 40 more days for reserve component members than for active duty members 

in completing the first two steps of the process, in order to provide sufficient time for employer 

notification, establish orders for active duty, and compile medical records. However, DOD and VA’s 

goal for total IDES processing time is only 10 days longer for reserve component members than for 

active duty members because the VA benefit phase goal of 30 days is not applied to reserve 

component members.

In addition to timeliness, the agencies also established a performance 

goal of having 80 percent of servicemembers satisfied with the IDES 

process. DOD measures satisfaction through surveys conducted after the 

completion of the MEB, PEB, and transition phases. Each survey consists 

of approximately 30 questions, including 4 questions that ask about the 

servicemember’s satisfaction with the overall IDES process up to that 

point. Reported satisfaction rates for each phase are based on an 

average of responses to these four questions, and reported overall 

satisfaction with IDES (which is used to track the percent satisfied under 

the performance goal) is an average of satisfaction rates for the three 

phases.

From the original 3 pilot military treatment facilities in the Washington, 

D.C., area,8

 

8 The three original pilot sites were Walter Reed Army Medical Center, Washington, D.C.; 

National Naval Medical Center, Bethesda, Maryland; and Malcolm Grow Air Force Medical 

Center, Andrews Air Force Base. 

the IDES has expanded to 139 military treatment facilities in 

the U.S. and several other countries. DOD and VA first added 24 military 

treatment facilities to the pilot in fiscal years 2009 and 2010, bringing the 

pilot total to 27. In 2010, DOD and VA leadership decided to implement 

the IDES world-wide, and did so in 4 stages between October 2010 and 

September 2011, adding 112 military treatment facilities. As IDES 

expanded, the number of new cases enrolled in IDES has also increased, 

totaling 18,651 in fiscal year 2011 (see fig. 2).

Rollout of IDES and 

Enrollment 
 

Page 7 GAO-12-676 Military Disability Evaluation

Figure 2: IDES Cases Enrolled and Completed by Fiscal Year

Note: Cases completed include those who exited the IDES process, including those who received 

benefits or returned to duty.

IDES caseloads vary by service, but the Army manages the bulk of IDES 

cases. Of new cases referred to IDES in fiscal year 2011, about 64 

percent were in the Army, and much of the growth in caseload has been 

in the Army. Additionally, active duty servicemembers make up the 

majority of IDES cases, with about 88 percent of new cases in fiscal year 

2011 involving this group (see fig. 3).
 

Page 8 GAO-12-676 Military Disability Evaluation

Figure 3: Distribution of New IDES Cases Each Year by Military Service and Status

IDES timeliness has worsened since the inception of the program. Since 

fiscal year 2008, the average number of days for servicemember cases to 

be processed and receive benefits increased from 283 to 394 for active 

duty cases (compared to the goal of 295 days) and from 297 to 420, for 

IDES Processing 

Times Increased Over 

Time, While Measures 

of Servicemember 

Satisfaction Have 

Shortcomings 

Overall IDES Case 

Processing Times Steadily 

Increased Since the Start 

of IDES
 

Page 9 GAO-12-676 Military Disability Evaluation

reserve component cases (compared to the goal of 305 days) (see 

fig. 4).9

Figure 4: Average Processing Times and Number of Completed Cases Resulting in 

Benefits by Fiscal Year of IDES Completion

Along with increasing average processing times, the percent of IDES 

cases awarded benefits within timeliness goals has steadily declined. 

DOD’s and VA’s current goal is to complete 60 percent of IDES cases on 

time. In fiscal year 2008, an average of 63 percent of cases for active 

duty servicemembers and 65 percent for reservists completed the 

process and received benefits within the timeliness goals; by fiscal year 

2011 this was down to 19 and 18 percent respectively (see fig. 5). These 

trends also hold when considering all cases that completed the IDES 

process regardless of outcome, although overall processing times were 

shorter. (See app. III for more information on case processing times 

regardless of outcome.)

 

9 When processing times are broken down by the year of completion, as in Figure 4, the 

average processing times in the first few years are lower since cases with longer 

processing times after the program’s inception in fiscal year 2008 would not show up in 

the data until fiscal year 2009 or later. 
 

Page 10 GAO-12-676 Military Disability Evaluation

Figure 5: Percentage of Cases Resulting in Benefits Meeting and Not Meeting 

Overall Processing Time Goals by Fiscal Year of IDES Completion

When examining timeliness across the four phases that make up IDES, 

data show that average processing time regularly fell short of goals for 

three—MEB, Transition, and VA Benefits. For example, for cases that 

completed the MEB phase in fiscal year 2011, active duty and reserve 

component members’ cases took an average of 181 and 188 days 

respectively to be processed, compared to goals of 100 and 140 days. 

For the PEB phase, processing times increased over time, but were still 

within the established goal of 120 days. Along with increasing average 

processing times, the percentage of cases meeting goals for most phases 

has generally declined (see fig. 6). In particular, the MEB and Transition 

phases have lower percentages of cases meeting goals than the other 

phases in most years, especially for active duty cases.

Key Contributors to 

Timeliness Problems 

Include Lengthy Medical 

Evaluations and 

Servicemember Separation 

Activities
 

Page 11 GAO-12-676 Military Disability Evaluation

Figure 6: Percent of Cases Meeting Timeliness Goals for each Phase of IDES by Fiscal Year of Completion

As noted above, the MEB phase was a key contributor to increases in 

overall processing times between 2008 and 2011 for both active duty 

servicemembers and reservists for cases that have completed the IDES 

process regardless of outcome (table 1).

Table 1: Average Processing Times for MEB Phase for Completed Cases by Fiscal Year of Completion (in days)

Component Goal FY 2008 FY2009 FY2010 FY2011

Active 100 114 126 141 181

Reserve 140 128 153 158 188

Source: GAO analysis of DOD and VA data.

To obtain a better understanding of more recent timeliness trends within 

the MEB phase, GAO analyzed MEB timeliness of all cases—all fiscal 

years combined—that completed the MEB process by sorting them into 

two groups: (1) those that completed the entire IDES process, and (2) 

those that had not yet completed IDES but completed the MEB phase. As 

shown in figure 7, for the group that completed IDES, 30 percent of active 

MEB Phase
 

Page 12 GAO-12-676 Military Disability Evaluation

duty servicemembers and 18 percent of reservists missed the goal by 

more than 90 days. For those still in IDES, representing more recent data, 

the picture is slightly better for active duty servicemembers with 37 

percent of cases meeting the MEB goal and 25 percent missing the goal 

by more than 90 days. However, the percentage of reserve component 

members who missed the goal by more than 90 days increased from 18 

to 28 percent.
 

Page 13 GAO-12-676 Military Disability Evaluation

Figure 7: Percent of Cases Completing MEB Within or in Excess of Goals All Fiscal 

Years Combined

Note: Numbers may not total 100 percent due to rounding.

For those servicemembers who were still enrolled in the MEB phase as of 

December 2011, the data show that 41 percent of active duty and 33 

percent of reserve component servicemember cases had already missed 

the goal processing times (see fig. 8). Of these, 15 percent of active duty 
 

Page 14 GAO-12-676 Military Disability Evaluation

and 10 percent of reservist component servicemember cases missed the 

goal by more than 90 days.10

Figure 8: Timeliness of Cases Enrolled in MEB Stage as of December 2011

Note: Numbers may not match numbers in the body of this report or total 100 percent due to 

rounding.

Within the MEB phase, significant delays have occurred in completing 

medical examinations (medical exam stage) and delivering an MEB 

decision (the MEB stage). For cases completing the MEB phase in fiscal 

year 2011, 31 percent of active duty and 29 percent of reservist cases 

met the 45-day goal for the medical exam stage and 20 percent of active 

duty and 17 percent of reservist cases met the 35-day goal for the MEB 

stage. Officials at some sites we visited told us that MEB phase goals 

were difficult to meet and not realistic given current resources. For 

example:

• Some military officials noted that they did not have sufficient numbers 

of doctors to write the narrative summaries of exam results needed to 

 

10 Our data were for cases in the MEB phase as of December 31, 2011. For cases that 

had not yet been in the MEB for 100 days (the MEB goal), we cannot predict whether they 

will be timely cases or not. For instance some of these cases entered the MEB phase just 

days before the cutoff date GAO chose.
 

Page 15 GAO-12-676 Military Disability Evaluation

complete the MEB stage in a timely manner.11 One facility noted that 

while they have 7 doctors, they would need 11 additional doctors and 

10 technician assistants to process cases through the initial medical 

exam and other additional disability specific examinations in a timely 

manner. Further, officials at another Army base we visited noted that 

there was a shortage of doctors and DOD board liaisons and that they 

had difficulty recruiting such staff due to the remote location of the 

base.

• At all the facilities we visited, officials told us DOD board liaisons and 

VA case managers had large case loads. While DOD has established 

a goal of 1 board liaison for every 20 servicemembers,12 the ratios 

varied widely by military treatment facility with a range from 1:1 as the 

lowest to the highest of 1:75 according to recent data. Because of 

high case loads and a reported increase in the complexity of cases, 

staff at one facility reported a liaison to servicemember ratio of 1:80 

and noted that liaisons must often prioritize cases to deal with the 

most pressing issues first. As a result, cases that might otherwise be 

quick to process take longer simply because they are waiting to be 

processed. Liaisons are often working overtime and weekends to 

keep up with cases.

Monthly data produced by DOD subsequent to the data we analyzed 

show significantly improved timeliness for the medical exam stage (66 

percent of active duty cases met the goal in June 2012) and some 

improvement for the MEB stage (40 percent of active duty cases met the 

goal in the month of June 2012). However, it is too early to tell whether 

these improvements will continue going forward. (See app. III for DOD 

reported monthly data, October 2011 – June 201213

Since fiscal year 2008, the majority of cases have completed the PEB 

phase under the goal of 120 days, however, PEB timeliness has still 

worsened over time. In 2011, 78 percent of active duty and 62 percent of 

reservist cases that completed the entire IDES process met the PEB goal. 

.)

 

11 As previously noted, the narrative summary documents the medical conditions and the 

impact of these conditions on the servicemembers’ ability to perform their military duties.

12 VA’s goal is 1 case manager for every 30 new cases.

13 DOD did not provide monthly data on the percentage of reservist cases meeting these 

stage goals. See app. III for more information on monthly processing times.

PEB Phase
 

Page 16 GAO-12-676 Military Disability Evaluation

The average processing time was 93 days for active duty 

servicemembers and 116 for reservists (see table 2).

Table 2: Average Processing Time in PEB Phase of IDES for Completed Cases (in days) 

Component Goal FY 2008 FY2009 FY2010 FY2011

Active 120 42 58 80 93

Reserve 120 41 60 83 116

Source: GAO analysis of DOD and VA data.

Despite meeting the overall PEB goal in fiscal year 2011, established 

goals were not met for any of the interim PEB stages, including the 

informal PEB and VA rating stages which are the two stages all 

servicemembers must complete. For all cases that completed the PEB 

phase in fiscal year 2011, only 38 percent of active duty and 38 percent of 

reservists’ cases received an informal PEB decision within the 15 days 

allotted. Further, only 32 percent of active duty and 27 percent of reservist 

cases received a preliminary VA rating within the 15-day goal. (see 

table 3).

Table 3: Average Processing Time for PEB Stages of IDES for Completed Cases (in days) 

Stage of PEB Phase Component Goal FY 2008 FY2009 FY2010 FY2011

Informal Physical Evaluation Board (IPEB) Active 15 17 12 21 26

Reserve 15 15 12 19 29

VA preliminary rating Active 15 6 20 27 33

Reserve 15 7 26 32 43

VA rating reconsiderationa Active 15 3 11 14 32

Reserve 15 8 29 18 30

Formal Physical Evaluation Board (FPEB)a Active 30 13 39 63 81

Reserve 30 33 38 55 69

FPEB appeala Active 30 196 5 100 103

Reserve 30 20 23 13 169

Source: GAO analysis of DOD and VA data

a

These stages are appeals. Fewer servicemembers completed each of the appeal stages compared 

to the non-appeal stages, but the average days spent within the appeal stages generally and 

significantly surpassed the goal times.

Regarding delays with the VA rating, VA officials told us that staffing has 

been a challenge at their IDES rating sites and that this has slowed case 

processing. Monthly data produced by DOD subsequent to the data we 

analyzed show similar trends for the informal PEB and VA preliminary 
 

Page 17 GAO-12-676 Military Disability Evaluation

rating stages. As of June 2012 (most recent data available), active duty 

cases showed slight improvements in timeliness for the informal PEB 

stage (41 percent of cases meeting the goal and processing times 

averaging 24 days). The VA rating stage, on the other hand, showed 

slight declines in timeliness (31 percent of cases meeting the established 

goal and processing times of 35 days) relative to FY 2011 averages for 

active duty servicemembers. However, as noted before, it is too early to 

tell the extent to which such trends will continue. (See app. III for DOD 

reported monthly data, October – June 2012.)

Also during this phase, IDES planners allocated the majority of overall 

PEB processing time (75 out of the 120 days) for appeals—including a 

formal PEB hearing and a reconsideration of the VA ratings. According to 

officials, while the three appeal stages do not happen for every case, 

appeals can significantly increase processing times for any one case. 

