Military Disability System: Improved Oversight Needed to Ensure  
Consistent and Timely Outcomes for Reserve and Active Duty	 
Service Members (31-MAR-06, GAO-06-362).			 
                                                                 
The House Committee on Armed Services report that accompanies the
National Defense Authorization Act of fiscal year 2006 directs	 
GAO to review results of the military disability evaluation	 
system. In response to this mandate, GAO determined: (1) how	 
current DOD policies and guidance for disability determinations  
compare for the Army, Navy, and Air Force, and what policies are 
specific to reserve component members of the military; (2) what  
oversight and quality control mechanisms are in place at DOD and 
these three services of the military to ensure consistent and	 
timely disability decisions for active and reserve component	 
members; and (3) how disability decisions, ratings, and 	 
processing times compare for active and reserve component members
of the Army, the largest branch of the service, and what factors 
might explain any differences.					 
-------------------------Indexing Terms------------------------- 
REPORTNUM:   GAO-06-362 					        
    ACCNO:   A50561						        
  TITLE:     Military Disability System: Improved Oversight Needed to 
Ensure Consistent and Timely Outcomes for Reserve and Active Duty
Service Members 						 
     DATE:   03/31/2006 
  SUBJECT:   Disabilities					 
	     Disability benefits				 
	     Eligibility determinations 			 
	     Military personnel 				 
	     Military policies					 
	     Persons with disabilities				 
	     Policy evaluation					 
	     Program evaluation 				 
	     Program management 				 
	     Quality assurance					 

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GAO-06-362

     

     * Results in Brief
     * Background
     * Military Disability Policies Differ among the Services, and Certain
       Policies May Result in Different Experiences for Reservists
     * DOD Has Guidance in Place to Promote Consistent and Timely Decisions,
       but Does Not Adequately Oversee Key Aspects of the Disability System
     * Disparities May Exist in Disability Benefits and Processing Times
       between Army Reservists and Active Duty Soldiers, but Lack of Data
       Prevents More Definitive Conclusions
     * Conclusions
     * Recommendations for Executive Action
     * Response to Agency Comments
     * Section 1: Data Reliability Tests
     * Section 2: Statistical Analyses
     * Multivariate regression analysis
     * Multinomial Logistic Analysis

                 United States Government Accountability Office

Report to Congressional Committees

GAO

March 2006

MILITARY DISABILITY SYSTEM

 Improved Oversight Needed to Ensure Consistent and Timely Outcomes for Reserve
                        and Active Duty Service Members

The Web version of this report was reposted on April 13, 2006, to reflect
a change to the text on page 16, in line 13 of the last paragraph, the "2
years" is revised to read " 1 year."

GAO-06-362

MILITARY DISABILITY SYSTEM

Improved Oversight Needed to Ensure Consistent and Timely Outcomes for Reserve
and Active Duty Service Members

  What GAO Found

Policies and guidance for military disability determinations differ
somewhat among the Army, Navy, and Air Force. DOD has explicitly given the
services the responsibility to set up their own processes for certain
aspects of the disability evaluation system and has given them latitude in
how they go about this. As a result, each service implements its system
somewhat differently. Further, the laws that govern military disability
and the policies that DOD and the services have developed to implement
these laws have led reservists to have different experiences in the
disability system compared to active duty members. For example, because
reservists are not on active duty at all times, it takes longer for them
to accrue the 20 years of service that may be needed to earn monthly
disability retirement benefits.

While DOD has issued policies and guidance to promote consistent and
timely disability decisions for active duty and reserve disability cases,
DOD is not monitoring compliance. To encourage consistent decision making,
DOD requires all services to use multiple reviewers to evaluate disability
cases. Furthermore, federal law requires that reviewers use a standardized
disability rating system to classify the severity of the medical
impairment. In addition, DOD periodically convenes the Disability Advisory
Council, comprised of DOD and service officials, to review and update
disability policy and to discuss current issues. However, neither DOD nor
the services systematically determine the consistency of disability
decision making. DOD has issued timeliness goals for processing disability
cases, but is not collecting information to determine compliance. Finally,
the consistency and timeliness of decisions depend, in part, on the
training that disability staff receive. However, DOD is not exercising
oversight over training for staff in the disability system.

While GAO's review of the military disability evaluation system's policies
and oversight covered the three services, GAO examined Army data on
disability ratings and benefit decisions from calendar year 2001 through
2005. After controlling for many of the differences between reserve and
active duty soldiers, GAO found that, among soldiers who received
disability ratings, the ratings of reservists were comparable to those of
active duty soldiers with similar conditions. GAO's analyses of the
military disability benefit decisions for the soldiers who were determined
to be unfit for duty were less definitive, but suggest that Army
reservists were less likely to receive permanent disability retirement or
lump sum disability severance pay than their active duty counterparts.
However, data on possible reasons for this difference, such as whether the
condition existed prior to service, were not available for our analysis.
GAO did not compare processing times for Army reserve and active duty
cases because GAO found that Army's data needed to calculate processing
times were unreliable. However, Army statistics based on this data
indicate that from fiscal 2001 through 2005, reservists' cases took longer
to process than active duty cases.

                 United States Government Accountability Office

                                    Contents

Letter        Results in Brief Background Military Disability Policies 1 3 
                      Differ among the Services, and Certain Policies May   5 
                   Result in Different Experiences for Reservists DOD Has  13 
                       Guidance in Place to Promote Consistent and Timely  18 
                Decisions, but Does Not Adequately Oversee Key Aspects of  22 
                the Disability System Disparities May Exist in Disability  27 
                Benefits and Processing Times between Army Reservists and  27 
                     Active Duty Soldiers, but Lack of Data Prevents More  28 
                   Definitive Conclusions Conclusions Recommendations for 
                             Executive Action Response to Agency Comments 
Appendix I   Objective, Scope, and Methodology                          29 
Appendix II  Selected Data from Service Branches on Processing Time,    38 
                Dispositions, and Medical Holdover                        
Appendix III Compilation of Differences in Regulations Governing the    44 
                Military Disability Evaluation System                     
Appendix IV  Characteristics of Army Service Members Entering the DES   48 
Appendix V   Disability Evaluation Outcomes for Army Active Duty and    50 
                Reserve Component Members for 2001 to 2005                
Appendix VI           Comments from the Department of Defense           51 

Appendix VII GAO Contact and Staff Acknowledgments

Related GAO Products

Tables

: Military Disability PEB Caseload, Fiscal Year 2001 to 2005 11
: Military Disability Funding Expenditures for Fiscal Year 2004 11
: Post-PEB Appeals Process across the Services 14
: Estimate of the Relationship between Being a Reservist and the Final
Disability Rating among Soldiers Receiving a Rating 34
: Estimate of the Relationship between Being a Reservist and Receipt of
Benefits before and after Controlling for Other Factors (among Those Unfit
and Assigned a Final Disposition) 36
: Army Processing Times for Disability Cases, Including both MEB and PEB
Processing, Fiscal Year 2001 to 2005 38
: Navy Processing Times for Disability Cases, Including Only PEB
Processing, Fiscal Year 2001 to 2005 39
: Air Force Processing Times for Disability Cases, Including Only PEB
Processing, Fiscal Year 2001 to 2005 40
: Final Dispositions Made by Navy PEB for Disability Cases, Fiscal Year
2001 to 2005 41
: Final Dispositions Made by Air Force PEB for Disability Cases, Fiscal
Year 2001 to 2005 42
: Number of Army Reserve Component Members Entering Medical Holdover by
Year, Calendar Year 2001 to 2005 43
: Occupational Codes for Services Members in Military Disability
Evaluation System, Calendar Years 2001 to 2005 48
: Rank Groups by Component for Services Members in the Military Disability
System, Calendar Years 2001 to 2005 49
: Descriptive Statistics on Disability Evaluation Outcomes for Active Duty
and Reserve Component Members in the Army, Calendar Years 2001 to 2005 50
: Descriptive Statistics on Disability Evaluation Outcomes for Active Duty
and Reserve Component Members in the Army, Calendar Years 2001 to 2005 50

Page ii GAO-06-362 Military Disability System

Figures 
           Figure 1: Decisions Made during the Military Disability Evaluation
           Process                                                          7 
                 Figure 2: Oversight of the Military Disability Evaluation 
                                                                   Process 
                          within the Department of Defense                 12 
             Figure 3: Yearly Percentage Change in PEB Caseload for Active 
                       Duty and Reserve Component Soldiers, Calendar Years 
           2001 to 2005                                                    24 
              Figure 4: Ages of Active Duty and Reserve Component Soldiers 
                 Entering the Disability Evaluation System, Calendar Years 
           2001 to 2005                                                    25 

