Military Disability Retirement: Closer Monitoring Would Improve the Temporary Retirement Process
Published: 2009-04-13T00:00:00

Fast Facts:

Highlights:
section_title: Why GAO Did This Study
paragraphs: Service members found unfit for duty due to a service-related illness or injury may be eligible for military disability retirement. When their disability is not stable, however, they may be placed on the military's Temporary Disability Retired List (TDRL) and granted temporary benefits for as long as 5 years. GAO was asked to respond to concerns about TDRL caseloads, management, and impact on servicemembers. To address these concerns, we analyzed TDRL data; interviewed military officials; reviewed laws, regulations, and other relevant documents; and conducted 12 focus groups with temporary retirees. This report examines (1) recent trends in the TDRL caseload size, (2) recent trends in the characteristics of those placed on the TDRL, (3) disability retirement outcomes for TDRL placements, (4) the adequacy of TDRL management, and (5) the adequacy of information provided to TDRL retirees.
section_title: What GAO Found
paragraphs: TDRL caseloads within the Department of Defense (DOD) grew by 43 percent, from 9,983 in fiscal year 2003 to 14,285 in fiscal year 2007. Growth in caseloads could be attributable to a combination of increases in the number of cases going through the military's disability evaluation system, higher TDRL placement rates, and low numbers of cases removed from the TDRL relative to new cases added to the list. DOD-wide, servicemembers placed on the TDRL in each calendar year from 2000 through 2007 varied little with respect to their military status, years of service, and disabilities. In each of these years, most TDRL placements had been active duty personnel, although the small proportion who had been reservists grew considerably. Most TDRL placements in each year also had fewer than 20 years of service and, over time, their average years of service declined. The disabilities most prevalent among TDRL placements were musculoskeletal, mental, or neurological in nature. Among those with mental and neurological disabilities, the incidence of post traumatic stress disorder and conditions related to traumatic brain injury increased substantially across the services. Although the experiences of temporary disability retirees varied, some outcomes were more common than others. DOD-wide, very few who were placed on the list between calendar years 2000 and 2003 returned to military service. Further, about half received a final determination within 3 years and, of those who ultimately received permanent disability benefits, 73 percent had final disability ratings that were no different than their initial ratings. Finally, only 7 percent of TDRL placements, DOD-wide, received a final disability rating that qualified them for permanent disability payment amounts higher than their TDRL payments. DOD and the services do not effectively manage key aspects of the TDRL process. The military does not systematically examine physical evaluation board (PEB) stability decisions for accuracy and consistency or routinely compile information on TDRL outcomes to better inform its assessments of stability. According to TDRL administrative staff, ensuring that medical reexaminations are done in TDRL cases at least once every 18 months is often a challenge. However, the military does not monitor the extent to which this requirement is met. Moreover, there is limited use of nonmilitary physicians to perform reexaminations, which could reduce burdens on medical treatment facilities. Finally, military procedures do not ensure consistent enforcement of TDRL rules. Information about the TDRL that the services provide is not always clear or complete and can be difficult to access. PEB findings forms provided to temporary retirees do not fully explain why service members are placed on the list or what is required of them. Temporary retirees reported that counseling related to PEB decisions was inconsistent and lacking in followthrough. Information from military pamphlets, brochures, fact sheets, and Web sites is often incomplete or difficult to find. Temporary retirees participating in our focus groups expressed considerable confusion about and dissatisfaction with their limited access to information and points of contact.

section_title: Letter
paragraphs: Since the beginning of Operations Enduring Freedom and Iraqi Freedom,  the number of servicemembers entering the military disability evaluation  system has grown, along with concerns that the system may not serve  returning wounded warriors very well. Recent evaluations by GAO and  others have found a number of problems, including lengthy case  processing times, inadequate staff training, inconsistencies in disability  ratings, and confusion and distrust on the part of servicemembers who  must navigate the system. In an effort to streamline military disability  determinations, the Department of Defense (DOD) is currently engaged in  a joint pilot with the Department of Veterans Affairs (VA) to test the use of  VA medical examinations to inform military disability decisions, but  significant challenges to addressing weaknesses in the military’s overall  disability evaluation system remain.
The Temporary Disability Retired List (TDRL) is one aspect of this system  that is currently receiving increased attention. Servicemembers may be  placed on the TDRL if they are found to be medically unfit for duty  (disabled) by a military Physical Evaluation Board (PEB), but their  service-related illnesses or injuries are not stable enough for the PEB to  assign them a permanent disability rating. A determination assigning  servicemembers to the TDRL temporarily retires and provides them with  disability retirement benefits for up to 5 years while they wait for their  disabling medical conditions to stabilize. Once a permanent disability  rating can be assigned, depending on the rating and the servicemember’s  years of military service, the PEB may place those on the TDRL on the  Permanent Disability Retired List (PDRL), grant them a one-time  severance payment, or find them fit to return to military service.
Questions have been raised about the TDRL process, including whether it  is administered appropriately and consistently across all services, whether  the military provides adequate support and guidance to servicemembers  who are placed on the list, and whether individuals may be staying on the  list longer than necessary. To better understand the TDRL process and the  issues surrounding it, this report provides information on (1) recent trends  in the TDRL caseload size, (2) recent trends in the characteristics of  servicemembers placed on the TDRL, (3) disability retirement outcomes  for TDRL placements, (4) the adequacy of TDRL management, and (5) the  adequacy of information provided to temporary retirees.
To determine trends in TDRL caseload size, we analyzed data from DOD’s  Defense Manpower Data Center Retired Pay File and administrative data  maintained by PEBs in the Air Force, Army, and Navy. Data from these  files were also used to determine the characteristics and TDRL outcomes  of all those placed on the list each calendar year from 2000 through 2007.  We also reviewed and discussed with DOD officials the results of their  own recently issued study of the TDRL, which also examined TDRL  retirees’ characteristics and outcomes. Based on information we obtained  from the military about how the data in these files were collected and  what measures were taken to assure their quality, we determined that  these data were adequately reliable for the purposes of this study. To  assess the adequacy of TDRL management, we reviewed relevant laws,  regulations, and procedures. In addition, we interviewed military officials  who are responsible for implementing these requirements across the  services, including PEB members, Medical Command representatives, and  PEB Liaison Officers (PEBLO) from military medical treatment facilities  across the services—specifically, at three Air Force, four Army, and three  Navy facilities. We assessed the adequacy of existing TDRL procedures  relative to internal control standards for the federal government and the  requirements of the Government Performance and Results Act of 1993. To  assess the adequacy of information provided to servicemembers who are  placed on the TDRL, we also reviewed each service’s PEB decision forms  and other written materials, as well as information available on the  services’ Web sites. We also obtained the experiences and views of TDRL  retirees across the services by conducting a series of 12 focus groups in  June and August 2008 with individuals who were on the TDRL. Focus  groups were conducted in Norfolk, Va., Quantico, Va., San Antonio, Tex.,  and Killeen, Tex., because collectively, these areas provided us with  access to a large pool of temporary retirees from each of the services.
We conducted this review from March 2008 to April 2009 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. Additional information about our objectives, scope, and  methodology is provided in appendix I.
subsections: section_title: Background
paragraphs: The TDRL was established under the Career Compensation Act of 1949 to  allow for temporary disability retirement pay and benefits for any  servicemember who would be eligible for disability retirement benefits,  were it not for the fact that their disability was not of a permanent nature.  In 1986, the law was amended to allow the military to place individuals on  the TDRL if it is determined that their disabilities could be of a permanent  nature but are not stable enough to rate their severity. Under this criterion,  a disability is considered not stable if the medical evidence indicates its  severity will probably change enough sometime within the next 5 years to  warrant an increase or decrease in the disability percentage rating. For  example, cancer is a condition that may be determined to be permanent  and stable when the disease has progressed to the point where treatments  are unlikely to cure it, or determined to be permanent and unstable when  the disease is being treated and the prognosis remains uncertain.
Consistent with how the military administers its overall disability  evaluation system, DOD gives each service responsibility for administering  its own TDRL process. DOD provides some guidance for administering the  TDRL, but gives the services broad latitude. Therefore, each service has  established more detailed guidance for its own day-to-day processes  related to the TDRL. The services have their own staff, or TDRL units, that  oversee and process TDRL cases. Figure 1 depicts the TDRL decision  process in detail.
