The IDES process begins at a military treatment facility when a physician identifies one or more conditions that may interfere with a servicemember’s ability to perform his or her duties. The process involves four main phases: the Medical Evaluation Board (MEB), the Physical Evaluation Board (PEB), transition out of military service (transition), and VA benefits. MEB phase: In this phase, medical examinations are conducted and decisions are made by the MEB regarding a servicemember’s ability to continue to serve in the military. This phase involves four stages: (1) the servicemember is counseled by a DOD board liaison on what to expect during the IDES process; (2) the servicemember is counseled by a VA case manager on what to expect during the IDES process and medical exams are scheduled; (3) medical exams are conducted according to VA standards for exams for disability compensation by VA, DOD, or contractor physicians, and (4) exam results are used by the MEB to identify conditions that limit the servicemember’s ability to serve in the military.an impartial medical review by a physician not on the MEB, or both. Also during this stage, a servicemember can seek a rebuttal, or PEB phase: In this subsequent phase, decisions are made about the servicemember’s fitness for duty, disability rating and DOD and VA disability benefits, and the servicemember has opportunities to appeal those decisions. This includes: (1) the informal PEB stage, an administrative review of the case file by the relevant military branch’s PEB without the presence of the servicemember; (2) VA rating stage, where a VA rating specialist prepares a rating that covers the conditions that DOD determined made a servicemember unfit for duty and any other conditions claimed by the servicemember to VA. This rating is prepared for use by both agencies in determining disability benefits. In addition, servicemembers have several opportunities to appeal different aspects of their disability evaluations: a servicemember dissatisfied with the decision on whether he or she is fit for duty may request a hearing with a “formal” PEB; a servicemember who disagrees with the formal PEB fitness decision can, under certain conditions, appeal to the reviewing authority of the PEB; and a servicemember can ask for VA to reconsider its rating, but only for conditions found unfitting by the PEB. Transition phase: If the servicemember is found unfit to serve, he or she enters the transition phase and begins the process of separating from the military. During this time, the servicemember may take accrued leave. Also, DOD board liaisons and VA case managers provide counseling on available benefits and services, such as job assistance. VA benefits phase: A servicemember found unfit and separated from service becomes a veteran and enters the VA benefits phase. VA finalizes its disability rating after receiving evidence of the servicemember’s separation from military service. VA then starts to award monthly disability compensation to the veteran. DOD and VA established timeliness goals for the IDES process to provide VA benefits to active duty servicemembers within 295 days of being referred into the process, and to reserve component members within 305 days (see fig. 1). DOD and VA also established interim timeliness goals for each phase and stage of the IDES process. The overall timeframes are intended to represent an improvement over the legacy disability evaluation system, which was estimated to take 540 days to complete. In addition to timeliness, the agencies also established a performance goal of having 80 percent of servicemembers satisfied with the IDES process. DOD measures satisfaction through surveys conducted after the completion of the MEB, PEB, and transition phases. Each survey consists of approximately 30 questions, including 4 questions that ask about the servicemember’s satisfaction with the overall IDES process up to that point. Reported satisfaction rates for each phase are based on an average of responses to these four questions, and reported overall satisfaction with IDES (which is used to track the percent satisfied under the performance goal) is an average of satisfaction rates for the three phases. From the original 3 pilot military treatment facilities in the Washington, the IDES has expanded to 139 military treatment facilities in D.C., area,the U.S. and several other countries. DOD and VA first added 24 military treatment facilities to the pilot in fiscal years 2009 and 2010, bringing the pilot total to 27. In 2010, DOD and VA leadership decided to implement the IDES world-wide, and did so in 4 stages between October 2010 and September 2011, adding 112 military treatment facilities. As IDES expanded, the number of new cases enrolled in IDES has also increased, totaling 18,651 in fiscal year 2011 (see fig. 2). IDES caseloads vary by service, but the Army manages