Abbreviations

CBHCO          Community-Based Health Care Organization                    
DOD            Department of Defense                                       
DES            disability evaluation system                                
DMDC           Defense Manpower Data Center                                
FY             fiscal year                                                 
GAO            Government Accountability Office                            
LOD            line of duty                                                
MEB            medical evaluation board                                    
MEBITT         Medical Evaluation Board Internal Tracking                  
                  Tool                                                        
MMRB           Military Occupational Specialty/Medical                     
                  Retention Board                                             
MTF            military treatment facility                                 
OLS            ordinary least squares                                      
PDCAPS             Physical Disability Computer Assisted Processing System 
PEB            physical evaluation board                                   
PEBLO          Physical Evaluation Board Liaison Officer                   
SSA            Social Security Administration                              
TDRL           temporary disability retired list                           
USMC           United States Marine Corps                                  
VA             Veterans Affairs                                            
VASRD             Veterans Administration Schedule for Rating Disabilities 

This is a work of the U.S. government and is not subject to copyright
protection in the United States. It may be reproduced and distributed in
its entirety without further permission from GAO. However, because this
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copyright holder may be necessary if you wish to reproduce this material
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United States Government Accountability Office Washington, DC 20548

Page 1 GAO-06-362 Military Disability Syste

review results of the military disability evaluation system. In response
to this mandate, GAO determined: (1) how current DOD policies and guidance
for disability determinations compare for the Army, Navy, and Air Force,
and what policies are specific to reserve component members of the
military; (2) what oversight and quality control mechanisms are in place
at DOD and these three services of the military to ensure consistent and
timely disability rating and benefit decisions for active and reserve
component members; and (3) how disability rating and benefit decisions,
and processing times compare for active and reserve component members of
the Army, the largest branch of the service, and what factors might
explain any differences.1

To address the first two objectives covering DOD and three branches of the
service, we reviewed relevant legislation, policy guidance, and
literature; interviewed officials from DOD, Army, Navy, Air Force,
Reserves, and National Guard; and visited Lackland and Randolph Air Force
Bases, Fort Sam Houston and Walter Reed Army Medical Center, Washington
Navy Yard and Bethesda Naval Hospital and interviewed relevant officials.2
We chose these sites because the services conduct physical disability
evaluations at these locations. In addition, we interviewed officials from
military treatment facilities (MTF), including Brooke Army Medical Center
and Wilford Hall Medical Center. We limited the scope of the third
objective to the Army because it currently processes the most military
disability cases. To determine if outcomes for active duty and reserve
disability cases were statistically consistent, we analyzed data provided
by the Army. Based on our assessment of the quality of the Army's data, we
concluded that data on disability determinations and ratings were
sufficiently reliable for our analyses. On the other hand, the Army's data
on processing times were not reliable for our analyses. Except for the
Army data used in our analyses, we did not test the reliability of other
data we received from the services and DOD. While GAO has noted in its
21st Century Challenges report that eligibility criteria for disability
programs need to be brought into line with the current state of science,
medicine, technology and labor market conditions, this study does not

1

The word reservist in this report refers to reserve component members.

2

This report addresses the military disability systems for three branches
of the service: the Army, Navy (including Marines), and Air Force. This
report does not address the Coast Guard or Coast Guard Reserve.

Page 2 GAO-06-362 Military Disability System

                                Results in Brief

examine the basic eligibility criteria for military disability benefits.3
We conducted our review from June 2005 through January 2006 in accordance
with generally accepted government auditing standards. A detailed
description of our scope and methodology is provided in appendix I.

There are differences in policies and guidance for disability
determinations, in general, among the Army, Navy, and Air Force. The
services' policies differ, in part because DOD has explicitly given the
services the responsibility to set up their own processes for certain
aspects of the disability evaluation system and has given them latitude in
how they go about this. For example, the services set different
qualifications for members of the medical disability decision making
boards. Further, the laws that govern military disability and the policies
that DOD and the services have developed to implement these laws have led
reservists to have different experiences in the system compared to the
active duty members. For example, because they are not on active duty at
all times, it takes longer for reservists to accrue the 20 years of
service that may be needed to earn monthly disability retirement benefits.
Moreover, unlike full-time active duty soldiers, many mobilized Army
reservists are assigned to special units while being treated for medically
limiting injuries or illnesses.

DOD has issued policies and guidance to promote consistent and timely
disability decisions for active duty and reserve disability cases, but the
agency is not monitoring compliance with these. To encourage consistent
decision making, DOD requires all services to use multiple reviewers to
evaluate disability cases. Furthermore, federal law requires that the
services use a standardized disability rating system to classify the
severity of the medical impairment. In addition, DOD periodically convenes
a Disability Advisory Council comprised of service officials to review and
update disability policy and to discuss current issues. However, neither
DOD nor the services systematically analyze the consistency of decision
making. Such an analysis of data should be one key component of quality
assurance. To ensure timely disability case processing, DOD has issued
timeliness goals for processing all service members' cases. However, DOD
is not collecting available information on disability evaluation
processing times from the services to determine compliance, nor are the
services

3

GAO, 21st Century Challenges: Reexamining the Base of the Federal
Government, GAO-05-325SP ( Washington, D.C.: March 4, 2005).

Page 3 GAO-06-362 Military Disability System

ensuring these data are reliable. Moreover, some military officials have
expressed concerns that the current goals may not be appropriate for all
cases. Finally, both the consistency and timeliness of decisions depend,
in part, on the training that disability officials receive. Despite a
regulation requiring DOD's Office of Health Affairs to develop relevant
training for disability staff, DOD is not exercising oversight over
training for staff in the disability system.

While our review of the military disability evaluation system's policies
and oversight covered three branches of the service, we most closely
examined data from the Army's disability evaluation process to better
understand how disability decisions and processing times compare for
reserve component and active duty soldiers. Our analyses of ratings from
the Army disability evaluation system from calendar year 2001 to 2005
indicated that, after taking into account many of the differences between
reserve and active duty soldiers, among soldiers who received disability
ratings, Army reservists received ratings comparable to their active duty
counterparts. The results of our analyses of military disability benefit
decisions for soldiers were less definitive, but suggest that Army
reservists with impairments that made them unfit for duty were less likely
to receive either permanent disability retirement or lump sum disability
severance pay than their active duty counterparts. However, data on all
possible reasons for this difference, such as whether the condition
existed prior to service, were not available for our analysis. With regard
to disability evaluation processing times, we did not compare processing
times for Army reserve and active duty cases because we found that the
data in the Army's electronic database needed to calculate processing
times were unreliable. The Army's own statistics indicate that from fiscal
year 2001 through 2005, more than half of all reservists' cases took
longer than 90 days to process as compared to about one third of active
duty soldiers' cases.

We are recommending that the Secretary of Defense improve oversight of the
military disability system, evaluate the appropriateness of timeliness
standards for case processing, and assess the adequacy of training for
disability evaluation staff. DOD agreed with our recommendations and
stated that it is taking steps toward implementing them.

Background

As provided by the Career Compensation Act of 1949, as amended, service
members who become physically unfit to perform military duties may receive
military disability compensation under certain conditions.4

Compensation for disabilities can be in the form of monthly disability
retirement benefits or a lump sum disability severance payment, depending
on the disability rating and years of creditable service.5 To qualify for
monthly disability retirement benefits, a service member with a permanent
impairment that renders him or her unfit for duty must have (1) at least
20 years of creditable service or (2) a disability rating of at least 30
percent.6 Service members with less than 20 years of creditable service
and a disability rating less than 30 percent receive a lump sum severance
disability payment.

Service members with service connected disabilities may also be eligible
for VA disability compensation. Until recently, this military benefit was
offset by any VA compensation received. However, the fiscal year 2004
National Defense Authorization Act now allows some military retirees to
concurrently receive VA and military benefits.7 Generally, military
disability retirement pay is taxable. Exceptions are (1) if the disability
pay is for combat-related injuries or (2) if the service member was in the
military, or so obligated, on September 24, 1975.

The Disability Evaluation Each of the military services administers its
own disability evaluation process. According to DOD regulations, the
process should include a

Process

medical evaluation board (MEB), a physical evaluation board (PEB), an
appellate review process, and a final disposition. Each service member
should be assigned a Physical Evaluation Board Liaison Officer (PEBLO),

4

Pub. L. No. 81-351(1949).

5

Creditable years are computed according to 10 U.S.C. S: 1208. To meet the
20-year threshold, reserve component members must have at least 7,200
points of combined active duty points, membership points, and inactive
duty points.

6

To qualify for monthly disability retirement payments, service members
with ratings of 30 percent or higher must have a disability incurred or
aggravated in the line of duty. For members on ordered active duty of
greater than 30 days, a non-aggravated pre-existing condition is awarded
disability compensation under 10 U.S.C. S: 1207a if the member has a total
of 8 years of active service (active duty).

