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. 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.” 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. 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. 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.) 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. 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.) 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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.) 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. 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. Appendix III: Sample Army Form: Physical Evaluation Board Proceedings (DA Form 199) Appendix V: Sample Air Force Form: Findings and Recommendations of the USAF Physical Evaluation Board (AF Form 356) 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. 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.

Summary: 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. 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.