Military Disability System: Improved Oversight Needed to Ensure Consistent and Timely Outcomes for Reserve and Active Duty Service Members
Published: 2006-03-31T00:00:00

Fast Facts:

Highlights:
section_title: Why GAO Did This Study
paragraphs: The House Committee on Armed Services report that accompanies the National Defense Authorization Act of fiscal year 2006 directs GAO to review results of the military disability evaluation system. In response to this mandate, GAO determined: (1) how current DOD policies and guidance for disability determinations compare for the Army, Navy, and Air Force, and what policies are specific to reserve component members of the military; (2) what oversight and quality control mechanisms are in place at DOD and these three services of the military to ensure consistent and timely disability decisions for active and reserve component members; and (3) how disability decisions, ratings, and processing times compare for active and reserve component members of the Army, the largest branch of the service, and what factors might explain any differences.
section_title: What GAO Found
paragraphs: Policies and guidance for military disability determinations differ somewhat among the Army, Navy, and Air Force. DOD has explicitly given the services the responsibility to set up their own processes for certain aspects of the disability evaluation system and has given them latitude in how they go about this. As a result, each service implements its system somewhat differently. Further, the laws that govern military disability and the policies that DOD and the services have developed to implement these laws have led reservists to have different experiences in the disability system compared to active duty members. For example, because reservists are not on active duty at all times, it takes longer for them to accrue the 20 years of service that may be needed to earn monthly disability retirement benefits. While DOD has issued policies and guidance to promote consistent and timely disability decisions for active duty and reserve disability cases, DOD is not monitoring compliance. To encourage consistent decision making, DOD requires all services to use multiple reviewers to evaluate disability cases. Furthermore, federal law requires that reviewers use a standardized disability rating system to classify the severity of the medical impairment. In addition, DOD periodically convenes the Disability Advisory Council, comprised of DOD and service officials, to review and update disability policy and to discuss current issues. However, neither DOD nor the services systematically determine the consistency of disability decision making. DOD has issued timeliness goals for processing disability cases, but is not collecting information to determine compliance. Finally, the consistency and timeliness of decisions depend, in part, on the training that disability staff receive. However, DOD is not exercising oversight over training for staff in the disability system. While GAO's review of the military disability evaluation system's policies and oversight covered the three services, GAO examined Army data on disability ratings and benefit decisions from calendar year 2001 through 2005. After controlling for many of the differences between reserve and active duty soldiers, GAO found that, among soldiers who received disability ratings, the ratings of reservists were comparable to those of active duty soldiers with similar conditions. GAO's analyses of the military disability benefit decisions for the soldiers who were determined to be unfit for duty were less definitive, but suggest that Army reservists were less likely to receive permanent disability retirement or lump sum disability severance pay than their active duty counterparts. However, data on possible reasons for this difference, such as whether the condition existed prior to service, were not available for our analysis. GAO did not compare processing times for Army reserve and active duty cases because GAO found that Army's data needed to calculate processing times were unreliable. However, Army statistics based on this data indicate that from fiscal 2001 through 2005, reservists' cases took longer to process than active duty cases.

section_title: Letter
paragraphs: In recent years, about 490,000 reserve members of the military have been  In recent years, about 490,000 reserve members of the military have been  called to augment active duty military forces in conflicts and peace- called to augment active duty military forces in conflicts and peace- keeping missions in support of the Global War on Terrorism. About  keeping missions in support of the Global War on Terrorism. About  110,000 mobilized reserve component members were on active duty on  110,000 mobilized reserve component members were on active duty on  January 31, 2006, down from about 174,000 the prior January. A number of  January 31, 2006, down from about 174,000 the prior January. A number of  these service members get injured or develop temporary or permanent  these service members get injured or develop temporary or permanent  disabilities related to their service, such as head, neck or spinal injuries  disabilities related to their service, such as head, neck or spinal injuries  and psychological conditions such as post-traumatic stress disorder.  and psychological conditions such as post-traumatic stress disorder.
The Department of Defense (DOD), through its disability evaluation  The Department of Defense (DOD), through its disability evaluation  system, is responsible for determining if active and reserve service  system, is responsible for determining if active and reserve service  members are unable to perform the military duties of their office, grade,  members are unable to perform the military duties of their office, grade,  rank, or rating as a result of a diagnosed medical condition and  rank, or rating as a result of a diagnosed medical condition and  compensating those with service-incurred or aggravated injuries or  compensating those with service-incurred or aggravated injuries or  diseases that render them unfit for continued military service. One of the  diseases that render them unfit for continued military service. One of the  primary goals of the military disability system is to ensure that disability  primary goals of the military disability system is to ensure that disability  evaluations for all service members are conducted in a consistent and  evaluations for all service members are conducted in a consistent and  timely manner. Each of the services administers its own disability  timely manner. Each of the services administers its own disability  evaluation system and assigns a standardized severity rating, from 0 to   evaluation system and assigns a standardized severity rating, from 0 to   100 percent, to each disabling condition, which along with years of service  100 percent, to each disabling condition, which along with years of service  and other factors, determines compensation. Disability compensation may  and other factors, determines compensation. Disability compensation may  be in the form of lump sum payments or monthly benefits, depending on  be in the form of lump sum payments or monthly benefits, depending on  the rating and years of service.  the rating and years of service.
The House Committee on Armed Services report that accompanies the  The House Committee on Armed Services report that accompanies the  National Defense Authorization Act of fiscal year 2006 directs GAO to  National Defense Authorization Act of fiscal year 2006 directs GAO to  review results of the military disability evaluation system. In response to  this mandate, GAO determined: (1) how current DOD policies and  guidance for disability determinations compare for the Army, Navy, and  Air Force, and what policies are specific to reserve component members  of the military; (2) what oversight and quality control mechanisms are in  place at DOD and these three services of the military to ensure consistent  and timely disability rating and benefit decisions for active and reserve  component members; and (3) how disability rating and benefit decisions,  and processing times compare for active and reserve component members  of the Army, the largest branch of the service, and what factors might  explain any differences.
To address the first two objectives covering DOD and three branches of  the service, we reviewed relevant legislation, policy guidance, and  literature; interviewed officials from DOD, Army, Navy, Air Force,  Reserves, and National Guard; and visited Lackland and Randolph Air  Force Bases, Fort Sam Houston and Walter Reed Army Medical Center,  Washington Navy Yard and Bethesda Naval Hospital and interviewed  relevant officials. We chose these sites because the services conduct  physical disability evaluations at these locations. In addition, we  interviewed officials from military treatment facilities (MTF), including  Brooke Army Medical Center and Wilford Hall Medical Center. We limited  the scope of the third objective to the Army because it currently processes  the most military disability cases. To determine if outcomes for active duty  and reserve disability cases were statistically consistent, we analyzed data  provided by the Army. Based on our assessment of the quality of the  Army’s data, we concluded that data on disability determinations and  ratings were sufficiently reliable for our analyses. On the other hand, the  Army’s data on processing times were not reliable for our analyses. Except  for the Army data used in our analyses, we did not test the reliability of  other data we received from the services and DOD. While GAO has noted  in its 21st Century Challenges report that eligibility criteria for disability  programs need to be brought into line with the current state of science,  medicine, technology and labor market conditions, this study does not  examine the basic eligibility criteria for military disability benefits. We  conducted our review from June 2005 through January 2006 in accordance  with generally accepted government auditing standards. A detailed  description of our scope and methodology is provided in appendix I.
subsections: section_title: Background
paragraphs: As provided by the Career Compensation Act of 1949, as amended, service  members who become physically unfit to perform military duties may  receive military disability compensation under certain conditions.