7

For more information about concurrent receipt of military retirement and
VA benefits see Military Retirement: Major Legislative Issues,
Congressional Research Service, updated January 3, 2006.

a counselor to help the service member navigate the system and prepare
documents for the PEB.

As shown in figure 1, there are a number of steps in the disability
evaluation process and several factors that play a role in the decisions
that are made at each step. There are four possible outcomes in the
disability evaluation system. A service member can be

     o found fit for duty;
     o separated from the service without benefits-service members whose
       disabilities were incurred while not on duty or as a result of
       intentional misconduct are discharged from the service without
       disability benefits;
     o separated from the service with lump sum disability severance pay; or
     o retired from the service with permanent monthly disability benefits or
       placed on the temporary disability retired list (TDRL).

Figure 1: Decisions Made during the Military Disability Evaluation Process

Medical Evaluation Board Physical Evaluation Board Dispositions: (MEB)
Decision (PEB) Decisions Disability benefits entitled to

Member with medically limiting injury/ condition

Return to duty

Placed on the Temporary Disability Retired List (TDRL)

Placed on Permanent Disability Retirement (Separated with monthly
disability retirement benefits)

Separated with lump sum disability severance

Separated without benefits Source: DOD documents.

Medical Evaluation Board

The disability evaluation process begins at a military treatment facility
(MTF), when a physician identifies a condition that may interfere with a
service member's ability to perform his or her duties.8 The physician
prepares a narrative summary detailing the injury or condition.9 DOD
policy establishes the date of dictation of the narrative summary as the
beginning of the disability evaluation process. This specific type of
medical evaluation is for the purpose of determining if the service member
meets the military's retention standards, according to each service's
regulations.10 This process is often referred to as a medical evaluation
board (MEB). Service members who meet retention standards are returned to
duty, and those who do not are referred to the physical evaluation board
(PEB).

                           Physical Evaluation Board

The PEB is responsible for determining whether service members have lost
the ability to perform their assigned military duties due to injury or
illness, which is referred to as being "unfit for duty". If the member is
found unfit, the PEB must then determine whether the condition was
incurred or permanently aggravated as a result of military service. While
the composition of the PEB varies by service, it is typically composed of
one or more physicians and one or more line officers. Each of the services
conducts this process for its service members. The Army has three PEBs
located at Fort Sam Houston, Texas; Walter Reed Army Medical Center in
Washington, D.C.; and Fort Lewis, Washington. The Navy has one located at
the Washington Navy Yard in Washington, D.C. The Air Force has one located
in San Antonio, Texas.

The first step in the PEB process is the informal PEB-an administrative
review of the case file without the presence of the service member. The
PEB makes the following findings and recommendations regarding possible
entitlement for disability benefits:

8

A physician is required to identify a condition that may cause the member
to fall below retention standards after the member has received the
maximum benefit of medical care.

9

In addition, there are specific conditions listed in DOD regulations that
require a service member to be referred to the disability evaluation
system.

10

According to DODI 1332.38, retention standards are the physical standards
or guidelines that establish those medical conditions or physical defects
that may render a member unfit for further military service and are
therefore cause for referral of the member into the disability evaluation
system.

     o Fitness for duty-The PEB determines whether or not the service member
       "is unable to reasonably perform the duties of his or her office,
       grade, rank, or rating," taking into consideration the requirements of
       a member's current specialty. Fitness determinations are made on each
       medical condition presented. Only those medical conditions which
       result in the finding of "unfit for continued military service" will
       potentially be compensated. Service members found fit must return to
       duty.
     o Compensability-The PEB determines if the service member's injuries or
       conditions are compensable, considering whether they existed prior to
       service (referred to as having a pre-existing condition) and whether
       they were incurred or permanently aggravated in the line of duty.11
       Service members found unfit with noncompensable conditions are
       separated without disability benefits.
     o Disability rating-When the PEB finds the service members unfit and
       their disabilities are compensable, it applies the medical criteria
       defined in the Veterans Administration Schedule for Rating
       Disabilities (VASRD) to assign a disability rating to each compensable
       condition. The PEB then determines (or calculates) the service
       member's overall degree of service connected disability. Disability
       ratings range from 0 (least severe) to 100 percent (most severe) in
       increments of 10 percent.12 Depending on the overall disability rating
       and number of years of active duty or equivalent service, the service
       member found unfit with compensable conditions is entitled to either
       monthly disability retirement benefits or lump sum disability
       severance pay.

In disability retirement cases, the PEB considers the stability of the
condition. Unstable conditions are those for which the severity might
change resulting in higher or lower disability ratings. Service members
with unstable conditions are placed on TDRL for periodic PEB reevaluation
at least every 18 months. While on TDRL, members receive monthly
retirement benefits. When members on TDRL are determined to be fit for
duty, they may choose to return to duty or leave the military at

11

According to 10 U.S.C. S: 1201, a service member is ineligible if 1) the
disease or injury was incurred while not entitled to receive basic pay
(i.e., the condition existed prior to service and is not service
aggravated) and the member does not fall under the 8-year provision of 10
U.S.C. S: 1207a; 2) the disease or injury was incurred while not in the
line of duty; 3) the disease or injury was incurred during a period of
unauthorized absence; or 4) the disease or injury resulted from
intentional misconduct or willful neglect.

12

For more information on the VA rating schedule, see DODI 1332.39, November
14, 1996.

Disability Evaluation System Caseloads

that time. Members who continue to be unfit for duty after 5 years on TDRL
are separated from the military with monthly retirement benefits,
discharged with severance pay, or discharged without benefits, depending
on their condition and years of service.

Service members have the opportunity to review the informal PEB's findings
and may request a formal hearing with the PEB; however, only those found
unfit are guaranteed a formal hearing. The formal PEB conducts a de novo
review of referred cases and renders its own decisions based upon the
evidence. At the formal PEB hearing, service members can appear before the
board, put forth evidence, introduce and question witnesses, and have
legal counsel help prepare their cases and represent them. The military
will provide military counsel or service members may retain their own
representative. If service members disagree with the formal PEB's findings
and recommendations, they can, under certain conditions, appeal to the
reviewing authority of the PEB. Once the service member either agrees with
the PEB's findings and recommendations or exhausts all available appeals,
the reviewing authority issues a final disability determination concerning
fitness for duty, disability rating, and entitlement to benefits.

In 2005, over 23,000 U.S. service members with physical injuries or other
conditions went through the military disability evaluation system,
according to DOD. In total, the Army, Navy, and Air Force report
evaluating over 90,000 PEB cases during the fiscal years 2001 to 2005. The
Army represents the largest share of disability cases, with Army reserve
component members representing approximately 32 percent of all Army cases
in 2005 (see table 1). PEB disability caseloads for all services have
increased over time from about 15,000 in fiscal year 2002 to about 23,000
in fiscal year 2005.

Table 1: Military Disability PEB Caseload, Fiscal Year 2001 to 2005
                                                    Number of service members
Services                              2001    2002     2003  2004     2005 
Army                                                                
Active duty                      6,627    6,510     6,659   7,694    9,322 
Reserve component                  591     812      1,546   4,187    4,426 
Navy                                                                
Active duty                      4,620    3,953     3,814   4,889    4,645 
Reserve component                  379     413       436        543    555 
Air Force                                                           
Active duty                 2,376    3,251       3,340      3,525    3,610 
Reserve component             441          535        633       719    758 
TOTAL                      15,034    15,474      16,428    21,557   23,316 

             Source: Departments of the Army, Navy, and Air Force.

Military Disability In fiscal year 2004, the military services spent over
$1 billion in disability

Retirement Expenditures retirement benefits for over 90,000 service
members. See table 2. This table does not include expenditures for lump
sum disability payments which DOD was unable to provide.

Table 2: Military Disability Funding Expenditures for Fiscal Year 2004
         Temporary disability Permanent disability            Total
                   retirement retirement             
                        Number            Number of                  
                Dollars of        Dollars service          Dollars 
                        service                                     Number of
Service      (in     members    (in     members   (in millions)    service
             millions)          millions)                             members
Army           $16.9   2,170    $432.3     34,372        $449.2     36,542
Navy           $21.4   2,769    $379.1     30,831        $400.5     33,600
Air                                               
Force             $4.1     399    $349.6  21,540      $353.7        21,939 
DOD                                               
(all)          $42.4    5,338   $1,161.0  86,743     $1,203.4       92,081 

         Source: DOD Office of the Actuary, Statistical Report FY 2004.

Oversight

The Secretary of Defense oversees the military disability evaluation
system through the Under Secretary of Defense for Personnel and
Readiness.13 The Surgeons General for each service are responsible for
overseeing their service's MTFs, including the MEBs conducted at each
facility. The Deputy Under Secretary of Defense for Military Personnel
Policy has oversight of the PEBs, and also oversees the Disability
Advisory Council. The council is composed of officials from DOD's offices
of Military Personnel Policy, Health Affairs, and Reserve Affairs, the
services' disability agencies; and the Department of Veterans Affairs. See
fig. 2.

