Military and Veterans Disability System: Preliminary Observations on Evaluation and Planned Expansion of DOD/VA Pilot
Published: 2010-11-18T00:00:00

Fast Facts:

Highlights:
section_title: Why GAO Did This Study
paragraphs: Since 2007, the Departments of Defense (DOD) and Veterans Affairs (VA) have been pilot testing a new disability evaluation system designed to integrate their separate processes and thereby expedite veterans' benefits for wounded, ill, and injured servicemembers. Having piloted the integrated disability evaluation system (IDES) at 27 military facilities, they are now planning for its expansion military-wide. This testimony is based on GAO's ongoing review of the IDES pilot and draft report, which is currently with DOD and VA for agency comment. GAO conducted this review pursuant to the National Defense Authorization Act for Fiscal Year 2008. This review specifically examined: (1) the results of the agencies' evaluation of the IDES pilot, (2) challenges in implementing the IDES pilot to date, and (3) whether the agencies' plans to expand the IDES adequately address potential future challenges. To address these questions, GAO analyzed data from DOD and VA, conducted site visits at 10 military facilities, and interviewed DOD and VA officials.
section_title: What GAO Found
paragraphs: In their evaluation of the IDES pilot, DOD and VA concluded that, as of February 2010, the pilot had (1) improved servicemember satisfaction relative to the existing "legacy" system and (2) met their established goal of delivering VA benefits to active duty and reserve component servicemembers within 295 and 305 days, respectively, on average. While these results are promising, average case processing times have since steadily increased--for example, for active duty servicemembers, the average has increased from 274 days in February 2010 to 296 days in August 2010. At 296 days, processing time for the IDES is still an improvement over the 540 days that DOD and VA estimated the legacy process takes to deliver VA benefits to servicemembers. However, the full extent of improvement of the IDES over the legacy system is unknown because (1) the 540-day estimate was based on a small, nonrepresentative sample of cases and (2) limitations in legacy case data prevent a comprehensive comparison of processing times, as well as appeal rates. In piloting the IDES, DOD and VA have run into several implementation challenges that have contributed to delays in the process. The most significant challenge was insufficient staffing by DOD and VA. Staffing shortages and process delays were particularly severe at two pilot sites we visited where the agencies did not anticipate caseload surges. For example, at one of these sites, due to a lack of medical examiners, it took 140 days on average to complete one of the key features of the pilot--the single exam--compared with the agencies' goal to complete this step of the process in 45 days. The single exam posed other challenges that contributed to process delays, such as disagreements between DOD and VA medical staff about diagnoses for servicemembers' medical conditions. Cases involving such disagreements often required further attention, adding time to the process. Pilot sites also experienced logistical challenges, such as incorporating VA staff at military facilities and housing and managing personnel going through the process. As DOD and VA move forward with plans to expand the IDES worldwide, they have taken steps to address a number of these challenges; however, these mitigation efforts have yet to be tested, and not all challenges have been addressed. For example, to address staffing shortages and ensure timely processing, VA is developing a contract for additional medical examiners, and DOD and VA are requiring local staff to develop written contingency plans for handling surges in caseloads. On the other hand, the agencies have not yet developed strategies for ensuring sufficient military physicians to handle anticipated workloads. Significantly, DOD and VA do not have a comprehensive monitoring plan for identifying problems as they occur--such as staffing shortages and disagreements about diagnoses--in order to take remedial actions as early as possible. GAO has draft recommendations aimed at helping DOD and VA, as they move forward with IDES expansion plans, to further address challenges surfaced during the pilot, which GAO plans to finalize in the forthcoming report after fully considering agency comments.

section_title: Letter
paragraphs: I am pleased to be here today to comment on the efforts by the  Departments of Defense (DOD) and Veterans Affairs (VA) to integrate  their disability evaluation systems. Over 40,000 servicemembers have been  wounded in the wars in Iraq and Afghanistan, as of October 2010. Many of  those who are unable to continue their military service must navigate  complex disability evaluation systems in both DOD and VA, through which  they are assessed for eligibility for disability compensation from the two  agencies. GAO and others have found problems with these systems,  including long delays, duplication in DOD and VA processes, confusion  among servicemembers, and distrust of systems regarded as adversarial by  servicemembers and veterans. To address these problems, DOD and VA  have designed an integrated disability evaluation system (IDES), with the  goal of expediting the delivery of VA benefits to servicemembers. DOD and  VA have pilot tested the IDES at 27 military treatment facilities. They are  now planning to expand the IDES worldwide, starting with 28 facilities by  the end of 2010.
