The military’s disability evaluation process begins with the identification of a medical condition that could render the servicemember unfit for duty. On the basis of medical examinations, a medical evaluation board (MEB) documents any conditions that may limit a servicemember’s ability to serve in the military. The servicemember’s case is then evaluated by a physical evaluation board (PEB) to make a determination of fitness or unfitness for duty. If the servicemember is found to be unfit due to medical conditions incurred in the line of duty, the PEB assigns the servicemember a combined percentage rating for those unfit conditions using VA’s rating system as a guideline, and the servicemember is discharged from duty. This disability rating, along with years of service and other factors, determines subsequent disability and health care benefits from DOD. Appendix II provides additional background information about the MEB and PEB processes. As servicemembers in the Army navigate DOD’s disability evaluation process, they interface with staff who play a key role in supporting them through the process. MEB physicians play a fundamental role because they are responsible for documenting the medical conditions of servicemembers for the disability evaluation case file. In addition, board physicians may require that servicemembers obtain additional medical evidence from specialty physicians, such as a psychiatrist. Throughout the MEB and PEB processes, a board liaison serves a key role by explaining the process to servicemembers, and ensuring that the servicemembers’ case files are complete before they are forwarded for evaluation by the PEB. The board liaison informs servicemembers of board results and of deadlines at key decision points in the process. The military also provides legal counsel to servicemembers in the disability evaluation process. The Army, for example, has a policy to provide legal counsel anytime upon request and to assign legal representation at formal PEB hearings, although servicemembers may retain their own representative at their own expense. In addition to receiving benefits from DOD, veterans with service- connected disabilities may receive compensation from VA for lost earnings capacity. Although a servicemember may file a VA claim while still in the military, he or she can only obtain disability compensation from VA as a veteran. VA will evaluate all claimed conditions, whether or not they were evaluated previously by the military service’s evaluation process. If VA finds that a veteran has one or more service-connected disabilities with a combined rating of at least 10 percent, the agency will pay monthly compensation. The veteran can claim additional benefits over time, for example, if a service-connected disability worsens or surfaces at a later point in time. In response to the deficiencies reported by the media, GAO, and the Army Inspector General about the care its injured and ill servicemembers received, the Army took several actions, including, most notably, initiating the development of the AMAP in March 2007. The plan, designed to help the Army become more patient-focused, includes tasks for automating portions of the disability evaluation process and maximizing coordination of efforts with VA. As part of the AMAP, the Army also developed a new organizational structure—Warrior Transition Units—to provide a more focused continuum of care and services to both active-duty and reservist servicemembers. Within each unit, the servicemember is assigned a primary care manager, a nurse case manager, and a squad leader to manage the servicemember’s medical treatment and help ensure that the needs of the servicemember and his or her family are met. In May 2007, DOD established the Senior Oversight Committee to bring high-level attention to addressing the systemic problems associated with the care and treatment of returning servicemembers. The committee is cochaired by the Deputy Secretaries of Defense and Veterans Affairs and also includes the military service secretaries and other high-ranking officials within DOD and VA. To conduct its work, the committee established workgroups to address specific issues, including the disability evaluation system. Originally intended to expire in May 2008, the committee was extended to January 2009. Under the direction of the Senior Oversight Committee, DOD and VA are piloting a joint disability evaluation system to improve the timeliness and resource use of DOD’s and VA’s separate disability evaluation systems. Begun in November 2007, the pilot involves cases at three Washington, D.C.-area military treatment facilities, including Walter Reed Army Medical Center. Key features of the pilot include (see fig. 1): a single physical examination conducted to VA standards as part of the disability ratings prepared by VA, for use by both DOD and VA in determining disability benefits; and additional outreach and nonclinical case management provided by VA staff at the DOD pilot locations to explain VA results and processes to servicemembers. The Army has taken a number of steps to help servicemembers navigate the disability evaluation process through additional supports and streamlining efforts, such as expanding support to servicemembers by hiring more board liaisons and legal personnel. In addition, the Army has established a staffing ratio for board physicians who document servicemembers’ medical conditions. Nevertheless, the Army continues to struggle with meeting internal goals for the staffing and timeliness of processing disability evaluation cases. In addition, the Army’s increased staffing, outreach efforts, and other supports may be insufficient to ensure that servicemembers understand the process and are aware of their legal rights. The Army faces challenges in demonstrating an impact on servicemember satisfaction, in part because the Army has not yet implemented a satisfaction survey that adequately targets and queries servicemembers who are undergoing disability evaluation. As part of the AMAP, the Army established staffing goals for staff who are key to helping servicemembers navigate the disability evaluation process. Specifically, the Army established caseload targets for board liaisons and board physicians, and articulated the need to provide servicemembers with access to legal counsel at the beginning of the process. For board liaisons—who explain the disability process to servicemembers and are responsible for ensuring that their disability case files are complete—the Army established for the first time a caseload target of 30 servicemembers per liaison in June 2007. At the same time, for board physicians—who evaluate and document servicemembers’ medical conditions for the disability evaluation case file—the Army established a caseload target of 200 servicemembers per physician. Although a caseload target was not set for legal counsel, the Army proposed dedicating 57 additional legal staff at 19 of its 35 treatment facilities to help servicemembers gain access to legal counsel prior to the formal board hearings when counsel is normally assigned. The Army has expanded hiring efforts for board liaisons, but it faces challenges in keeping up with the increased demand for the liaisons’ services. From August 2007 to June 2008, the number of board liaisons grew from 160 to 221—a 38 percent increase Army-wide—and the average caseload per liaison declined from 46 to 29 servicemembers. However, as of June 2008, the Army had not met its internal staffing goal of 30 servicemembers per liaison at 14 of its 35 treatment facilities, and about 70 percent of servicemembers in the disability evaluation process were located at facilities with shortages (see fig. 2). Liaisons we spoke with at one of the locations with the highest average caseloads had difficulty in making appointments with servicemembers, which challenged their ability to provide timely and comprehensive support. While the Army plans to hire additional board liaisons, it has encountered difficulty in attracting qualified liaisons at some locations due in part to their remote location. The Army’s ability to meet internal staffing goals is also affected by increases in demand. According to Army data, the total number of servicemembers completing the MEB increased about 19 percent from year-end 2006 to year-end 2007. Regarding MEB physicians, the Army has mostly met its goal for the average number of servicemembers at each treatment facility, but challenges with physician staffing remain. As of June 2008, the Army met its goal of 200 servicemembers per board physician at 28 of 35 treatment facilities. However, 47 percent of servicemembers undergoing disability evaluation are located at the 7 facilities that did not meet the goal. In addition, according to Army officials, physicians are having difficulty in managing their caseloads, even at locations where they have met or are close to the Army’s goal of 200 servicemembers per physician. Several physicians and Army officials told us that the Army could provide better service to servicemembers if more physicians were available to conduct medical evaluations. To help improve case processing, in July 2008 the Army changed the target staffing ratio for board physicians from 200 servicemembers to 120 servicemembers per physician. Some Army physicians told us that the ratio of servicemembers per physician allows little buffer when there is a surge in caseloads at a treatment facility, and that delays in case processing result from these imbalances. A mobile unit—comprising a board physician, a board liaison, and other staff—has been deployed since 2004 in the Army’s southeast region. According to an Army official who works with the mobile unit, its deployment has helped reduce backlogs where it has been deployed, but such units are not used throughout the Army. In addition to gaps in board liaisons and board physicians, staffing of legal personnel who provide counsel to injured and ill servicemembers throughout the disability evaluation process is currently insufficient. According to the Army, servicemembers should receive legal assistance upon request during both the MEB and PEB processes.