However, only 20 percent of cases completed in fiscal year 2011 actually 

had any appeals; calling into question DOD and VA’s assumption on the 

prevalence and average effect of appeals, and potentially masking 

processing delays in other mandatory parts of the PEB phase.

The transition phase has consistently taken longer than its 45-day goal—

almost twice as long on average. While processing times improved 

slightly for cases that completed this phase in fiscal year 2011 (from 79 

days in fiscal year 2010 to 76 days in fiscal year 2011 for active duty 

cases), timeliness has remained consistently problematic since fiscal year 

2008 (see table 4).

Table 4: Average Processing Time in Transition Phase of IDES for Completed Cases (in days)

Component Goal FY 2008 FY2009 FY2010 FY2011

Active 45 88 80 79 76

Reserve 45 81 73 82 75

Source: GAO analysis of DOD and VA data. 

DOD lacks comprehensive data on how servicemembers spend their time 

in the transition phase, which includes many different activities related to 

separation from the military. These activities vary widely depending on 

the case.14

 

14 According to VA officials, reservists who are not on active duty do not have a transition 

phase.

For example, during this phase servicemembers receive 

Transition Phase
 

Page 18 GAO-12-676 Military Disability Evaluation

mandatory training such as job training through the Transition Assistance 

Program and may also receive counseling such as pre-discharge 

Vocational Rehabilitation and Employment counseling. In addition, 

servicemembers may be placed on temporary duty while house hunting, 

or to allow for a servicemember’s children to complete the school year 

before moving. Servicemembers may also take earned leave time—to 

which they are entitled—before separating from the service. For example, 

an Army official said that Army policy allows servicemembers to take up 

to 90 days of earned leave prior to separating, and that average leave 

time was about 80 days. Because many of these activities can occur 

simultaneously or in small intermittent segments of time, DOD officials 

said it is difficult to track which activities servicemembers participate in or 

determine how much time each activity takes. DOD is exploring options 

for better tracking how time is spent in this phase. Because a potentially 

substantial amount of the time in this phase may be for the personal 

benefit of servicemembers, DOD recently began reporting time in IDES 

with and without the transition phase included.

Processing time improved somewhat for the benefits phase (48 days in 

fiscal year 2010 to 38 days in fiscal year 2011), but continued to exceed 

the 30-day goal for active duty servicemembers (see table 5).15

Table 5: Average Processing Time in Benefits Phase of IDES for Completed Cases (in days)

Component Goal FY 2008 FY2009 FY2010 FY2011

Active 30 29 43 48 38

Source: GAO analysis of DOD and VA data.

Several factors may contribute to delays in this final phase. VA officials 

told us that cases cannot be closed without the proper discharge forms 

and that sometimes they do not receive this information in a timely 

manner from the military services. Additionally, if data are missing from 

the IDES tracking system (e.g., the servicemember already separated, 

but this was not recorded in the database), processing time will continue 

 

15 DOD and VA did not set a goal for reserve component servicemembers. As noted 

above, for purposes of this report, we opted to not include reserve component time spent 

in the VA benefit phase in our calculations phase because this goal applies to some but 

not all reservists, depending on their active duty status. Any time spent within the VA 

benefit phase is reflected within the overall processing time calculations for such reserve 

component servicemembers.

Benefits Phase
 

Page 19 GAO-12-676 Military Disability Evaluation

to accrue for cases that remain open in the system. Officials could not 

provide data on the extent to which these factors had an impact on 

processing times for pending cases, but said that once errors are 

detected and addressed, reported processing times are also corrected.

In addition to timeliness, DOD and VA evaluate IDES performance using 

the results of servicemember satisfaction surveys. In principle, all 

members have an opportunity to complete satisfaction surveys at the end 

of the MEB, PEB, and transition phases; however, under current survey 

procedures servicemembers become ineligible to complete a survey for 

either the PEB or transition phases if they did not complete a survey in an 

earlier phase. Additionally, servicemembers who start but do not 

complete a phase are not surveyed. As such, DOD may be missing 

opportunities to obtain input from servicemembers who did not complete 

a prior survey or exited IDES in the middle of a phase.16 Further, 

response rates may be affected because DOD does not survey 

servicemembers once they separate from the service and become 

veterans. While it is not necessary for DOD to survey all servicemembers 

at the end of every phase,17 the percentage and characteristics of 

servicemembers covered by the survey (i.e., who completed a phase and 

were ultimately interviewed) may be insufficient to establish that the 

survey results are representative of servicemember satisfaction, 

especially for later phases. (See table 6 for response and coverage 

rates.) DOD officials recently told us that they will consider alternative 

survey eligibility requirements, including working with the Office of 

Management and Budget for permission to interview veterans. (For 

additional information regarding the timing of the survey, see app. II).

 

16 DOD officials also told us that a servicemember may be surveyed simultaneously for a 

prior phase along with the phase just completed (e.g. the MEB and PEB phases). 

However, in some cases a significant amount of time may have passed since the 

servicemember completed the prior phase and, thus, it may be more difficult for the 

servicemember to isolate his or her satisfaction with a particular phase.

17 DOD could interview a probability sample of servicemembers to accurately assess 

satisfaction with IDES in the population as a whole. A sample could decrease the cost of 

obtaining this information, because DOD would need to contact fewer servicemembers 

and the cost of surveys generally increases with the number of people interviewed. If 

properly designed and executed, a probability sample would provide estimates that would 

be equally valid as interviewing all servicemembers. 

Shortcomings in the 

Design and Administration 

of Servicemember Surveys 

Hamper their Usefulness
 

Page 20 GAO-12-676 Military Disability Evaluation

Table 6: Survey Response and Coverage Rates

Phase

Servicemembers 

who completed 

phase (N)

Servicemembers eligible

to be surveyed (i.e.,

completed both phase

and survey for prior 

phase, if applicable)

Servicemembers 

who completed 

survey

Response rate

(Servicemembers who 

completed survey /

Servicemembers eligible)

Coverage rate

(Servicemembers 

who completed 

survey /

Servicemembers who 

completed phase)

MEB 25,212 all 9,604 38.1% 38.1%

PEB 18,296 8,968 4,795 53.5% 26.2%

Transition 12,352 3,996 2,893 72.4% 23.4%

Source: GAO analysis of DOD and VA data.

In addition, alternate survey measures show lower satisfaction rates 

than those reported by DOD. Using DOD’s measure, we found an 

overall satisfaction rate of about 67 percent since the inception of 

IDES. DOD defines a servicemember as satisfied if the average of his 

or her responses across several surveys is above 3 on a 5-point 

scale, with 3 denoting neither satisfied nor dissatisfied. However, 

using our alternate measure that defines servicemembers as satisfied 

only when all of their responses are 4 or above,18

 

18 Using DOD’s satisfaction measure, we found less than expected variation in satisfaction 

over time and across key case characteristics, such as component, military branch, final 

rating and final disposition. To better understand factors that may drive servicemember 

satisfaction, we included neutral responses in the category of “not satisfied” rather than 

counting such responses as “satisfied” in the manner that DOD did thus arriving at a 

measure that more strongly reflects satisfaction and might be a more sensitive indicator of 

factors affecting satisfaction for performance management purposes.

we calculated the 

satisfaction rate to be about 24 percent (see fig. 9).
 

Page 21 GAO-12-676 Military Disability Evaluation

Figure 9: Comparison of Percent of Servicemembers Satisfied Using GAO and DOD 

Calculations for Overall Satisfaction

Note: GAO combined reserve and national guard, while DOD reported satisfaction scores for guard 

and reserve separately.

Our calculation is a more conservative measure of satisfaction, because it 

rules out the possibility that a servicemember is deemed “satisfied” even 

when he or she is dissatisfied on one or more questions in the scale. 

While not incorrect, DOD’s scale can mask pockets of servicemember 

dissatisfaction. For example, an individual may indicate that he or she is 

very dissatisfied with one phase of the program, but satisfied with other 

phases, and the overall satisfaction score can be the same as one for a 

servicemember who is generally satisfied across all phases of the 

process. Measuring satisfaction, or even dissatisfaction, in different ways 

may provide a more complete picture of satisfaction and how it varies in 

different circumstances, and thus may reveal areas where DOD could 

focus on improving management and performance.

Finally, using either DOD’s or our calculated measure, we found that 

overall satisfaction did not vary much according to differences in the 

experiences of servicemembers. For example, our model estimated that 

satisfaction varied by no more than approximately five percentage points 

across branch, component, disenrollment outcome, sex, MEB exam 

provider, enlisted and officer personnel classes, and the number of 

claimed and referred conditions. While lack of variation could be a 

positive outcome signaling consistent treatment, it could equally mean 

that the survey does not measure opinions in enough detail to 

discriminate among servicemembers’ experiences. Either way, such 

results provide little insight into identifying areas for improvement or 

effective practices. Further, while we found some association between 

servicemembers satisfaction and the timeliness of their case processing, 

we also found many servicemembers were highly dissatisfied even when 

their cases were completed on time, and many were highly satisfied even 
 

Page 22 GAO-12-676 Military Disability Evaluation

when their cases were not. For example, 68 percent of those who said 

that PEB timeliness was “very poor” completed the phase on time, and 55 

percent of those who said that MEB timeliness was “very good” did not 

complete on time. The lack of variation and/or correlation between 

satisfaction and experiences of servicemembers—coupled with low 

coverage rates—raise questions about the value of the survey results as 

a performance measure and program evaluation tool. (See app. II for 

more information on servicemember satisfaction results.)

DOD is reconsidering its options for measuring customer satisfaction, but 

has yet to select a particular approach. As noted above, possible changes 

might include widening the criteria for who is eligible for the survey, 

modifying survey questions, changing when and how the survey is 

delivered, and changing how satisfaction is calculated. Officials already 

concluded that the survey, in its current form, is not a useful management 

tool for determining what changes are needed in IDES and said that it is 

expensive to administer—costing approximately $4.3 million in total since 

the start of the IDES pilot. Navy officials told us they believed that the 

satisfaction surveys could be made more useful if they knew whether 

servicemember’s satisfaction was actually influenced by the 

servicemember’s desired or actual outcome of the IDES process. Further, 

Army officials already determined that the DOD survey is of limited value, 

and are proceeding with plans to field their own survey in the hopes of 

obtaining more detailed information at the facility level. Because of fiscal 

constraints, DOD suspended the survey in December 2011, but officials 

told us that they hope to resume collecting data in fiscal year 2013.

We identified two potential alternatives to assessing servicemember 

experiences.

• Surveying a sample of servicemembers: While a census gives each 

servicemember a chance to describe his or her experiences with 

IDES, DOD could collect the same data at a lower cost by surveying a 

probability sample of servicemembers. If appropriately designed and 

executed, a sample would accurately represent all groups of 

servicemembers and produce the necessary data for important 

subgroups, such as facilities or branches. Since the cost of 

administering a survey is strongly related to the number of people 

surveyed, probability sampling could also allow DOD to assess 

servicemember experiences while substantially reducing data 

collection costs.
 

Page 23 GAO-12-676 Military Disability Evaluation

• Exit interviews: In-depth interviews with servicemembers, completed 

at disenrollment from IDES, could also yield more detailed and 

actionable information about the program. Although the current survey 

includes open-ended questions, it is primarily designed to collect 

standardized, quantitative measures of satisfaction with broad aspects 

of IDES, such as fairness and the performance of DOD board liaisons 

and VA case managers. As a result, the survey provides a limited 

amount of detailed feedback on particular facilities, staff members, 

and stages of the process that managers might use to improve the 

servicemember experience, decrease processing times, or reduce 

cost. In contrast, semi-structured exit interviews would allow 

servicemembers to provide this type of qualitative, detailed feedback. 

Interviewing servicemembers at the end of the process would also 

allow servicemembers to assess their overall experiences with IDES 

rather than at an earlier stage, without having completed the entire 

process. Exit interviews could also reach servicemembers who exit 

IDES without completing the process such as those who are returned 

to duty. Exit interviews, however, have the potential to be labor 

intensive and expensive.

DOD and VA have undertaken a number of actions to address IDES 

challenges—many of which we identified in our past work. Some 

actions—such as increased oversight and staffing—represent important 

steps in the right direction, but progress is uneven in some areas.

Recent Actions and 

Ongoing Initiatives

May Improve IDES 

Performance, but It Is 

Too Early to Assess 

Their Overall Impact

DOD and VA Took Steps to 

Address Previously 

Identified IDES Challenges
 

Page 24 GAO-12-676 Military Disability Evaluation

Increased monitoring and oversight: We identified the need for agency 

leadership to provide continuous oversight of IDES in 200819

• The secretaries of DOD and VA have met several times since 

February 2011 to discuss progress in improving IDES timeliness and 

have tasked their agencies to find ways to streamline the process so 

that the timeliness goals can be shortened. The secretaries also 

tasked their agencies to expand the use of expedited disability 

evaluations for severely combat-wounded servicemembers;

and the 

need for system-wide monitoring mechanisms in 2010. Since then, 

agency leadership has established mechanisms to improve 

communication, monitoring, and accountability.

20 and 

develop a system to electronically transfer case files between DOD 

and VA locations.