  Figure 2: Oversight of the Military Disability Evaluation Process within the
                             Department of Defense

                     Source: GAO analysis of DOD documents.

13

The Under Secretary of Defense for Personnel and Readiness also oversees
the Defense Health Program, Defense Commissaries and Exchanges, the
Defense Education Activity, and the Defense Equal Opportunity Management
Institute.

  Page 12 GAO-06-362 Military Disability System

Military Disability Policies Differ among the Services, and Certain
Policies May Result in Different Experiences for Reservists

The policies and guidance for disability determinations for all service
members are somewhat different among the Army, Navy, and Air Force. DOD
has explicitly given the services the responsibility to set up their own
processes for some aspects of the disability system and has given the
services much room for interpretation. Each service has implemented its
system somewhat differently. For example, the composition of decision
making bodies differs across the services. Additionally, the laws that
govern military disability and the policies that DOD and the services have
developed to implement these laws have led to reserve members having
different experiences with the disability system than active duty members.
Some of these experiences result from the part-time nature of reserve
service while others are the consequence of policies and laws specific to
reservists.

DOD Policies and Guidance Allow Services to Implement the Disability
System Differently

Medical Evaluation Boards

Physical Evaluation Boards

DOD regulations establish some parameters for the disability system and
provide guidelines to the services, and the services each have their own
regulations in accordance with these. Specifically, the aspects of the
system that differ among the services include: characteristics of the
medical evaluation board (MEB) and physical evaluation board (PEB), the
use of counselors to help service members navigate the system, and
procedures to make line of duty determinations. Appendix III provides a
compilation of these and other differences.

DOD regulations require that each service set up MEBs to conduct medical
evaluations to determine if the service member meets retention standards
according to each service's regulations. The services carry out MEB
procedures differently. For example, the Air Force MEB convenes an actual
board of physicians who meet regularly and vote to decide whether a
service member meets retention standards. In the Army and Navy, in
contrast, the MEB is an informal procedure. A service member's case file
is passed among the board's members, who separately evaluate it. In all of
the services, the medical commander or his designee may sign off on the
final decision. The services also differ in the qualifications and
requirements for MEB board membership. The Army and Navy require that at
least two physicians serve on an MEB, while the Air Force requires three.

In accordance with DOD regulations, the military services have set up PEBs
to evaluate whether service members are fit for duty. DOD regulations
provide no guidance concerning how much time a service member has to
decide whether to accept the disability decision of his or her informal
PEB. Army provides service members 10 calendar days; Navy provides 15
calendar days; and Air Force provides 3 duty days, according to their
regulations. Additionally, DOD regulations provide that service members
found unfit for duty by an informal PEB are guaranteed the right to appeal
to a formal PEB. However, service members found fit are not guaranteed the
right to appear before a formal PEB.

While DOD regulations state that a service member has the right to appeal
the decision of a formal PEB, they do not state what this appeal process
should look like. The services differ in how many appeal opportunities
they offer service members after the formal PEB. For example, the Navy and
Air Force offer two opportunities for appeal after the formal PEB. The
Army also has two opportunities for appeal. However, it also has the Army
Physical Disability Appeal Board, which provides appeal for only certain
cases, for example, if the Army Physical Disability Agency revises the
finding of the PEB during a quality or mandatory review and the soldier
disagrees with the change (see table 3).

             Table 3: Post-PEB Appeals Process across the Services

                      Military service Appellate authority

Army

                   1st appeal Army Physical Disability Agency

            Additional appeala Army Physical Disability Appeal Board

         Final appeal Army Board for the Correction of Military Records

Navy

           1st appeal Secretary of the Navy Council of Review Boards

             Final appeal Board for the Correction of Naval Records

Air Force

       1st appeal Air Force Secretary of the Air Force Personnel Council

         Final appeal Air Force Board of Correction of Military Records

Source: DOD documents.

a

Note: Applicable only to cases in which Army Physical Disability Agency
revises the PEB findings as part of a quality or mandatory review and the
soldier does not concur with the revised finding.

Further, the services also differ on whether they permit the same members
to sit on the informal and formal PEB of the same case. The Army allows
PEB members to do this while the Air Force only allows this under certain
circumstances. The Navy has no written policy on the matter, although one
official from the Navy PEB indicated that the members of the two boards
were often the same for a case.

Physical Evaluation Board Liaison Officers

Line of Duty Determinations

The point at which PEBLOs become involved in the disability evaluation
system and the training PEBLOs receive differ between the services. DOD
regulations require that each service provide members counseling during
the disability evaluation process and outline the responsibilities of
these counselors. For example, they are expected to discuss with service
members their rights, the effects of MEB and PEB decisions, and available
benefits.

Each service has created PEBLOs in accordance with these rules, but the
services have placed the PEBLOs under different commands. In the Army and
Air Force, PEBLOs are the responsibility of the medical command. In the
Navy, in contrast, the PEBLO responsibility is shared by the PEB and MTF.
Further, the services involve PEBLOs at different points in the disability
process. In the Army and Air Force, PEBLOs begin counseling the service
member at the MEB level of the disability process. However, while Navy,
officials told us that PEBLOs provide counseling at the MEB level, some
PEBLOs we interviewed told us that they begin counseling members after the
informal PEB has issued its decision. At some MTFs, case managers provide
counseling for service members going through the disability evaluation
process. The services also differ in their training of PEBLOs. The Army
holds an annual conference for PEBLOs and provides on-the-job training.
The Navy relies primarily on on-the-job training and also offers quarterly
and annual training. The Air Force also relies heavily on on-the-job
training and, until recently, held regular training for PEBLOs.

As required by law, a service member may receive disability compensation
for an injury or illness that was incurred or permanently aggravated while
in the line of duty. Generally, the military services document that an
injury occurred in the line of duty by filling out a form or noting it in
the service member's health record. Typically, a service member's
commanding officer is responsible for this action, according to the
service's policies. Unlike the Army and Navy, the Air Force always
requires a line of duty determination for reservists.

DOD regulations state that an injury is presumed to have been in the line
of duty when it clearly resulted from enemy or terrorist attack,
regardless of whether the member is a reserve or active duty member.
However, if the injury may have resulted from misconduct or willful
negligence, DOD requires the military services to investigate and
determine whether the injury did, in fact, occur in the line of duty. The
line of duty determination is a complicated process involving a number of
people, such as the examining medical official and higher commands. DOD
gives the services responsibility for creating the procedures for
conducting line of duty

Page 15 GAO-06-362 Military Disability System

DOD and the Services Have Established Policies That Result in Different
Experiences with the Disability System for Reservists

Twenty Years of Service Requirement for Disability Retirement

Eight Years of Service Requirement for Compensation for Preexisting
Conditions

determinations, and there are some technical differences in the processes
among the services. For example, the services have different rules
regarding how long this process should take. The Army and the Air Force
place time frames on the process, while the Navy does not.

The laws that govern the military disability system and the policies and
guidance that DOD and the services have developed to implement the laws
can result in different experiences with the disability system for
reservists. Some of these differences are due to the part-time nature of
reserve service, while others result from laws and policies specific to
reservists.

Because they are not on duty at all times, reservists take longer to
accrue the 20 years of service that may be needed to earn the monthly
disability retirement benefit when the disability rating is less than 30
percent. For example, an active duty service member who enlisted in the
Army in 1985 and stayed on continuous active duty would have 20 years
toward disability retirement by 2005. An Army reservist who enlisted at
the same time, met his training obligations, and had been activated for 1
year would have roughly 5 years and 9 months toward disability retirement
by 2005, according to the formula the Army uses to determine years of
service toward disability retirement benefits. All three services use the
same formula when calculating the 20 years of service requirement for
disability retirement benefits.

