Page 1 GAO-13-443R DOD Chiropractor Wage Rates

United States Government Accountability Office

Washington, DC 20548

March 14, 2013

The Honorable Carl Levin

Chairman

The Honorable James N. Inhofe

Ranking Member

Committee on Armed Services

United States Senate

The Honorable Howard P. McKeon

Chairman

The Honorable Adam Smith

Ranking Member

Committee on Armed Services

House of Representatives

Subject: Defense Health Care: DOD Chiropractor Wage Rates

In response to congressional direction in House Report 112-479,1

 the enclosed 

briefing provides information on the wage rates of the Department of Defense’s 

(DOD) federal civilian chiropractors compared with the wages of other federal civilian 

health care professionals within DOD with similar training and education. We 

provided this briefing to the staff from the Senate and House Committees on Armed 

Services on February 4, 2013 and January 29, 2013, respectively. We found that 

DOD employs 90 chiropractors at 62 military treatment facilities as of January 2013. 

Further, the mean salary of DOD’s federal civilian chiropractors is similar to the 

mean salary of those serving in comparable DOD federal civilian health care 

occupations. Specifically, we found that the mean salaries of our selected health 

care professions ranged from approximately $77,000 to approximately $94,000 with

the mean salary for chiropractors approximately 7 percent higher than the lowest 

mean salary and approximately 12 percent lower than the highest mean salary.

Although these health care positions have similar education and training

requirements, they have some different responsibilities.

To identify the number and location of DOD chiropractors that provide care for active 

duty servicemembers, we interviewed DOD officials and requested and analyzed 

information about the number and location of DOD chiropractors. To determine 

wage rates for DOD federal civilian chiropractors and selected DOD federal civilian 

health care professionals, we analyzed salary and GS grade level data. We selected 

 

1 H.R. Rep. No. 112-479, at page 178 (2012).
Page 2 GAO-13-443R DOD Chiropractor Wage Rates

health care positions within DOD that have requirements and health care responsibilities that 

are comparable to chiropractors. Finally, we assessed the reliability of the data source and 

found it sufficiently reliable for our purposes. 

We conducted this performance audit from August 2012 to March 2013 in accordance with 

generally accepted government auditing standards. Those standards require that we plan and 

perform the audit to obtain sufficient, appropriate evidence to provide a reasonable basis for 

our findings based on our audit objectives. We believe that the evidence obtained provides a 

reasonable basis for our findings based on our audit objectives.

In response to a draft of the enclosed briefing slides, DOD provided technical comments that 

have been incorporated as appropriate. We are sending a copy of this report to the appropriate 

congressional committees, Secretary of Defense, the Under Secretary of Defense for 

Personnel and Readiness, and the Assistant Secretary of Defense for Health Affairs. In 

addition, this report will be available at no charge on the GAO Web site at http://www.gao.gov. 

- - - - - 

 

Should you or your staff have any questions concerning this report, please contact me at 

(202) 512-3604 or farrellb@gao.gov. Contact points for our Office of Congressional Relations 

and Public Affairs may be found on the last page of this report. GAO staff who made 

contributions to this report are listed on the last page of the enclosed briefing.

Brenda S. Farrell

Director

Defense Capabilities and Management

Enclosure
DOD Chiropractor Wage Rates 

Briefing to Congressional Staff 

Senate Armed Services Committee • February 4, 2013

House Armed Services Committee • January 29, 2013

Enclosure

Page 1
Contents

• Introduction

• Background

• Objectives

• Scope and Methodology

• GAO Contact and Staff Acknowledgments

Page 2
Introduction

• In 2000, Congress mandated that the Department of Defense (DOD) develop a 

plan to provide chiropractic care as a permanent part of the Defense Health 

Program. 

• Prior to the establishment of DOD’s chiropractic program, Congress 

directed DOD to conduct demonstration projects to evaluate the feasibility 

and advisability of expanding DOD’s health system to include chiropractic 

care. 

• The National Defense Authorization Act for Fiscal Year 1995 directed the 

Secretary of Defense to establish a chiropractic demonstration project at a 

minimum of 10 military treatment facilities for 3 years. 

• Following the demonstration project, DOD reported that providing 

chiropractic care was feasible, but not fiscally practical. 

• In 2012, Congress directed GAO to conduct a study on the wage rates of DOD 

chiropractors compared with the wages of health care professionals with similar 

training; skill sets; licensure requirements; certification requirements; and health 

care responsibilities.