Compensation for disabilities can be in the form of monthly disability  retirement benefits or a lump sum disability severance payment,  depending on the disability rating and years of creditable service. To  qualify for monthly disability retirement benefits, a service member with a  permanent impairment that renders him or her unfit for duty must have   (1) at least 20 years of creditable service or (2) a disability rating of at least  30 percent. Service members with less than 20 years of creditable service  and a disability rating less than 30 percent receive a lump sum severance  disability payment.
Service members with service connected disabilities may also be eligible  for VA disability compensation. Until recently, this military benefit was  offset by any VA compensation received. However, the fiscal year 2004  National Defense Authorization Act now allows some military retirees to  concurrently receive VA and military benefits. Generally, military  disability retirement pay is taxable. Exceptions are (1) if the disability pay  is for combat-related injuries or (2) if the service member was in the  military, or so obligated, on September 24, 1975.
subsections: section_title: The Disability Evaluation Process
paragraphs: Each of the military services administers its own disability evaluation  process. According to DOD regulations, the process should include a  medical evaluation board (MEB), a physical evaluation board (PEB), an  appellate review process, and a final disposition. Each service member  should be assigned a Physical Evaluation Board Liaison Officer (PEBLO),  a counselor to help the service member navigate the system and prepare  documents for the PEB.
As shown in figure 1, there are a number of steps in the disability  evaluation process and several factors that play a role in the decisions that  are made at each step. There are four possible outcomes in the disability  evaluation system. A service member can be  found fit for duty;    separated from the service without benefits—service members whose  disabilities were incurred while not on duty or as a result of intentional  misconduct are discharged from the service without disability benefits;    separated from the service with lump sum disability severance pay; or retired from the service with permanent monthly disability benefits or  placed on the temporary disability retired list (TDRL).
section_title: Medical Evaluation Board
paragraphs: The disability evaluation process begins at a military treatment facility  (MTF), when a physician identifies a condition that may interfere with a  service member’s ability to perform his or her duties. The physician  prepares a narrative summary detailing the injury or condition. DOD  policy establishes the date of dictation of the narrative summary as the  beginning of the disability evaluation process. This specific type of  medical evaluation is for the purpose of determining if the service member  meets the military’s retention standards, according to each service’s  regulations. This process is often referred to as a medical evaluation  board (MEB). Service members who meet retention standards are  returned to duty, and those who do not are referred to the physical  evaluation board (PEB).
section_title: Physical Evaluation Board
paragraphs: The PEB is responsible for determining whether service members have  lost the ability to perform their assigned military duties due to injury or  illness, which is referred to as being “unfit for duty”. If the member is  found unfit, the PEB must then determine whether the condition was  incurred or permanently aggravated as a result of military service. While  the composition of the PEB varies by service, it is typically composed of  one or more physicians and one or more line officers. Each of the services  conducts this process for its service members. The Army has three PEBs  located at Fort Sam Houston, Texas; Walter Reed Army Medical Center in  Washington, D.C.; and Fort Lewis, Washington. The Navy has one located  at the Washington Navy Yard in Washington, D.C. The Air Force has one  located in San Antonio, Texas.
The first step in the PEB process is the informal PEB—an administrative  review of the case file without the presence of the service member. The  PEB makes the following findings and recommendations regarding  possible entitlement for disability benefits:    Fitness for duty—The PEB determines whether or not the service  member “is unable to reasonably perform the duties of his or her office,  grade, rank, or rating,” taking into consideration the requirements of a  member’s current specialty. Fitness determinations are made on each  medical condition presented. Only those medical conditions which  result in the finding of “unfit for continued military service” will  potentially be compensated. Service members found fit must return to  duty.
Compensability—The PEB determines if the service member’s injuries  or conditions are compensable, considering whether they existed prior  to service (referred to as having a pre-existing condition) and whether  they were incurred or permanently aggravated in the line of duty.  Service members found unfit with noncompensable conditions are  separated without disability benefits.
Disability rating—When the PEB finds the service members unfit and  their disabilities are compensable, it applies the medical criteria  defined in the Veterans Administration Schedule for Rating Disabilities  (VASRD) to assign a disability rating to each compensable condition.  The PEB then determines (or calculates) the service member’s overall  degree of service connected disability. Disability ratings range from   0 (least severe) to 100 percent (most severe) in increments of 10  percent. Depending on the overall disability rating and number of  years of active duty or equivalent service, the service member found  unfit with compensable conditions is entitled to either monthly  disability retirement benefits or lump sum disability severance pay.
In disability retirement cases, the PEB considers the stability of the  condition. Unstable conditions are those for which the severity might  change resulting in higher or lower disability ratings. Service members  with unstable conditions are placed on TDRL for periodic PEB  reevaluation at least every 18 months. While on TDRL, members receive  monthly retirement benefits. When members on TDRL are determined to  be fit for duty, they may choose to return to duty or leave the military at  that time. Members who continue to be unfit for duty after 5 years on  TDRL are separated from the military with monthly retirement benefits,  discharged with severance pay, or discharged without benefits, depending  on their condition and years of service.
Service members have the opportunity to review the informal PEB’s  findings and may request a formal hearing with the PEB; however, only  those found unfit are guaranteed a formal hearing. The formal PEB  conducts a de novo review of referred cases and renders its own decisions  based upon the evidence. At the formal PEB hearing, service members can  appear before the board, put forth evidence, introduce and question  witnesses, and have legal counsel help prepare their cases and represent  them. The military will provide military counsel or service members may  retain their own representative. If service members disagree with the  formal PEB’s findings and recommendations, they can, under certain  conditions, appeal to the reviewing authority of the PEB. Once the service  member either agrees with the PEB’s findings and recommendations or  exhausts all available appeals, the reviewing authority issues a final  disability determination concerning fitness for duty, disability rating, and  entitlement to benefits.
section_title: Disability Evaluation System Caseloads
paragraphs: In 2005, over 23,000 U.S. service members with physical injuries or other  conditions went through the military disability evaluation system,  according to DOD. In total, the Army, Navy, and Air Force report  evaluating over 90,000 PEB cases during the fiscal years 2001 to 2005. The  Army represents the largest share of disability cases, with Army reserve  component members representing approximately 32 percent of all Army  cases in 2005 (see table 1). PEB disability caseloads for all services have  increased over time from about 15,000 in fiscal year 2002 to about 23,000  in fiscal year 2005.