The part-time status of reservists also makes it more difficult for
reservists with preexisting conditions to be covered by the 8-year rule
and therefore eligible for compensation. By law, service members with at
least 8 years of active duty service are entitled to compensation even if
their conditions existed before the beginning of their military service or
were not service aggravated. This entitlement only applies to reservists
when they are on ordered active duty of more than 30 days at the time of
PEB adjudication. For reservists, accruing the 8 years necessary for a
condition to be covered by this rule can be more difficult than for active
duty service members. For example, an active duty service member who
enlisted in the Army in 1997 and stayed on continuous active duty would
have 8 years toward disability retirement by 2005. A reservist who
enlisted at the same time, met his training obligations, and has been
activated for 1 year would have roughly 1 year and 3 months of service,
according to the Army's 8year rule formula and would not be eligible for
compensation for a preexisting condition. Further, the services differ
slightly in how they

Line of Duty Determinations

Medical Holdover

calculate the 8 years for reservists. The Army and Navy calculate the 8
years differently from the 20 year requirement, but the Air Force uses the
same formula for both. The Army and Navy count only active duty time,
while the Air Force also counts time spent in other activities, such as
continuing education.14

Officials reported that commanders and others responsible for completing
line of duty determinations were often uncertain as to when line of duty
determinations were necessary for reservists and active duty members.
Moreover, these officials noted that in some cases, the necessary line of
duty determinations were not made, resulting in delays for service
members. For example, Air Force officials we spoke with had different
impressions as to whether line of duty determinations were always required
for reservists, even though Air Force regulations state they are.
Officials from the Army and Army National Guard similarly offered
different perspectives on the need for line of duty determinations for
reservists.

In the Army, deployed active duty soldiers return to their unit in a back
up capacity when they are injured or ill. However, mobilized injured or
ill Army reservists have no similar unit to return to. Consequently, they
may be removed from their mobilization orders and retained on active duty
in "medical holdover status" and assigned to a unit, such as a medical
retention processing unit.15 While in medical holdover status, reservists
may live on base, at a military treatment facility, at home or other
locations. After their mobilization orders expire, they can elect to
continue on active duty through a program such as medical retention
processing, which allows them to continue receiving pay and benefits.
Between 2003 and 2005 the Army reports that about 26,000 reservists
entered medical holdover status (see appendix II).

Unlike most injured active duty soldiers, reservists in medical holdover
generally live farther from their families than active duty members
because the units at military medical facilities are often far from where

14

Army and Navy officials offered different views on the requirements of DOD
regulations, disagreeing on whether they were obligated to count time
spent through the appeals process toward the 8 years or not. However, this
difference applied to both active duty and reserve component members
alike.

15

Medical holdover status provides for the command and control of mobilized
reserve component members.

Page 17 GAO-06-362 Military Disability System

their families live. In certain cases reservists in medical holdover may
receive treatment and recuperate at home. The Army's Community-Based
Health Care Organizations (CBHCOs) provide medical and case management for
these reservists living at home as they receive medical care in their
communities. As of December 2005, about 35 percent of the reservists in
medical holdover were being cared for in the CBHCO program. In order to be
assigned to the CBHCO program, reservists must meet a number of criteria.
For example, reservists must live in communities where they can get
appropriate care, and they must also be reliable in keeping medical
appointments.

DOD has policies and guidance to promote consistent and timely disability
decisions, but is not monitoring whether the services are compliant.
Neither DOD nor the services systematically determine the consistency of
decision making, which would be a key component of quality assurance. With
regard to timeliness, DOD has issued goals for processing service members'
cases but is not collecting available information from the services, and
military officials have expressed concerns that the goals may not be
realistic. Finally, DOD is not exercising any oversight over training for
staff in the disability system, despite being required to do so.

DOD Has Guidance in Place to Promote Consistent and Timely Decisions, but
Does Not Adequately Oversee Key Aspects of the Disability System

DOD Requires All Services to Use a Common Ratings System and Multiple
Reviewers and Convenes a Disability Council

To encourage consistent decision making, DOD policies require that service
members' case files undergo multiple reviews and federal law requires that
disability ratings be based on a common schedule. During both the MEB and
PEB stages of the disability process, a service member's case must be
reviewed and approved by several officials with different roles. When
rating the severity of a service member's impairment, all services are
required to use a common schedule, VA's Schedule for Rating Disabilities
(VASRD), in accordance with federal law. The VASRD is a descriptive list
of medical conditions along with associated disability ratings. For
example, if a service member has x-ray evidence of degenerative arthritis
affecting two or more joints, "with occasional incapacitating
exacerbations," he or she should receive a rating of 20 percent according
to the VASRD.

DOD also convenes the Disability Advisory Council, which DOD officials
told us is the primary oversight body of the disability system. The
disability council is composed of key officials from the three disability
agencies of the services, the VA, and relevant DOD officials from the

Page 18 GAO-06-362 Military Disability System

Lack of Oversight by DOD and the Services Provides Little Assurance
Decisions Are Consistent

health affairs, reserve affairs, and personnel departments. The council's
mission is to monitor the administration of the disability system and,
according to DOD officials, the council serves as a forum to discuss
issues such as rules changes and increasing coordination among the
services. Currently, the disability council is facilitating a review and
revision of all DOD regulations pertaining to the disability system.
Military officials view the council as a group that aims to meet quarterly
to discuss issues raised by the services. By having these meetings, DOD
hopes to bring all of the services "on the same page" when it comes to the
disability system. However, military officials reported that the council
has not met quarterly in the past year and generally does not produce
formal reports for the DOD chain of command. Furthermore, the disability
council is staffed by one person at DOD who has additional
responsibilities.

Military officials also regard the appeals process as helping to ensure
the consistency of disability evaluation decision making. However, not all
service members appeal. In addition, during the appeals process additional
evidence may be presented that may result in a different outcome for the
same case. Furthermore, the appeals process is designed to determine
whether the correct decision was made, rather than whether consistent
decisions were made across comparable cases.

Despite this policy guidance and the presence of the disability council,
both DOD and the three services lack quality assurance mechanisms to
ensure that decisions are consistent. Given that one of the primary goals
of the disability system is that disability evaluations take place in a
consistent manner, collecting and analyzing the service members' final
disability determinations are critical for ensuring that decisions are
consistent. DOD regulations recognize this and require that the agency
establish necessary reporting requirements to monitor and assess the
performance of the disability system and compliance with relevant DOD
regulations. Yet, DOD does not collect information from the services on
the final disability determinations and personal characteristics of
service members going through the disability system.

In addition, DOD has not established quality parameters for the services
to follow to evaluate the consistency of decision making. As a result, the
services generally lack a robust quality assurance process. In our past
work on federal disability programs, we have recommended that quality
assurance have two components: (1) the use of multivariate regression
analysis examining disability decisions along with controlling factors to
determine whether the decisions are consistent and (2) an in depth

Page 19 GAO-06-362 Military Disability System

independent review of a statistically valid group of case files to
determine what factors may contribute to inconsistencies. However, the
services were unable to provide any evidence that they are conducting
statistical reviews - such as multivariate regression analysis - on their
data to determine the consistency of decision making for service members
with similar characteristics. Furthermore, while we found that the Army is
conducting independent reviews of 25 to 30 percent of its PEB cases, the
Navy and Air Force conduct these reviews only when a service member
appeals the PEB's decision. Additionally, these reviews reflect how a
single case's medical evidence supports the dispositions made (accuracy)
rather than the degree to which decisions in cases, in general, with
similar impairments and characteristics compare (consistency). Without
such an analysis the services are unable to assure that adjudicators are
making consistent decisions in reservist and active duty cases with
similar characteristics.

Officials from the services said that it was very difficult to examine
outcomes for consistency because each disability decision is unique and
there are a multitude of factors considered when rendering a disability
decision, some of which could not be captured in a database. For example,
individuals' pain tolerance varies, along with their motivation to adhere
to treatment programs. Nonetheless, other federal disability programs face
the same challenges, have acknowledged the importance of determining
consistency of decision making, and have taken some initial steps to
develop quality assurance systems. For example, the VA selects a random
sample of files for independent review using a standard methodology and
compiles the results of these reviews.16

Although VA compiles this data, it does not systematically assess
decision-making consistency. In a past report, we recommended that the VA
use its data to identify possible inconsistencies. VA officials concurred
with this recommendation and indicated they were implementing a nationwide
information system which they would use to determine consistency of their
disability decisions. See GAO, Veterans Benefits: VA Needs Plan for
Assessing Consistency of Decisions, GAO-05-99 (Washington, D.C.: Nov. 19,
2004) and GAO, VA Disability Benefits: Routine Monitoring of Disability
Decisions Could Improve Consistency, GAO-06-120T (Washington, D.C.: Oct.
20, 2005).

DOD Has Instituted Timeliness Goals for Processing Service Members' Cases,
but Does Not Oversee Compliance with Them

DOD regulations set forth timeliness goals for the two major processes of
the disability system. According to DOD, the first stage of the process-
the MEB-should normally be completed in 30 days or less. The second stage
of the process-the PEB-should normally take 40 days or less. Despite
establishing these timeliness goals for the services, DOD is not ensuring
compliance with them. DOD does not regularly collect available timeliness
data from the services, a necessary first step for determining compliance.