• Senior Army and Navy officials regularly hold conferences to assess 

performance and address performance issues, including at specific 

facilities. With respect to the Army, meetings are led by the Army’s 

vice-chief of staff and VA’s chief of staff, and include reviews of 

performance where regional and local facility commanders provide 

feedback on best practices and challenges. For example, recent 

Army-VA conferences focused on delays in completion of preliminary 

ratings for Army PEBs by VA’s Seattle rating site, efforts by the Army 

to increase MEB staffing, development of Army-wide IDES 

standardization guidance, and Army-VA electronic records 

interchange. Periodic meetings are also held between senior Navy 

medical and VA officials to discuss performance issues at Navy 

military treatment facilities.

VA holds its own biweekly conferences with local staff responsible for 

VA’s portion of the process. These conferences are supplemented by a 

bi-weekly IDES “dashboard” that tracks performance data for portions of 

 

19 Military Disability System: Increased Supports for Servicemembers and Better Pilot 

Planning Could Improve the Disability Evaluation Process, GAO-08-1137 (Washington, 

D.C.: Sept. 24, 2008).

20 In January 2012, senior agency officials decided to merge the DOD-VA Senior 

Oversight Committee into the DOD-VA Joint Executive Council, co-chaired by the Under 

Secretary of Defense (Personnel and Readiness) and the Deputy Secretary of Veterans 

Affairs. DOD and VA plan to establish a joint IDES working group under the Joint 

Executive Council. Meanwhile, the IDES has been incorporated into the agencies’ Joint 

Strategic Plan, and agency stakeholders meet weekly to discuss IDES issues.
 

Page 25 GAO-12-676 Military Disability Evaluation

the IDES for which VA is responsible. According to VA officials, in 

addition to identifying best practices, these conferences focus on sites 

with performance problems and identify potential corrective actions. For 

example, officials said a recent conference addressed delays at Fort 

Benning, Georgia, and discussed how they could be reduced. VA officials 

noted that examiner staff were reassigned to this site and worked on 

weekends to address the problems at this site. In addition, senior VA 

health care officials hold periodic conferences with officials responsible 

for exams at IDES sites, to monitor performance.

Ensuring sufficient medical exam resources: In our December 2010 

report, we noted that VA struggled to provide enough medical examiners 

(both VA employees and contractors) to meet demand and deliver exam 

summaries within its 45-day goal. For example, significant deficiencies in 

examiner staffing (particularly for mental health exams) at Fort Carson 

contributed to exams for active duty members taking an average of 140 

days. To improve exam timeliness, VA hired more examiners and is 

devoting more resources at those sites where VA clinicians perform IDES 

exams. In addition, in July 2011, VA awarded a revised compensation 

and pension (including IDES) contract that provides more flexibility for VA 

to have contractors perform IDES exams at sites needing additional 

resources. As a result, VA can use contractors to conduct exams for 

regional offices beyond the 10 offices for which the contractor normally 

provides services. Also, VA contracted with 5 companies to provide shortterm exam assistance at IDES sites needing it. Further, VA procedures 

allow reserve component servicemembers in remote locations to receive 

exams close to their homes. VA exam timeliness has improved and the 

agency met its 45-day goal for active component members in every 

month from August 2011 through June 2012. VA officials attributed 

improved exam timeliness, in part, to additional exam resources provided 

to IDES sites. (See app. III for additional information on fiscal year 2012 

timeliness.)

Ensuring sufficient exam summaries: In our December 2010 report, we 

noted that some cases were delayed because VA medical exam 

summaries were not complete and clear enough for use in making rating 

and fitness decisions and needed to be sent back to examiners for 

additional work. VA officials told us that they have been reinforcing the 

importance of training and communication between rating staff and 

medical examiners as ways to improve exam summary sufficiency. For 

example, VA identified types of information which, if missing from an 

exam summary, would cause it to be insufficient, and has been training 

examiners to include such information. Additionally, VA noted that VTA 
 

Page 26 GAO-12-676 Military Disability Evaluation

now has the ability to track cases with insufficient exams by allowing staff 

to annotate information on exam summaries. However, staff are not 

required to provide this information and rules and procedures for its use 

have not been established. 

Ensuring sufficient MEB staffing: In our December 2010 report, we noted 

that some sites had insufficient MEB physicians, leading to delays in 

completing the MEB phase. At that time, most of the 27 pilot sites were 

not meeting the 35-day goal, with average times for active component 

cases as high as 109 days. Meanwhile, DOD did not have sufficient board 

liaison staff to handle IDES caseloads. The Army is in the midst of a 

major hiring initiative intended to more than double staffing for its MEBs 

over its October 2011 level, which will include additional board liaison and 

MEB physician positions.21

Ensuring sufficient VA rating staff: In our December 2010 report, we 

noted that VA had insufficient staff at one of its rating sites to handle the 

demand for preliminary ratings, rating reconsiderations, and final VA 

benefit decisions. VA officials said that the agency has more than tripled 

the staffing at its IDES rating sites–from 78 to 262 positions. Further, VA 

has moved staff resources to IDES rating sites from other VA regional 

offices to provide short-term help in working down rating backlogs. 

Recent monthly data show an increase in the number of preliminary VA 

ratings completed, and a slight improvement in processing times. 

However, as noted before, it is too early to tell the extent to which such 

trends will continue. (See app. III for additional information on fiscal year 

2012 timeliness.)

The Army reported having 610 full-time 

equivalent MEB staff positions in October 2011, and planned to hire up to 

1,410; this would include 172 MEB physician and 513 board liaison 

positions. The Army also planned to hire an average of one contact 

representative per board liaison; these staff members assist the board 

liaisons with clerical functions, freeing more of the liaisons’ time for 

counseling servicemembers. As of June 2012, the Army had filled 1,219 

(86 percent) of the planned 1,410 positions.

Improving completeness of reserve component members’ records: 

Service officials noted that incomplete medical records and administrative 

 

21 The Army has physicians dedicated to MEB cases. In contrast, Navy and Air Force 

MEB determinations are prepared by physicians who perform other responsibilities, such 

as clinical treatment and supervision.
 

Page 27 GAO-12-676 Military Disability Evaluation

documentation, especially for reserve component members, often 

contribute to delays in the early IDES stages, including the VA exam 

stage. For example, a reserve unit may not have complete medical 

records for a member who received care from a private provider. When 

the servicemember enters the IDES, a board liaison is responsible for 

obtaining the private provider records before handing off the case to VA 

for exams. To address issues with reserve component servicemembers’ 

records, the Army established an interim office in Pinellas Park, Florida in 

January 2011. For reserve component servicemembers who may require 

IDES referral, this office is tasked with obtaining records from the 

member’s reserve unit; reviewing them to identify missing information; 

and, if necessary, requiring the reserve unit to obtain additional records to 

complete the case file. Staff at this office also determine whether the 

member needs IDES referral.22

Improving MEB documentation and decisions: In response to delays in 

completing the MEB stage, the Navy and Army have initiatives underway 

to help ensure the timely completion of narrative summaries and MEB 

decisions. For example, the Navy piloted electronic narrative summary 

preparation at Naval Hospital Camp Lejeune, North Carolina. In May 

2012, after determining that the piloted process led to improved MEB 

completion timeliness, the Navy deployed electronic narrative summary 

preparation Navy-wide. In March 2011, the Army also deployed an 

abbreviated MEB narrative summary format, intended to provide better 

information for MEB and PEB decision making while helping reduce 

delays in the completion of these summaries by MEB clinicians. 

Incorporating feedback from its MEBs and PEBs, the Army expects the 

revised IDES template to reduce redundant information, make summaries 

simpler and easier to use, and standardize summary preparation across 

their sites.

Army officials indicated that this office is 

expected to help reduce the backlog of Army reserve component cases in 

the IDES. However, Army officials noted that they are providing training to 

reserve units to improve their ability to maintain complete records on their 

servicemembers and eventually, the Army may discontinue this office if 

no longer needed.

 

22 Originally, reserve component members determined to require IDES referral were 

referred to the MEB at Fort Gordon, Georgia. According to Army officials, these members 

are referred to one of 10 Army MEBs.
 

Page 28 GAO-12-676 Military Disability Evaluation

Resolving diagnostic differences: In our December 2010 report, we 

identified differences in diagnoses between DOD physicians and VA 

examiners, especially regarding mental health conditions, as a potential 

source of delay in IDES. We also noted inconsistencies among services 

in providing guidance and a lack of a tracking mechanism for determining 

the extent of diagnostic differences. In response to our recommendation, 

DOD commissioned a study on the subject. The resulting report 

confirmed the lack of data on the extent and nature of such differences, 

and noted that the Army has established guidance more comprehensive 

than the guidance DOD was developing. It also recommended that DOD 

or the other services develop similar guidance. A DOD official told us that 

consistent guidance across the services, similar to the Army’s, was 

included in DOD’s December 2011 IDES manual. Also, in response to our 

recommendation, VA took steps to modify the VTA database used to 

track IDES to collect information on diagnostic differences. The VTA 

upgrade was completed in June 2012 after several delays. The report 

also recommended that DOD and VA establish a committee to improve 

the accuracy of posttraumatic stress disorder ratings. DOD noted that 

training on diagnostic differences has been incorporated into its 

continuing medical education curriculum for military clinicians, but DOD 

considers the issue of posttraumatic stress disorder ratings largely 

resolved. Meanwhile, the Army’s new IDES narrative summary template 

includes a section where the MEB clinician identifies any inconsistencies 

in the case record, including any diagnostic differences with VA 

examiners.

DOD and VA are working to remedy shortcomings in information systems 

that support the IDES process. These shortcomings include VTA’s lack of 

capability for local sites to track cases, and the potential for erroneous 

and missing data in VTA, affecting timeliness measurement. However, 

some efforts related to information systems are causing work 

inefficiencies, are still in progress, or otherwise are limited.

Improving local IDES reporting capability: DOD and VA are implementing 

solutions to improve the ability of local military treatment facilities to track 

their IDES cases, but multiple initiatives may result in redundant work 

efforts. Officials told us that the VTA—which is the primary means of 

tracking the completion of IDES cases—has limited reporting capabilities 

and staff at local facilities are unable to use it for monitoring the cases for 

which they are responsible. DOD and VA developed VTA improvements 

that will allow DOD board liaisons and VA case managers— and their 

supervisors—to track the status of their cases. VA included these 

DOD and VA Are 

Addressing Shortcomings 

in Information Systems, 

but Efforts to Date Are 

Limited
 

Page 29 GAO-12-676 Military Disability Evaluation

operational reporting improvements in its June 2012 VTA upgrade. In the 

meantime, staff at many IDES sites have been using their own local 

systems to track cases and alleviate limitations in VTA. Further, the 

military services have been moving ahead with their own solutions. For 

instance, the Army has deployed its own information system for MEBs 

and PEBs Army-wide. In addition, DOD has also been piloting its own 

tracking system at 9 IDES sites.23

Improving IDES data quality: DOD is taking steps to improve the quality of 

data in VTA. Our analysis of VTA data identified erroneous or missing 

dates in at least 4 percent of the cases reviewed. Officials told us that 

VTA lacks adequate controls to prevent erroneous data entry, and that 

incorrect dates may be entered, or dates may not be entered at all, which 

can result in inaccurate timeliness data. For example, Army officials noted 

that some cases shown in VTA as very old were actually closed, but were 

missing key dates. In September 2011, DOD began a focused effort with 

the services to correct erroneous and missing case data in VTA. Officials 

noted that the Air Force and Navy completed substantial efforts to correct 

the issues identified at that time, but Army efforts continue. DOD and 

Army officials noted that additional staff resources are being devoted to 

cleaning up Army VTA data. While improved local tracking and reporting 

capabilities will help facilities identify and correct erroneous data, keeping 

VTA data accurate will be an ongoing challenge due to a lack of data 

entry controls. While DOD is currently assisting the services, DOD 

officials said they expect that eventually the services will be responsible 

for identifying and fixing data errors.

As a result, staff at IDES sites we 

visited reported having to enter the same data into multiple systems. For 

example, board liaisons at Army MEBs Fort Meade and Joint Base LewisMcChord reported entering data into VTA and the Army’s new system, 

while board liaisons at Andrews Air Force Base reported entering data 

into VTA and DOD’s pilot data system.

DOD and VA are also pursuing options to allow them to save time by 

replacing the shipping of paper case files among facilities with electronic 

file transfers. Requirements for an electronic case file transfer solution 

have been completed and DOD and VA officials expect to begin piloting it 

in August 2012. As a short-term solution, the Army and VA began using 

 

23 A DOD official told us that based on recent negative feedback, including from site visits, 

DOD is considering cancelling this pilot project.
 

Page 30 GAO-12-676 Military Disability Evaluation

an Army file transfer Web site to move IDES records between the Army’s 

PEBs and the Seattle VA rating site in March 2012.24 According to VA 

officials, this could save several days currently spent shipping paper files 

between these offices. VA officials noted that the same Web site is being 

used for transfers between the Navy PEB and Providence rating site. 

Meanwhile, the secretaries of Defense and Veterans Affairs tasked their 

staffs to develop standards for electronic IDES case files by July 2012.