My testimony summarizes findings of a draft report that is currently with  DOD and VA for their review and comment. It reflects work we performed  under a mandate in the National Defense Authorization Act for Fiscal Year  2008, which required GAO to review DOD and VA’s implementation of a  comprehensive policy on improvements to the care, management, and  transition of recovering servicemembers, including improvements to the  agencies’ disability evaluation systems. Consistent with this mandate, we  examined: (1) the results of DOD and VA’s evaluation of their pilot of the  IDES, (2) challenges in implementing the piloted system to date, and (3)  DOD and VA’s plans to expand the piloted system and whether those plans  adequately address potential challenges. With respect to the pilot  evaluation, we reviewed evaluation reports and analysis plans and  assessed the reliability of two types of data that DOD and VA used as the  basis of their evaluation. To identify challenges in implementing the  piloted system to date, we visited 10 of the 27 military treatment facilities  participating in the pilot, selected to represent each military service  branch, different geographical regions, and sites with varying caseloads  and organizational structures. For all of the research objectives, we  conducted interviews with key officials involved in the pilot at DOD, VA,  and each of the military services; analyzed case data; and reviewed  pertinent reports, guidance, plans, other documents, and relevant federal  laws and regulations. We are conducting this performance audit from  November 2009 to December 2010, 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 and conclusions based on our audit  objectives. We believe that the evidence obtained provides a reasonable  basis for our findings and conclusions based on our audit objectives.
subsections: section_title: Background
paragraphs: Under the existing, or “legacy” system, the military’s disability evaluation  process begins at a military treatment facility when a physician identifies a  condition that may interfere with a servicemember’s ability to perform his  or her duties. On the basis of medical examinations and the  servicemember’s medical records, a medical evaluation board (MEB)  identifies and documents any conditions that may limit a servicemember’s  ability to serve in the military. The servicemember’s case is then evaluated  by a physical evaluation board (PEB) to make a determination of fitness or  unfitness for duty. If the servicemember is found to be unfit due to medical  conditions incurred in the line of duty, the PEB assigns the servicemember  a combined percentage rating for those unfit conditions, and the  servicemember is discharged from duty. Depending on the overall  disability rating and number of years of active duty or equivalent service,  the servicemember found unfit with compensable conditions is entitled to  either monthly disability retirement benefits or lump sum disability  severance pay.
In addition to receiving disability benefits from DOD, veterans with  service-connected disabilities may receive compensation from VA for lost  earnings capacity. VA’s disability compensation claims process starts  when a veteran submits a claim listing the medical conditions that he or  she believes are service-connected. In contrast to DOD’s disability  evaluation system, which evaluates only medical conditions affecting  servicemembers’ fitness for duty, VA evaluates all medical conditions  claimed by the veteran, whether or not they were previously evaluated in  DOD’s disability evaluation process. For each claimed condition, VA must  determine if there is credible evidence to support the veteran’s contention  of a service connection. Such evidence may include the veteran’s military  service records and treatment records from VA medical facilities and  private medical service providers. Also, if necessary for reaching a  decision on a claim, VA arranges for the veteran to receive a medical  examination. Medical examiners are clinicians (including physicians,  nurse practitioners, or physician assistants) certified to perform the exams  under VA’s Compensation and Pension program. Once a claim has all of  the necessary evidence, a VA rating specialist evaluates the claim and  determines whether the claimant is eligible for benefits. If so, the rating  specialist assigns a percentage rating. If VA finds that a veteran has one or  more service-connected disabilities with a combined rating of at least 10  percent, the agency will pay monthly compensation.
In November 2007, DOD and VA began piloting the IDES, a joint disability  evaluation system, to eliminate duplication in their separate systems and  expedite receipt of VA benefits for wounded, ill, and injured  servicemembers. The IDES merges DOD and VA processes, so that  servicemembers begin their VA disability claim while they undergo their  DOD disability evaluation, rather than sequentially, making it possible for  them to receive VA disability benefits shortly after leaving military service  (see fig. 1). Specifically, the IDES    merges DOD and VA’s separate exam processes into a single exam process  conducted to VA standards. This single exam (which may involve more  than one medical examination, for example, by different specialists), in  conjunction with the servicemembers’ medical records, is used by military  service PEBs to make a determination of servicemembers’ fitness for  continued military service, and by VA as evidence of service-connected  disabilities. The exam may be performed by medical staff working for VA,  DOD, or a private provider contracted with either agency.    consolidates DOD and VA’s separate rating phases into one VA rating  phase. If the PEB has determined that a servicemember is unfit for duty,  VA rating specialists prepare two ratings—one for the conditions that DOD  determined made a servicemember unfit for duty, which DOD uses to  provide military disability benefits, and the other for all service-connected  disabilities, which VA uses to determine VA disability benefits.    provides VA case managers to perform outreach and nonclinical case  management and explain VA results and processes to servicemembers.