section_title: Military Disability Retirement Expenditures
paragraphs: In fiscal year 2004, the military services spent over $1 billion in disability  retirement benefits for over 90,000 service members. See table 2.  This  table does not include expenditures for lump sum disability payments  which DOD was unable to provide.
section_title: Oversight
paragraphs: The Secretary of Defense oversees the military disability evaluation  system through the Under Secretary of Defense for Personnel and  Readiness. The Surgeons General for each service are responsible for  overseeing their service’s MTFs, including the MEBs conducted at each  facility. The Deputy Under Secretary of Defense for Military Personnel  Policy has oversight of the PEBs, and also oversees the Disability Advisory  Council. The council is composed of officials from DOD’s offices of  Military Personnel Policy, Health Affairs, and Reserve Affairs, the services’  disability agencies; and the Department of Veterans Affairs. See fig. 2.
section_title: Military Disability Policies Differ among the Services, and Certain Policies May Result in Different Experiences for Reservists
paragraphs: The policies and guidance for disability determinations for all service  members are somewhat different among the Army, Navy, and Air Force.  DOD has explicitly given the services the responsibility to set up their own  processes for some aspects of the disability system and has given the  services much room for interpretation. Each service has implemented its  system somewhat differently. For example, the composition of decision  making bodies differs across the services. Additionally, the laws that  govern military disability and the policies that DOD and the services have  developed to implement these laws have led to reserve members having  different experiences with the disability system than active duty members.  Some of these experiences result from the part-time nature of reserve  service while others are the consequence of policies and laws specific to  reservists.
subsections: section_title: DOD Policies and Guidance Allow Services to Implement the Disability System Differently
paragraphs: DOD regulations establish some parameters for the disability system and  provide guidelines to the services, and the services each have their own  regulations in accordance with these. Specifically, the aspects of the  system that differ among the services include: characteristics of the  medical evaluation board (MEB) and physical evaluation board (PEB), the  use of counselors to help service members navigate the system, and  procedures to make line of duty determinations. Appendix III provides a  compilation of these and other differences.
subsections: section_title: Medical Evaluation Boards
paragraphs: DOD regulations require that each service set up MEBs to conduct medical  evaluations to determine if the service member meets retention standards  according to each service’s regulations. The services carry out MEB  procedures differently. For example, the Air Force MEB convenes an  actual board of physicians who meet regularly and vote to decide whether  a service member meets retention standards. In the Army and Navy, in  contrast, the MEB is an informal procedure. A service member’s case file  is passed among the board’s members, who separately evaluate it. In all of  the services, the medical commander or his designee may sign off on the  final decision. The services also differ in the qualifications and  requirements for MEB board membership. The Army and Navy require that  at least two physicians serve on an MEB, while the Air Force requires  three.
section_title: Physical Evaluation Boards
paragraphs: In accordance with DOD regulations, the military services have set up  PEBs to evaluate whether service members are fit for duty. DOD  regulations provide no guidance concerning how much time a service  member has to decide whether to accept the disability decision of his or  her informal PEB. Army provides service members 10 calendar days; Navy  provides 15 calendar days; and Air Force provides 3 duty days, according  to their regulations. Additionally, DOD regulations provide that service  members found unfit for duty by an informal PEB are guaranteed the right  to appeal to a formal PEB. However, service members found fit are not  guaranteed the right to appear before a formal PEB.
While DOD regulations state that a service member has the right to appeal  the decision of a formal PEB, they do not state what this appeal process  should look like. The services differ in how many appeal opportunities  they offer service members after the formal PEB. For example, the Navy  and Air Force offer two opportunities for appeal after the formal PEB. The  Army also has two opportunities for appeal. However, it also has the Army  Physical Disability Appeal Board, which provides appeal for only certain  cases, for example, if the Army Physical Disability Agency revises the  finding of the PEB during a quality or mandatory review and the soldier  disagrees with the change (see table 3).
Further, the services also differ on whether they permit the same members  to sit on the informal and formal PEB of the same case. The Army allows  PEB members to do this while the Air Force only allows this under certain  circumstances. The Navy has no written policy on the matter, although  one official from the Navy PEB indicated that the members of the two  boards were often the same for a case.
section_title: Physical Evaluation Board Liaison Officers
paragraphs: The point at which PEBLOs become involved in the disability evaluation  system and the training PEBLOs receive differ between the services. DOD  regulations require that each service provide members counseling during  the disability evaluation process and outline the responsibilities of these  counselors. For example, they are expected to discuss with service  members their rights, the effects of MEB and PEB decisions, and available  benefits.
Each service has created PEBLOs in accordance with these rules, but the  services have placed the PEBLOs under different commands. In the Army  and Air Force, PEBLOs are the responsibility of the medical command. In  the Navy, in contrast, the PEBLO responsibility is shared by the PEB and  MTF. Further, the services involve PEBLOs at different points in the  disability process. In the Army and Air Force, PEBLOs begin counseling  the service member at the MEB level of the disability process. However,  while Navy, officials told us that PEBLOs provide counseling at the MEB  level, some PEBLOs we interviewed told us that they begin counseling  members after the informal PEB has issued its decision. At some MTFs,  case managers provide counseling for service members going through the  disability evaluation process. The services also differ in their training of  PEBLOs. The Army holds an annual conference for PEBLOs and provides  on-the-job training. The Navy relies primarily on on-the-job training and  also offers quarterly and annual training. The Air Force also relies heavily  on on-the-job training and, until recently, held regular training for PEBLOs.
section_title: Line of Duty Determinations
paragraphs: As required by law, a service member may receive disability compensation  for an injury or illness that was incurred or permanently aggravated while  in the line of duty. Generally, the military services document that an injury  occurred in the line of duty by filling out a form or noting it in the service  member’s health record. Typically, a service member’s commanding  officer is responsible for this action, according to the service’s policies.  Unlike the Army and Navy, the Air Force always requires a line of duty  determination for reservists.