To qualify for permanent disability retirement benefits, or placement on  the Permanent Disability Retired List (PDRL), a servicemember must have  a service-related medical condition that renders him or her unfit for duty.  The condition must be compensable, and the severity of the condition,  expressed as a percentage rating, must be 30 percent or higher. Typically,  the percentage disability rating dictates the amount of monthly disability  retirement payments to which a servicemember is permanently entitled.  If, based on the medical evidence, the PEB determines that a  servicemember’s disabling condition is unstable—that the condition’s  current percentage rating could change within the next 5 years—the PEB  will place the servicemember on the TDRL. In effect, placement on the  TDRL postpones a final determination of the percentage rating and the  associated monthly disability payments to which the retiree may  eventually and permanently be entitled.
Once placed on the TDRL, temporary retirees must undergo periodic  medical reexaminations and evaluations by a PEB at least once every 18  months. Under the law, assignment to the TDRL must end with a final  determination at the end of 5 years, or sooner if the results of a medical  reexamination indicate that the temporary retiree’s condition is of a  permanent nature and stable or the servicemember’s rating drops below 30  percent. Typically, temporary retirees receive medical reexaminations in  conjunction with PEB determinations. These examinations are usually  conducted at military treatment facilities (MTF). Each service’s TDRL  administrative unit is responsible for determining when temporary retirees  are due for medical reexaminations, notifying them of upcoming medical  reexaminations and arranging for the examinations at MTFs, and following  up with temporary retirees who fail to keep appointments. Temporary  retirees are required to make sure the appropriate service’s TDRL unit has  their current address. Temporary retirees are also required to report for  medical reexaminations at appointed times and places. Typically,  reexaminations are scheduled by the relevant service’s MTF that is nearest  to the TDRL retiree’s place of residence. If a temporary retiree is unable to  keep an appointment, he or she is required to make alternate  arrangements to complete the medical reexamination. If temporary  retirees refuse or fail to report for required reexaminations, the services  have the authority to terminate their temporary disability retirement pay.
The benefits that servicemembers are entitled to while on the TDRL are  similar to those for servicemembers who are placed on the PDRL. In most  cases, the amount of TDRL monthly payments are calculated in the same  way as PDRL monthly cash payments: retirees with fewer than 20 years of  service receive their base pay at retirement, multiplied by the assigned  percentage rating for their disabling medical conditions; servicemembers  with 20 or more years of service receive the higher of either their base pay  at retirement, multiplied by either their assigned percentage rating, or 2.5  times their years of service—whichever is higher. Regardless of years of  service, temporary retirees with a disability percentage rating of 50  percent or less are entitled to no less than 50 percent of their base pay at  retirement. Both TDRL and PDRL monthly cash payments are subject to a  cap of 75 percent of servicemembers’ base pay and are subject to income  taxes. In addition to receiving cash payments, temporary retirees are  entitled to other military retirement benefits, including health insurance  coverage for themselves, their spouses, and eligible dependents, and  access to discounted goods and services through military exchange  facilities. Finally, temporary retirees are also eligible to apply for VA  disability compensation, which is not subject to income taxes. The military  benefits of both permanent and temporary retirees are reduced, however,  by the amount of VA benefits they receive.
subsections: section_title: Evolving Purpose of the TDRL
paragraphs: While the Career Compensation Act of 1949 does not cite a specific  purpose for the TDRL or state a rationale for the eligibility threshold of 30  percent, a 1948 report of the Advisory Commission on Service Pay (the  Hook Commission), upon which much of the act was based, suggests that  the TDRL may have been established as a means of “minimizing the loss of  trained, experienced service members who, given additional time, might  recover sufficiently to return to” the military. Meanwhile, a recently  issued report by DOD suggests that the purpose of the TDRL has also  evolved into a vehicle to safeguard the interests of servicemembers whose  conditions may develop into more serious permanent disabilities. The  report also notes that other means might be used to accomplish the  current purposes of the TDRL and suggests that changes may be  warranted, including reducing the maximum tenure on the TDRL and  establishing standardized guidance for classifying impairments as  “permanent and stable.”
section_title: TDRL Caseloads Have Grown for a Combination of Reasons
paragraphs: TDRL caseloads grew DOD-wide by 43 percent from fiscal years 2003  through 2007. Growth in TDRL caseloads could be related to a  combination of increases in the number of cases going through the  military’s disability evaluation system, higher TDRL placement rates, and  low numbers of cases removed from the TDRL relative to numbers of new  cases being added to the list.
subsections: section_title: TDRL Caseloads Grew from Fiscal Years 2003 through 2007
paragraphs: While DOD-wide TDRL caseload size declined slightly from fiscal years  2001 through 2003, it grew steadily from 9,983 cases in 2003, to 14,285  cases in 2007, an increase of 43 percent. (See fig. 2.) Air Force and Marine  Corps caseloads had the highest rate of growth during this time (72  percent each), and the Army’s caseload grew by 54 percent. The Navy’s  also grew during this time, but only by 14 percent.
section_title: Caseload Growth Has Been Related to Increases in New Disability Cases, Higher TDRL Placement Rates, and Relatively Few Removals from the List
paragraphs: A combination of factors contributed to the growth in TDRL caseloads  between fiscal years 2003 and 2007. TDRL caseloads grew along with an  increase in cases going through the disability evaluation system as a result  of Operations Enduring Freedom and Iraqi Freedom. The number of  disability evaluation system cases DOD-wide grew from about 16,500 in  2003, to about 20,000 in 2007, an increase of 21 percent. (See app. II, table  7.) Each service also experienced an overall growth in disability evaluation  system cases during this period. (See app. II, table 8.)
Higher TDRL placement rates—the number of placements on the TDRL in  a given year relative to the number of all cases receiving a disability  determination that same year—also contributed to the growth in TDRL  caseloads. (See table 1.)
The increase in TDRL placement rates was most significant for the Air  Force and the Marine Corps. Marine Corps and Navy placement rates were  also consistently much higher than rates in the other services.
Finally, the growth in the TDRL caseload DOD-wide may also be due, in  part, to the relatively low numbers of cases removed from the TDRL,  compared with the numbers of new cases added to the list each year. (See  fig. 3.) In fiscal year 2003, there were 18 more cases placed on the TDRL  than were removed from the TDRL that year. By 2007, this difference grew  to 1,442 more cases placed on than removed from the TDRL. Within each  service, the difference between the numbers of cases added to and  removed from the TDRL varied over time. (See app. II, tables 9 and 10.)
section_title: The Characteristics of TDRL Placements Have Changed Somewhat in Recent Years
paragraphs: DOD-wide, servicemembers placed on the TDRL in each calendar year  from 2000 through 2007 varied little with respect to their military status,  years of service, and most prevalent disabling conditions. In each of these  years, most TDRL placements had been active duty personnel, although  the small proportion who had been reservists grew considerably between  2000 and 2007. Most TDRL placements in each year also had fewer than 20  years of service and, over time, their average years of service declined,  DOD-wide. The disabilities most prevalent among TDRL placements have  consistently been musculoskeletal, mental, or neurological in nature.  Among those with mental and neurological disabilities, the incidence of  Post Traumatic Stress Disorder (PTSD) and residual conditions related to  traumatic brain injury (TBI) increased substantially across all of the  services.
subsections: section_title: Most TDRL Placements Have Been Active Duty Personnel, though the Proportion Who Were Reservists Grew Significantly
paragraphs: Eighty-four percent of all servicemembers placed on the TDRL in calendar  years 2000 through 2007 were active duty military. The percent of TDRL  placements who were reservists grew DOD-wide, from about 8 percent in  2000, to about 21 percent in 2006. (See app. II, table 11.) This overall  increase appears to have been driven primarily by the Army, where the  proportion of reservists among TDRL placements nearly tripled from 12  percent in 2000, to 35 percent in 2006.
Although the majority of servicemembers placed on the TDRL have been  active duty military, the overall number of reservists placed on the TDRL,  though small, has generally been increasing over time. This increase is  consistent with the activation of reservists needed for military operations  in Afghanistan and Iraq, which in turn, added to the number of reservists  who entered the disability evaluation system during this time. (See app.  II, table 12.)
section_title: Most TDRL Placements Have Had Fewer Than 20 Years of Service, and Their Average Years of Service Has Declined
paragraphs: DOD-wide, the vast majority of TDRL placements have had fewer than 20  years of service. This has changed little over time. Across the services, this  proportion ranged from 91 percent for the Navy and Air Force, to 99  percent for the Marine Corps. (See table 2.)