The services generally are using their databases to track the timeliness
of decisions, but military officials cited confusion regarding the start
date for the process. Both the Army and Navy are tracking processing times
for both the MEB and PEB using their databases. The Air Force lacks a
centralized database to track its MEB cases and therefore can only track
PEB timeliness. However, we found that the usefulness of these timeliness
data may be undermined by confusion among military officials and data
entry staff regarding the starting dates for the disability process. We
compared original Army PEB case files to Army electronic data from both
its MEB and PEB databases, and found that the date a physician dictates a
narrative summary, the beginning of the disability process and a critical
data point for timeliness calculations, was frequently entered incorrectly
into the Army's databases. When we asked about these errors, Army
officials said that increased training of data entry staff would help with
these problems. Navy officials also said that there was some confusion
about how to record starting dates for cases when additional medical
information was needed to make a disability decision for a service member.

Data reported by the services on the timeliness of cases generally show
that the services are not meeting DOD timeliness goals (see appendix II).
Military officials said that these results stemmed in part from the
unrealistic nature of the goals themselves. Navy officials told us that
they do not consider the 30-day goal as a performance standard for MEB
processing to be held accountable for. They said that the 30-day goal is
also unrealistic, especially in certain cases when there were addendums to
the narrative summary. Army officials also said that it was unrealistic
for all MEB cases to be processed in 30 days because certain cases take
longer. For example, cases when a line of duty determination is needed or
when certain medical tests are required to diagnose some orthopedic or
psychiatric conditions.

Page 21 GAO-06-362 Military Disability System

DOD's Delegation of Training to the Services and Staff Turnover Presents
Additional Challenges for the Disability System

While DOD regulations require that the agency develop and maintain
training for key participants in the disability system, DOD officials told
us that they had given this responsibility to the services. The Assistant
Secretary of Defense for Health Affairs is given explicit instructions to
develop and maintain a training program for MEB and PEB staff, but
officials from the Office of Health Affairs indicated they were unaware
that they had the responsibility to develop a training program. In
addition, despite high turnover among military disability evaluation
staff, the services do not have a system to ensure that all staff are
properly trained. This turnover stems, in part, from the military
requirement that personnel rotate to different positions in order to be
promoted. Depending on the positions involved, military officials told us
that some staff remain in their positions from 1 to 6 years, with most
remaining about 3 years. This turnover and the resulting loss of
institutional knowledge require that the services systematically track who
has been properly trained. However, all of the services lack data systems
that would allow them to do so, an issue that was highlighted in a
previous report by the RAND Corporation.17

Disparities May Exist in Disability Benefits and Processing Times between
Army Reservists and Active Duty Soldiers, but Lack of Data Prevents More
Definitive Conclusions

Our analysis of Army disability data from calendar years 2001 to 2005
indicated that after controlling for many of the differences we found
between reservists and active duty soldiers, Army reservists received
similar disability ratings to their active duty counterparts. We also
found that reservists may be less likely to receive military disability
benefits. Data on years of service and preexisting conditions were not
available for this analysis, however, factors that influence disability
benefit decisions. Finally, we were unable to compare processing times for
reserve and active duty disability cases because we found that Army data
on processing times were not reliable. However, based on these data, some
Army officials conclude that reservists' cases often take longer to
process through the disability evaluation system than the cases of active
duty soldiers.

17

Cheryl Y. Marcum, Robert M. Emmerichs, Jennifer S. Sloan, and Harry J.
Thie, Methods and Actions for Improving Performance of the Department of
Defense Disability Evaluation System. MR-1228-OSD (Santa Monica, Calif.:
the Rand Corporation, 2002).

Page 22 GAO-06-362 Military Disability System

Army Reservists and Active Duty Soldiers in the Disability Evaluation
System Had Different Characteristics

From 2001 through 2005, the characteristics of Army reservists and active
duty soldiers in the disability evaluation system differed in a number of
ways. Specifically, reservists tended to have more impairments than active
duty soldiers; they were more likely than active duty soldiers to have
three or four impairments. Reservists also experienced higher rates of
impairments affecting the cardiovascular and endocrine systems, while
active duty soldiers experienced a higher rate of impairments affecting
the musculoskeletal system. Reservists were more often classified in
higher pay grades and more often worked as functional support and
administration, crafts workers, and service and supply handlers. See
appendix IV. Active component soldiers worked more often as infantry and
gun crews; electronic equipment repairers; and communications and
intelligence specialists.18 In addition, compared to the number of active
duty disability cases from 2001 through 2005, which remained relatively
constant, the proportion of reservists going through the PEB process rose
dramatically through 2004. See figure 3.

18

Army military occupational specialty data were translated into DOD
occupation categories, as derived by the Defense Manpower Data Center.

Page 23 GAO-06-362 Military Disability System

Figure 3: Yearly Percentage Change in PEB Caseload for Active Duty and
Reserve Component Soldiers, Calendar Years 2001 to 2005

    Percentage change

138

140 135 120 100

80 60 40 33

29 22

20

4

0

                                       -7

                                                                          -18
           2001           2002         2003         2004     2005 (projected) 
      Year                                                   
           Active duty                                       

Reserve component

Source: GAO analysis of Army data.

Note: The 2005 numbers represent annual projections based on data
collected through Aug 2005.

Finally, the demographic characteristics of Army reservists and active
duty soldiers in the disability evaluation system also differed. Eighty
percent of reservists were male, compared to 76 percent of active duty
soldiers, while, on average, reservists were 11 years older than active
duty soldiers.19 See figure 4.

The average reservist was 38 years old, while the average active duty
soldier was 27 years old.

Page 24 GAO-06-362 Military Disability System

Army Reservists Received Disability Ratings Similar to Their Active Duty
Counterparts, but Reservists May Be Less Likely to Receive Benefits

Figure 4: Ages of Active Duty and Reserve Component Soldiers Entering the
Disability Evaluation System, Calendar Years 2001 to 2005 Percentage of
soldiers 100 90 80 70 60 50

42 43

40

32

30

22

22

17 13

20

10

2

0.2

0 17-24 25-34 35-44 45-54 55+ Age groups

Active duty Reserve component Source: GAO analysis of Army data. Note: The
2005 numbers represent annual projections based on data collected through
August 2005.

Before controlling for factors that could account for differences in the
outcomes of the Army disability evaluation system for reserve and active
duty soldiers, our analysis of Army data indicates that, from 2001 through
2005, reservists were assigned slightly higher disability ratings, but
received benefits less often than active duty soldiers. See appendix V.
When we controlled for many of the characteristics of reserve and active
duty soldiers that could account for their difference in ratings, we found
that, among soldiers who received ratings, the ratings assigned to Army
reservists were comparable to those assigned to their active duty
counterparts. When we controlled for a more limited number of factors,
Army reservists who were determined to be unfit for duty appeared less
likely to receive benefits (either monthly disability payments or
severance pay). See appendix I. This analysis of benefit outcomes for Army
reserve

Poor Quality Data Precluded GAO Analysis, but the Army Reports Reservists'
Cases Can Take Longer

and active duty disability cases could not account for the influence that
preexisting conditions and years of service can have on disability
decisions.20 These factors are key in determining whether an injured or
ill service member qualify for disability benefits.21 Because we could not
test the effect of these factors empirically, we cannot rule out the
possibility that one or the other may account for the differences we
found.

While, according to the Army's own statistics, the PEB process can take
longer for reservists than active duty soldiers, we found the Army data
used to calculate processing times not of sufficient quality to warrant
its use in our analysis. Specifically, the dates in Army's electronic
database often did not correspond with the dates recorded in paper files.
See appendix I. Nonetheless, the statistics the Army provided indicate
that disability cases reviewed between fiscal years 2001 and 2005 took
consistently longer than those of active duty soldiers. Over half (54
percent) of reserve soldiers took longer than 90 days while over one-third
(35 percent) of active duty soldiers exceed this threshold. See appendix
II for more detail.

There are several possible explanations for the differences in processing
times between reservists and active duty members, according to the Army.
For example, the Army officials reported that MEBs often must request
medical records from private medical practitioners for reservists' cases,
which can involve considerable delays. In addition, the personnel
documents for reservists are stored in facilities around the U.S., and
therefore they may take longer to obtain than records for centrally
located active duty soldiers. Due to the lack of data on these issues as
well as the problems we encountered with the data provided by the Army we
were not able to measure the differences or empirically test possible
explanations for differences the Army reported in the timeliness of
disability case processing for Army reservists and active duty soldiers.

20

If an impairment that renders a member of the military unfit for duty
existed prior to service, it is only compensable when the member has 8 or
more years of service.

21

Prior GAO research found that, in recent years, reserve members were
deployed with preexisting medical conditions. In addition, because
reservists are not on duty fulltime (except when mobilized/activated),
their injuries are more likely to occur while not in the line of duty.
Both explanations could result in reserves having a higher likelihood to
be separated without benefits.