1 

Page 3 1See page 178 of H.R. Rep. No. 112-479, the conference report accompanying the National Defense Authorization Act for Fiscal Year 2013.
Background

• Chiropractic is a health care discipline concerned with 

disorders of the musculoskeletal system—consisting of 

muscles, tendons, ligaments, and bones—and the 

effects of these disorders on the function of the nervous 

system and general health. Chiropractic emphasizes 

manual treatments, including spinal adjustment and 

other joint and soft-tissue manipulation. 

• According to DOD officials, in 2009, DOD gave the 

services the option to convert their chiropractor 

positions from contractor to civilian status; therefore, 

the civilian chiropractor position is new to DOD.

Page 4
Background

Table 1: Timeline of DOD’s Chiropractic Program

Year Event

1984 The DOD Authorization Act of 1985 directed DOD to conduct a demonstration project to evaluate the cost effectiveness of providing chiropractic 

services for active duty service members, retirees, and their dependents.

1993 DOD prepared a report to Congress on the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS) Chiropractic

Demonstration Project. The report stated that after a 2-year demonstration project conducted in two states, DOD did not favor establishing a 

permanent benefit because other types of care had higher priority for the Defense Health Program’s (DHP) limited funds.

1994 The National Defense Authorization Act for Fiscal Year 1995 directed DOD to (1) establish another demonstration program at no fewer than 10 

Military Treatment Facilities for 3 years to evaluate the feasibility and advisability of expanding DOD’s health system to include chiropractic care 

and (2) convene the Oversight Advisory Committee to prepare and submit to Congress a plan for evaluating the program.

1997 The National Defense Authorization Act for Fiscal Year 1998 directed DOD to add 3 additional sites to the demonstration project.

2000 DOD issued its Final Chiropractic Health Care Demonstration Program Report in which it determined that the program was feasible but not 

fiscally practical.

2000 The Floyd D. Spence National Defense Authorization Act for Fiscal Year 2001 directed DOD to develop a plan to provide the chiropractic benefit 

for all active duty members of the military. The act also required GAO to monitor and evaluate the implementation of DOD’s chiropractic care 

program.

2001 DOD issued its implementation plan, which served as an operational framework for implementing its chiropractic benefit.

2005 In its September 2005 report,2 GAO concluded that DOD’s chiropractic program had been implemented at 42 military treatment facilities but that 

DOD had not completed all of the actions described in its implementation plan.

2011 Letters exchanged between members of the House Armed Services Committee and the Assistant Secretary of Defense for Health Affairs

requested that DOD review DOD chiropractor classifications using the Department of Veterans Affairs (VA) classification as a guide.

2012 Congress directed GAO to review the wage rates of DOD chiropractors and report no later than April 1, 2013.

 3

Page 5 2GAO, Defense Health Care: DOD Has Established a Chiropractic Benefit for Active Duty Personnel, GAO-05-890R (Washington, D.C.: Sept. 6, 2005).

3See page 178 of H.R. Rep. No. 112-479, the conference report accompanying the National Defense Authorization Act for Fiscal Year 2013.

Source: GAO analysis of DOD information.
Objectives 

1. Identify the number and location of DOD’s 

chiropractors who provide care for active duty 

servicemembers.

2. Compare the wage rates of DOD’s federal civilian 

chiropractors with the wage rates of other DOD

federal civilian health care professionals with similar 

requirements and health care responsibilities.

Page 6
Objective 1: Identify the number and location of 

DOD’s chiropractors who provide care for active duty 

servicemembers.

DOD employs 90 chiropractors at 62 military treatment facilities. 

The distribution of DOD’s chiropractic care program across the 

services, as of January 2013, is detailed below:

Page 7

Table 2: Distribution of Chiropractors Working for DOD

Service DOD’s federal civilian 

chiropractors

Contracted 

chiropractors

Total chiropractors Military treatment 

facilities

Army 41 0 41 25

Navy 4 20 24 16

Air Force 0 22 22 20

Othera 1 2 3 1 

Total 46 44 90b 62

aThe Joint Task Force National Capital Region Medical Command employs two chiropractors, and another is employed by TRICARE Management 

Activity. 

bThree chiropractors work part-time, two from the Army and one from the Navy. In addition, according to officials, the Army is in the process of hiring 

one additional federal civilian chiropractor and both the Army and the Air Force are in the process of contracting additional chiropractors.

Source: GAO analysis of DOD data.
Objective 2: Compare the wage rates of DOD’s federal civilian chiropractors 

with the wage rates of other DOD civilian health care professionals with 

similar requirements and health care responsibilities.

• The mean salary of DOD’s federal civilian chiropractors is similar to the 

mean salary of comparable DOD federal civilian health care 

occupations.

• All 46 DOD federal civilian chiropractors are employed at the Office of 

Personnel Management (OPM) General Schedule (GS) 12 level. The 

GS is the pay plan for most DOD federal civilians. The pay range for a 

GS 12 position is $60,274 to $78,355, which reflects basic pay only, as 

of fiscal year 2012.