Based on concerns of the Secretaries of DOD and VA about IDES delays, 

the departments have undertaken additional initiatives to achieve time 

savings for servicemembers. For example, in response to the secretaries’ 

February 2011 directive to streamline the process, DOD and VA officials 

proposed a remodeled IDES process. In December 2011, senior agency 

leadership decided to postpone the pilot of a remodeled IDES process, 

and instead tasked the agencies to explore other ways to streamline the 

process.25 As a result, DOD, with VA’s assistance, began a business 

process review to better understand how IDES is operating and identify 

best practices for possible implementation. This review incorporates 

several efforts, including visits to 8 IDES sites to examine how the 

process was operating and identify best practices.26

• Process simulation model: Using data from site visits and VTA, DOD 

is developing a simulation model of the IDES process. According to a 

DOD official, this process model will allow the agencies to assess the 

impact of potential situations or changes on IDES processing times, 

such as surges in workloads or changes in staffing.

This review also 

includes the following:

 

24 As of March 2012, the Seattle rating site is responsible for cases from all 3 Army PEBs. 

25 Under this proposed process, VA would not begin work on a case until a 

servicemember was found to be unfit for military service by an informal PEB. The pilot was 

postponed in response to concerns raised by the military services and VA about specific 

changes to the existing process. For example, VA officials expressed concerns that the 

preliminary VA rating could occur long after the servicemember was found to be unfit for 

duty, which could cause the servicemember to seek a formal PEB hearing.

26 In January and February 2012, teams visited Little Rock Air Force Base, Arkansas; 

Naval Medical Center San Diego, California; Fort Carson, Colorado; Wright-Patterson Air 

Force Base, Ohio; and Naval Medical Center Portsmouth, Virginia. In March 2012, a team 

visited Joint Base Andrews, Maryland, and Fort Eustis and Naval Health Clinic Quantico, 

Virginia, to examine the piloting of a new DOD-wide IDES information system.

DOD and VA are Pursuing 

Broader Solutions to 

Improving IDES 

Performance
 

Page 31 GAO-12-676 Military Disability Evaluation

• Fusion diagram: DOD is developing this diagram to identify the 

various sources of IDES data—including VA claim forms and narrative 

summaries—and different information technology systems that play a 

role in supporting the IDES process. Officials said this diagram would 

allow them to better understand and identify overlaps and gaps in 

data systems.

Ultimately, according to DOD officials, this business process review could 

lead to short- and long-term recommendations to improve IDES 

performance, potentially including changes to the different steps in the 

IDES process, performance goals, and staffing levels; and possibly the 

procurement of a new information system to support process 

improvements. However, a DOD official noted that these efforts are in 

their early stages, and thus there is no timetable yet for completing the 

review or providing recommendations to senior DOD and VA leadership. 

DOD officials indicated that they expect this to be a continuous IDES 

improvement process, including further site visits.

Finally, DOD is also developing guidance to expand implementation of an 

expedited disability evaluation process for servicemembers with 

catastrophic, combat-related conditions by allowing it to be operated at 

more military treatment facilities. DOD created this expedited process in 

January 2009 for servicemembers who suffer catastrophic, combatrelated disabilities. Under an agreement with VA, the services can rate 

such members as 100 percent disabled without the need to use VA’s 

rating schedule. However, according to DOD officials, the services report 

that no eligible servicemembers are using this process. Instead, 

servicemembers are having their cases expedited through the IDES 

informally. The revisions to DOD’s policy would allow the expedited 

process to be used at additional military treatment facilities beyond the 

original 4 facilities.27 According to DOD officials, this guidance will be part 

of a rewrite of DOD’s key guidance documents, and was undergoing 

review at the time of our review.

By merging two duplicative disability evaluation systems, IDES shows 

promise for expediting the delivery of DOD and VA benefits to injured 

 

27 The original facilities were Walter Reed Army Medical Center, National Naval Medical 

Center, Brooke Army Medical Center (Fort Sam Houston), and Naval Medical Center San 

Diego.

Conclusions 
 

Page 32 GAO-12-676 Military Disability Evaluation

servicemembers and is considered by many to be an improvement over 

the legacy process it replaced. However, nearly 5 years after its inception 

as a pilot, delays continue to affect the system and the contribution of 

various, complex factors to timeliness is not fully understood. Recent 

efforts by DOD and VA to better understand how different IDES 

processes contribute to timeliness are promising and may provide the 

departments with an opportunity to reassess resource levels and 

timeframes, and to make adjustments if needed. This information will also 

help to ensure that DOD and VA are making the best use of limited 

resources to improve IDES performance. However, it is not clear when 

these efforts will be complete or if any recommended actions will be 

implemented. DOD has also begun rethinking its approach to determining 

servicemember satisfaction with IDES. Our analysis of customer 

satisfaction data suggests that there are opportunities for improving the 

representativeness of the survey information collected and reconsidering 

the cost-effectiveness of the current lengthy surveys. Finally, providing 

local facilities the capability to track and generate reports on the status of 

their cases is long overdue and may empower local staff to better address 

challenges. However, tracking reports are only as good as the data that 

are entered into VTA, and DOD and VA can ensure the quality of these 

data through continuous monitoring. Meanwhile, the DOD-led business 

process review should identify and ultimately eliminate any redundant or 

inefficient information systems for tracking cases as well as for other 

IDES purposes.

1) To ensure that servicemember cases are processed and are awarded 

benefits in a timely manner, we recommend that the Secretaries of 

Defense and Veterans Affairs work together to develop timeframes for 

completing the IDES business process review and implementing any 

resulting recommendations.

2) To improve DOD’s ability to measure servicemembers’ satisfaction with 

the IDES process, we recommend that the Secretary of Defense develop 

alternative approaches for collecting more meaningful and representative 

information in a cost effective manner.

3) To ensure that IDES management decisions continue to be based 

upon reliable and accurate data, we recommend that the Secretaries of 

Defense and Veterans Affairs work together to develop a strategy to 

continuously monitor and remedy issues with VTA timeliness information. 

This could include issuing guidance to facilities or developing best 

practices on preventing and correcting data entry errors; and developing 

Recommendations for 

Executive Action
 

Page 33 GAO-12-676 Military Disability Evaluation

reporting capabilities in VTA to alert facilities to potential issues with their 

data.

We provided a draft of this report to DOD and VA for review and 

comment. In their written comments, which are reproduced in appendixes 

IV and V, DOD and VA both concurred with our recommendations. VA 

also provided technical comments, which we incorporated as appropriate.

While concurring with our recommendations, DOD also commented that 

our discussion of IDES surveys contained inaccuracies, but did not 

specify the inaccurate information in our draft report. In a subsequent 

communication, DOD officials noted that our draft inaccurately described 

DOD’s decision to not survey veterans. We corrected this information 

accordingly. Further, while VA concurred with our recommendation that it 

work with DOD to develop timeframes for completing the IDES business 

process review and implementing any resulting recommendations, VA 

stated that DOD is leading the business process review, and therefore 

should develop the timeframes for completing the review. We have 

revised this report to clarify that DOD is leading the business process 

review, but we did not alter the recommendation because we believe that 

it is important for VA to work closely with DOD, including in developing 

review timeframes.

As agreed with your offices, unless you publicly announce the contents of 

this report earlier, we plan no further distribution until 30 days from the 

report date. At that time, we will send copies of this report to the 

appropriate congressional committees, the Secretary of Defense, the

Secretary of Veterans Affairs, and other interested parties. The report is 

also available at no charge on the GAO Web site at www.gao.gov. 

Agency Comments 

and Our Evaluation
 

Page 34 GAO-12-676 Military Disability Evaluation

If you or your staff members have any questions about this report, please 

contact me at (202) 512-7215 or at bertonid@gao.gov. Contact points for 

our Offices of Congressional Relations and Public Affairs may be found 

on the last page of this report. Staff members who made key contributions 

to this report are listed in appendix VI. 

Daniel Bertoni

Director, Education, Workforce,

and Income Security Issues
Appendix I: Objectives, Scope, and 

Methodology

Page 35 GAO-12-676 Military Disability Evaluation

In conducting our review of the Integrated Disability Evaluation System 

(IDES), our objectives were to examine (1) the extent to which the 

Departments of Defense (DOD) and Veterans Affairs (VA) are meeting 

IDES performance goals, and (2) steps DOD and VA are taking to 

improve IDES performance. We conducted this performance audit from 

May 2011 to August 2012, in accordance with generally accepted 

government auditing standards. These standards require that we plan 

and perform the audit to obtain sufficient, appropriate evidence to provide 

a reasonable basis for our findings and conclusions based on our audit 

objectives. We believe the evidence obtained provides a reasonable 

basis for our findings and conclusions based on our audit objectives.

To determine the extent to which IDES is meeting established timeliness 

goals, we analyzed data collected through VA’s Veterans Tracking 

Application (VTA) database. While VA manages VTA, both DOD and VA 

staff enter data into VTA, and the evaluation of IDES data is primarily 

conducted by staff at DOD’s Office of Warrior Care Policy (WCP).1 WCP 

provided us with a dataset that was current as of January 1, 2012 and 

contained data spanning back to the inception of IDES in late 2007. This 

data export included data on a total of 39,260 cases. Of these cases, 

34,185 were active duty servicemembers and 5,068 were Reserve/Guard 

servicemembers.2 This VTA data set contained demographic data for 

each individual IDES case as well as a record of dates for when 

servicemembers reached various milestones in IDES.3

 

1 DOD’s Office of Warrior Care Policy changed its name from the Office of Wounded 

Warrior Care and Transition Policy (WWCTP) in 2012. 

Overall and 

interim IDES timeliness calculations are based on computing the number 

of days elapsed between appropriate milestone dates. For example, 

overall timeliness for servicemembers that receive benefits is calculated 

as the number of days between the individual being referred into the 

IDES and the date on which his or her VA benefits letter is issued. We 

met with staff at WCP to ensure we used appropriate variables when 

calculating timeliness. We also met with officials at VA to discuss the 

calculations used to determine the timeliness of cases. 

2 The number of active and Reserve components cases do not add up to the number of 

total cases because seven cases did not have a component code in the data. 

3 Demographic data included such information as gender, personnel class, service 

branch, component, and the number of conditions claimed and referred.

Appendix I: Objectives, Scope, and 

Methodology 

Review of IDES Timeliness 

Data
Appendix I: Objectives, Scope, and 

Methodology

Page 36 GAO-12-676 Military Disability Evaluation

We took a number of steps to assess the reliability of VTA data and 

ultimately found the data to be sufficiently reliable for the purposes of our 

audit. Past GAO work4

• We interviewed DOD and VA and determined that internal controls on 

VTA data had not changed substantially since our past review.

relied on VTA data, and therefore we took a 

number of steps to follow up on past assessments of VTA.

• We conducted electronic testing of the VTA data and generally found 

low rates of missing data or erroneous dates pertinent to our 

analysis—approximately 4 percent of cases. 5 For IDES cases in 

which we found missing dates or dates out of sequence, we excluded 

those cases from all of our analyses. While there were some 

instances in which the erroneous dates may be justified, we excluded 

the entire case from our analysis if any such dates appeared at any 

point in the VTA database. Such data included cases in which (1) 

there was no MEB referral date signifying the start of IDES process, 

and (2) the ending date preceded the beginning date of the IDES 

phase (resulting in timeliness calculations appearing as a negative 

amount of time).

• We also conducted a limited trace-to-file process to determine 

whether date fields in VTA were an accurate reflection of the 

information in IDES case files. Specifically, we compared VTA dates 

in 15 IDES cases completed in fiscal year 2011 against the dates in 

the corresponding paper files. In comparing dates, we allowed for a 

discrepancy of 5 days in dates to allow for the possibility that dates 

may have been entered into the database after an event took place. 

Ninety-three percent of the dates we traced back to the original file 

documents were found to be accurate, that is falling within our 5 day 

allowance.

 

4 GAO, Military and Veterans Disability System: Pilot Has Achieved Some Goals, but 

Further Planning and Monitoring Needed, GAO-11-69 (Washington, D.C.: Dec. 6, 2010).

5 Our analysis found an additional 11 percent of cases with dates missing for stages in the 

IDES program—dates that were not critical to our analyses. We believe that many if not 

most of these cases of missing data might be explainable. Servicemembers do not always 

pass through every step of the process and we believe this may explain some portion of 

missing dates. However, without looking at case files for all of these cases or the VTA 

data in more detail we cannot determine what portion of those 11 percent have a 

reasonable explanation for being missing. 
Appendix I: Objectives, Scope, and 

Methodology

Page 37 GAO-12-676 Military Disability Evaluation

For the cases meeting our criteria for reliability, we analyzed timeliness 

data for those cases that had completed the entire IDES process or had 

completed each of the four IDES phases. We specifically:

• Identified the total number of cases enrolled each fiscal year6 from FY 

2008 through 2011, by active as well as National Guard and reserve 

servicemembers, and by military branch of service.7

• Identified the number of cases that completed the entire IDES process 

for each fiscal year from fiscal year 2008 through fiscal year 2011. We 

analyzed completed cases in two different ways: (1) those who 

completed the process and received VA benefits and (2) those who 

completed the IDES with any outcome (such as permanent 

retirement, Temporary Disability Retirement List, return to duty, etc.). 

In order to be able to make comparisons across cases with different 

outcomes for a given point in time, we defined fiscal year by using the 

VTA variable “final disposition date”. We did this because most 

completed cases—regardless of outcome—have a final disposition 

date in VTA. In contrast to our approach, VA use the “VA benefit date” 

variable to determine fiscal year of completion for cases resulting in 

benefits. As such, their number of cases and timeliness calculations 

by fiscal year differed from ours, although overall trends are similar.