section_title: Pilot Evaluation Results Are Promising, but the Degree of Improvement Achieved Is Unknown
paragraphs: In August 2010, DOD and VA officials issued an interim report to Congress  summarizing the results of their evaluation of the IDES pilot as of early  2010. In that report, the agencies concluded that, as of February 2010,  servicemembers who went through the IDES pilot were more satisfied  than those who went through the legacy system, and that the IDES process  met the agencies’ goals of delivering VA benefits to active duty  servicemembers within 295 days and to reserve component  servicemembers within 305 days. Furthermore, they concluded that the  IDES pilot has achieved a faster processing time than the legacy system,  which they estimated to be 540 days.
While our review of DOD and VA’s data and reports generally confirm  DOD and VA’s findings, as of early 2010, we also found that not all of the  service branches were achieving the same results, case processing times  have increased since February, and other agency goals have not been met.
Servicemember satisfaction: Our reviews of the survey data indicate that,  on average, servicemembers in the IDES pilot have had higher satisfaction  levels than those who went through the legacy process. However, Air  Force members—who represented a small proportion (7 percent) of pilot  cases—were less satisfied. We reviewed the agencies’ survey methodology  and generally found their survey design and conclusions to be sound.
Average case processing times: The agencies have been meeting their 295- day and 305-day timeliness goals for much of the past 2 years, but the  average case processing time for active duty servicemembers has steadily  increased from 274 days in February 2010 to 296 days, as of August 2010.  While still an improvement over the 540-day estimate for the legacy  system, the agencies missed their timeliness goal by 1 day. Among the  military service branches, only the Army—which comprised about 60  percent of cases that had completed the pilot process—met the agencies’  timeliness goals in August, while average processing times for each of the  other services exceeded 330 days. Across all military service branches,  processing times for individual pilot sites have generally increased as their  caseloads have increased. We reviewed the reliability of the case data  upon which the agencies based their analyses and generally found these  data to be sufficiently reliable for purposes of these analyses.
Goals to process 80 percent of cases in targeted time frames: DOD and  VA had indicated in their planning documents that they had goals to  deliver VA benefits to 80 percent of servicemembers within the 295-day  and 305-day targets. As of February 2010, these goals were not met. For  both active duty and reserve cases, about 60 percent (rather than 80  percent) of cases were meeting the targeted time frames. By service  branch, the Army had the highest rate of active duty cases (66 percent)  meeting the goal, and the Air Force had the lowest (42 percent).
Although DOD and VA’s evaluation results indicate promise for the IDES,  the extent to which the IDES is an improvement over the legacy system  cannot be known because of limitations in the legacy data. DOD and VA’s  estimate of 540 days for the legacy system was based on a small,  nonrepresentative sample of cases. DOD officials told us that they planned  to use a broader sample of legacy cases to compare against pilot cases  with respect to processing times and appeal rates. However, significant  gaps in the legacy case data precluded such comparisons. Specifically,  DOD compiled the legacy case data from each of the military services and  the VA, but the military services did not track the same information. In  addition, VA was not able to provide data on the date VA benefits were  delivered for legacy cases, which are needed to determine the full  processing time from referral to final delivery of VA benefits.
Limited comparisons of pilot and legacy timeliness are possible with Army  data, which appears to be reliable on some key processing dates. Our  analysis of Army legacy data suggests that active duty cases took on  average 369 days to complete the DOD legacy process and reach the VA  rating phase—which does not include time to complete the VA rating and  deliver the VA benefits to servicemembers. In comparison, it took on  average 266 days to deliver VA benefits to soldiers in the pilot, according  to the agencies’ August data. However, Army comparisons cannot be  generalized to the other services.
section_title: Pilot Sites Experienced Several Challenges
paragraphs: As DOD and VA tested the IDES at different facilities and added cases to  the pilot, they encountered several challenges that led to delays in certain  phases of the process.