• As of January 2013, the pay range for a DOD federal civilian 

chiropractor is $68,809 to $99,590, which includes both basic pay and 

locality pay.

• The mean DOD federal civilian chiropractor salary is $84,004, which 

includes both basic pay and locality pay. This does not include the 

value of in-kind and deferred benefits, such as those for health care 

insurance or retirement.4 

Page 8 4GAO has previously reported —see GAO, Military Personnel: Military and Civilian Pay Comparisons Present Challenges and Are One of Many Tools in Assessing Compensation, 

GAO-10-561R (Washington, D.C. : Apr.1, 2010)—that when comparing compensation, it is important to assess total compensation. That includes a position’s cash compensation 

or wages in addition to in-kind and deferred benefits. However, for this briefing we did not capture benefits because DOD federal civilians receive the same benefits package.
Objective 2: Compare the wage rates of DOD’s federal civilian chiropractors 

with the wage rates of other DOD federal civilian health care professionals 

with similar requirements and health care responsibilities.

5 DOD federal civilian salary information is as of January 31, 2013, and reflects both basic and locality pay. Page 9

The DOD federal civilian 

chiropractor mean salary5

is similar to the mean 

salary of comparable 

DOD federal civilian 

health care occupations. 

Our comparison of mean 

salaries for the selected 

positions shows they are 

within 12 percent of the 

chiropractor salary. While 

these positions have 

similar education and 

training, they have some 

different responsibilities.

Figure 1: Annual Salary Range for Selected Civilian Medical Positions at DOD 
Objective 2: Compare the wage rates of DOD’s federal civilian chiropractors 

with the wage rates of other DOD federal civilian health care professionals 

with similar requirements and health care responsibilities.

Page 10

Source: GAO analysis of DOD information.

DRAFT

Table 3: Description of Selected DOD Health Care Positionsa

Occupation Education/Training Licensure Certification

Chiropractor Doctor of Chiropractic degree: 7 years of total education = 3 

years of undergraduate education + 4-year degree from a 

program accredited by the Council on Chiropractic Education; 

National Board of Chiropractic Examiners Part IV Examination

A current, active, valid, and 

unrestricted license in chiropractic 

practice in a U.S. state or in the 

District of Columbia

Optional; None required

Physical 

Therapist

Masters or doctoral degree in physical therapy: 6 to 8 years 

total education from a program accredited by the American 

Physical Therapy Association Commission on Accreditation in 

Physical Therapy Education; National Physical Therapy

Examination

A current, full, and unrestricted 

license in physical therapy practice 

in a U.S. state or in the District of 

Columbia

Optional; Additional certifications 

may be required to perform 

advanced clinical privileges

Occupational 

Therapist

Masters or doctoral degree in occupational therapy from a 

program accredited by the Accreditation Council for 

Occupational Therapy Education, including completion of a 

clinical internship of at least 6-months’ duration

A current, unrestricted license to 

practice occupational therapy in a 

U.S. state or in the District of 

Columbia

Optional; however, current 

certification from the National 

Board for Certification in 

Occupational Therapy is required 

for the Army

Physician 

Assistant 

Masters degree from a Physician Assistant Training Program 

accredited by the Accreditation Review Commission on 

Education for the Physician Assistant

A current, unrestricted license in a 

U.S. State or in the District of 

Columbia 

Yes, current certification by 

passing the Physician Assistant 

National Certifying Examination

before clinical privileges are 

granted

Optometrist Doctor of Optometry degree: 8 years of total education = 4- 

year undergraduate degree + 4-year degree from a program 

accredited by the Council on Optometric Education.

A current, unrestricted license as an 

optometrist in a U.S. state or in the 

District of Columbia

Optional; None required

a These positions were selected for comparison with the chiropractors because they have similar post and undergraduate education 

requirements, licensure and certification requirements, and types of responsibilities.
Objective 2: Compare the wage rates of DOD’s federal civilian chiropractors 

with the wage rates of other DOD federal civilian health care professionals 

with similar requirements and health care responsibilities.

• In addition to identifying the wage ranges and mean salaries 

of select DOD federal civilian health care positions, we also 

identified the grade levels of these positions on the OPM 

General Schedule.

• According to officials, DOD used chiropractor position 

descriptions and OPM’s guidance to classify and grade its 

federal civilian chiropractors at the appropriate GS grade 

level.

Page 11
Objective 2: Compare the wage rates of DOD’s federal civilian chiropractors 

with the wage rates of other DOD federal civilian health care professionals 

with similar requirements and health care responsibilities.