the bulk of IDES cases. Of new cases referred to IDES in fiscal year 2011, about 64 percent were in the Army, and much of the growth in caseload has been in the Army. Additionally, active duty servicemembers make up the majority of IDES cases, with about 88 percent of new cases in fiscal year 2011 involving this group (see fig. 3). IDES timeliness has worsened since the inception of the program. Since fiscal year 2008, the average number of days for servicemember cases to be processed and receive benefits increased from 283 to 394 for active duty cases (compared to the goal of 295 days) and from 297 to 420, for reserve component cases (compared to the goal of 305 days) (see fig. 4). Along with increasing average processing times, the percent of IDES cases awarded benefits within timeliness goals has steadily declined. DOD’s and VA’s current goal is to complete 60 percent of IDES cases on time. In fiscal year 2008, an average of 63 percent of cases for active duty servicemembers and 65 percent for reservists completed the process and received benefits within the timeliness goals; by fiscal year 2011 this was down to 19 and 18 percent respectively (see fig. 5). These trends also hold when considering all cases that completed the IDES process regardless of outcome, although overall processing times were shorter. (See app. III for more information on case processing times regardless of outcome.) When examining timeliness across the four phases that make up IDES, data show that average processing time regularly fell short of goals for three—MEB, Transition, and VA Benefits. For example, for cases that completed the MEB phase in fiscal year 2011, active duty and reserve component members’ cases took an average of 181 and 188 days respectively to be processed, compared to goals of 100 and 140 days. For the PEB phase, processing times increased over time, but were still within the established goal of 120 days. Along with increasing average processing times, the percentage of cases meeting goals for most phases has generally declined (see fig. 6). In particular, the MEB and Transition phases have lower percentages of cases meeting goals than the other phases in most years, especially for active duty cases. As noted above, the MEB phase was a key contributor to increases in overall processing times between 2008 and 2011 for both active duty servicemembers and reservists for cases that have completed the IDES process regardless of outcome (table 1). To obtain a better understanding of more recent timeliness trends within the MEB phase, GAO analyzed MEB timeliness of all cases—all fiscal years combined—that completed the MEB process by sorting them into two groups: (1) those that completed the entire IDES process, and (2) those that had not yet completed IDES but completed the MEB phase. As shown in figure 7, for the group that completed IDES, 30 percent of active duty servicemembers and 18 percent of reservists missed the goal by more than 90 days. For those still in IDES, representing more recent data, the picture is slightly better for active duty servicemembers with 37 percent of cases meeting the MEB goal and 25 percent missing the goal by more than 90 days. However, the percentage of reserve component members who missed the goal by more than 90 days increased from 18 to 28 percent. For those servicemembers who were still enrolled in the MEB phase as of December 2011, the data show that 41 percent of active duty and 33 percent of reserve component servicemember cases had already missed the goal processing times (see fig. 8). Of these, 15 percent of active duty and 10 percent of reservist component servicemember cases missed the goal by more than 90 days. Within the MEB phase, significant delays have occurred in completing medical examinations (medical exam stage) and delivering an MEB decision (the MEB stage). For cases completing the MEB phase in fiscal year 2011, 31 percent of active duty and 29 percent of reservist cases met the 45-day goal for the medical exam stage and 20 percent of active duty and 17 percent of reservist cases met the 35-day goal for the MEB stage. Officials at some sites we visited told us that MEB phase goals were difficult to meet and not realistic given current resources. For example: Some military officials noted that they did not have sufficient numbers of doctors to write the narrative summaries of exam results needed to complete the MEB stage in a timely manner. One facility noted that while they have 7 doctors, they would need 11 additional doctors and 10 technician assistants to process cases through the initial medical exam and other additional disability specific examinations in a timely manner. Further, officials at another Army base we visited noted that there was a shortage of doctors and DOD board liaisons and that they had difficulty recruiting such staff due to the remote location of the base.