Staffing: Most significantly, most of the 10 sites we visited reported  experiencing staffing shortages and related delays to some extent, in part  due to workloads exceeding the agencies’ initial estimates. The IDES  involves several different types of staff across several different DOD and  VA offices, some of which have specific caseload ratios set by the  agencies, and we learned about insufficient staff in many key positions.  With regard to VA positions, officials cited shortages in examiners for the  single exam, rating staff, and case managers. With regard to DOD  positions, officials cited shortages of physicians who serve on the MEBs,  PEB adjudicators, and DOD case managers. In addition to shortages cited  at pilot sites, DOD data indicate that 19 of the 27 pilot sites did not meet  DOD’s caseload target of 30 cases per manager. Local DOD and VA  officials attributed staffing shortages to higher than anticipated caseloads  and difficulty finding qualified staff, particularly physicians, in rural areas.  These staffing shortages contributed to delays in the IDES process.
Two of the sites we visited—Fort Carson and Fort Stewart—were  particularly challenged to provide staff in response to surges in caseload,  which occurred when Army units were preparing to deploy to combat  zones. Through the Army’s predeployment medical assessment process,  large numbers of servicemembers were determined to be unable to deploy  due to a medical condition and were referred to the IDES within a short  period of time, overwhelming the staff. These two sites were unable to  quickly increase staffing levels, particularly of examiners. As a result, at  Fort Carson, it took 140 days on average to complete the single exam for  active duty servicemembers, as of August 2010, far exceeding the agencies’  goal to complete the exams in 45 days.
Exam summaries: Issues related to the completeness and clarity of single  exam summaries were an additional cause of delays in the VA rating phase  of the IDES process. Officials from VA rating offices said that some exam  summaries did not contain information necessary to determine a rating. As  a result, VA rating office staff must ask the examiner to clarify these  summaries and, in some cases, redo the exam. VA officials attributed the  problems with exam summaries to several factors, including the  complexity of IDES pilot cases, the volume of exams, and examiners not  receiving records of servicemembers’ medical history in time. The extent  to which insufficient exam summaries caused delays in the IDES process  is unknown because DOD and VA’s case tracking system for the IDES does  not track whether an exam summary has to be returned to the examiner or  whether it has been resolved.
Medical diagnoses: While the single exam in the IDES eliminates  duplicative exams performed by DOD and VA in the legacy system, it  raises the potential for there to be disagreements about diagnoses of  servicemembers’ conditions. For example, officials at Army pilot sites  informed us about cases in which a DOD physician had treated members  for mental disorders, such as major depression. However, when the  members went to see the VA examiners for their single exam, the  examiners diagnosed them with posttraumatic stress disorder (PTSD).  Officials told us that attempting to resolve such differences added time to  the process and sometimes led to disagreements between DOD’s PEBs and  VA’s rating offices about what the rating should be for purposes of  determining DOD disability benefits. Although the Army developed  guidance to help resolve diagnostic differences, other services have not.
Moreover, PEB officials we spoke with noted that there is no guidance on  how disagreements about servicemembers’ ratings between DOD and VA  should be resolved beyond the PEBs informally requesting that the VA  rating office reconsider the case. While DOD and VA officials cited several  potential causes for diagnostic disagreements, the number of cases with  disagreements about diagnoses and the extent to which they have  increased processing time are unknown because the agencies’ case  tracking system does not track when a case has had such disagreements.
Logistical challenges integrating VA staff at military treatment  facilities: DOD and VA officials at some pilot sites we visited said that  they experienced logistical challenges integrating VA staff at the military  facilities. At a few sites, it took time for VA staff to receive common access  cards needed to access the military facilities and to use the facilities’  computer systems, and for VA physicians to be credentialed. DOD and VA  staff also noted several difficulties using the agencies’ multiple  information technology (IT) systems to process cases, including redundant  data entry and a lack of integration between systems.