• Identified the number of cases that completed each phase of IDES 

and the interim stages within each phase, again by fiscal year (fiscal 

years 2008 through 2011).

• Computed timeliness statistics for the completion of the IDES 

process, phases, and stages against the performance goals set by 

DOD and VA, such as average days and percent meeting goals.

• Computed number and percent of cases where a servicemember 

appealed a decision made during the IDES process, by fiscal year.

 

6 We did not review the data on a monthly basis because this is done in DOD’s monthly 

reports and we wanted to provide a longer term perspective of the evolution of the IDES 

program. 

7 While we have data through December for fiscal year 2012, we did not include these 

data in our analysis because we sought to compare completed fiscal years. 

Analysis Conducted Using 

VTA Data
Appendix I: Objectives, Scope, and 

Methodology

Page 38 GAO-12-676 Military Disability Evaluation

For the purposes of this report, GAO opted to not include reserve 

component time spent in the VA benefit phase in our calculations for 

overall time because the 30 days allotted for this phase is not included in 

the 305-day overall goal for the reserve component.

GAO also performed analyses similar to those above, except that we 

grouped cases according to the year in which they were enrolled in IDES. 

(See app. II for more detail on these analyses.) Additionally, we analyzed 

timeliness for cases that had not yet completed the MEB stage as of the 

date we received the VTA data.

To determine the extent to which IDES is meeting its customer 

satisfaction goals, we analyzed data collected from IDES customer 

satisfaction surveys conducted at the end of three phases: MEB, PEB 

and Transition. These surveys are administered by telephone by 

contractors hired by DOD. The dataset we received contained survey 

responses for individual servicemembers from the beginning of the IDES 

pilot to December 2011, at which time administration of the survey was 

suspended. Additionally, we matched individual survey responses with 

information from VTA to gain additional understanding into how customer 

satisfaction varied according to different factors such as timeliness and 

case outcome. We matched survey and VTA data using the unique case 

identifier attached to each IDES case, maintaining the anonymity of the 

servicemembers. See appendix II for the results of additional analyses we 

conducted using survey data and survey data matched with VTA data.

In the course of our review we concluded that the survey data were 

sufficiently reliable for our purposes. We interviewed relevant officials at 

DOD and their contractors about eligibility requirements and the 

administration of the surveys. Further, we met with DOD and their 

contractors on multiple occasions to discuss the calculations used to 

determine response rates for the survey and servicemembers’ level of 

satisfaction. See appendix II for more details on GAO’s review of 

response rates.

To identify challenges in implementing IDES as well as steps taken to 

improve performance, we visited six military treatment facilities. During 

the site visits, we interviewed officials involved in implementing IDES from 

both DOD and VA, including military facility commanders and 

administrators, DOD board liaisons, military physicians involved in MEB 

determinations, DOD legal staff, VA case workers, VA or contract 

Review of IDES Customer 

Satisfaction Data

Identifying Challenges and 

Actions Taken to Improve 

Performance
Appendix I: Objectives, Scope, and 

Methodology

Page 39 GAO-12-676 Military Disability Evaluation

examiners, and administrators at VA medical clinics and regional offices. 

Additionally, we interviewed servicemembers who were currently enrolled 

in the IDES process. We selected the six facilities to obtain perspectives 

from sites in different military services, geographic areas, and their ability 

to meet timeliness goals for different phases of the process (see table 7). 

In addition, we visited the Air Force’s Formal Physical Evaluation Board at 

Randolph Air Force Base, Texas. During this visit we observed a hearing 

and met with board members to obtain a better understanding of the 

process.

Table 7: Selected Characteristics of IDES Pilot Sites Visited as of May 2011

Military treatment facility

Military 

service State 

IDES

caseload

Average

exam times

(goal = 45 days)

Average

MEB stage times 

(goal = 35 days)

Average

Total IDES time 

(goal = 295 days)

Joint Base Andrews Air Force Maryland 511 24 56 472

Fort Hood Army Texas 1,976 31 107 334

Joint Base Lewis-McChord Army Washington 1,069 46 102 339

Fort Meade Army Maryland 543 35 140 556

Fort Sam Houston Army Texas 1,336 65 72 412

Naval Hospital Bremerton Navy Washington 199 52 14 348

Source: GAO analysis of DOD’s June 2011 IDES Monthly Report.

Note: Processing times listed in table are for active duty cases.

We also interviewed officials in various offices at DOD and VA involved in 

implementing IDES. At DOD, these offices included Warrior Care Policy; 

Office of the Assistant Secretary of Defense (Reserve Affairs); Office of 

the Deputy Chief Management Officer; Air Force Physical Disability 

Division; Army Physical Disability Agency; Navy Physical Evaluation 

Board; Air Force Surgeon General; Army Medical Command; and Navy 

Bureau of Medicine and Surgery. At VA, we interviewed officials in the 

Veterans Benefits Administration, Veterans Health Administration, and 

the VA/DOD Collaboration Service. Furthermore, we reviewed relevant 

documents, including DOD and VA policies, federal laws, regulations, 

directives8

 

8 Including Directive-Type Memorandum 11-015, which establishes policies, assigns 

responsibilities, and prescribes procedures for the IDES.

and guidance, a study produced for DOD on diagnostic 

variances, and plans to streamline IDES or improve performance.
Appendix II: Additional Timeliness and 

Satisfaction Analyses

Page 40 GAO-12-676 Military Disability Evaluation

This appendix provides additional information on the timeliness of the 

IDES process and servicemember satisfaction with it. First, we use 

timeliness data to examine whether changes over time in processing 

times and the percentage of cases meeting timeliness goals look any 

different when cases are grouped according to the fiscal year in which the 

cases were first enrolled rather than the fiscal year in which the cases 

were completed.1 Second, we use survey data to examine different 

measurements of servicemember satisfaction with IDES, how satisfaction 

varied according to various servicemember characteristics, response and 

coverage rates for the servicemembers surveyed, and how the survey 

respondents differed from nonrespondents.2

With respect to timeliness, we find generally similar trends for cases 

grouped by fiscal year of enrollment versus fiscal year of completion, with 

some key differences. Organizing cases by completion date results in 

shorter average processing times in 2008, since only those cases that are 

processed quickly could be completed in the first year of IDES. As such, 

organizing cases by enrollment date provides a better estimate of the 

processing times for the early IDES cases. However, this approach 

results in shorter processing times in 2011, the most recent full year of 

the program, since only cases that finish quickly can be analyzed.

With respect to satisfaction, we find that the particular index used to 

summarize servicemembers’ responses can affect the proportion reported 

as being “satisfied” or “dissatisfied” with IDES overall. DOD’s index 

suggests that 67 percent of servicemembers have been satisfied since 

the IDES program began, but a reasonable alternative measure we 

developed suggests that only 24 percent of servicemembers have been 

satisfied. Using this measure, satisfaction varies only slightly across many 

important groups of servicemembers, such as by disenrollment outcome, 

 

1 We consider processing times overall, for the four phases of IDES (MEB, PEB, 

Transition, and VA Benefits), Active Duty, Reserve, or National Guard status, and for 

servicemembers receiving benefits versus all servicemembers regardless of the outcome 

of their cases. 

2 Response rates refer to the percentages of servicemen who responded to the surveys 

among those who DOD deemed eligible. For the MEB survey, eligibles included all 

servicemen who completed the MEB phase, but for the PEB and Transition surveys 

eligibles included only those who completed those phases and also completed the prior 

surveys. Coverage rates refer the percentages of servicemen that responded to each 

survey among those who completed each phase, regardless of whether they completed 

prior surveys.

Appendix II: Additional Timeliness and 

Satisfaction Analyses
Appendix II: Additional Timeliness and 

Satisfaction Analyses

Page 41 GAO-12-676 Military Disability Evaluation

suggesting that available program data cannot precisely explain 

satisfaction outcomes. Also, servicemembers surveyed may not represent 

the servicemembers who completed the different phases of IDES well 

enough to generalize to them, given the low response rates to the MEB 

survey and fact that being selected for latter (PEB and Transition) surveys 

were conditional on completing the MEB survey.

Average IDES processing times for completed cases resulting in benefits 

generally worsened since 2008, especially for active duty cases, 

regardless of whether cases are grouped by the fiscal year in which they 

were completed (fig. 10) or by the fiscal year in which they were enrolled 

(fig. 11). The notable exception is when fiscal year 2011 is the year of 

enrollment. However, caution must be used when examining cases 

enrolled in 2011 because over 15,600 service members of the 18,651 (or 

at least 84 percent) who entered IDES in fiscal year 2011 did not have an 

outcome in 2011 and were enrolled in IDES as of January 1, 2012,3

 

3 GAO’s latest data export from the VTA database included data through January 1, 2012.

potentially changing the distribution of processing times as they proceed 

through IDES.

Overall IDES Timeliness: 

Processing Times and 

Percent of Cases Meeting 

Timeliness Goals
Appendix II: Additional Timeliness and 

Satisfaction Analyses

Page 42 GAO-12-676 Military Disability Evaluation

Figure 10: Average IDES Processing Times by Year of Completion, for Completed 

Cases Resulting in Benefits
Appendix II: Additional Timeliness and 

Satisfaction Analyses

Page 43 GAO-12-676 Military Disability Evaluation

Figure 11: Average IDES Processing Times by Fiscal Year of Enrollment for 

Completed Cases Resulting in Benefits

Note: Enrolled cases reflects those cases that were enrolled for each year with cases with erroneous 

or questionable dates removed. This number does not match the number of enrolled cases previously 

reported for this reason.

We also examine average IDES processing times according to year of 

completion (see fig. 12) and year of enrollment for cases (see fig. 13) for 

all completed cases regardless of outcome. As with cases that resulted in 

benefits, for cases resulting in any outcome we find that average 

processing times increased since 2008—again with the exception of fiscal 

year 2011 for reasons discussed earlier—although average processing 

times are somewhat shorter than when only servicemembers receiving 

benefits are included (fig. 11).
Appendix II: Additional Timeliness and 

Satisfaction Analyses

Page 44 GAO-12-676 Military Disability Evaluation

Figure 12: Average IDES Processing Times by Year of Completion, for All 

Completed Cases Regardless of Outcome
Appendix II: Additional Timeliness and 

Satisfaction Analyses

Page 45 GAO-12-676 Military Disability Evaluation

Figure 13: Average IDES Processing Times by Fiscal Year of Enrollment for All 

Completed Cases Regardless of Outcome

Note: Enrolled cases reflects those cases that were enrolled for each year with cases with erroneous 

or questionable dates removed. This number does not match the number of enrolled cases previously 

reported for this reason.

Figures 14 and 15 show that regardless of whether cases are organized 

by year of completion or enrollment, the percent of completed cases 

resulting in benefits that were not timely increased between fiscal year 

2008 and 2010 for both active duty servicemembers and members in the 

Reserves or National Guard. As with the average processing times, 

caution must be used when examining cases enrolled in fiscal year 2011 

(fig. 15), since only those cases that are processed quickly are observed 

in the last year. Similarly, caution also must be used when examining 

cases in 2008 (fig. 14), since the only cases that are included in the first 

year are those that completed IDES quickly.
Appendix II: Additional Timeliness and 

Satisfaction Analyses

Page 46 GAO-12-676 Military Disability Evaluation

Figure 14: Percentage of Completed Cases Meeting and Missing the Overall 

Processing Time Goals, by Fiscal Year of IDES Completion, for Servicemembers 

Receiving Benefits
Appendix II: Additional Timeliness and 

Satisfaction Analyses

Page 47 GAO-12-676 Military Disability Evaluation

Figure 15: Percentage of Completed Cases Meeting and Missing the Overall 

Processing Time Goals, by Fiscal Year of IDES Enrollment, for Servicemembers 

Receiving Benefits

Figures 16 and 17 show how average processing times for each of the 

four phases of IDES have changed over the four fiscal years when cases 

are grouped by the fiscal year in which they completed a given phase and 

when cases are grouped by the fiscal year in which they were enrolled or 

started a given phase.4

 

4 The servicemembers included in these figures have not necessarily completed the entire 

IDES process, but did complete a given phase to be included in the figure for that phase. 

Figure 16 shows that when cases are grouped 

according to the fiscal year in which the different phases were completed, 

processing times increased for all phases except the Transition phase. 

Figure 17 shows a roughly similar pattern of increases in processing 

times in all but the Transition phase, though processing times in 2011 are 

skewed for the reason mentioned above. Figures 18 and 19 show how 

the percentages meeting the timeliness goals for each of the four phases 

of IDES have changed over the four fiscal years when cases are grouped 

by the fiscal year in which they completed a given phase and when cases 
Appendix II: Additional Timeliness and 

Satisfaction Analyses

Page 48 GAO-12-676 Military Disability Evaluation

are grouped by the fiscal year in which they were enrolled or started a 

given phase. Figure 18 shows that the percent of cases meeting 

timeliness goals decreased over the four years for the MEB and PEB 

phases, although a high percent of cases met PEB goals. However, the 

Transition and Benefits phases fluctuated up and down and both were 

favorable across some years. Figure 19 also shows decreases in 

percentages of cases meeting timeliness goals at the MEB and PEB 

phases when cases are grouped by fiscal year of starting a given phase. 

The fluctuations in the timeliness of the Transition and Benefits phases 

were more prevalent when cases were grouped in this manner.