Additionally, the average years of service decreased from 8 years among  TDRL placements in calendar year 2000, to 6 years for placements in 2007.  (See app. II, table 13.) In each service, the average decreased by 1 or 2  years. The overall decline among TDRL placements who had been Marine  Corps reservists was particularly pronounced. Their average years of  service decreased from 13 in 2000, to 4 in 2007. (See app. II, table 14.) The  decline in average years of service is likely associated, at least in part, with  the increasing numbers of reservists on the TDRL, who typically take  longer to accumulate years of service than active duty servicemembers.
section_title: There Has Been Little Change in the Prevalence of Certain Types of Disabling Conditions
paragraphs: Between calendar years 2000 and 2007, there has been little change in the  types of disabling conditions most common among servicemembers  placed on the TDRL each year. Over this period, the most prevalent  disabilities, DOD-wide, have largely fallen into 1 of 3 out of 15 possible  disability categories in the Department of Veterans Affairs Schedule for  Rating Disabilities (VASRD): (1) the musculoskeletal system, (2) mental  disorders, and (3) neurological conditions and convulsive disorders. (See  fig. 4.)
For DOD-wide placements in each calendar year from 2000 through 2007,  the most common musculoskeletal disabling condition was degenerative  arthritis, accounting for 24 percent of all musculoskeletal disabilities.  Many of the other disabling conditions in this category were unspecified,  although the combination of various types of spinal injuries accounted for  about an additional 30 percent of musculoskeletal disabilities.
The most common neurological conditions and convulsive disorders  among TDRL placements were migraines and residuals of TBI, each  accounting for 16 percent of all types of disabilities within this category.  In recent years, the DOD-wide number of TDRL placements due to a  residual condition from TBI has increased fourfold, DOD-wide, from 63 in  2000, to 274 in 2007. (See app. II, table 15.) The incidence of residuals of  TBI, as a percentage of all neurological conditions and convulsive  disorders among TDRL placements grew from 10 percent in 2000, to 21  percent in 2007. (See app. II, table 16.) The Army experienced the greatest  increase in TBI residuals cases—from 9 percent, to 26 percent—as the  proportion of all neurological conditions and convulsive disorders among  TDRL placements.
The most common mental disorder among TDRL placements in calendar  years 2000 through 2007 was PTSD, which accounted for 26 percent of all  mental disorders. The number of TDRL placements with PTSD increased  dramatically, DOD-wide, from 44 in 2000, to 672 in 2007. (See app. II, table  17.) PTSD incidence, as a percentage of all mental disorders among TDRL  placements, also grew, DOD-wide, from 8 percent in 2000, to 43 percent in  2007. (See app. II, table 18.) The Marine Corps experienced the greatest  increase—from 6 percent, to 52 percent.
According to some DOD officials, the increase in TBI residuals and PTSD  among TDRL placements may be due to the increasing numbers of  servicemembers returning from military operations in Afghanistan and  Iraq with these conditions. The increased incidence of these disabling  conditions among TDRL placements could also be attributed to growing  acceptance of PTSD as a disabling condition and more concerted efforts to  identify residuals of TBI.
Very Few TDRL Placements Returned to Military Service, Half Received a  Final Determination within 3 Years, and Many Received a Final Disability  Rating Identical to the Initial Rating  While there are variations in TDRL results across the services, some  outcomes for this group were more common than others. Specifically, very  few TDRL placements between calendar years 2000 and 2003 returned to  military service. Further, about half received a final determination within 3  years or less. Finally, only 7 percent of TDRL placements, DOD-wide,  received a final disability rating that would have resulted in permanent  disability payment amounts higher than their TDRL payments.
section_title: Very Few TDRL Placements Returned to Military Service
paragraphs: DOD-wide, only 1 percent of those placed on the TDRL in calendar years  2000 through 2003 eventually returned to military service. More than 80  percent were determined to be permanently disabled. Of these, 5,465 were  placed on the PDRL. The remaining 2,315 received a lump sum severance  payment for their disability because their final rating was lower than 30  percent and they had fewer than 20 years of military service. Another 9  percent of these placements received no military disability benefits after  they were removed from the TDRL. (See fig. 5.)
It should be noted that of all those placed on the PDRL, nearly 10 percent  (1,004) did not receive a final disability determination until some time after  they were removed from the TDRL. As a result, they experienced a gap in  benefits that, in 18 percent (176) of these cases, lasted longer than 6  months.
Each service’s distribution of outcomes for those placed on the TDRL in  calendar years 2000 through 2003 differed somewhat from the distribution  DOD-wide. (See app. II, table 19.) Specifically, the Marine Corps and Air  Force returned about 4 percent of temporary retirees to military service,  while the Army and Navy returned less than one half of one percent of  their respective TDRL retirees to active duty.
section_title: About Half Received a Final Determination within 3 Years
paragraphs: About half (46 percent) of all those placed on the TDRL, DOD-wide, in  calendar years 2000 through 2003 received a final determination on their  case within 3 years. (See app. II, table 20.) The amount of time spent  waiting for a final determination varied by type of determination and by  service. We found that, DOD-wide, final determinations placing temporary  retirees on the PDRL happened somewhat sooner (median time, 56  months) than final determinations returning temporary retirees to civilian  status with either no military disability benefits or with severance for a  disability (median time, 60 months). We also found that TDRL placements  from the Air Force tended to receive final determinations in fewer months  than TDRL placements from other services. (See fig. 6.) For example, by  36 months after placement on the list, the percent of temporary retirees  from the Air Force, Army, Marine Corps, and Navy who had received their  final determination and were removed from the list were 83 percent, 57  percent, 25 percent, and 22 percent, respectively.
The law provides that a temporary retiree can spend no more than 5 years  on the TDRL and must receive a final determination upon the expiration of  5 years, in cases where the individual remains on the list for the full 5  years. However, we found that about 12 percent of TDRL placements in  calendar years 2000 to 2003—1,163 cases—did not receive a final  determination within the 5 years, although they were removed from the  TDRL and their temporary retirement payments were discontinued. While  most of these individuals—735—were eventually placed on the PDRL,  none received monthly disability retirement payments between the time  they were removed from the TDRL and the time they were placed on the  PDRL. The amount of time that individuals spent waiting for a final  determination in some cases was significant. For example, of the 1,004  cases that were first removed from the TDRL and then subsequently  placed on the PDRL, there were 176 (18 percent) who waited longer than 6  months between being removed from the TDRL to being placed on the  PDRL, and very few received any military disability payments during this  period.
When asked about these cases, DOD officials reported that extra time is  needed to reach a final determination in some cases. For example, if TDRL  placements who have been on the list nearly 5 years are having trouble  scheduling a medical reexamination for their final determination, it may  take an extra month or two before a final determination can be made.  Also, DOD officials stated that they need the flexibility to allow some to  remain on the TDRL more than 5 years because their disabilities are still  not stable to rate at 5 years. Nevertheless, as stated earlier, a final  determination must be made upon the expiration of 5 years on the TDRL,  at which time disability is considered to be permanent and stable by  statute.
section_title: Final Disability Ratings for More Than Half Were Identical to Initial Ratings
paragraphs: Final disability ratings for temporary retirees determine whether retirees  are ultimately eligible for a disability severance payment or permanent  disability retirement. Final disability ratings also help determine the  amount of permanent monthly payments TDRL placements are eligible  for. DOD-wide, for those placed on the TDRL in calendar years 2000  through 2003 who were ultimately placed on the PDRL, 73 percent were  assigned a final disability rating that was no different from their initial  disability rating.  (See app. II, tables 21 and 22.) In other words, in these  cases, the severity of disabilities when placed on the TDRL was no  different from their severity when removed from it. Because one would  expect to find a difference between the initial and final ratings when  disabilities are determined to be unstable, the appropriateness of the  TDRL placement decision in cases where initial and final ratings are  identical could be called into question.