DOD regulations state that an injury is presumed to have been in the line  of duty when it clearly resulted from enemy or terrorist attack, regardless  of whether the member is a reserve or active duty member. However, if  the injury may have resulted from misconduct or willful negligence, DOD  requires the military services to investigate and determine whether the  injury did, in fact, occur in the line of duty. The line of duty determination  is a complicated process involving a number of people, such as the  examining medical official and higher commands. DOD gives the services  responsibility for creating the procedures for conducting line of duty  determinations, and there are some technical differences in the processes  among the services. For example, the services have different rules  regarding how long this process should take. The Army and the Air Force  place time frames on the process, while the Navy does not.
section_title: DOD and the Services Have Established Policies That Result in Different Experiences with the Disability System for Reservists
paragraphs: The laws that govern the military disability system and the policies and  guidance that DOD and the services have developed to implement the laws  can result in different experiences with the disability system for reservists.  Some of these differences are due to the part-time nature of reserve  service, while others result from laws and policies specific to reservists.
subsections: section_title: Twenty Years of Service Requirement for Disability Retirement
paragraphs: Because they are not on duty at all times, reservists take longer to accrue  the 20 years of service that may be needed to earn the monthly disability  retirement benefit when the disability rating is less than 30 percent. For  example, an active duty service member who enlisted in the Army in 1985  and stayed on continuous active duty would have 20 years toward  disability retirement by 2005. An Army reservist who enlisted at the same  time, met his training obligations, and had been activated for 1 year would  have roughly 5 years and 9 months toward disability retirement by 2005,  according to the formula the Army uses to determine years of service  toward disability retirement benefits. All three services use the same  formula when calculating the 20 years of service requirement for disability  retirement benefits.
section_title: Eight Years of Service Requirement for Compensation for Preexisting Conditions
paragraphs: The part-time status of reservists also makes it more difficult for reservists  with preexisting conditions to be covered by the 8-year rule and therefore  eligible for compensation. By law, service members with at least 8 years of  active duty service are entitled to compensation even if their conditions  existed before the beginning of their military service or were not service  aggravated. This entitlement only applies to reservists when they are on  ordered active duty of more than 30 days at the time of PEB adjudication.   For reservists, accruing the 8 years necessary for a condition to be  covered by this rule can be more difficult than for active duty service  members. For example, an active duty service member who enlisted in the  Army in 1997 and stayed on continuous active duty would have 8 years  toward disability retirement by 2005. A reservist who enlisted at the same  time, met his training obligations, and has been activated for 2 years would  have roughly 1 year and 3 months of service, according to the Army’s   8-year rule formula and would not be eligible for compensation for a  preexisting condition. Further, the services differ slightly in how they  calculate the 8 years for reservists. The Army and Navy calculate the 8  years differently from the 20 year requirement, but the Air Force uses the  same formula for both. The Army and Navy count only active duty time,  while the Air Force also counts time spent in other activities, such as  continuing education.
section_title: Line of Duty Determinations
paragraphs: Officials reported that commanders and others responsible for completing  line of duty determinations were often uncertain as to when line of duty  determinations were necessary for reservists and active duty members.  Moreover, these officials noted that in some cases, the necessary line of  duty determinations were not made, resulting in delays for service  members. For example, Air Force officials we spoke with had different  impressions as to whether line of duty determinations were always  required for reservists, even though Air Force regulations state they are.  Officials from the Army and Army National Guard similarly offered  different perspectives on the need for line of duty determinations for  reservists.
section_title: Medical Holdover
paragraphs: In the Army, deployed active duty soldiers return to their unit in a back up  capacity when they are injured or ill. However, mobilized injured or ill  Army reservists have no similar unit to return to. Consequently, they may  be removed from their mobilization orders and retained on active duty in  “medical holdover status” and assigned to a unit, such as a medical  retention processing unit. While in medical holdover status, reservists  may live on base, at a military treatment facility, at home or other  locations. After their mobilization orders expire, they can elect to continue  on active duty through a program such as medical retention processing,  which allows them to continue receiving pay and benefits. Between 2003  and 2005 the Army reports that about 26,000 reservists entered medical  holdover status (see appendix II).
Unlike most injured active duty soldiers, reservists in medical holdover  generally live farther from their families than active duty members  because the units at military medical facilities are often far from where  their families live. In certain cases reservists in medical holdover may  receive treatment and recuperate at home. The Army’s Community-Based  Health Care Organizations (CBHCOs) provide medical and case  management for these reservists living at home as they receive medical  care in their communities. As of December 2005, about 35 percent of the  reservists in medical holdover were being cared for in the CBHCO  program. In order to be assigned to the CBHCO program, reservists must  meet a number of criteria. For example, reservists must live in  communities where they can get appropriate care, and they must also be  reliable in keeping medical appointments.
section_title: DOD Has Guidance in Place to Promote Consistent and Timely Decisions, but Does Not Adequately Oversee Key Aspects of the Disability System
paragraphs: DOD has policies and guidance to promote consistent and timely disability  decisions, but is not monitoring whether the services are compliant.  Neither DOD nor the services systematically determine the consistency of  decision making, which would be a key component of quality assurance.  With regard to timeliness, DOD has issued goals for processing service  members’ cases but is not collecting available information from the  services, and military officials have expressed concerns that the goals may  not be realistic. Finally, DOD is not exercising any oversight over training  for staff in the disability system, despite being required to do so.
subsections: section_title: DOD Requires All Services to Use a Common Ratings System and Multiple Reviewers and Convenes a Disability Council
paragraphs: To encourage consistent decision making, DOD policies require that  service members’ case files undergo multiple reviews and federal law  requires that disability ratings be based on a common schedule. During  both the MEB and PEB stages of the disability process, a service member’s  case must be reviewed and approved by several officials with different  roles. When rating the severity of a service member’s impairment, all  services are required to use a common schedule, VA’s Schedule for Rating  Disabilities (VASRD), in accordance with federal law. The VASRD is a  descriptive list of medical conditions along with associated disability  ratings. For example, if a service member has x-ray evidence of  degenerative arthritis affecting two or more joints, “with occasional  incapacitating exacerbations,” he or she should receive a rating of   20 percent according to the VASRD.
DOD also convenes the Disability Advisory Council, which DOD officials  told us is the primary oversight body of the disability system. The  disability council is composed of key officials from the three disability  agencies of the services, the VA, and relevant DOD officials from the  health affairs, reserve affairs, and personnel departments. The council’s  mission is to monitor the administration of the disability system and,  according to DOD officials, the council serves as a forum to discuss issues  such as rules changes and increasing coordination among the services.  Currently, the disability council is facilitating a review and revision of all  DOD regulations pertaining to the disability system. Military officials view  the council as a group that aims to meet quarterly to discuss issues raised  by the services. By having these meetings, DOD hopes to bring all of the  services “on the same page” when it comes to the disability system.  However, military officials reported that the council has not met quarterly  in the past year and generally does not produce formal reports for the  DOD chain of command. Furthermore, the disability council is staffed by  one person at DOD who has additional responsibilities.
Military officials also regard the appeals process as helping to ensure the  consistency of disability evaluation decision making. However, not all  service members appeal. In addition, during the appeals process additional  evidence may be presented that may result in a different outcome for the  same case. Furthermore, the appeals process is designed to determine  whether the correct decision was made, rather than whether consistent  decisions were made across comparable cases.
section_title: Lack of Oversight by DOD and the Services Provides Little Assurance Decisions Are Consistent
paragraphs: Despite this policy guidance and the presence of the disability council,  both DOD and the three services lack quality assurance mechanisms to  ensure that decisions are consistent. Given that one of the primary goals of  the disability system is that disability evaluations take place in a consistent  manner, collecting and analyzing the service members’ final disability  determinations are critical for ensuring that decisions are consistent. DOD  regulations recognize this and require that the agency establish necessary  reporting requirements to monitor and assess the performance of the  disability system and compliance with relevant DOD regulations. Yet, DOD  does not collect information from the services on the final disability  determinations and personal characteristics of service members going  through the disability system.