Figure 16: Average Processing Time for Each IDES Phase, by Fiscal Year in Which the Phase Was Completed

Note: Data shown in figures 16, 17, 18, and 19 are for servicemember cases that either started or 

completed a phase in a particular year, according to the figure title. For purposes of this report, we 

opted to not include reserve component time spent in the VA benefit phase in our calculations phase 

because this goal applies to some but not all reservists, depending on their active duty status. Any 

time spent within the VA benefit phase is reflected within the overall processing time calculations for 

such reserve component servicemembers.
Appendix II: Additional Timeliness and 

Satisfaction Analyses

Page 49 GAO-12-676 Military Disability Evaluation

Figure 17: Average Processing Time for Each IDES Phase, by Fiscal Year of Enrollment in Each Phase

Note: Data shown in figures 16, 17, 18, and 19 are for servicemember cases that either started or 

completed a phase in a particular year, according to the figure title. For purposes of this report, we 

opted to not include reserve component time spent in the VA benefit phase in our calculations phase 

because this goal applies to some but not all reservists, depending on their active duty status. Any 

time spent within the VA benefit phase is reflected within the overall processing time calculations for 

such reserve component servicemembers.
Appendix II: Additional Timeliness and 

Satisfaction Analyses

Page 50 GAO-12-676 Military Disability Evaluation

Figure 18: Percent of Cases Meeting Timeliness Goals for each Phase of IDES, by Fiscal Year in Which the Phase Was 

Completed

Note: Data shown in figures 16, 17, 18, and 19 are for servicemember cases that either started or 

completed a phase in a particular year, according to the figure title. For purposes of this report, we 

opted to not include reserve component time spent in the VA benefit phase in our calculations phase 

because this goal applies to some but not all reservists, depending on their active duty status. Any 

time spent within the VA benefit phase is reflected within the overall processing time calculations for 

such reserve component servicemembers.
Appendix II: Additional Timeliness and 

Satisfaction Analyses

Page 51 GAO-12-676 Military Disability Evaluation

Figure 19: Percent of Cases Meeting Timeliness Goals for each Phase of IDES, by Fiscal Year of Enrollment in Each Phase

Note: Data shown in figures 16, 17, 18, and 19 are for servicemember cases that either started or 

completed a phase in a particular year, according to the figure title. For purposes of this report, we 

opted to not include reserve component time spent in the VA benefit phase in our calculations phase 

because this goal applies to some but not all reservists, depending on their active duty status. Any 

time spent within the VA benefit phase is reflected within the overall processing time calculations for 

such reserve component servicemembers.

Low response and coverage rates for servicemember satisfaction surveys 

administered after each phase of IDES raise concerns about how well the 

satisfaction survey results represented the larger population of 

servicemembers who completed one or more phases.

DOD surveys servicemembers after they complete the MEB, PEB, and 

Transition phases of IDES. The department attempts to survey all 

servicemembers who complete each phase, but only if they completed 

the prior surveys. For example, the MEB survey must be completed 

before a servicemember is eligible to complete the PEB survey.

Using the data available to us, and as table 8 below shows, we found that 

9,604 of the 25,212 servicemembers who completed the MEB phase 

Servicemember 

Satisfaction Survey: 

Response and Coverage 

Rates
Appendix II: Additional Timeliness and 

Satisfaction Analyses

Page 52 GAO-12-676 Military Disability Evaluation

were surveyed, for a 38 percent response and coverage rate.5

Table 8: Survey phase response and coverage rates

Of the 

18,296 servicemembers who completed the PEB phase, only 8,968 of 

them completed the prior MEB survey and were eligible for the PEB 

survey and of these only 4,795 were surveyed. Using DOD’s eligibility 

criteria, the response rate for the PEB survey was roughly 54 percent 

(4,795 of 8,968). However, the coverage rate for all servicemembers who 

completed the PEB phase (regardless of whether they completed the 

prior survey) was only 26 percent (4,795 of 18,296). Similarly, the 

response rate for the Transition survey was 72 percent while the 

coverage rate was only 23 percent (See table 8).

Phase

Servicemembers 

completing phase 

Servicemembers eligible 

for survey (completed 

prior phase survey)

Servicemembers 

surveyed

Response rate

(No. surveyed /

No. eligible) (%)

Coverage rate

(No. surveyed / No. 

completing phase) (%)

MEB 25,212 all 9,604 38.1% 38.1%

PEB 18,296 8,968 4,795 53.5% 26.2%

Transition 12,352 3,996 2,893 72.4% 23.4%

Source: GAO analysis of DOD and VA data.

Note: This table excludes 558 cases (or approximately 1.4 percent) of VTA data with logical errors in 

IDES phase start and end days for any IDES phase (e.g. exclude cases where MEB start date occurs 

after MEB end date). This table includes the approximately 4 percent of cases we found to have 

inconsistent start and end dates across phases.

As table 9 below shows, there were some sizable differences between 

respondents and nonrespondents, especially for the PEB and Transition 

surveys. For example, respondents to the transition survey spent more 

time than nonrespondents in the Transition phase, were less likely to be 

separated with benefits, and were more likely to be placed on the 

Permanent Disability Retired List. These differences, combined with low 

response and coverage rates, raise the possibility of biased responses.

 

5 Though there are different ways to calculate response and coverage rates, which can 

result in different estimates of these quantities, we chose our response rate and coverage 

estimates in order to better understand what fraction of the intended group was actually 

surveyed.
Appendix II: Additional Timeliness and 

Satisfaction Analyses

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Table 9: Selected Servicemember Characteristics of Respondents and Nonrespondents to the MEB, PEB and Transition 

Surveys

Survey Variable

Respondents Nonrespondents

N 

Mean or 

percent N 

Mean or 

percent

MEB survey Timeliness 

Total days in MEB 9,604 158.8 15,608 156.6

Met MEB goal 2,854 29.7% 5,187 33.2%

Branch

Army 5,191 54.1% 8,910 57.1%

Marine Corps 2,177 22.7% 2,802 18.0%

Navy 1,417 14.8% 2,168 13.9%

US Air Force 819 8.5% 1,728 11.1%

Component

Active duty 8,628 89.8% 14,111 90.4%

Reserve/National Guard 976 10.2% 1,497 9.6%

Outcome of case

Separated with benefits 2,778 31.4% 2,678 31.0%

Separated without benefits 152 1.7% 134 1.6%

Permanent disability retirement list 2,191 24.7% 2,192 25.3%

Temporary disability retirement list 2,704 30.5% 2,730 31.6%

Found fit and returned to duty 959 10.8% 856 9.9%

Found unfit and returned to duty 73 0.8% 61 0.7%

PEB Survey Timeliness 

Total days in PEB 4,764 85.0 13,364 91.2

Met PEB goal 3,762 79.0% 10,424 78.0%

Branch

Army 2,646 55.5% 8,298 62.1%

Marine Corps 1,061 22.3% 2,347 17.6%

Navy 708 14.9% 1,640 12.3%

US Air Force 349 7.3% 1,079 8.1%

Component

Active duty 4,262 89.5% 12,228 91.5%
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Survey Variable

Respondents Nonrespondents

N 

Mean or 

percent N 

Mean or 

percent

Reserve/National Guard 502 10.54 1,136 8.50

Outcome of case

Separated with benefits 1,408 29.6% 4,035 31.9%

Separated without benefits 72 1.51 211 1.7%

Permanent disability retirement list 1,222 25.7% 3,147 24.9%

Temporary disability retirement list 1,440 30.2% 3,962 31.4%

Found fit and returned to duty 584 12.3% 1,181 9.4%

Found unfit and returned to duty 38 0.8% 94 0.7%

Transition

survey

Timeliness 

Total days in transition 2,894 82.3 9,259 75.1

Met transition goal 455 15.7% 1,856 20.0%

Branch

Army 1,744 60.3% 5,972 64.5%

Marine Corps 597 20.6% 1,837 19.8%

Navy 344 11.9% 924 10.0%

US Air Force 209 7.2% 526 5.7%

Component

Active Duty 2,587 89.4% 8,562 92.5%

Reserve/National Guard 307 10.6% 697 7.5%

Outcome of Case

Separated with benefits 783 27.1% 3,496 38.1%

Separated without benefits 47 1.6% 173 1.9%

Permanent disability retirement list 955 33.0% 2,405 26.2%

Temporary disability retirement list 1,102 38.1% 3,086 33.7%

Found fit and returned to duty 5 0.2% 4 0.0%

Found unfit and returned to duty 2 0.1% 3 0.0%

Source: GAO analysis of DOD and VA data.

Note: This table excludes 558 cases (or approximately 1.4 percent) of VTA data with logical errors in 

IDES phase start and end days, for any IDES phase (e.g. exclude cases where MEB start date 

occurs after MEB end date). This table includes the approximately 4 percent of cases we found to 

have inconsistent start and end dates across phases.
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The particular measure used to assess servicemember satisfaction can 

affect the proportion reported as “satisfied” with the IDES program. 

Depending on the measure used, satisfaction is about 2.8 times lower 

than what DOD has reported, and many servicemembers classified as 

“satisfied” express moderate dissatisfaction with some aspects of the 

process.

DOD has reported average servicemember satisfaction with IDES overall 

and with three phases of the process, i.e., MEB, PEB, and Transition 

phases. In so doing, DOD has developed indices of satisfaction on 

several broad dimensions, such as satisfaction with the overall 

experience and fairness, which combine responses to selected survey 

questions. Although the number of questions used in each index vary 

depending on the number of phases completed, each index classifies 

servicemembers as “satisfied” or “dissatisfied” using the average of their 

responses across all questions in the index. Each question’s scale ranges 

from 1 to 5, with 1 denoting “very dissatisfied” (or a similar negative 

response), 5 denoting “very satisfied,” and 3 denoting “neither satisfied 

nor dissatisfied.” DOD reports that a servicemember is “satisfied” if his or 

her average response across all items in the scale exceeds 3. Table 10 

summarizes the responses to each question that DOD uses in its overall 

satisfaction index at each phase (as of August 2011).

Measuring Servicemember 

Satisfaction 
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Table 10: Questions Used in DOD Indices of Overall Servicemember Satisfaction

MEB phase PEB phase Transition phase

Number Percent Number Percent Number Percent

How satisfied or dissatisfied were you with the management of your case during the [MEB/PEB/Transition] phase of the pilot 

process?

Very dissatisfied 813 8.4 388 7.9 223 6.4

Dissatisfied 1,369 14.1 607 12.4 406 11.6

Neither 1,259 13 578 11.8 397 11.3

Satisfied 4,310 44.5 2,306 47.1 1,737 49.6

Very satisfied 1,926 19.9 1,019 20.8 741 21.1

Total 9,677 100 4,898 100 3,504 100

How satisfied or dissatisfied were you with the overall [MEB/PEB/Transition] phase of determining your retention status?

Very dissatisfied 559 6.7 269 5.5 224 6.4

Dissatisfied 1,131 13.6 548 11.2 401 11.5

Neither 1,007 12.1 510 10.4 345 9.9

Satisfied 4,048 48.6 2,562 52.3 1,798 51.6

Very satisfied 1,578 19 1014 20.7 715 20.5

Total 8,323 100 4,903 100 3,483 100

How would you evaluate the timeliness of the process since entering the Disability Evaluation Pilot process?

Very poor 1,685 17.4 759 15.4 500 14.1

Poor 1,594 16.5 681 13.9 468 13.2

Mix of poor/good 2,397 24.7 1,262 25.7 967 27.3

Good 2,811 29 1,470 29.9 1,065 30.1

Very good 1,200 12.4 743 15.1 543 15.3

Total 9,687 100 4,915 100 3,543 100

How would you evaluate your overall experience since entering the Disability Evaluation Pilot process?

Very poor 686 7 356 7.2 235 6.6

Poor 921 9.4 413 8.4 285 8 

Mix of poor/good 2,875 29.4 1,477 29.9 1,115 31.4

Good 3,891 39.8 1,917 38.8 1,333 37.5

Very good 1,402 14.3 772 15.6 587 16.5

Total 9,775 100 4,935 100 3,555 100

Source: GAO analysis of DOD data.

Note: Entries are responses to four survey questions (rows) asked after servicemembers complete 

the MEB, PEB, or Transition phase (columns).
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DOD’s indices are one reasonable method of summarizing 

servicemember opinions. In quarterly performance reports, DOD notes 

that it has used factor analysis, a form of latent variable statistical models 

to assess the reliability of its scales. While we did not review DOD’s 

models, we independently found that DOD’s overall index of satisfaction 

with IDES was highly reliable. (Specifically, using Cronbach’s alpha, the 

index was highly correlated with a single latent dimension at α = 0.92.) 

This supports DOD’s choice to measure the single concept of 

“satisfaction” by averaging the ordinal servicemember responses.

Nevertheless, the average survey response can obscure variation in the 

responses that make up the index. For example, suppose that a 

servicemember said she was “very satisfied” (response of 5) on two of the 

four questions in the index, “dissatisfied” on one (response of 2) and “very 

dissatisfied” on the last one (response of 1). With an average response 

over 3, the DOD measure would classify her as “satisfied,” despite the 

fact that she was “somewhat dissatisfied” or “very dissatisfied” with two of 

the four aspects of IDES that DOD considers important. The grouping rule 

considers this servicemember equally happy with IDES as someone who 

says they are “satisfied” with all four aspects in the index.