Housing and other challenges posed by extended time in the military  disability evaluation process: Although many DOD and VA officials we  interviewed at central offices and pilot sites felt that the IDES process  expedited the delivery of VA benefits to servicemembers, several also  indicated that it may increase the amount of time servicemembers are in  the military’s disability evaluation process. Therefore, some DOD officials  noted that servicemembers must be cared for, managed, and housed for a  longer period. The military services may move some servicemembers to  temporary medical units or to special medical units such as Warrior  Transition Units in the Army or Wounded Warrior Regiments in the Marine  Corps, but at a few pilot sites we visited, these units were either full or  members in the IDES did not meet their admission criteria. Where  servicemembers remain with their units while going through the IDES, the  units cannot replace them with able-bodied members. In addition, officials  at two sites said that members are not gainfully employed by their units  and, left idle, are more likely to be discharged due to misconduct and  forfeit their disability benefits. However, DOD officials also noted that  servicemembers benefit from continuing to receive their salaries and  benefits while their case undergoes scrutiny by two agencies, though some  also acknowledged that these additional salaries and benefits create costs  for DOD.
section_title: DOD and VA Expansion Plans Incorporate Many Lessons Learned but Do Not Address All Challenges
paragraphs: DOD and VA plan to expand the IDES to military facilities worldwide on  an ambitious timetable—to 113 sites during fiscal year 2011, a pace of  about 1 site every 3 days. Expansion is scheduled to occur in four stages,  beginning with 28 sites in the southeastern and western United States by  the end of December 2010.
In preparing for IDES expansion military-wide, DOD and VA have many  efforts under way to address challenges experienced to date, though their  efforts have yet to be implemented or tested. For example, the agencies  have completed a significant revision of their site assessment matrix—a  checklist used by local DOD and VA officials to ascertain their readiness to  begin the pilot—to address areas where prior IDES sites had experienced  challenges. In addition, local senior-level DOD and VA officials will be  expected to sign the site assessment matrix to certify that a site is ready  for IDES implementation. This differs from the pilot phase where,  according to DOD and VA officials, some sites implemented the IDES  without having been fully prepared.
Through the new site assessment matrix and other initiatives, DOD and VA  are addressing several of the challenges identified in the pilot phase.
Ensuring sufficient staff: With regard to VA staff, VA plans to increase  the number of examiners by awarding a new contract through which sites  can acquire additional examiners. To increase rating staff, VA has filled  vacant rating specialist positions and anticipates hiring a small number of  additional staff. With regard to DOD staff, Air Force and Navy officials told  us they have added adjudicators for their PEBs or are planning to do so.  Both DOD and VA indicated they plan to increase their numbers of case  managers. Meanwhile, sites are being asked in the assessment matrix to  provide longer and more detailed histories of their caseloads, as opposed  to the 1-year history that DOD and VA had based their staffing decisions  on during the pilot phase. The matrix also asks sites to anticipate any  surges in caseloads and to provide a written contingency plan for dealing  with them.
Ensuring the sufficiency of single exams: VA has begun the process of  revising its exam templates to better ensure that examiners include the  information needed for a VA disability rating decision and to enable them  to complete their exam reports in less time. VA is also examining whether  it can add capabilities to the IDES case tracking system that would enable  staff to identify where problems with exams have occurred and track the  progress of their resolution.
Ensuring adequate logistics at IDES sites: The site assessment matrix  asks sites whether they have the logistical arrangements needed to  implement the IDES. In terms of information technology, DOD and VA are  developing a general memorandum of agreement intended to enable DOD  and VA staff access to each other’s IT systems. DOD officials also said that  they are developing two new IT solutions—one currently being tested is  intended to help military treatment facilities better manage their cases,  while another still at a preliminary stage of development would reduce  multiple data entry.
However, in some areas, DOD and VA’s efforts to prepare for IDES  expansion do not fully address some challenges or are not yet complete.
Ensuring sufficient DOD MEB physician staffing: DOD does not yet  have strategies or plans to address potential shortages of physicians to  serve on MEBs. For example, the site assessment matrix does not include  a question about the sufficiency of military providers to handle expected  numbers of MEB cases at the site, or ask sites to identify strategies for  ensuring sufficient MEB physicians if there is a caseload surge or staff  turnover.
Ensuring sufficient housing and organizational oversight for IDES  participants: Although the site assessment matrix asks sites whether they  will have sufficient temporary housing available for servicemembers going  through the IDES, the matrix requires only a yes or no response and does  not ensure that sites will have conducted a thorough review of their  housing capacity. In addition, the site assessment matrix does not address  plans for ensuring that IDES participants are gainfully employed or  sufficiently supported by their organizational units.
Addressing differences in diagnoses: According to agency officials, DOD  is currently developing guidance on how staff should address differences  in diagnoses. However, since the new guidance and procedures are still  being developed, we cannot determine whether they will aid in resolving  discrepancies or disagreements. Significantly, DOD and VA do not have a  mechanism for tracking when and where disagreements about diagnoses  and ratings occur and, consequently, may not be able to determine  whether the guidance sufficiently addresses the discrepancies.