Another 14 percent of those ultimately placed on the PDRL received a final  rating that was lower than their initial one, indicating that their disabilities  were less severe when they left the TDRL than when they were placed on  it. Finally, 13 percent received a final rating that was higher, indicating that  their disabilities were more severe when they left the TDRL. The  differences between initial and final disability ratings for temporary  retirees in each of the service branches who were placed on the PDRL  were generally similar to the differences among these temporary retirees  DOD-wide.
section_title: Relatively Few Ultimately Qualified for PDRL Payments Higher Than Their TDRL Payments
paragraphs: According to military officials, being on the TDRL provides additional time  for the military services to determine an individual’s final disability rating,  which could result in more accurate payments. Although we could not  determine whether differences in initial and final ratings resulted in more  accurate payments, we estimated that for the 5,465 TDRL placements that  were placed on the PDRL, 7 percent would have received higher monthly  disability retirement payments, 20 percent would have received the same  disability payments, and 73 percent would have received lower payments,  based on their final ratings. Lower permanent disability retirement  payments were either due to a decrease in the disability rating or to the  fact that PDRL payments are not subject to the TDRL minimum payment  provision. For example, a temporary retiree with an initial rating of 40  percent who is moved to the PDRL with a final rating of 40 percent would  receive PDRL payments lower than their TDRL payments.
Of the 3,190 TDRL placements that were ultimately determined not to be  eligible for permanent disability payments, 73 percent received a disability  severance payment, and 26 percent had their disability benefits  terminated when they were removed from the TDRL.
section_title: DOD and the Services Do Not Provide Sufficient Management Attention to Key Aspects of the TDRL Process
paragraphs: DOD and the services do not effectively manage key aspects of the TDRL  process. While TDRL determinations vary considerably across the  services, neither DOD nor the services systematically examine PEB  stability decisions for accuracy and consistency, although these decisions  determine whether servicemembers are placed or retained on the TDRL.  They also do not routinely compile information on TDRL outcomes that  could better inform PEB determinations related to the stability of  disabilities. Despite indications that the services face challenges providing  medical reexaminations at least once every 18 months as required by law,  none monitor the extent to which this requirement is met. Moreover,  although TDRL reexamination requirements can place burdens on TDRL  retirees and MTFs, the use of examinations by nonmilitary physicians to  reduce these burdens is limited. Finally, the services lack procedures to  ensure consistent enforcement of TDRL rules.
subsections: section_title: TDRL Placement and Retention Decisions Are Not Systematically Analyzed for Accuracy and Consistency
paragraphs: One of the primary goals of any disability evaluation system is making  accurate and consistent disability determinations. In order to meet this  goal, there should be appropriate policies, procedures, and control  mechanisms in place to ensure that no one is placed or retained on the  TDRL who does not meet the criteria established by law. Such policies,  procedures, and control mechanisms are an important part of an effective  system of internal controls.
The accuracy and consistency of decisions to place servicemembers on  the TDRL are particularly important because of the significant impact  these decisions have on the military and on servicemembers’ lives.  According to military officials, placing servicemembers on the TDRL  provides an opportunity for the military to recover some of its investment  in recruitment and training by returning servicemembers to duty, and  provides more time to make an appropriate disability determination in  cases where a condition is likely to improve or deteriorate. Despite these  potential benefits, many military officials noted that the TDRL is  administratively burdensome and contributes to the workload of an  already overburdened disability evaluation system. For servicemembers,  benefits of being on the TDRL may include potentially higher disability  payments or returning to military service. Conversely, many focus group  participants said that being on the TDLR limited their ability to move  forward in their lives, and they expressed confusion, uncertainty, and a  sense of being adrift while on the TDRL.
To ensure uniformity in military disability case processing and decision  making, DOD requires each service to establish a quality assurance  process. However, decisions related to the stability of disabilities for rating  purposes—a key criterion for initially placing servicemembers on the  TDRL—are not systematically examined within or across the services. For  their part, the services do review some individual cases to ensure that the  medical evidence supports the determination. However, they do not  compare TDRL determinations made in cases with similar disabilities and  other characteristics.
Military officials we spoke with acknowledged that instability is defined  broadly and can be open to different interpretations by the PEBs.  Specifically, some military officials said that predicting whether or not a  disability rating may fluctuate within 5 years is not always easy and can  involve considerable professional judgment. In fact, our analysis shows  that some services have been classifying disabilities as “unstable” more  often than other services. TDRL determinations have consistently  accounted for a larger proportion of all PEB determinations in the Navy  and Marine Corps than in the other services. (See fig. 7.) Specifically,  between fiscal years 2001 and 2007, TDRL determinations constituted 27  percent of all Navy PEB determinations and 26 percent of all Marine Corps  PEB determinations. In contrast, TDRL determinations accounted for 15  percent of all Army PEB determinations and 11 percent of all Air Force  PEB determinations.
Another possible explanation for why some services classify disabilities as  unstable more often than other services, according to DOD officials, is that  there may be greater incidence of disabilities in some services that are  more likely to be unstable. Currently there are no data available from  either DOD or the services that could be used to determine why placement  rates vary. Further, DOD does not compare PEB instability decisions  across the services. As a result, DOD and the services have no way of  knowing the extent to which the military is making consistent decisions.
Furthermore, although most TDRL disability ratings did not change even  after several years on the list, DOD and the services do not routinely  compile and study how TDRL outcomes are related to different types of  disabilities, even though this information could help inform future TDRL  placement and retention decisions. For example, such information could  shed additional light on which conditions are more likely to change over  time and which ones are not. Meanwhile, participants in our focus groups  often questioned the appropriateness of their placement on the TDRL, and  the perceived unfairness of TDRL placement and retention decisions was a  theme that emerged in each of our focus groups. Some of the military  physicians we spoke with also questioned the value of having placed  individuals with certain conditions, such as certain types of cancer, on the  TDRL. For example, we were told that in one case, a cancer patient whose  cancer had metastasized was placed on the list, even though he was not  expected to recover.
section_title: The Services Do Not Track Periodic Medical Reexaminations for Timeliness
paragraphs: Officials that we spoke with in each of the services told us that TDRL  medical reexaminations do not necessarily occur every 18 months, as  required by law. As previously noted, an effective system of internal  controls would include policies, procedures, and mechanisms to help the  services ensure that the requirements of the law are being met. However,  the services do not collect data needed to know how often and why TDRL  medical reexaminations are late or fail to occur, nor have they established  performance measures or goals to guide the timely processing of TDRL  reexaminations.
The services’ procedures for tracking TDRL cases and enforcing the  statutory requirements are roughly similar. (See fig. 8.) Each service  assigns someone from their TDRL administrative unit to monitor when a  TDRL case is due for a reexamination and to forward the details of the  servicemember’s case, including which medical tests need to be  performed, to the MTF located nearest to the most current address on file  for the temporary retiree. Typically, the MTF is notified 2 months before  the reexamination is due, to allow the MTF time to schedule the  examinations and forward orders to the temporary retiree, and to allow  the temporary retiree to make other arrangements, if needed.
The services do not track the extent to which TDRL reexaminations occur  every 18 months, as required. However, late or missed TDRL medical  reexaminations are not uncommon, based on our interviews with staff at  MTFs, PEB officials, and focus group discussions with temporary  retirees. When asked about the reasons for late or missed TDRL  reexaminations, military officials and administrative staff responsible for  scheduling them in each of the services offered several possible reasons.  They cited temporary retiree noncompliance, such as failure to update  contact information or to attend scheduled appointments, as an obstacle  to completing examinations on time. They also acknowledged that the  MTFs cannot always schedule examinations on time. This may be because  they do not always receive the reexamination package far enough in  advance from TDRL administrators or because appointment slots for  certain medical specialties, particularly mental health, are limited. Staff at  MTFs across the services also reported that TDRL cases are not always  given the appropriate level of priority when appointments are scheduled.  Nevertheless, without better data, the services cannot effectively identify  and address the reasons for delayed or missed reexaminations.
section_title: There Is Only Limited Use of Nonmilitary Physicians to Reduce Burdens Associated with TDRL Reexaminations
paragraphs: To better leverage limited resources and expedite TDRL case processing,  current service procedures allow MTF’s to rely on the results of medical  examinations performed by civilian and VA physicians to meet  reexamination requirements. However, staff at most MTFs we contacted  said that they knew of few instances in which the military allowed TDRL  reexaminations to be conducted by nonmilitary physicians to reduce the  travel burden on a temporary retiree, or to ease MTF workloads.