In addition, DOD has not established quality parameters for the services to  follow to evaluate the consistency of decision making. As a result, the  services generally lack a robust quality assurance process. In our past  work on federal disability programs, we have recommended that quality  assurance have two components: (1) the use of multivariate regression  analysis examining disability decisions along with controlling factors to  determine whether the decisions are consistent and (2) an in depth  independent review of a statistically valid group of case files to determine  what factors may contribute to inconsistencies. However, the services  were unable to provide any evidence that they are conducting statistical  reviews – such as multivariate regression analysis – on their data to  determine the consistency of decision making for service members with  similar characteristics. Furthermore, while we found that the Army is  conducting independent reviews of 25 to 30 percent of its PEB cases, the  Navy and Air Force conduct these reviews only when a service member  appeals the PEB’s decision. Additionally, these reviews reflect how a  single case’s medical evidence supports the dispositions made (accuracy)  rather than the degree to which decisions in cases, in general, with similar  impairments and characteristics compare (consistency). Without such an  analysis the services are unable to assure that adjudicators are making  consistent decisions in reservist and active duty cases with similar  characteristics.
Officials from the services said that it was very difficult to examine  outcomes for consistency because each disability decision is unique and  there are a multitude of factors considered when rendering a disability  decision, some of which could not be captured in a database. For example,  individuals’ pain tolerance varies, along with their motivation to adhere to  treatment programs. Nonetheless, other federal disability programs face  the same challenges, have acknowledged the importance of determining  consistency of decision making, and have taken some initial steps to  develop quality assurance systems. For example, the VA selects a random  sample of files for independent review using a standard methodology and  compiles the results of these reviews.
section_title: DOD Has Instituted Timeliness Goals for Processing Service Members’ Cases, but Does Not Oversee Compliance with Them
paragraphs: DOD regulations set forth timeliness goals for the two major processes of  the disability system. According to DOD, the first stage of the process— the MEB—should normally be completed in 30 days or less. The second  stage of the process—the PEB—should normally take 40 days or less.  Despite establishing these timeliness goals for the services, DOD is not  ensuring compliance with them. DOD does not regularly collect available  timeliness data from the services, a necessary first step for determining  compliance.
The services generally are using their databases to track the timeliness of  decisions, but military officials cited confusion regarding the start date for  the process. Both the Army and Navy are tracking processing times for  both the MEB and PEB using their databases. The Air Force lacks a  centralized database to track its MEB cases and therefore can only track  PEB timeliness. However, we found that the usefulness of these timeliness  data may be undermined by confusion among military officials and data  entry staff regarding the starting dates for the disability process. We  compared original Army PEB case files to Army electronic data from both  its MEB and PEB databases, and found that the date a physician dictates a  narrative summary, the beginning of the disability process and a critical  data point for timeliness calculations, was frequently entered incorrectly  into the Army’s databases. When we asked about these errors, Army  officials said that increased training of data entry staff would help with  these problems. Navy officials also said that there was some confusion  about how to record starting dates for cases when additional medical  information was needed to make a disability decision for a service  member.
Data reported by the services on the timeliness of cases generally show  that the services are not meeting DOD timeliness goals (see appendix II).  Military officials said that these results stemmed in part from the  unrealistic nature of the goals themselves. Navy officials told us that they  do not consider the 30-day goal as a performance standard for MEB  processing to be held accountable for. They said that the 30-day goal is  also unrealistic, especially in certain cases when there were addendums to  the narrative summary. Army officials also said that it was unrealistic for  all MEB cases to be processed in 30 days because certain cases take  longer. For example, cases when a line of duty determination is needed or  when certain medical tests are required to diagnose some orthopedic or  psychiatric conditions.
section_title: DOD’s Delegation of Training to the Services and Staff Turnover Presents Additional Challenges for the Disability System
paragraphs: While DOD regulations require that the agency develop and maintain  training for key participants in the disability system, DOD officials told us  that they had given this responsibility to the services. The Assistant  Secretary of Defense for Health Affairs is given explicit instructions to  develop and maintain a training program for MEB and PEB staff, but  officials from the Office of Health Affairs indicated they were unaware  that they had the responsibility to develop a training program. In addition,  despite high turnover among military disability evaluation staff, the  services do not have a system to ensure that all staff are properly trained.   This turnover stems, in part, from the military requirement that personnel  rotate to different positions in order to be promoted. Depending on the  positions involved, military officials told us that some staff remain in their  positions from 1 to 6 years, with most remaining about 3 years. This  turnover and the resulting loss of institutional knowledge require that the  services systematically track who has been properly trained. However, all  of the services lack data systems that would allow them to do so, an issue  that was highlighted in a previous report by the RAND Corporation.
section_title: Disparities May Exist in Disability Benefits and Processing Times between Army Reservists and Active Duty Soldiers, but Lack of Data Prevents More Definitive Conclusions
paragraphs: Our analysis of Army disability data from calendar years 2001 to 2005  indicated that after controlling for many of the differences we found  between reservists and active duty soldiers, Army reservists received  similar disability ratings to their active duty counterparts. We also found  that reservists may be less likely to receive military disability benefits.  Data on years of service and preexisting conditions were not available for  this analysis, however, factors that influence disability benefit decisions.  Finally, we were unable to compare processing times for reserve and  active duty disability cases because we found that Army data on  processing times were not reliable. However, based on these data, some  Army officials conclude that reservists’ cases often take longer to process  through the disability evaluation system than the cases of active duty  soldiers.
subsections: section_title: Army Reservists and Active Duty Soldiers in the Disability Evaluation System Had Different Characteristics
paragraphs: From 2001 through 2005, the characteristics of Army reservists and active  duty soldiers in the disability evaluation system differed in a number of  ways. Specifically, reservists tended to have more impairments than active  duty soldiers; they were more likely than active duty soldiers to have three  or four impairments. Reservists also experienced higher rates of  impairments affecting the cardiovascular and endocrine systems, while  active duty soldiers experienced a higher rate of impairments affecting the  musculoskeletal system. Reservists were more often classified in higher  pay grades and more often worked as functional support and  administration, crafts workers, and service and supply handlers. See  appendix IV. Active component soldiers worked more often as infantry  and gun crews; electronic equipment repairers; and communications and  intelligence specialists. In addition, compared to the number of active  duty disability cases from 2001 through 2005, which remained relatively  constant, the proportion of reservists going through the PEB process rose  dramatically through 2004. See figure 3.