• As of January 2013, all DOD federal civilian chiropractors 

were GS grade level 12. Most federal civilians in the other 

selected health care positions we reviewed were in the GS 

11 and 12 grade levels; however, some were at the GS 9, 

GS 13, and GS 14 grade levels.

• According to DOD officials, DOD civilian chiropractors are 

currently not above the GS 12 grade level because they 

represent a small population, and DOD has not identified a need for chiropractors at the GS 13 grade level based on job responsibilities, such as supervision. 

• For example, DOD has almost 6 times more civilian 

physical therapists and over 15 times more civilian 

physician assistants than civilian chiropractors.

• See table 4 on page 13 for the distribution of GS grade 

levels for the selected health care positions.

Page 12
Table 4: General Schedule (GS) Distribution of Selected DOD Civilian Health Care Professionals

Occupation GS 09 GS 11 GS 12 GS 13 GS 14 Total

Chiropractor 46 46

Physical Therapist 7 160 95 7 1 270

Occupational 

Therapist

3 69 68 8 1 149

Physician Assistant 4 115 559 35 713

Nurse Practitionera 6 108 474 148 1 737

Optometrist 6 84 12 1 103

Page 13

Objective 2: Compare the wage rates of DOD’s federal civilian 

chiropractors with the wage rates of other DOD federal civilian health care 

professionals with similar requirements and health care responsibilities.

Source: GAO analysis of DOD data.

aBecause they typically have more specialized training, this analysis does not include nurse midwives and nurse anesthetists in the nurse 

practitioner occupation. 
Scope and Methodology

• To identify the number and location of DOD 

chiropractors that provide care for active duty 

servicemembers, we included in our scope all DOD 

chiropractors—those contracted and those working as 

DOD federal civilians—in the Army, the Navy, and the 

Air Force as of January 2013.

• For the comparison of wage rates and GS grade levels, 

we included in our scope DOD’s federal civilian 

chiropractors and DOD federal civilian health care 

positions that we identified based on the criteria in the 

mandate. These data are from DOD’s system of record 

for civilian personnel as of January 2013.

Page 14

DRAFT
Scope and Methodology

To identify the number and location of DOD chiropractors, we

• interviewed DOD officials from the

• Office of the Assistant Secretary of Defense for Health 

Affairs, TRICARE Management Activity

• Military Health System Chief Human Capital Office

• Army Office of the Surgeon General/Medical Command

• Naval Medical Logistics Command

• Navy Bureau of Medicine

• Air Force Commodity Council

• requested and analyzed information about the number, 

location, and employer of chiropractors working for DOD.

Page 15

DRAFT
Scope and Methodology

To identify health care positions within DOD that have somewhat 

comparable training, skill sets, licensure requirements, 

certification requirements, and health care responsibilities, we

• obtained and reviewed military service position descriptions 

for chiropractors and other health care professionals and 

compared the positions using the criteria identified in the 

mandate

• interviewed DOD officials from the Office of the Assistant 

Secretary of Defense for Health Affairs, the Military Health 

System Chief Human Capital Office

• reviewed relevant reports and congressional correspondence 

from DOD.

Page 16

DRAFT
Scope and Methodology

To determine wage rates for DOD federal civilian 

chiropractors and other identified DOD federal civilian 

health care professionals, we 

• requested, analyzed, and assessed the reliability of 

salary and GS grade level data from the Defense 

Civilian Personnel Data System, the system of record 

for DOD’s civilian personnel data. We found these data 

reliable for the purposes of our work.

• compared the wage range and mean wage of DOD 

federal civilian chiropractors with DOD federal civilian 

health care professions that we determined to be 

comparable. 

Page 17

DRAFT
Scope and Methodology

• We provided DOD with the opportunity to review these 

slides, and its comments were incorporated as appropriate.

• We conducted this performance audit from August 2012 

through March 2013 in accordance with generally accepted 

government auditing standards. Those standards require 

that we plan and perform the audit to obtain sufficient, 

appropriate evidence to provide a reasonable basis for our 

findings based on our audit objectives. We believe that the 

evidence obtained provides a reasonable basis for our 

findings based on our audit objectives.

Page 18

DRAFT
GAO Contact and Staff Acknowledgments

• For more information on this subject, please contact 

Brenda S. Farrell at (202) 512-3604 or farrellb@gao.gov

• In addition to the contact named above, Lori Atkinson 

(Assistant Director), Edward Anderson, Jr., Timothy Carr, 

Grace Coleman, Sara Cradic, Cynthia Grant, Kelly Rubin, 

Amie Steele, and Michael Willems made key contributions to 

this briefing.

(351763) Page 19

DRAFT
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