Conclusions

The military disability system's outcomes can greatly impact the future of
service members, including reservists, injured in service to their
country. Given the significance of these decisions as well as the latitude
that services have to implement the system, it is important that DOD
exercise proper oversight to make sure the system meets the needs of
service members today and in the future. However, DOD is not adequately
monitoring the outcomes for active duty and reservist cases in the
disability evaluation system. DOD and the services do not have complete
and reliable data for all aspects of the disability system. Further,
neither DOD nor the services are systematically evaluating consistency and
timeliness of decision making in the system.

Military officials recognize that in many cases, service members' cases
are not determined within timeliness goals and have suggested that the
goals may not be appropriate in many cases. In addition, it may take
longer for reservist cases to go through the system. If a goal does not
reflect appropriate processing times, it may not be useful as a program
management tool. Furthermore, both consistency and timeliness of decisions
depend on the adequate training and experience of all participants in the
disability system. Yet we found that DOD had little assurance that staff
at all levels are properly trained.

To ensure that all service members-both active duty and reserves-

Recommendations for

receive consistent and timely treatment within the disability evaluation
Executive Action process, we recommend that the Secretary of Defense take
the following five actions

     o require the Army, Navy, and Air Force to take action to ensure that
       data needed to assess consistency and timeliness of military
       disability rating and benefit decisions are reliable;
     o require these services to track and regularly report these data-
       including comparisons of processing times, ratings and benefit
       decisions for reservists and active duty members-to the Under
       Secretary of Personnel and Readiness and the Surgeons General;
     o determine, based on these reports, if ratings and benefit decisions
       are consistent and timely across the services and between reservists
       and active duty members and institute improvements to address any
       deficiencies that might be found;
     o evaluate the appropriateness of current timeliness goals for the
       disability process and make any necessary changes; and

Page 27 GAO-06-362 Military Disability System

o  assess the adequacy of training for MEB and PEB disability evaluation
staff.

We provided a draft of this report to the Department of Defense for its
review. DOD agreed with our recommendations, indicating the Comments
Department will implement all of them and listing a number of steps it
will

take to do so. DOD also provided technical comments, which we

incorporated into the report as appropriate.

We are sending copies of this report to the Secretary of Defense, relevant
congressional committees, and others who are interested. Copies will also
be made available to others upon request. The report is also available at
no charge on GAO's Web site at http://www.gao.gov.

Please contact me on (202) 512-7215 if you or your staff have any
questions about this report. Contact points for our Offices of
Congressional Relations and Public Affairs can be found on the last page
of this report. Other major contributors to this report are listed in
appendix VII.

Robert E. Robertson Director Education, Workforce, and Income Security

Appendix I: Objective, Scope, and Methodology

                       Section 1: Data Reliability Tests

The objectives of our report were to determine: (1) how current DOD
policies and guidance for disability determinations compare for the Army,
Navy, and Air Force, and what policies are specific to reserve component
members of the military; (2) what oversight and quality control mechanisms
are in place at DOD and these three services of the military to ensure
consistent and timely disability rating and benefit decisions for active
and reserve component members, and (3) how disability rating and benefit
decisions, and processing times compare for active and reserve component
members of the Army, the largest branch of the service, and what factors
might explain any differences.

To address objectives 1 and 2, we reviewed relevant legislation, policy
guidance, and literature; interviewed officials from DOD, Army, Navy, Air
Force, Reserves, and National Guard; and visited Lackland and Randolph Air
Force Bases, Fort Sam Houston and Walter Reed Army Medical Center;
Washington Navy Yard and Bethesda Naval Hospital; and interviewed relevant
officials. In addition, we interviewed officials from military treatment
facilities.

To determine if outcomes for active duty and reserve service members'
disability cases were statistically consistent, we analyzed data provided
by the physical evaluation board (PEB) of the Army. We also obtained
summary information on total caseloads and processing times from the
services and from the Department of Defense. Based on our assessment of
the quality of the Army's data, we concluded that data on disability
determinations and ratings made by the Army's PEB were sufficiently
reliable for our analysis. On the other hand, the Army's data on
processing times were not reliable for our analysis. We did not test the
reliability of statistical data provided by DOD and the services.

This appendix is organized into two sections: Section 1 describes the
analyses related to our tests of data quality and reliability. Section 2
describes the empirical analyses that were used to determine if outcomes
for active duty and reserve disability cases were statistically
consistent.

To ensure that the Army data were sufficiently reliable for our analyses,
we conducted detailed data reliability assessments of the data sets that
we used. We restricted these assessments, however, to the specific
variables that were pertinent to our analyses. We found that all of the
data sets used in this report were sufficiently reliable for use in our
analyses.

Page 29 GAO-06-362 Military Disability System Appendix I: Objective,
Scope, and Methodology

To allow us to analyze the outcomes of the disability evaluation process
and determine whether decisions were made in a timely fashion, we
requested that the Army share data from both the Medical Evaluation Board
and the Physical Evaluation Board for our review. The Army provided
extracts from both the Medical Evaluation Board Internal Tracking Tool
(MEBITT), used by the Medical Evaluation Board and the Physical Disability
Computer Assisted Processing System (PDCAPS), used by the PEB.

During interviews with the database managers responsible for MEBITT and
PDCAPS, we learned that the Army has few internal controls to ensure that
the data are complete and accurate. Consequently, we conducted a
trace-to-file process to determine whether the data in the electronic
systems were an accurate reflection of what was recorded in the paper
files. We requested that the Army provide us with the paper files for a
sample of 130 cases that completed the Army's disability evaluation
process between 2000 and August, 2005. Army officials provided 93 paper
files for our review. The remaining files were archived or were not found.

We checked the data in files provided against the electronic records in
MEBITT and PDCAPS. We determined that the MEBITT data were not
sufficiently reliable for our use. We also determined that in the PDCAPS,
there was a high degree of accuracy in the data fields related to: rank,
component (active duty versus reserve component), date of entry into
military service, primary military occupational specialty, disposition of
disability case, percentage rating for disability, location of PEB, and
illness/diagnosis codes. These fields were deemed reliable for use in our
report.1 However, this review also revealed that the data in the date
fields, such as the narrative summary dates and the final decision dates,
were often inaccurate and were therefore determined to be of insufficient
quality for use in our report.

To determine if outcomes for active duty and reserve disability cases were

Section 2: Statistical

statistically consistent, we conducted extensive statistical analyses
Analyses including cross tabulations and econometric modeling. This was
important because active and reserve component soldiers being evaluated
differ

1

We concluded that data for a particular variable was sufficiently reliable
for use in our analyses if entries in the electronic system and the paper
record matched in at least 99 percent of the cases reviewed.

Page 30 GAO-06-362 Military Disability System Appendix I: Objective,
Scope, and Methodology

greatly in demographic characteristics and in administrative
characteristics, such as pay grade and occupational specialty. Recognizing
the potential of these characteristics to influence final outcomes and
disability ratings, we developed econometric models to assess whether the
observed differences between active and reserve component soldiers persist
after controlling for these factors.

We began with a series of bivariate cross tabulations and then expanded
these cross-classifications and examined three-way and four-way tables.
These allowed us to compare large groups of active and reserve soldiers,
as well as to compare soldiers in specific sets of categories-such as
active and reserve soldiers of different grades being evaluated at
different PEBs. To control for additional factors, we supplemented the
crosstabulations with ordinary least squares (OLS) and multivariate
logistic regressions. Our analyses considered both the size and
significance of the relationships of interest, using means, percentages,
and odds and odds ratios to assess magnitude, and f-tests, chi-square
tests and Wald statistics to assess the significance of the differences.

The analyses are limited due to our inability to control for several
important factors in the disability evaluation process. For example, no
reliable electronic data existed to indicate whether an injury existed
prior to service or was incurred outside of the line of duty, both primary
reasons for separating a soldier without benefits. Similarly, Army
officials told us that data on years of service for reservists in the
electronic data the Army provided were unreliable. Additionally, soldiers
declared fit or separated without benefits do not receive percentage
disability ratings, and the Army reports no impairment codes for soldiers
declared fit. As such, we could not determine whether active and reserve
component soldiers were similarly likely to be declared fit controlling
for impairment or percentage rating. Given these difficulties, we
restricted our multivariate analyses to soldiers rated unfit.

Appendix I: Objective, Scope, and Methodology

Multivariate regression analysis

To assess factors contributing to the final rating among those members
declared unfit and receiving a percentage rating (that is, excluding those
separated without benefits), we ran a series of multivariate models. Army
data systems report up to four impairments.2 Their final percentage
disability rating is determined by a composite of ratings for individual
impairments, the system(s) affected and how the specific impairment
relates to the soldier's ability to perform his or her duties.3 Regression
analysis allows us to assess whether the observed differences between
reserve and active soldiers' final ratings persist controlling for factors
that enter the decision process, such as military occupational specialty4
and system of impairment, as well as other factors such as demographic
differences between the reserve component and active duty soldiers.