Generally, TDRL administrators refer temporary retirees to the closest  MTF that has all medical specialties needed to evaluate their case.  However, many temporary retirees do not live near an MTF with all  needed medical specialties. Staff at some MTFs reported that, among  those for whom they schedule TDRL reexaminations, between one-quarter  to one-half travel more than a few hours to be examined—despite having  easier access to nonmilitary physicians. One MTF staff member we spoke  with described a case in which a temporary retiree from the Navy traveled  by car for nearly 10 hours—approximately 460 miles—from Sacramento,  Calif., to Camp Pendleton Hospital in southern California. In another case,  an MTF staff member described a case in which an Army retiree drove for  nearly 8 hours—approximately 480 miles—from Wisconsin to Ireland  Community Hospital in Fort Knox, Ky. Lengthy travel can be particularly  burdensome for those who experience pain as a result of their medical  conditions or for those who have limited finances or inflexible  employment situations. Moreover, according to some MTF staff, some  temporary retirees have told them that they fear losing their job if they  miss work to keep a medical appointment for a TDRL reexamination.
As noted, the limited availability of appointment slots for certain medical  specialties and a lack of priority in scheduling at some MTFs can  contribute to delays in completing TDRL reexaminations. This may be a  result of rising MTF workloads, caused by increasing numbers of injured  servicemembers returning from combat and increasing disability  caseloads.
Despite travel burdens for some temporary retirees and difficulties in  completing timely TDRL reexaminations at MTFs in the face of heavy  workloads, the use of nonmilitary physicians to help prepare TDRL  medical examination reports has been limited, according to MTF staff.  Military officials said that this is because VA and civilian physicians, who  are not subject to DOD requirements, are not always familiar with military  disability evaluation requirements and may not include information that  the services need to make a determination about whether a temporary  retiree should be removed from the TDRL. However, military officials said  that this could be addressed by providing clearer guidance to nonmilitary  physicians on how to prepare TDRL reexamination reports. It should be  noted that one VA hospital is already conducting medical examinations for  three MTFs as part of the joint DOD-VA disability evaluation pilot.
section_title: The Services’ Procedures Do Not Ensure Consistent Enforcement of TDRL Rules
paragraphs: DOD requires temporary retirees to submit to a periodic medical  examination at least once every 18 months. In addition, the services  require temporary retirees to provide them with current contact  information to facilitate these examinations. Although the services do not  collect data on the extent to which temporary retirees fail to comply with  reexamination requirements, MTF staff in each service reported problems  with temporary retirees not showing up for scheduled appointments.  Some MTF staff that we spoke with said that cancelled TDRL  appointments due to temporary retirees’ failure to show up happened in  relatively few cases each month, while others said that this happened  much more often.
Although DOD and military service regulations allow for suspending TDRL  pay if temporary retirees fail to satisfy these requirements, the procedures  in place across the services are insufficient to ensure that these provisions  are enforced consistently. For example, when temporary retirees fail to  update their contact information, each service’s procedures specify what  TDRL staff should do to locate and contact them, but do not clearly  specify at what point these efforts should be discontinued. In addition,  when temporary retirees fail to keep appointments for medical  reexaminations, these procedures allow for rescheduling them, but do not  specify how many appointments the retirees can miss before TDRL  monthly payments are stopped or what constitutes a valid reason for  missing an appointment. As a result of the lack of specificity, the number  of steps taken at different MTFs to locate and encourage temporary  retirees to go to their reexaminations before sending these cases back to  TDRL administrators for a stop-pay decision may vary widely.
Service officials said that the flexibility they have in making stop-pay  decisions allows them to consider extenuating circumstances, including  the potential impact that temporary retirees’ disabilities may have on their  ability to comply. For example, those with certain brain injuries or mental  health conditions may have trouble remembering what they are required  to do while on the TDRL. Stopping pay in these circumstances may be  unfair to the temporary retiree, particularly when servicemembers have  dependents who rely on these benefits. However, DOD regulations do not  provide guidance to the services on permissible exceptions.
section_title: TDRL Information Is Not Always Adequate or Accessible to Temporary Retirees
paragraphs: Information about temporary disability retirement that the services  provide to those they place on the TDRL is not always clear or complete  and can be difficult for TDRL retirees to access. The official PEB findings  forms, themselves, do not fully explain the reason for an individual’s  placement on the list or what is required of the TDRL retiree. Counseling  provided by PEBLOs was reported to be inconsistent and lacking in  follow-through, while the information contained in the services’  pamphlets, brochures, and fact sheets was not always complete. Military  Web sites that might have provided more thorough and ongoing  information were also incomplete or difficult to find. TDRL retirees  participating in our focus groups expressed considerable confusion about  and dissatisfaction with their limited access to information and contacts.
subsections: section_title: PEB Findings Forms Lack Important Information about the TDRL and Can Be Confusing
paragraphs: A PEB findings form is used to document each PEB disability decision. A  copy of this form is also given to servicemembers to notify them of the  PEB’s decision in their case. In addition to indicating the decision, each  service’s PEB findings form provides basic information about all disabling  conditions—how each is related to military service, a disability rating for  each disabling condition, and an overall rating—and the servicemember’s  years of qualifying service. When the decision is made to place a  servicemember on the TDRL, the PEB findings form can lack important  information about the TDRL, and the information that is provided can be  confusing. (See apps. III, IV, and V for examples of each service’s PEB  findings form.) For example, in TDRL cases, the services are not required  to explain the following on the findings form:    Why disability retirement benefits were granted temporarily rather than  permanently—specifically, that the PEB was unable to determine, based  on the medical evidence at that time, what the servicemember’s  permanent disability rating should be.
When a final disability decision will be made—specifically, that the PEB  will determine the servicemember’s permanent disability rating when the  medical evidence shows that the disabling condition has stabilized or  when the TDRL retiree has been on the list for 5 years, whichever comes  first.
We examined a limited number of actual PEB findings forms that  temporary retirees had received. None clearly explained why the  servicemembers were granted temporary versus permanent disability  retirement, when they could expect to receive a final disability decision, or  which disabling conditions have been determined to be unstable. Further,  the Army’s finding form does not specify for a TDRL determination which,  if any, of the listed conditions is considered permanent and stable. It does,  however, include standard language about the servicemember’s duty to  keep the Army informed about their current mailing address and to report  for medical reexaminations associated with PEB determinations, as well  as when the servicemember’s first TDRL reexamination is likely to occur.  In contrast, the Air Force, Marine Corps, and Navy PEB findings forms do  not include information about the servicemember’s responsibilities while  on the list or when their first reexamination is likely to occur, but they do  indicate that the servicemember has a medical condition that may be  permanent.
In some cases, the information in PEB findings forms is presented in a way  that makes it difficult for servicemembers to understand, regardless of the  disability decision made in their case. Based on the information contained  in their PEB findings forms, some TDRL retirees in our focus groups found  it difficult to understand how ratings for individual disabling conditions  are combined into a single overall disability rating. For example, one Army  PEB findings form that we reviewed presented the equation, shown in  figure 9, to demonstrate how one servicemember’s overall disability rating  had been calculated.
CR: 50 + 40 = 70 + 20 = 76 + 20 = 81 + 10 = 83 + 10 = 85 = 90 percent Although the equation includes all of the percentage ratings for each of the  servicemember’s rated conditions, it is not clear as to how the numbers  correspond to each percentage rating and how each of the listed  percentages logically results in the final placement rating. Furthermore,  many TDRL retirees in our focus groups indicated their difficulty in  understanding this information.
section_title: PEBLO Counseling Is Not Always Useful
paragraphs: DOD requires that servicemembers evaluated by a PEB be provided  counseling about the significance and consequences of their PEB disability  determination and any associated rights and benefits. For temporary  retirees, this should occur at the time a PEB places them on the list and  when any subsequent decisions to retain them on the list are made. In  practice, each service provides this counseling through a PEBLO.  PEBLOs have a critical role in helping temporary retirees understand what  it means to be placed on the TDRL. According to focus group discussions,  however, PEBLO counseling was not necessarily thorough or consistent. It  involved meeting one-on-one with a PEBLO in some cases and  participating in a group meeting in others. While some focus group  participants knew of someone they could call if they needed information  about the TDRL, many did not. Moreover, the counseling that temporary  retirees receive also appears to vary across services. Air Force and Navy  procedures allow for PEBLO counseling to be available at any time  throughout the disability evaluation process, while the Army requires only  that counseling be provided at specific times in the process. Although  officials from each of the services told us that temporary retirees are  provided with a point of contact, the lack of access to someone who could  answer their questions was a repeated theme in our focus groups.