To assess the extent to which DOD’s index might mask dissatisfaction, 

we calculated the proportion of questions in the scale on which 

servicemembers whom DOD classified as “satisfied” gave neutral or 

negative responses (1, 2, or 3). We found that half of these 

servicemembers gave neutral or negative answers to at least 25 percent 

of the items in the index, and a quarter gave such answers to at least 41 

percent of the items. For these servicemembers, the DOD index may 

suggest more satisfaction than the underlying survey questions would 

support.

We further assessed the sensitivity of DOD’s index by comparing it 

against a different (i.e., GAO’s) measure of satisfaction: whether a 

servicemember is “somewhat” or “very satisfied” (or gives a similarly 

positive response) on all items in DOD’s scale of overall IDES 

satisfaction. Our measure is more conservative than DOD’s, because 

ours only includes positive responses and uses a broader cutpoint (two 

response categories) to distinguish between “satisfied” and “not satisfied” 

servicemembers. (In contrast, DOD calculates average satisfaction on an 

ordinal scale of 1 to 5, and then uses a cutpoint at 3.) Our measure is not 
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inherently more valid, however, and has its own weaknesses. In 

particular, we classify a servicemember as “not satisfied” if she gives a 

neutral or negative response to just one of the four items in DOD’s scale.6

When we analyzed overall satisfaction using both measures, we found 

that overall, servicemembers are 2.8 times less satisfied on our measure 

than on DOD’s (i.e., 23.8 versus 67 percent). Further, only about 20 to 30 

percent of servicemembers are “satisfied” with each aspect of the IDES 

process that DOD considers important across most of the subgroups we 

analyzed, while DOD classifies about 60 to 70 percent of such 

servicemembers as “satisfied” on average. In the next section, we present 

further information on variation in satisfaction across servicemember 

groups.

Although the servicemember survey provides numerous measures of 

satisfaction, it is also important to explain variation in satisfaction 

outcomes—i.e. why some servicemembers are more satisfied than 

others. Explaining variation can connect dissatisfaction with poor program 

performance and help identify specific reforms to improve the 

experiences of servicemembers who typically have been less satisfied. 

However, the available program data cannot precisely explain outcomes 

when used in this type of explanatory analysis. Using the available data, 

we could predict satisfaction only 1.9 percentage points better after 

controlling for multiple factors than what we would have achieved by 

chance (65.5 percent vs. 63.7 percent of satisfied responses predicted 

correctly).

In order to further explain variation in satisfaction, we matched the survey 

responses to the data that DOD and VA maintain on the processing of 

each servicemember’s case, known as the VTA data. This database 

primarily measures the time it took servicemembers to complete each 

phase of the IDES process. A small number of other program and 

demographic variables are also available, such as service branch, 

 

6 Both measures of satisfaction combine responses from servicemembers who have 

finished various phases of IDES. For example, a servicemember who completed only the 

MEB would provide at most 4 responses from that wave’s survey, while a servicemember 

who completed all phases would provide at most 12 responses from all three surveys. 

Each measure calculates overall satisfaction using all responses available, even though 

the number of responses varies among servicemembers (e.g., 4 vs. 12). 

Explaining Servicemember 

Satisfaction Outcomes
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component, and the number of conditions claimed and referred. Using the 

matched survey and VTA data, we estimated the association between 

satisfaction and observable factors that could potentially explain variation 

in servicemembers’ experiences.

Table 11 below (columns 2-4) presents these associations for both DOD’s 

and GAO’s overall measures of satisfaction. The “raw data” estimates are 

simply the proportion of servicemembers in a particular group who were 

satisfied according to either measure. In the fourth column (“model 

estimates”), we estimate this proportion holding constant all of the other 

factors listed, using a statistical model. Specifically, the estimates are insample mean predicted probabilities of giving a satisfied response on the 

GAO satisfaction index from a logistic model of satisfaction. The 

covariates are given by indicators of whether the servicemember 

belonged to each group in column 4. The maximum likelihood estimators 

allowed the probability of satisfaction, given the covariates, to be 

dependent across observations within the 26 cross-classified groups of 

PEB location and MEB medical treatment facility. This adjusted for the 

possibility that servicemembers were similarly satisfied if they were 

processed in the same locations, given similar values on the observed 

covariates.7

Table 11: Overall IDES Satisfaction by Subgroups

DOD Measure: Average 

answer exceeded neutral

 GAO Measure:

All answers positive

N 

Raw data Raw data Model estimates

Percentage Percentage Percentage

All respondents 67 23.8 9,865

Component 

Active 67.4 23.7 23.7 8,692

Reserves/National Guard 63.5 24.6 23.7 1,173

 

7 Because the “cluster-robust” variance estimator is only consistent as the number of 

clusters becomes large, the relatively small number of MEB-PEB locations in our data 

raises the possibility of finite-sample bias. The practical effect of this problem should be 

minimal, however, since the model controls for MEB and PEB location and, thus, residual 

intraclass correlation should be small.
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DOD Measure: Average 

answer exceeded neutral

 GAO Measure:

All answers positive

N 

Raw data Raw data Model estimates

Percentage Percentage Percentage

Branch

Air Force 61.8 23.6 23.7 838

Army 70.3 26.5 24.5 5,398

Marine Corps 61.3 19 23.8 2,198

Navy 65.9 21.2 23 1,431

Rollout phasea 

1 63.7 20.2 1,430

1.1 65.1 21.8 4,827

2 72.7 30.4 1,601

3.1 69.6 34.6 257

3.2 67.7 38.5 65

3.3 0 0 1 

Final disposition 

Fit and Returned to Duty 70.9 27.4 21.7 963

Permanent Disability Retirement List 69.9 25.4 25.6 2,286

Separated with Benefits 66.9 23.1 22.5 2,848

Separated without Benefits 63.1 20.4 21.5 157

Temporary Disability Retirement List 65.9 21.8 24.4 2,786

Unfit and Returned to Duty 63 16.4 17 73

Fiscal Year started MEB 

2008 60.4 15.1 13 530

2009 68.1 21.4 21.2 2,627

2010 66.1 22.9 24.5 4,721

2011 69.3 31.6 28.3 1,986

Claimed conditions 

0-4 71.5 27.7 24.2 2,309

5-7 69.4 25.1 23.9 2,028

8-12 65.9 22.5 23.1 2,771 

13-19 62.6 22.6 25.1 1,882

20+ 61.7 16.6 20.2 825
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DOD Measure: Average 

answer exceeded neutral

 GAO Measure:

All answers positive

N 

Raw data Raw data Model estimates

Percentage Percentage Percentage

Referred conditions 

0-1 67.7 24.9 24.1 4,686

2 66.1 24 23.7 2,482

3 65.8 21.6 23.4 1,679

4+ 67.8 22.5 22 953

DOD Percentage Rating

0 66.5 20.8 236

10 67.3 24.6 1,287

20 66.6 23.1 978

30 67.1 23.7 680

40 67.2 22.2 531

50 65.4 21.5 786

60 66.7 23 609

70 68.2 21.2 556

80 68.9 30 280

90 63.1 21.3 122

100 75.5 35.5 282

MEB treatment facility

Andrews 57.4 18.5 19.8 319

Lejeune 56.9 18 18.4 1,046

Pendleton 62.1 17 19.2 372

Belvoir 66.3 25 30.1 252

Benning 77.3 34 25.6 260

Bliss 0 

Bragg 72.9 36.8 34.3 288

Campbell 90 50 47 10

Carson 64.3 19 23.7 736

Drum 67.3 30 27.9 397

Gordon 50 50 2 

Hood 81.1 33.3 30.7 519

Lewis 59.5 21 20.2 252

Meade 55.5 15.6 14.7 218

Polk 81 33.3 28.1 400
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DOD Measure: Average 

answer exceeded neutral

 GAO Measure:

All answers positive

N 

Raw data Raw data Model estimates

Percentage Percentage Percentage

Riley 59 20 17.4 105

Stewart 74.2 26.7 27 718

Other 68 25.6 20.3 961

Portsmouth 65 23 21.8 283

San Antonio 71.1 26.3 24.2 505

San Diego 65.2 20.5 21.3 1,127

Tripler 83.3 53 37.8 30

Walter Reed (Army) 65.2 21.7 26.4 511

Walter Reed (Navy/Marine Corps) 66.4 19.9 24.1 554

Time in IDES (GAO calculation) at 

disenrollment or December 31, 2011)

1st quartile 81.5 38.3 41.1 313

2nd quartile 78.2 35 33.8 1,658

3rd quartile 70.1 24.8 23.7 3,667

4th quartile 58.8 17.4 17.8 4,226

Sex 

Female 66.9 25.4 25.2 1,799

Male 67 23.5 23.3 8,063

Personnel Class 

Enlisted 67.1 23.9 23.9 9,126

Officer 64.5 21.7 21 691

Warrant 77 29.2 27.6 48

PEB Location 

Lewis 64.2 20.4 1,283

National Capital Region 66 26.1 1,698

San Antonio (Randolph) 61.8 23.6 838

San Antonio (Sam Houston) 76.5 30 2,417

Washington Navy Yard 63.1 19.9 3,629

MEB Exam Location

Military Treatment Facility 67.2 24.1 22.1 868
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DOD Measure: Average 

answer exceeded neutral

 GAO Measure:

All answers positive

N 

Raw data Raw data Model estimates

Percentage Percentage Percentage

Contractor Facility 67 23.9 23.7 1,991

VA Medical Center 66.9 24.2 23.4 5,976

Not Available 66.9 21.2 27.2 1,030

Source: GAO analysis of DOD and VA data.

a

Rollout phases correspond with the order in which IDES deployed at various facilities.

Regardless of which measure is used (DOD’s or GAO’s), satisfaction 

varied only modestly across many important groups of servicemembers. 

Our model estimates that the GAO measure of satisfaction varied by no 

more than approximately five percentage points across branch, 

component, disenrollment outcome, sex, MEB exam provider, enlisted 

and officer personnel classes, and the number of claimed and referred 

conditions, although differences across MEB treatment facilities and PEB 

locations were larger.8

Also shown in table 11, satisfaction had a stronger association with case 

processing time (time spent in IDES) than some of the other factors we 

examined. Servicemembers whose case processing times were among 

the quickest 25 percent were about 2.3 times as likely to be satisfied (on 

the GAO scale) than those whose times were among the 25 percent of 

cases with the longest overall timeframes (i.e., 41 versus 18 percent). 

Nevertheless, only 41 percent of those servicemembers whose cases 

were processed most quickly were satisfied (holding constant the other 

factors). This suggests that servicemembers’ opinions about IDES may 

be only loosely related to the amount of time they spent in IDES, as 

discussed in the next section below.

This can be seen as a positive outcome, if this 

correlation implies that DOD and VA administer the program consistently 

across servicemembers and locations. However, the lack of variation also 

could suggest that the survey items do not measure opinions in enough 

detail to discriminate among servicemembers’ experiences.

 

8 In addition, servicemembers who were found unfit and returned to duty—a rare 

outcome—were approximately 4 to 10 percentage points less likely to be satisfied than 

servicemembers who had any of the other outcomes.
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Although the average case processing time has generally increased since 

2008, when we look at satisfaction by fiscal year, servicemember 

satisfaction shows evidence of improvement since fiscal year 2008. 

Specifically, our measure of satisfaction from the model increased by 15 

percentage points since 2008, roughly doubling from 13 to 28. Because 

the model estimates control for various other factors, these results 

suggest that servicemember views of the IDES process have improved 

over time, rather than the possibility that IDES has simply processed 

different types of cases.

Satisfaction does not vary by a large amount across many MEB treatment 

facilities, but there are exceptions. Our model estimates that about 18 to 

26 percent of servicemembers were satisfied at most facilities. However, 

there were pockets of greater satisfaction. Specifically, servicemembers 

had more positive experiences at Forts Belvoir, Bragg, Campbell, Drum, 

Hood, and Polk, with satisfaction estimated to have ranged from 28 to 45 

percentage points. Fort Meade had the lowest satisfaction at 15 percent. 

These estimates hold constant time spent in IDES and other factors in 

column 4 and, thus, partially account for the types of cases each facility 

processes.

DOD and VA measure IDES timeliness directly in VTA and as part of the 

overall servicemember satisfaction scale. These overlapping measures 

let us compare servicemembers’ opinions to their actual experiences in 

the program. To do this, we calculated processing times at each phase of 

IDES for servicemembers who expressed varying degrees of satisfaction 

with the timeliness of their case processing at that phase. In addition, we 

analyzed whether servicemembers who were satisfied with the overall 

IDES process were more or less likely to meet timeliness goals. Table 12 

provides these statistics.