Finally, the demographic characteristics of Army reservists and active duty  soldiers in the disability evaluation system also differed. Eighty percent of  reservists were male, compared to 76 percent of active duty soldiers,  while, on average, reservists were 11 years older than active duty  soldiers. See figure 4.
section_title: Army Reservists Received Disability Ratings Similar to Their Active Duty Counterparts, but Reservists May Be Less Likely to Receive Benefits
paragraphs: Before controlling for factors that could account for differences in the  outcomes of the Army disability evaluation system for reserve and active  duty soldiers, our analysis of Army data indicates that, from 2001 through  2005, reservists were assigned slightly higher disability ratings, but  received benefits less often than active duty soldiers. See appendix V.  When we controlled for many of the characteristics of reserve and active  duty soldiers that could account for their difference in ratings, we found  that, among soldiers who received ratings, the ratings assigned to Army  reservists were comparable to those assigned to their active duty  counterparts. When we controlled for a more limited number of factors,  Army reservists who were determined to be unfit for duty appeared less  likely to receive benefits (either monthly disability payments or severance  pay). See appendix I. This analysis of benefit outcomes for Army reserve  and active duty disability cases could not account for the influence that  preexisting conditions and years of service can have on disability  decisions. These factors are key in determining whether an injured or ill  service member qualify for disability benefits. Because we could not test  the effect of these factors empirically, we cannot rule out the possibility  that one or the other may account for the differences we found.
section_title: Poor Quality Data Precluded GAO Analysis, but the Army Reports Reservists’ Cases Can Take Longer
paragraphs: While, according to the Army’s own statistics, the PEB process can take  longer for reservists than active duty soldiers, we found the Army data  used to calculate processing times not of sufficient quality to warrant its  use in our analysis. Specifically, the dates in Army’s electronic database  often did not correspond with the dates recorded in paper files. See  appendix I. Nonetheless, the statistics the Army provided indicate that  disability cases reviewed between fiscal years 2001 and 2005 took  consistently longer than those of active duty soldiers. Over half (54  percent) of reserve soldiers took longer than 90 days while over one-third  (35 percent) of active duty soldiers exceed this threshold. See appendix II  for more detail.
There are several possible explanations for the differences in processing  times between reservists and active duty members, according to the Army.  For example, the Army officials reported that MEBs often must request  medical records from private medical practitioners for reservists’ cases,  which can involve considerable delays. In addition, the personnel  documents for reservists are stored in facilities around the U.S., and  therefore they may take longer to obtain than records for centrally located  active duty soldiers. Due to the lack of data on these issues as well as the  problems we encountered with the data provided by the Army we were  not able to measure the differences or empirically test possible  explanations for differences the Army reported in the timeliness of  disability case processing for Army reservists and active duty soldiers.
section_title: Conclusions
paragraphs: The military disability system’s outcomes can greatly impact the future of  service members, including reservists, injured in service to their country.  Given the significance of these decisions as well as the latitude that  services have to implement the system, it is important that DOD exercise  proper oversight to make sure the system meets the needs of service  members today and in the future. However, DOD is not adequately  monitoring the outcomes for active duty and reservist cases in the  disability evaluation system. DOD and the services do not have complete  and reliable data for all aspects of the disability system. Further, neither  DOD nor the services are systematically evaluating consistency and  timeliness of decision making in the system.
Military officials recognize that in many cases, service members’ cases are  not determined within timeliness goals and have suggested that the goals  may not be appropriate in many cases. In addition, it may take longer for  reservist cases to go through the system. If a goal does not reflect  appropriate processing times, it may not be useful as a program  management tool. Furthermore, both consistency and timeliness of  decisions depend on the adequate training and experience of all  participants in the disability system. Yet we found that DOD had little  assurance that staff at all levels are properly trained.
section_title: Recommendations for Executive Action
paragraphs: To ensure that all service members—both active duty and reserves— receive consistent and timely treatment within the disability evaluation  process, we recommend that the Secretary of Defense take the following  five actions  require the Army, Navy, and Air Force to take action to ensure that  data needed to assess consistency and timeliness of military disability  rating and benefit decisions are reliable;  require these services to track and regularly report these data— including comparisons of processing times, ratings and benefit  decisions for reservists and active duty members—to the Under  Secretary of Personnel and Readiness and the Surgeons General;    determine, based on these reports, if ratings and benefit decisions are  consistent and timely across the services and between reservists and  active duty members and institute improvements to address any  deficiencies that might be found;    evaluate the appropriateness of current timeliness goals for the  disability process and make any necessary changes; and    assess the adequacy of training for MEB and PEB disability evaluation  staff.
section_title: Response to Agency Comments
paragraphs: We provided a draft of this report to the Department of Defense for its  review. DOD agreed with our recommendations, indicating the  Department will implement all of them and listing a number of steps it will  take to do so. DOD also provided technical comments, which we  incorporated into the report as appropriate.
We are sending copies of this report to the Secretary of Defense, relevant  congressional committees, and others who are interested. Copies will also  be made available to others upon request. The report is also available at no  charge on GAO’s Web site at http://www.gao.gov.
Please contact me on (202) 512-7215 if you or your staff have any  questions about this report. Contact points for our Offices of  Congressional Relations and Public Affairs can be found on the last page  of this report. Other major contributors to this report are listed in  appendix VII.
section_title: Appendix I: Objective, Scope, and Methodology
paragraphs: The objectives of our report were to determine: (1) how current DOD  policies and guidance for disability determinations compare for the Army,  Navy, and Air Force, and what policies are specific to reserve component  members of the military; (2) what oversight and quality control  mechanisms are in place at DOD and these three services of the military to  ensure consistent and timely disability rating and benefit decisions for  active and reserve component members, and (3) how disability rating and  benefit decisions, and processing times compare for active and reserve  component members of the Army, the largest branch of the service, and  what factors might explain any differences.
To address objectives 1 and 2, we reviewed relevant legislation, policy  guidance, and literature; interviewed officials from DOD, Army, Navy, Air  Force, Reserves, and National Guard; and visited Lackland and Randolph  Air Force Bases, Fort Sam Houston and Walter Reed Army Medical Center;  Washington Navy Yard and Bethesda Naval Hospital; and interviewed  relevant officials. In addition, we interviewed officials from military  treatment facilities.
To determine if outcomes for active duty and reserve service members’  disability cases were statistically consistent, we analyzed data provided by  the physical evaluation board (PEB) of the Army. We also obtained  summary information on total caseloads and processing times from the  services and from the Department of Defense. Based on our assessment of  the quality of the Army’s data, we concluded that data on disability  determinations and ratings made by the Army’s PEB were sufficiently  reliable for our analysis. On the other hand, the Army’s data on processing  times were not reliable for our analysis. We did not test the reliability of  statistical data provided by DOD and the services.
This appendix is organized into two sections: Section 1 describes the  analyses related to our tests of data quality and reliability. Section 2  describes the empirical analyses that were used to determine if outcomes  for active duty and reserve disability cases were statistically consistent.
subsections: section_title: Section 1: Data Reliability Tests
paragraphs: To ensure that the Army data were sufficiently reliable for our analyses,  we conducted detailed data reliability assessments of the data sets that we  used. We restricted these assessments, however, to the specific variables  that were pertinent to our analyses. We found that all of the data sets used  in this report were sufficiently reliable for use in our analyses.