There are several reasons why the quality of PEB counseling may vary  across the services. In a previous report, we found that, although each  service employs PEBLO counselors in accordance with DOD rules, each  places them in a different organizational unit, provides them with different  levels of training, and begins the counseling process at different points in  the disability evaluation process.
In each of our focus groups, the quality of counseling was a common  theme, and not all participants remembered receiving counseling at the  time they were placed on the TDRL. Although some participants in each of  our focus groups said that counseling had been helpful, the prevailing  opinion across all groups was that it did not meet their needs and that it  was not helpful.
section_title: Additional Information about the TDRL Is Not Always Complete or Easily Accessible
paragraphs: In addition to what appears on the PEB findings form and what is provided  by PEBLOs, each of the services provides information about the TDRL  through written handouts. However, the additional material provided by  the Air Force and Navy does not always address what temporary retirees  indicated was confusing or of most importance to them. Specifically, the  Air Force and Navy material does not always include information about  the overall disability evaluation system, stability of disabilities, the  consequences of not complying with TDRL requirements, or what the  eventual outcome of a TDRL case might be. It also does not always  provide a correct point of contact for questions temporary retirees might  have about the TDRL after they have read through this additional material.  The information the Air Force and Navy have developed includes general  information about the TDRL process. The Air Force’s one-page fact sheet  offers a broad explanation of why a servicemember may be placed on the  TDRL, the rights and responsibilities of TDRL retirees, and points of  contact for general questions about retired pay. It does not provide  specific information servicemembers may need about the TDRL, such as  who servicemembers may notify when they need to report changes to their  addresses and phone numbers. The Navy also has a brochure that answers  seven questions about TDRL pay and benefits, and like the Air Force fact  sheet, offers a broad explanation of why a servicemember may be placed  on the TDRL and the rights and responsibilities of temporary retirees. The  Navy brochure also provides a list of administrative offices that temporary  retirees may contact about pay and benefits; however, the phone number  listed for TDRL information was not working when we called it.  Additionally, while some MTF staff reported that paying for travel costs  up-front can be an issue for temporary retirees with limited finances, the  Navy brochure does not mention that temporary retirees may request an  advance payment for travel costs prior to incurring them. Lastly, the Air  Force and Navy materials do not explain that in addition to loss of  monthly pay, noncompliance with TDRL requirements may also result in a  loss of health insurance, including coverage for family members.
In contrast, the Army provides temporary retirees with a frequently asked  questions (FAQ) sheet, with answers to 25 questions about why a  servicemember is placed on the TDRL, their rights and responsibilities  while on the TDRL, potential final determinations, and points of contact  servicemembers can go to for answers to their questions about the TDRL.  The Army has also developed a handbook that describes the entire  disability evaluation process and includes basic information about the  TDRL.
Information on the TDRL was also generally available on service Web  sites, but we found that it was not easy to locate and was often  incomplete. None of the services’ home pages included a direct link to  TDRL information, and simple searches for TDRL information on each of  these pages did not lead directly to TDRL information. A more lengthy  search of the services’ individual Web sites eventually led to information  about the TDRL, although the amount of information varied by branch. On  the Army’s Web site, information on the TDRL could be found by  accessing a link to the Army’s Physical Disability Evaluation System  handbook. Although the Navy’s printed TDRL brochure offered a Web  address for TDRL information, the address was not available when we  attempted to access it. However, the Bureau of Naval Personnel Web page  included a TDRL information page that offered a series of links to relevant  regulations, potential final determinations for temporary retirees, and  likely reexamination time frames. A phone number was also provided on  this Navy Web page, but it was the same, nonworking phone number  provided in the Navy’s printed brochure. The Air Force Web site included  a brief summary of the TDRL, but lacked information about  noncompliance with TDRL requirements and the 5-year limit on receipt of  temporary retirement benefits.
Based on the results of our focus groups with temporary retirees, in  particular the gaps in information we found in the PEB findings forms and  lack of a specific TDRL point of contact, appear to result in confusion  about the TDRL and dissatisfaction with placement on the list. In most of  our focus groups, there was confusion about why participants had been  placed on the TDRL or what participants might expect throughout the  TDRL process. In some cases, participants were unable to reconcile what  they knew about the TDRL with the circumstances in their individual case.  Specifically, there was little understanding across our focus groups of the  concept of stability and how it applied to their particular disabilities.  Furthermore, in several focus groups, participants said that they had  learned what they were required to do while on the TDRL through their  own initiative, largely relying on contacts with colleagues or their own  research to obtain information about the purpose of TDRL reexaminations  and decisions to retain them on the TDRL as opposed to receiving  permanent disability.
section_title: Conclusions
paragraphs: The growth in TDRL caseloads further taxes limited resources available to  the military disability evaluation system, which is already struggling to  efficiently process increasing numbers of cases involving ill and injured  servicemembers. Processing TDRL cases adds to the complexity of this  system and to its cost. The TDRL process also has a significant impact on  servicemembers’ lives. If not managed effectively and efficiently, it can  deprive servicemembers of timely, appropriate, and fair disability  determinations, and prevent many from moving on with their lives after  incurring service-related disabilities.
There are several indications that the services’ management of the TDRL is  problematic. Currently, DOD’s quality assurance procedures do not take  advantage of available data on outcomes in past TDRL cases to avoid  postponing final disability determinations for servicemembers with disabilities  whose severity is unlikely to change. Current quality assurance procedures also  do not provide for the systematic review of TDRL placement decisions.  Therefore, the DOD has no way of knowing whether these placements are  appropriate or consistent. Further, DOD does not have effective mechanisms  for holding staff accountable for the timeliness of TDRL reexaminations or  otherwise ensuring the overall efficiency of TDRL case processing. Without a  system for monitoring the timeliness of reexaminations, a clear policy for  addressing noncompliance, and a strategy for leveraging nonmilitary resources  to complete reexaminations, DOD cannot avoid sometimes lengthy delays in  final determinations in TDRL cases. Further, by failing to make a final  determination as soon as temporary retirees are removed from the TDRL, the  services are denying some temporary retirees benefits to which they are  entitled. Finally, inadequate information on PEB finding forms about why  individuals are placed on the TDRL and little or no access to a point of contact  that can address temporary retirees’ questions about the process, make it less  transparent. This may generate distrust and frustration among many temporary  retirees and affect their ability and willingness to comply with TDRL  requirements. Without a better understanding of the information needs of  temporary retirees and more proactive contact with them, DOD is missing an  important opportunity to remove potential obstacles to temporary retirees’  compliance with TDRL requirements.
In addition to the TDRL management issues we identified, the outcomes  we found in TDRL cases raise questions about the list’s design and  purpose. In most of the cases we reviewed, the temporary retiree received  a permanent disability rating well before the 5-year TDRL limit, which  suggests that the current TDRL time limit could be shortened. With only 1  in 100 temporary retirees returning to active duty, the TDRL also does not  appear to be a very effective mechanism for meeting the needs of the  military. Finally, most temporary retirees received a final rating equal to or  lower than their initial one, and very few were eventually eligible for  higher permanent disability payments. As a result, the TDRL simply  postponed the inevitable for many with service-related disabilities and  delayed their transition from military to civilian life.
section_title: Recommendations for Executive Action
paragraphs: To ensure that TDRL placement and retention decisions are appropriate  and consistent, the Secretary of Defense should take the following two  actions:    Direct the Secretaries of the Air Force, Army, and Navy to better  inform their decisions about whether or not to place or retain someone  on the TDRL by taking into account data from past TDRL cases on  outcomes for particular types of disabilities; and  systematically review the appropriateness and consistency of each  service’s PEB decisions regarding the stability of disabilities.
To ensure that TDRL reexaminations occur at least once every 18 months,  the Secretary of Defense should take the following four actions:    Direct each service to track and periodically report on the timeliness  of medical reexaminations in TDRL cases;   develop DOD-wide standards and goals for the timeliness of TDRL  establish a clearer policy specifying how the services should enforce  the requirements that temporary retirees submit to periodic  reexaminations and notify TDRL administrators when they have a  change of address; and expand the use of nonmilitary physicians for conducting TDRL  reexaminations, in accordance with DOD guidance.