As DOD and VA move to implement the IDES worldwide, they have some  mechanisms in place to monitor challenges that may arise in the IDES,  such as regular reporting of data on caseloads, processing times, and  servicemember satisfaction, and preparation of an annual report on  challenges in the IDES. However, DOD and VA do not have a system-wide  monitoring mechanism to help ensure that steps they took to address  challenges are sufficient and to identify problems in a more timely basis.  For example, they do not collect data centrally on staffing levels at each  site relative to caseload. As a result, DOD and VA may be delayed in taking  corrective action, since it takes time to assess what types of staff are  needed at a site and to hire or reassign staff. DOD and VA also lack  mechanisms or forums for systematically sharing information on  challenges, as well as best practices between and among sites. For  example, DOD and VA have not established a process for local sites to  systematically report challenges to DOD and VA management and for  lessons learned to be systematically shared system-wide. During the pilot  phase, VA surveyed pilot sites on a monthly basis about challenges they  faced in completing single exams. Such a practice has the potential to  provide useful feedback if extended to other IDES challenges.
section_title: Concluding Observations
paragraphs: By merging two duplicative disability evaluation systems, the IDES shows  promise for expediting the delivery of VA benefits to servicemembers  leaving the military due to a disability. However, piloting of the system has  revealed several significant challenges that require careful management  attention and oversight. DOD and VA are currently taking steps to address  many of these challenges. However, given the agencies’ ambitious  implementation schedule—more than 100 sites in a year—it is unclear  whether these steps will be completed before DOD and VA deploy the  IDES to additional military facilities. Ultimately, the success or failure of  the IDES will depend on DOD and VA’s ability to sufficiently staff the  various offices involved in the IDES and to resolve challenges not only at  the initiation of the transition to IDES, but also on an ongoing, long-term  basis. Because they do not have a mechanism for routinely monitoring  staffing and other risk factors, DOD and VA may not be able to know  whether their efforts to address these factors are sufficient or to identify  new problems as they emerge, so that they may take immediate steps to  address them before they become major problems.
We have draft recommendations aimed at helping DOD and VA further  address challenges surfaced during the pilot, which we plan to finalize in  our forthcoming report after fully considering agency comments.
Mr. Chairman, this concludes my prepared statement. I would be pleased  to respond to any questions that you or other Members of the Committee  may have at this time.
section_title: GAO Contact and Staff Acknowledgments
paragraphs: For further information about this testimony, please contact Daniel  Bertoni at (202) 512-7215 or bertonid@gao.gov. Contact points for our  Offices of Congressional Relations and Public Affairs may be found on the  last page of this testimony. In addition to the individual named above, key  contributors to this testimony include Michele Grgich, Yunsian Tai, Jeremy  Conley, and Greg Whitney. Key advisors include Bonnie Anderson,  Rebecca Beale, Mark Bird, Brenda Farrell, Valerie Melvin, Patricia Owens,  Roger Thomas, Walter Vance, and Randall Williamson.
section_title: Related GAO Products
paragraphs: Veterans’ Disability Benefits: Further Evaluation of Ongoing Initiatives  Could Help Identify Effective Approaches for Improving Claims  Processing. GAO-10-213. Washington, D.C.: January 29, 2010.
Recovering Servicemembers: DOD and VA Have Jointly Developed the  Majority of Required Policies but Challenges Remain. GAO-09-728.  Washington, D.C.: July 8, 2009.
Recovering Servicemembers: DOD and VA Have Made Progress to Jointly  Develop Required Policies but Additional Challenges Remain.  GAO-09-540T. Washington, D.C.: April 29, 2009.
Military Disability System: Increased Supports for Servicemembers and  Better Pilot Planning Could Improve the Disability Evaluation Process.  GAO-08-1137. Washington, D.C.: September 24, 2008.
DOD and VA: Preliminary Observations on Efforts to Improve Care  Management and Disability Evaluations for Servicemembers.  GAO-08-514T. Washington, D.C.: February 27, 2008.
DOD and VA: Preliminary Observations on Efforts to Improve Health  Care and Disability Evaluations for Returning Servicemembers.  GAO-07-1256T Washington, D.C.: September 26, 2007.
Military Disability System: Improved Oversight Needed to Ensure  Consistent and Timely Outcomes for Reserve and Active Duty Service  Members. GAO-06-362. Washington, D.C.: March 31, 2006.
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