To allow us to analyze the outcomes of the disability evaluation process  and determine whether decisions were made in a timely fashion, we  requested that the Army share data from both the Medical Evaluation  Board and the Physical Evaluation Board for our review. The Army  provided extracts from both the Medical Evaluation Board Internal  Tracking Tool (MEBITT), used by the Medical Evaluation Board and the  Physical Disability Computer Assisted Processing System (PDCAPS), used  by the PEB.
During interviews with the database managers responsible for MEBITT  and PDCAPS, we learned that the Army has few internal controls to ensure  that the data are complete and accurate. Consequently, we conducted a  trace-to-file process to determine whether the data in the electronic  systems were an accurate reflection of what was recorded in the paper  files. We requested that the Army provide us with the paper files for a  sample of 130 cases that completed the Army’s disability evaluation  process between 2000 and August, 2005. Army officials provided 93 paper  files for our review. The remaining files were archived or were not found.
We checked the data in files provided against the electronic records in  MEBITT and PDCAPS. We determined that the MEBITT data were not  sufficiently reliable for our use. We also determined that in the PDCAPS,  there was a high degree of accuracy in the data fields related to: rank,  component (active duty versus reserve component), date of entry into  military service, primary military occupational specialty, disposition of  disability case, percentage rating for disability, location of PEB, and  illness/diagnosis codes. These fields were deemed reliable for use in our  report. However, this review also revealed that the data in the date fields,  such as the narrative summary dates and the final decision dates, were  often inaccurate and were therefore determined to be of insufficient  quality for use in our report.
section_title: Section 2: Statistical Analyses
paragraphs: To determine if outcomes for active duty and reserve disability cases were  statistically consistent, we conducted extensive statistical analyses  including cross tabulations and econometric modeling. This was important  because active and reserve component soldiers being evaluated differ  greatly in demographic characteristics and in administrative  characteristics, such as pay grade and occupational specialty. Recognizing  the potential of these characteristics to influence final outcomes and  disability ratings, we developed econometric models to assess whether the  observed differences between active and reserve component soldiers  persist after controlling for these factors.
We began with a series of bivariate cross tabulations and then expanded  these cross-classifications and examined three-way and four-way tables.  These allowed us to compare large groups of active and reserve soldiers,  as well as to compare soldiers in specific sets of categories—such as  active and reserve soldiers of different grades being evaluated at different  PEBs. To control for additional factors, we supplemented the cross- tabulations with ordinary least squares (OLS) and multivariate logistic  regressions. Our analyses considered both the size and significance of the  relationships of interest, using means, percentages, and odds and odds  ratios to assess magnitude, and f-tests, chi-square tests and Wald statistics  to assess the significance of the differences.
The analyses are limited due to our inability to control for several  important factors in the disability evaluation process. For example, no  reliable electronic data existed to indicate whether an injury existed prior  to service or was incurred outside of the line of duty, both primary reasons  for separating a soldier without benefits. Similarly, Army officials told us  that data on years of service for reservists in the electronic data the Army  provided were unreliable. Additionally, soldiers declared fit or separated  without benefits do not receive percentage disability ratings, and the Army  reports no impairment codes for soldiers declared fit. As such, we could  not determine whether active and reserve component soldiers were  similarly likely to be declared fit controlling for impairment or percentage  rating. Given these difficulties, we restricted our multivariate analyses to  soldiers rated unfit.
section_title: Multivariate regression analysis
paragraphs: To assess factors contributing to the final rating among those members  declared unfit and receiving a percentage rating (that is, excluding those  separated without benefits), we ran a series of multivariate models. Army  data systems report up to four impairments. Their final percentage  disability rating is determined by a composite of ratings for individual  impairments, the system(s) affected and how the specific impairment  relates to the soldier’s ability to perform his or her duties. Regression  analysis allows us to assess whether the observed differences between  reserve and active soldiers’ final ratings persist controlling for factors that  enter the decision process, such as military occupational specialty and  system of impairment, as well as other factors such as demographic  differences between the reserve component and active duty soldiers.
We began by estimating a “gross effects” (or unadjusted) model, which  considers the gross difference in mean disability ratings between active  and reserve component soldiers ignoring other factors. The model  confirms descriptive statistics showing that reserve component members’  ratings average approximately 4 points higher than those of active  component members.
We next estimated a series of alternative “net effects” (or adjusted) models  to account for other factors that influence the decision process; these  models estimate the impact of being a reservist on rating “net” of other  factors. Our first model included number of reported impairments,  physical system affected and occupational specialty; a second model  added year of decision, age, race, sex, pay grade, and PEB to control for  forces that may influence the decision process unofficially and certain  demographic differences between components. Additionally, we ran a  variety of alternative specifications to ensure the stability and robustness  of the results; this included, for example, a model testing the interaction  between system affected and occupational specialty and a model to  account for the clustering (and potential “nonindependence”) of cases  within each PEB.
Table 4 presents the coefficient representing the relationship between  being a reservist on final disability ratings in models that control for a  limited set of controls both relevant and external to the formal decision  process. What appears to be a small difference in ratings between reserve  and active component members diminishes controlling for other factors.  Overall, results of our OLS regression analyses suggest that active and  reserve component members receive similar disability ratings controlling  for factors that enter the formal decision process formally and indirectly.
section_title: Multinomial Logistic Analysis
paragraphs: To assess receipt of benefits, we estimated a multinomial logistic model, a  technique that allows us to estimate the likelihood of placement in one of  several categories controlling for additional factors. The model produces  relative risk ratios that compare the relative odds of reserve component  soldiers and active duty soldiers determined unfit for duty being placed  into either one of two categories (severance pay or permanent disability  retirement) rather than the base or referant category (separated without  benefits). With controls, the relative risk ratio compares the odds of  placement in the given category for similarly situated active and reserve  component soldiers.
A relative risk ratio of 1 indicates that reserve and active component  members have equal odds of being placed in one category rather than the  base category. A relative risk ratio of less than 1 for reserve soldiers  indicates that reservists have lower odds than active members of  placement in the category rather than in the base category, and a relative  risk ratio of greater than 1 indicates that reservists have higher odds than  active duty members of being placed in that category rather than in the  base category. Because soldiers placed on the temporary disability retired  list (TDRL) have not received a final benefits determination, they are  excluded from the model.
The relative risk ratios in table 5 demonstrate that among those declared  unfit, reserve component soldiers have significantly lower odds than  active component soldiers of receiving either permanent disability  retirement or lump sum disability severance pay. Prior to controlling for  other factors (our “gross effects” model), reserve soldiers have  significantly lower odds than active component members of receiving  either permanent disability retirement or severance pay rather than being  separated without benefits—the relative risk ratios of 0.5 and 0.4 in the  first row of the table respectively demonstrate reservists are only half or  less than half as likely to receive permanent disability retirement or  severance pay, respectively.