To prevent unnecessary delays in permanent disability determinations for  temporary retirees and gaps in the receipt of disability benefits they are  entitled to, the Secretary of Defense should take the following action:    Direct the services to ensure that temporary retirees receive a final  determination upon expiration of their 5 years on the TDRL, as  required by law.
To ensure that temporary retirees receive adequate information to  understand why they are placed on the list and the importance of  complying with TDRL requirements, we recommend that the Secretaries of  the Air Force, Army, and Navy take the following three actions:    Assess the adequacy of information they provide regarding the TDRL,  including the information contained on their PEB findings forms and  other materials, and provided by PEBLOs, and make improvements  where needed; take steps to encourage ongoing contact between temporary retirees  and TDRL administrators by, for example, maintaining a working and  easily accessible TDRL administrative telephone hotline for temporary  retirees; and  improve access to Web-based information about the TDRL.
section_title: Matter for Congressional Consideration
paragraphs: Given the low number of temporary retirees who return to the military, the  high proportion who eventually become eligible to receive permanent  military disability retirement benefits, and the added cost to the military of  administering TDRL cases, the Congress may wish to consider shortening  the current 5-year maximum tenure on the TDRL.
section_title: Agency Comments and Our Evaluation
paragraphs: We provided a draft of this report to DOD and the services for review and  comments. DOD provided written comments, which are reproduced in  appendix IX. DOD indicated that it concurs with each of our  recommendations, with comments in a few cases.
With respect to our recommendation that DOD establish a clearer policy  for how the services should enforce TDRL requirements for temporary  retirees, DOD commented that the services provide servicemembers  directions regarding TDRL requirements that they must comply with, and  that it is not reasonable to assume that DOD can keep track of every  change of address if temporary retirees fail to keep the information  current. We agree. However, our recommendation calls for DOD to  establish more specific guidelines on when and what action should be  taken in response to temporary retirees’ failure to comply with TDRL  requirements, and is intended to ensure equitable treatment in all cases of  noncompliance across the services.
DOD noted that our recommendation to expand the use of nonmilitary  physicians for conducting TDRL reexaminations should include a  statement that nonmilitary physicians should be “trained in and will accept  examinations of individuals using VA-approved templates.” DOD also  indicated that “use of non-military physicians should also include specific  reference to reexaminations at non-military and non-VA facilities given  training and qualification consistent with Title 10 and Title 38, USC.” We  believe that our recommendation falls within the services’ current  authority to use reports of medical examinations from nonmilitary  physicians and facilities under DOD Instruction 1332.38, which assigns the  responsibility for assuring the adequacy of these examinations to MTFs. In  addition, this instruction currently encourages physicians performing  reexaminations for the TDRL to use VA’s physician’s guide. Our  recommendation is not suggesting a change to the underlying guidelines  prescribing the use of nonmilitary physicians; rather, we are  recommending that use of nonmilitary physicians should be expanded. In  response to DOD’s comments, we have added the phrase “in accordance  with DOD guidance” to our recommendation.
Finally, DOD concurred with our recommendations for ensuring that  temporary retirees are provided easier access to military personnel who  can answer their TDRL questions and to Web-based TDRL information. It  also commented that both are readily available to temporary retirees.  While we acknowledge the services’ current efforts in this area, they do  not appear to be enough to meet the needs of temporary retirees. The  results of our review of the accessibility of TDRL points of contact and  Web-based information, as well as temporary retirees’ reports of difficulty  accessing both, indicate a need for improvement in these areas.
DOD also provided technical comments, which we incorporated in the  report as appropriate.
We are sending copies of this report to relevant congressional committees,  the Secretary of Defense, the Secretary of Veterans Affairs, and other  interested parties. In addition, the report will be available at no charge on  GAO’s Web site at http://www.gao.gov.
If you or your staffs have any questions about this report, please contact  me 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 report. Key contributors to this report are listed in appendix X.
section_title: Appendix I: Scope and Methodology
paragraphs: The objectives of our review were to examine (1) recent trends in the  Temporary Disability Retired List (TDRL) caseload size, (2) recent trends  in the characteristics of servicemembers placed on the TDRL, (3) disability  retirement outcomes for TDRL placements, (4) the adequacy of TDRL  management, and (5) the adequacy of information provided to temporary  retirees.
subsections: section_title: Identifying Trends in TDRL Caseload Size
paragraphs: To identify trends in TDRL caseload size, we examined data provided by  the Department of Defense’s (DOD) Defense Manpower Data Center  (DMDC) on the size and makeup of each service’s annual TDRL caseload  for fiscal years 2001 through 2007. More specifically, we compared TDRL  caseload sizes in the last month of each fiscal year (September) over time,  both within and across the services. We also compared the relative  proportion of former active duty and reserve servicemembers in the  annual TDRL caseload over time.
To determine what could have contributed to the growth in TDRL  caseloads, we compared the trend in TDRL caseload size to the trend in  the (1) number of cases that received disability evaluation system  determinations, (2) TDRL placement rate, and (3) number of cases  removed from the TDRL each year, for fiscal years 2001 through 2007. We  obtained these data from  the Air Force Military Personnel Data System; the Army Physical Disability Case Processing System; and the Joint Disability Evaluation System, which captures Physical Evaluation  Board (PEB) case data for the Navy and Marine Corps.
To assess the reliability of each of these systems, we reviewed  documentation related to each that provided information such as record  layout, data dictionary, how data were collected and stored, measures  taken to ensure data quality, and screens used to extract the data we  required. We also interviewed military personnel knowledgeable about  each system to obtain more detailed information about the system and the  data in it. Based on our assessment, we determined that data from each of  these systems were sufficiently reliable for our analyses.
section_title: Determining the Characteristics of TDRL Placements
paragraphs: To identify the characteristics of individuals placed on the TDRL each  month from January 2000 through December 2007 (see table 3), we  analyzed monthly transaction-level data DMDC had extracted for us from  its Retired Pay File, a database containing information on individual  retirees from the Army, Air Force, Marine Corps, and Navy.
To determine the characteristics of temporary retirees placed on the TDRL  in calendar years 2000 through 2007—including disability rating  percentages, their years of service, and the proportions who were formerly  active duty servicemembers and reservists—we analyzed data for these  individuals the DMDC extracted for us from their Retired Pay File.
To identify disabilities among temporary retirees placed on the TDRL in  calendar years 2000 through 2007, we obtained the Department of  Veterans Affairs Schedule for Rating Disabilities (VASRD) diagnostic  codes associated with each temporary retiree’s case from the services’  PEBs, and grouped these disabilities under the appropriate disability  categories provided in the VASRD.
section_title: Determining TDRL Outcomes for Those Placed on the List
paragraphs: We focused many of our analyses of TDRL outcomes on individuals placed  on the list in calendar years 2000 through 2003. At least 5 years (the  maximum amount of time someone can spend on the TDRL) had elapsed  since these individuals had been placed on the list, so a final disability  determination should already have been made in each case.
To determine what final PEB disability determinations were for TDRL  placements from calendar years 2000 through 2007, we examined monthly  transactions from January 2000 through August 2008 for each case,  contained in the data we received from DMDC, to identify movement off  the TDRL due to (1) placement on the PDRL, (2) separation from the  service, (3) death, or (4) return to active duty. We counted the first of  these pay actions encountered after the date of placement on the TDRL as  the final disability determination in that case. We examined data we had  received from the relevant PEB in each case to determine which of those  separated from the service had received a disability severance payment  and which had been separated with no disability benefits.
We also used the same DMDC monthly transaction data to determine how  long after placement on the TDRL temporary retirees received a final  disability determination. We counted the number of months, from the  month the individual in each TDRL case was initially placed on the list, to  the month that the individual was first removed from the TDRL due to (1)  placement on the PDRL, (2) separation from the service, (3) death, or (4)  return to active duty. In 1,004 cases, a separation from the service action  was followed in 1 or more months by a placed on the PDRL action. In  these cases, the time it took to receive a final disability determination was  based, instead, on the month in which placement on the PDRL occurred.