Satisfaction with Timeliness
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Table 12: Perceived Timeliness of IDES by Actual Processing Times

Days in IDES

(by phase)

 Actual processing time

(by Phase) % Met 

DOD 

10th Pctile Median 90th Pctile Goal N 

% in 1st 

Quartile

% in 2nd 

Quartile

% in 3rd 

Quartile

% in 4th 

Quartile

Overall satisfaction 

with IDES (GAO 

Measure)

Not satisfied 198 348 544 2.57 14.33 36.68 46.42 33.8 7,516

Satisfied 159 297 479 5.11 24.74 38.76 31.39 50.2 2,349

Perceived MEB 

timeliness

Very poor 88 175 323 7.9 22.5 30.9 38.7 16.8 1,685

Poor 78 156 290 11.6 25.7 35.1 27.6 23.4 1,594

Mix of poor/good 72 142 273 15.1 28.6 34.7 21.6 27.9 2,397

Good 66 128 254 19.8 31.9 29.8 18.6 35.6 2,811

Very good 62 114 223 24.9 38.2 24.3 12.6 45.3 1,200

Perceived PEB 

timeliness satisfaction

Very poor 28 88 203 22.8 18.1 23.7 35.4 67.8 759

Poor 28 89 186 20.8 18.9 24.7 35.7 69.7 680

Mix of poor/good 23 70 155 28.3 23.4 24 24.3 79.5 1,262

Good 23 65 138 30.7 25.5 24.4 19.4 84.3 1,470

Very good 17 55 128 40.2 26.2 18 15.6 88.1 740

Perceived Transition 

timeliness

Very poor 33 87 461 7.9 22.5 30.9 38.7 16.1 500

Poor 43 90 459 11.6 25.7 35.1 27.6 12.6 468

Mix of poor/good 40 90 481 15.1 28.6 34.7 21.6 13.3 967

Good 37 91 496 19.8 31.9 29.8 18.6 12.8 1,065

Very good 39 91 657 24.9 38.2 24.3 12.6 12.8 541

Source: GAO analysis of DOD and VA data.

As shown in table 12, satisfaction generally stayed the same or 

decreased as processing times increased. The median days spent in the 

MEB and PEB phases were 35 and 38 percent lower, respectively, 

among those servicemembers who said that MEB and PEB timeliness 

was “very good” as compared to those who said it was “very poor.” The 
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former group was 170 percent more likely to have met the MEB 

timeliness goal and 30 percent more likely to have met the PEB 

timeliness goal. Similarly, the case for a median servicemember—whom 

we classified as “satisfied” with the overall IDES process—was completed 

15 percent more quickly and was 49 percent more likely to have met the 

timeliness goal than the median servicemember who was “dissatisfied.” 

The model estimates in table 11 confirm that the GAO measure of 

satisfaction and timeliness (time spent in IDES) are negatively related 

even when holding constant several other variables.

Perceived and actual timeliness had little association at the Transition 

phase. Across all levels of satisfaction with timeliness, the median 

processing time varied by no more than 4 days, and the proportion 

meeting the timeliness goal varied by no more than 4 percentage points. 

The use of personal leave is one plausible explanation for the 

unresponsiveness of servicemember satisfaction to actual processing 

times in the Transition phase. A servicemember might not have been 

dissatisfied with delays if taking leave was the reason, rather than the 

IDES process itself. 

Despite the associations between actual and perceived timeliness at the 

MEB and PEB phases, there were many servicemembers who were 

satisfied or dissatisfied with timeliness that spent similar amounts of time 

in the program. For example, 68 percent of those who said that PEB 

timeliness was “very poor” completed the phase on time, and 55 percent 

of those who said that MEB timeliness was “very good” did not complete 

on time. Among servicemembers who said that MEB timeliness was “very 

good,” the middle 80 percent of processing times ranged from 62 days to 

223 days. The same range for servicemembers who said MEB timeliness 

was “very poor” was 88 to 323 days. As table 12 shows, a similar pattern 

holds for the PEB phase. Although servicemembers tend to be more 

satisfied in MEB and PEB when their cases take less time, many of them 

are highly dissatisfied even when their cases take an unusually short 

amount of time (and vice versa). In the Transition phase, however, 40 

percent of servicemembers who said that timeliness was “very good” 

were processed in 91 to 657 days—a more lengthy range than at the 

other phases. The large range and relationship with satisfaction may 

reflect the use of servicemember leave.

The fact that many servicemembers are similarly satisfied with timeliness, 

even though they can have widely different processing times, has broader 

implications for measuring the performance of IDES. DOD’s timeliness 

goals may not be meaningful to servicemembers or necessarily reflect 
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high-quality service. Alternatively, servicemembers may not use 

reasonable standards to assess the time required to process their cases, 

or they may not accurately perceive the time they have spent in the 

program. In these scenarios, the value of servicemember satisfaction as a 

performance measure becomes less certain.

The relationship between perceived and actual timeliness may simply 

reflect a large amount of unobserved heterogeneity across 

servicemembers. For example, a servicemember whose case has been in 

IDES for an extremely long time might still be highly satisfied with 

timeliness if the case was complex or personal leave was taken during 

the process. Neither the survey nor the VTA data measure these or other 

such characteristics that might affect the program’s key performance 

measures.

The lack of variation in satisfaction across servicemember groups and 

according case timeliness might be seen as a positive outcome, and may 

suggest that DOD and VA administer the program consistently across 

servicemembers and locations. However, the lack of variation also could 

suggest shortcomings in the design and administration of the survey, or in 

data limitations that, alone or together, may reduce the usefulness of 

survey data for program evaluation. For example:

• Survey questions: The survey questions may not be sufficiently 

detailed to measure important differences among 

servicemembers’ experiences. For example, the survey includes 

12 questions (4 per survey) that measure broad opinions about 

IDES, and DOD subsequently averages these responses 

together. This approach may limit the survey’s capacity to 

describe IDES experiences in sufficient detail.

• Precision of DOD indices: DOD reports measures of overall 

satisfaction with IDES for each phase, using the questions in table 

9. However, these measures include one question that asks 

respondents to “evaluate their overall experience since entering 

the IDES process,” which could be influenced by experiences in 

prior phases. Consequently, the satisfaction measures reported 

for each phase could represent a combination of servicemembers’ 

experiences in that phase and prior phases.

• Completing two surveys at once: DOD officials told us that a 

servicemember may be surveyed for the PEB and Transition 

Factors Affecting Survey 

Results and Implications 

for Program Evaluation
Appendix II: Additional Timeliness and 

Satisfaction Analyses

Page 68 GAO-12-676 Military Disability Evaluation

phases in one session. In these instances a large amount of time 

may have passed since the servicemember completed the PEB 

phase and it may be more difficult for the servicemember to 

isolate his or her satisfaction with a particular phase. 

• Survey design: The satisfaction survey is primarily designed to 

measure performance, not explain it. The survey includes many 

highly correlated questions measuring satisfaction with the overall 

process or broad components of it, such as DOD board liaisons, 

VA case managers, or timeliness. While multiple questions can 

improve the statistical reliability and validity of DOD’s performance 

measures, they require costly survey administration time that 

could be used for other purposes, such as to measure a larger 

number of variables that could explain servicemember satisfaction 

or case processing times.

• VTA data limitations: The VTA administrative data that we 

matched to survey data primarily measure processing times and 

basic servicemember demographics, such as service branch, 

component, and treatment facility. The data support detailed 

reporting of performance measures, but they do not measure 

similarly detailed information on the nature of each case that might 

allow DOD and VA to understand the reasons for lengthy case 

processing times or to identify cases that might become delayed 

and ensure that they remain on schedule. For example, the 

database does not measure the type or severity of referred 

medical conditions in detail, the nature of delays experienced 

early in the process, or the use of servicemember leave. In 

addition, little information is available on staffing at or caseloads 

for MEB and PEB locations, DOD board liaisons, or VA case 

managers, which might help to explain or predict performance.

• Low response and coverage rates: The response and coverage 

rates of the satisfaction survey further limit the degree to which 

DOD can generalize the data obtained to the population of 

servicemembers who participate in IDES. In particular, the survey 

does not assess the views of servicemembers who disenroll from 

the process before finishing a stage or those who do not complete 

prior waves of the survey. Including servicemembers who do not 

complete all waves would complicate longitudinal analysis, 

however.
Appendix III: Monthly DOD Timeliness Data for 

Active Duty Cases in Fiscal Year 2012

Page 69 GAO-12-676 Military Disability Evaluation

Table 13 presents data reported by DOD on average processing time for 

active duty cases completed during part of fiscal year 2012—Oct. 2011 to 

June 2012. DOD’s data are provided as a supplement the analyses GAO 

conducted for fiscal years 2008 through 2011.1

Table 13: DOD Reported Monthly Average Processing Times for Active Component Servicemembers in Fiscal Year 2012 (in 

days) 

We did not evaluate the 

reliability of these data and cannot predict the extent to which any trends 

will continue for the rest of the fiscal year.

Time spent in: Goal (days)

Month that IDES process, phase or stage was completed

Oct. 

2011

Nov. 

2011

Dec. 

2011

Jan. 

2012

Feb. 

2012

Mar. 

2012

Apr. 

2012

May 

2012

June 

2012

IDES overall (only cases 

resulting in receipt of 

benefits) 295 395 391 404 395 392 394 400 409 395

MEB phase 100 136 130 128 132 130 124 114 116 122

Medical Exam Stage 45 40 39 41 44 37 37 39 39 39

MEB Stage 35 76 71 73 76 77 72 64 66 69

 PEB phase 120 95 100 104 112 116 111 114 120 122

Informal PEB stage 15 23 28 34 34 28 23 22 19 24

VA Preliminary Rating 

stage 15 26 27 31 34 37 51 58 45 35

Transition phase 45 71 70 69 75 77 76 74 77 74

VA Benefits phase 30 38 36 47 56 49 50 57 66 62

Source: DOD IDES Monthly Reports for April, May June , and July 2012.

Note: This table does not reflect data on all phases or stages of the IDES process. Instead, it 

presents data on those phases and stages that GAO also presented data on in the body of the report.

 

1 DOD calculates timeliness separately for active, reserve, and guard components. 

Because our report includes analysis for active and reserve/guard combined, we are only 

including active servicemembers in this appendix for easy comparison. Active duty cases 

reflect the bulk of cases in fiscal year 2012, as with other fiscal years.

Appendix III: Monthly DOD Timeliness Data 

for Active Duty Cases in Fiscal Year 2012
Appendix IV: Comments from the Department 

of Defense

Page 70 GAO-12-676 Military Disability Evaluation

Appendix IV: Comments from the 

Department of Defense
Appendix IV: Comments from the Department 

of Defense

Page 71 GAO-12-676 Military Disability Evaluation
Appendix V: Comments from the Department 

of Veterans Affairs

Page 72 GAO-12-676 Military Disability Evaluation

Appendix V: Comments from the Department 

of Veterans Affairs
Appendix V: Comments from the Department 

of Veterans Affairs

Page 73 GAO-12-676 Military Disability Evaluation
Appendix VI: GAO Contact and Staff 

Acknowledgments

Page 74 GAO-12-676 Military Disability Evaluation

Daniel Bertoni, (202) 512-7215, bertonid@gao.gov

Michele Grgich (Assistant Director), Daniel Concepcion, Melissa Jaynes, 

and Greg Whitney made significant contributions to all aspects of this 

report. Also contributing to this report were Bonnie Anderson, James 

Bennett, Mark Bird, Joanna Chan, Brenda Farrell, Jamila Jones Kennedy, 

Douglas Sloane, Almeta Spencer, Vanessa Taylor, Jeffrey Tessin, Roger 

Thomas, Walter Vance, Kathleen van Gelder, and Sonya Vartivarian. 

Appendix VI: GAO Contact and Staff 

Acknowledgments 

GAO Contact

Staff 

Acknowledgments 
Related GAO Products

Page 75 GAO-12-676 Military Disability Evaluation

Military Disability System: Preliminary Observations on Efforts to Improve 

Performance. GAO-12-718T (Washington, D.C.: May 23, 2012).

Military and Veterans Disability System: Worldwide Deployment of 

Integrated System Warrants Careful Monitoring. GAO-11-633T

(Washington, D.C.: May 4, 2011).

Military and Veterans Disability System: Pilot Has Achieved Some Goals, 

but Further Planning and Monitoring Needed. GAO-11-69 (Washington, 

D.C.: December 6, 2010).

Military and Veterans Disability System: Preliminary Observations on 

Evaluation and Planned Expansion of DOD/VA Pilot. GAO-11-191T

(Washington, D.C.: November 18, 2010).

Veterans’ Disability Benefits: Further Evaluation of Ongoing Initiatives 

Could Help Identify Effective Approaches for Improving Claims 

Processing. GAO-10-213 (Washington, D.C.: January 29, 2010).

Recovering Servicemembers: DOD and VA Have Jointly Developed the 

Majority of Required Policies but Challenges Remain. GAO-09-728

(Washington, D.C.: July 8, 2009).

Recovering Servicemembers: DOD and VA Have Made Progress to 

Jointly Develop Required Policies but Additional Challenges Remain. 

GAO-09-540T (Washington, D.C.: April 29, 2009).

Military Disability System: Increased Supports for Servicemembers and 

Better Pilot Planning Could Improve the Disability Evaluation Process. 

GAO-08-1137 (Washington, D.C.: September 24, 2008).

DOD and VA: Preliminary Observations on Efforts to Improve Care 

Management and Disability Evaluations for Servicemembers. 

GAO-08-514T (Washington, D.C.: February 27, 2008).

DOD and VA: Preliminary Observations on Efforts to Improve Health Care 

and Disability Evaluations for Returning Servicemembers. GAO-07-1256T

(Washington, D.C.: September 26, 2007).

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.: March 31, 2006).

Related GAO Products

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