This relationship persists after controlling for limited factors both relevant  to and external to the official decision making process (“net effects”  models), and in fact the estimated difference between reservists and active  duty soldiers is in fact increased by the inclusion of variables such as race,  sex and PEB location. While these additional factors do not directly enter  the decision making process, they control for some of the administrative  and demographic differences we observe between active and reserve  component members. The relationship differs for the odds of receiving  severance pay, where reserve soldiers have less than one third the odds of  active soldiers, and the odds of receiving permanent disability retirement,  where the odds of reservists’ receiving this type of benefit rather than  separation without benefits is about one-tenth that of active component  members.
We lacked reliable electronic data on two potentially important factors.  This inability to control for length of service and injuries existing prior to  service prevents us from determining whether the differences presented  above are warranted or defensible.
section_title: Appendix II: Selected Data from Service Branches on Processing Time, Dispositions, and Medical Holdover
paragraphs: Includes “presumed fit” cases.
section_title: Appendix III: Compilation of Differences in Regulations Governing the Military Disability Evaluation System
subsections: section_title: Disability Evaluation Related Regulations
paragraphs: Federal Code  38 CFR Part 4: Veterans Affairs Schedule for Rating Disabilities Department of Defense  DODD 1332.18 “Separation or Retirement for Physical Disability”  DODI 1332.38 “Physical Disability Evaluation”  DODI 1332.39 “Application of the Veterans Administration Schedule for  Rating Disabilities”
Army  AR 40-400 “Patient Administration”  AR 40-501 “Standards of Medical Fitness”  AR 600-8-4 “Line of Duty Policy, Procedures, and Investigations”  AR 600-60 “Physical Performance Evaluation System”  AR 635-40 “Physical Evaluation for Retention, Retirement, or Separation”
Navy  SECNAV 1850.4E “Department of the Navy Disability Evaluation Manual”  JAGINST 5800.7D “Manual of the Judge Advocate General”  NAVMED P-117 “Manual of the Medical Department”
Air Force  AFI 36-2910 “Line of Duty (Misconduct) Determinations”  AFI 36-3212 “Physical Evaluation for Retention, Retirement and  Separation”  AFI 41-210 “Patient Administration Functions”  AFI 44-157 “Medical Evaluation Boards and Continued Military Service”  AFI 48-123 “Medical Examination and Standards”
section_title: Appendix IV: Characteristics of Army Service Members Entering the DES
section_title: Appendix V: Disability Evaluation Outcomes for Army Active Duty and Reserve Component Members for 2001 to 2005
paragraphs: This appendix compares Army disability evaluation outcomes in effect for  active duty and reserve component service members as of August 2005.  For the purpose of our analysis, we counted only final dispositions for  service members initially placed on the temporary disability retired list  (TDRL) and subsequently taken off that list when a final disposition was  made by the Army’s Physical Evaluation Board (PEB). In these cases, we  counted the final disposition in the year the initial TDRL decision was  made. As a result, the tables in this appendix show fewer TDRL  dispositions than the number issued by the PEB annually, according to the  Army. The tables also show greater numbers of permanent disability  retirement and other dispositions than the numbers reported by the Army  PEB annually for the years 2001 through 2004. In each case, the  differences are more pronounced in earlier years. Therefore, data in these  tables do not represent the number of each type of disability disposition  issued by the Army PEB annually.
section_title: Appendix VI: Comments from the Department of Defense
section_title: Appendix VII: GAO Contact and Staff Acknowledgments
subsections: section_title: Staff Acknowledgments
paragraphs: In addition to the contact named above, Clarita A. Mrena, Assistant  Director; and Anna M. Kelley made major contributions to this report. In  addition, Jason Barnosky, Melinda Cordero, Erin Godtland, and   Scott Heacock served as team members; Lynn Milan, Anna Maria Ortiz,  Doug Sloane, Mitch Karpman, and Wil Holloway provided guidance and  assistance with design and analysis; Rachel Valliere advised on report  preparation; and Roger Thomas provided legal advice.
section_title: Related GAO Products
paragraphs: Veterans’ Disability Benefits: Claims Processing Challenges and  Opportunities for Improvements. GAO-06-283T. Washington,  D.C.: December 7, 2005.
Military Personnel: Top Management Attention Is Needed to Address  Long-standing Problems with Determining Medical and Physical  Fitness of the Reserve Force. GAO-06-105. Washington, D.C.: October 27,  2005.
Military Personnel: DOD Needs to Improve the Transparency and  Reassess the Reasonableness, Appropriateness, Affordability, and  Sustainability of Its Military Compensation System. GAO-05-798.  Washington, D.C.: July 19, 2005.
Federal Disability Assistance: Wide Array of Programs Needs to be  Examined in Light of 21st Century Challenges. GAO-05-626. Washington,  D.C.: June 2, 2005.
Veterans’ Disability Benefits: Claims Processing Problems Persist and  Major Performance Improvements May Be Difficult. GAO-05-749T.  Washington, D.C.: May 26, 2005.  21st Century Challenges: Reexamining the Base of the Federal  Government. GAO-05-325SP Washington, D.C.: March 4, 2005.
Military Pay: Gaps in Pay and Benefits Create Financial Hardships for  Injured Army National Guard and Reserve Soldiers. GAO-05-125 and  related testimony GAO-05-322T. Washington, D.C.: February 17, 2005.
High-Risk Series: An Update. GAO-05-207. Washington, D.C.: January 1,  2005.
SSA’s Disability Programs: Improvements Could Increase the Usefulness  of Electronic Data for Program Oversight. GAO-05-100R. Washington,  D.C.: December 10, 2004.
Veterans Benefits: VA Needs Plan for Assessing Consistency of  Decisions. GAO-05-99. Washington, D.C.: November 19, 2004 and related  testimony GAO-06-120T.
Military Personnel: DOD Needs to Address Long-term Reserve Force  Availability and Related Mobilization and Demobilization Issues.   GAO-04-1031. Washington, D.C.: September 15, 2004.
Social Security Administration: More Effort Needed to Assess  Consistency of Disability Decisions. GAO-04-656. Washington, D.C.: July  2, 2004.
SSA Disability Decision Making: Additional Steps Needed to Ensure  Accuracy and Fairness of Decisions at the Hearing Level. GAO-04-14.  Washington, D.C.: November 12, 2003.
Defense Health Care: Army Needs to Assess the Health Status of All  Early-Deploying Reservists. GAO-03-437. April 15, 2003 and related  testimony GAO-03-997T Washington, D.C.: July 9, 2003.
Veterans’ Benefits: Quality Assurance for Disability Claims and Appeals  Processing Can Be Further Improved. GAO-02-806. August 16, 2002 and  related testimony GAO-05-655T. Washington, D.C.: May 5, 2005.
Defense Health Care: Disability Programs Need Improvement and Face  Challenges. GAO-02-73. Washington, D.C.: October 12, 2001.
DOD Disability: Overview of Compensation Program for Service  Members Unfit for Duty. GAO-01-622. Washington, D.C.: April 27, 2001.
Disability Benefits: Selected Data on Military and VA Recipients.  HRD-92-106. Washington, D.C.: August 13, 1992.