Finally, data from the DMDC Retired Pay File on the initial and final  disability percentage ratings for TDRL placements in calendar years 2000  through 2003 were used to identify how these ratings differed, if at all. To  determine the amount of monthly benefits individuals would receive, we  multiplied the disability rating as a percentage of base pay. Thus, we  looked at the disability rating and applied the following pay guidelines to  determine what percentage of base pay TDRL retirees would be eligible to  receive: (1) TDRL payments are a minimum of 50 percent of base pay;   (2) the PDRL is not subject to any minimum payments; and (3) for both the  PDRL and the TDRL, the maximum payment is 75 percent of base pay. We  then compared the percentage of base pay individuals would be eligible  for while on the TDRL verses the percentage they would be eligible for on  the PDRL. From here, we could determine the number of TDRL retirees  whose monthly payments would increase, decrease, or stay the same once  they moved to the PDRL.
To assess the reliability of data from DMDC’s Retired Pay File, as well as  the TDRL caseload data we received from the DMDC, we performed initial  tests and checks on the data to verify that records matched our selection  criteria and were sufficiently reliable for our analyses. We obtained  documents from the military on the Retired Pay File edit file layout, the  record layout of the pay file, the definition of the data variables, how the  data in this file were collected, and the measures taken to assure data  quality. We also conducted interviews with DMDC staff to obtain more  specific information regarding the data, such as how they are stored and  maintained and how they should be interpreted and used. Based on our  assessment, we determined that these data were sufficiently reliable for  our analyses.
In addition to our own analysis, we reviewed and discussed with DOD  officials the results of their recent study of the TDRL, which also  examined TDRL retirees’ characteristics and outcomes.
section_title: Assessing the Adequacy of TDRL Management
paragraphs: To assess the adequacy of TDRL management, we reviewed relevant laws,  regulations and procedures to determine    how TDRL decisions were made, monitored, and evaluated;    how reexaminations for TDRL were arranged and tracked for timeliness;    what use was made of reexaminations by nonmilitary physicians to reduce  the burden on MTFs; and   how TDRL requirements for temporary retirees were enforced.
Specifically, we interviewed military officials and staff from each service  involved in the TDRL process, including PEB members and physicians,  Medical Command representatives, staff in each service’s TDRL  administrative office or unit, Physical Evaluation Board Liaison Officers  (PEBLO), and staff at selected military treatment facilities (MTF)  responsible for scheduling and monitoring the completion of TDRL  reexaminations. We assessed the adequacy of what we learned about the  management of the TDRL based on (1) our review of TDRL laws,  regulations, and other written policies and guidance; (2) the results of our  interviews; and (3) its consistency with internal control standards for the  federal government and the requirements of the Government Performance  and Results Act of 1993.
For our discussions with PEBLOs, we selected MTFs across the services.  We also considered geographic diversity and facility size when selecting  these facilities. The information we obtained from PEBLOs at these  facilities is testimonial in nature and not intended to reflect the practices,  experiences, or opinions of PEBLOs at MTFs, in general. (See table 4.)
To help assess the adequacy of TDRL management, we also examined the  experiences and views of temporary retirees from the Air Force, Army,  Marine Corps, and Navy. To obtain this information, we conducted a series  of 12 focus groups in June and August 2008 with individuals who were on  the TDRL. Three focus groups were conducted at each of four locations— Norfolk, Va.; Quantico, Va.; San Antonio, Tex.; and Killeen, Tex. These  locations were selected because each provided a large pool of temporary  retirees from which to draw focus group volunteers. Together, these  locations also enabled us to obtain the perspectives of temporary retirees  from each of the services.
To recruit volunteers for these focus groups, we obtained a list of  temporary retirees who resided within a 50-mile radius of each location  from the Defense Finance and Accounting Service. We attempted to  contact each temporary retiree on the list to invite them to participate in a  focus group conducted in their area. A total of 57 temporary retirees  participated in these focus groups. (See table 5.)
Focus group participants had a wide range of characteristics. They had an  average of 12 years of military service, ranging from a minimum of 2, to a  maximum of 28 years. About three-quarters had been active duty, and  about one-quarter had been in the reserves. About one-quarter had served  in Operations Enduring Freedom or Iraqi Freedom.  To obtain information from the focus groups, we established a standard  protocol to facilitate the discussions. Each focus group covered several  major topics, including the overall disability evaluation process, placement  on the TDRL, periodic reexaminations while on the TDRL, and advantages  and disadvantages of being placed on the list. A GAO facilitator led each  discussion to keep participants focused on the specified issues within  discussion time frames. With the consent of focus group participants, we  recorded each discussion and had each recording professionally  transcribed.
To summarize the results of our focus groups, we identified themes  participants raised that were common to more than one group. We verified  our analysis to ensure its reliability. While we identified a number of  common themes across the 12 focus groups, our results cannot be  generalized to the universe of all temporary retirees.
Finally, we contacted six veterans’ service organizations to obtain their  views about the TDRL process and how it affects servicemembers placed  on the list. We obtained written comments from the Disabled American  Veterans, the Iraq and Afghanistan Veterans Association, and the Military  Officers Association of America.  (See apps. VI, VII, and VIII.)
section_title: Assessing the Adequacy of Information Provided to Temporary Retirees
paragraphs: To assess the completeness, clarity, and accessibility of information  provided to individuals placed on the TDRL, we reviewed each service’s  PEB findings form and other written materials, as well as information  available on the services’ Web sites. (See table 6.)
The specific topics we looked for in PEB findings forms and other written  materials, and on a service’s Web site were (1) the purpose of the TDRL,  (2) definitions of “stability” and “permanency,” (3) rolls and  responsibilities of temporary retirees while on the list, (4) ramifications of  noncompliance with TDRL requirements, and (5) potential final disability  determinations.
We also obtained information from our focus groups about the types of  information they needed and wanted about the TDRL, their sources for  information about the list, and the adequacy of the information they  received.
section_title: Appendix II: Additional Data Tables
subsections: section_title: Num Pct Num Pct
paragraphs: Num Pct Num Pct Num Pct    Num  Pct 118  12    102  10    148  14    158 16 8    252  10    222  10    271 12 16 6  4.6  26 63 uest from DMDC yielded Retired Pay File records through August 200. Thus, 1 (6  Air Force, 54 Army, 14 Marine Corps, and 64 Navy) of the cases shown as still on the TDRL in the  2000 through 200 cohort had less than 5 years worth of data in our dataset. It is possible that some  of these cases could have had final dispositions before or at 5 years that occurred after August 200  and were not captured in our analysis.
section_title: Appendix III: Sample Army Form: Physical Evaluation Board Proceedings (DA Form 199)
paragraphs: Appendix III: Sample Army Form: Physical  Evaluation Board Proceedings (DA Form 199)
section_title: Appendix IV: Sample Navy Form: Findings of the Physical Evaluation Board Proceedings
section_title: Appendix V: Sample Air Force Form: Findings and Recommendations of the USAF Physical Evaluation Board (AF Form 356)
paragraphs: Appendix V: Sample Air Force Form: Findings  and Recommendations of the USAF Physical  Evaluation Board (AF Form 356)
section_title: Appendix VI: Comments on the TDRL from Disabled American Veterans
section_title: Appendix VII: Comments on the TDRL from Iraq and Afghanistan Veterans of America
section_title: Appendix VIII: Comments on the TDRL from the Military Officers Association of America
section_title: Appendix IX: Comments from the Department of Defense
section_title: Appendix X: GAO Contact and Staff Acknowledgments
subsections: section_title: Staff Acknowledgments
paragraphs: Clarita Mrena (Assistant Director), Regina Santucci (Analyst-in-Charge),  Salvatore Sorbello, Mark Ward, John Fisher, and Susan Bernstein made  major contributions to this report. Walter Vance, Beverly Ross, and Anna  Maria Ortiz assisted with study design and data analysis; James Rebbe and  Doreen Feldman provided legal advice; Almeta Spencer assisted with  study processing; Mimi Nguyen and Armetha Liles assisted with graphics;  and Holly Dye assisted with editing.
section_title: Related GAO Products
paragraphs: Traumatic Brain Injury: Better DOD and VA Oversight Can Help  Ensure More Accurate, Consistent, and Timely Decisions for the  Traumatic Injury Insurance Program. GAO-09-108. Washington, D.C.:  January 29, 2009.
Military Disability Systems: 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.
VA Health Care: Mild Traumatic Brain Injury Screening and  Evaluation Implemented for OEF/OIF Veterans, but Challenges Remain.  GAO-08-276. Washington, D.C.: February 8, 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 Evaluation: Ensuring Consistent and Timely  Outcomes for Reserve and Active Duty Service Members. GAO-06-561T.  Washington, D.C.: April 6, 2006.
Military Disability Systems: 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.