We began by estimating a "gross effects" (or unadjusted) model, which
considers the gross difference in mean disability ratings between active
and reserve component soldiers ignoring other factors. The model confirms
descriptive statistics showing that reserve component members' ratings
average approximately 4 points higher than those of active component
members.

We next estimated a series of alternative "net effects" (or adjusted)
models to account for other factors that influence the decision process;
these models estimate the impact of being a reservist on rating "net" of
other factors. Our first model included number of reported impairments,
physical system affected and occupational specialty; a second model added
year of decision, age, race, sex, pay grade, and PEB to control for forces
that may influence the decision process unofficially and certain
demographic differences between components. Additionally, we ran a variety
of alternative specifications to ensure the stability and robustness of
the results; this included, for example, a model testing the interaction

2

According to the Army their databases list impairments in order of
severity. While some soldiers with multiple impairments might have
consecutive impairments of equal severity, we only included the first
impairment listed in models presented here. Alternative models with the
full set of potential impairments did not alter the substantive
interpretation of being a reservist on final ratings.

3

As the final disability rating is measured in increments of 10, some might
question our choice of OLS rather than a categorical analysis or a count
model (e.g., Poisson). We believe that the data represent an underlying
continuous distribution between zero and 100, and are thus appropriately
modeled using OLS regression.

4

Our measure of occupation converts military occupational specialty codes
into DOD standard occupational codes.

Appendix I: Objective, Scope, and Methodology

between system affected and occupational specialty5 and a model to account
for the clustering (and potential "nonindependence") of cases within each
PEB.6

Table 4 presents the coefficient representing the relationship between
being a reservist on final disability ratings in models that control for a
limited set of controls both relevant and external to the formal decision
process. What appears to be a small difference in ratings between reserve
and active component members diminishes controlling for other factors.
Overall, results of our OLS regression analyses suggest that active and
reserve component members receive similar disability ratings controlling
for factors that enter the formal decision process formally and
indirectly.

5

As this more complicated model produced nearly identical estimates of the
effect of being a reservist on ratings, we present only the results of the
simpler models without interactions here.

6

Standard error estimates are usually calculated under the assumption of
independent observations. A control for clustering adjusts the standard
errors to account for the possibility of non-independence of observations
within each cluster (here, PEB).

Page 33 GAO-06-362 Military Disability System

                 Appendix I: Objective, Scope, and Methodology

Table 4: Estimate of the Relationship between Being a Reservist and the
Final Disability Rating among Soldiers Receiving a Rating

Effect of Being a Reservist on Disability Ratings Unstandardized
coefficient (standard error) Interpretation

Gross effects model 3.8a Reserve component soldiers

(no controls) (0.25) receive ratings approximately 4 percentage points
higher than active component soldiers.

Net effects model, limited       1.9a (0.22) Reserve component soldiers    
controls (number of impairments,             receive ratings approximately 
main body system affected, and               2 percentage points higher    
occupational specialty)                      than active component         
                                                soldiers.                     
Net effects model, expanded      -1.1b       Reserve component soldiers    
controls (year of decision,      (0.40)      receive disability ratings    
controls above plus age, race,               approximately 1 percentage    
sex, pay grade, PEB and PEB                  point lower than active duty  
cluster adjustment)                          soldiers, but this result is  
                                                not                           
                                                statistically significant at  
                                                conventional levels after     
                                                adjusting for clustering      
                                                within each PEB.              

Source: GAO analysis of Army PDCAPS data.

a

Coefficients statistically significant at the 99 percent level.

b

Standard errors in the final model presented here account for PEB
clustering and reduce the statistical significance of the estimate to just
below the 90 percent confidence level based on three independent clusters;
the coefficient is significant at the 99 percent level in an identical
model that does not adjust standard errors for clustering.

To assess receipt of benefits, we estimated a multinomial logistic model,
a technique that allows us to estimate the likelihood of placement in one
of several categories controlling for additional factors. The model
produces relative risk ratios that compare the relative odds of reserve
component soldiers and active duty soldiers determined unfit for duty
being placed into either one of two categories (severance pay or permanent
disability retirement) rather than the base or referant category
(separated without benefits). With controls, the relative risk ratio
compares the odds of placement in the given category for similarly
situated active and reserve component soldiers.

A relative risk ratio of 1 indicates that reserve and active component
members have equal odds of being placed in one category rather than the
base category. A relative risk ratio of less than 1 for reserve soldiers

Page 34 GAO-06-362 Military Disability System

Multinomial Logistic Analysis

Appendix I: Objective, Scope, and Methodology

indicates that reservists have lower odds than active members of placement
in the category rather than in the base category, and a relative risk
ratio of greater than 1 indicates that reservists have higher odds than
active duty members of being placed in that category rather than in the
base category. Because soldiers placed on the temporary disability retired
list (TDRL) have not received a final benefits determination, they are
excluded from the model.

The relative risk ratios in table 5 demonstrate that among those declared
unfit, reserve component soldiers have significantly lower odds than
active component soldiers of receiving either permanent disability
retirement or lump sum disability severance pay. Prior to controlling for
other factors (our "gross effects" model), reserve soldiers have
significantly lower odds than active component members of receiving either
permanent disability retirement or severance pay rather than being
separated without benefits-the relative risk ratios of 0.5 and 0.4 in the
first row of the table respectively demonstrate reservists are only half
or less than half as likely to receive permanent disability retirement or
severance pay, respectively.

Appendix I: Objective, Scope, and Methodology

Table 5: Estimate of the Relationship between Being a Reservist and
Receipt of Benefits before and after Controlling for Other Factors (among
Those Unfit and Assigned a Final Disposition)

Effect of Being a Reservist on odds of Permanent receiving (relative risk
disability Severance ratio) retirement pay Interpretation

Gross effects model (no controls, base 0.5category is separation without
benefits) The odds of receiving

0.4 permanent disability retirement or severance pay are lower for
reservists

Net effects model, The odds of receiving limited controls permanent
disability retirement (number of impairments, or severance pay are lower
for main body system 0.4 0.4 reservists affected, occupational specialty)

Net effects model, expanded controls (year of decision, controls above
plus age, 0.1 race, sex, pay, and PEB

The odds of receiving permanent disability retirement or severance pay are
lower for

0.3 reservists

Source: GAO analysis of Army PDCAPS data.

Note: This analysis compared relative risk ratios of those who were
granted permanent disability retirement and severance pay with those who
were separated without benefits. Relative risk ratios are statistically
significant at the 99 percent level.

This relationship persists after controlling for limited factors both
relevant to7 and external to8 the official decision making process ("net
effects" models), and in fact the estimated difference between reservists
and active duty soldiers is in fact increased by the inclusion of
variables such as race, sex and PEB location. While these additional
factors do not directly enter the decision making process, they control
for some of the administrative and demographic differences we observe
between active and reserve component members. The relationship differs for
the odds of receiving severance pay, where reserve soldiers have less than
one third the odds of active soldiers, and the odds of receiving permanent
disability retirement, where the odds of reservists' receiving this type
of benefit rather than

7

These "relevant" factors include number of reported impairments, body
system affected, and occupation.

8

This analysis adds age, race, sex, pay grade, PEB location, and year the
decision was reported.

Page 36 GAO-06-362 Military Disability System Appendix I: Objective,
Scope, and Methodology

separation without benefits is about one-tenth that of active component
members.

We lacked reliable electronic data on two potentially important factors.
This inability to control for length of service and injuries existing
prior to service prevents us from determining whether the differences
presented above are warranted or defensible.

Appendix II: Selected Data from Service Branches on Processing Time,
Dispositions, and Medical Holdover

Table 6: Army Processing Times for Disability Cases, Including both MEB and PEB
                      Processing, Fiscal Year 2001 to 2005

                       Percentage of cases processed in:

Total Number of Cases "30 days 31-60 days 61-90 days 91-120 days >120 days

FY2001

                   Active duty 6,627 1.6 13.6 41.3 20.1 23.4

                 Reserve component 591 4.1 14.5 24.2 15.9 41.3

FY2002

                   Active duty 6,510 1.7 10.9 36.6 22.6 28.2

                 Reserve component 812 3.6 10.5 24.9 20.2 40.9

FY2003

                   Active duty 6,659 7.4 31.9 28.9 14.7 17.1

                Reserve component 1,546 6.5 25.5 23.9 17.7 26.3

FY2004

                   Active duty 7,694 5.5 35.9 27.9 13.9 16.8

                Reserve component 4,187 2.0 18.7 22.3 19.6 37.2

FY2005

                   Active duty 9,322 16.0 37.1 21.3 12.3 13.2

                Reserve component 4,426 5.5 21.8 20.3 16.3 36.0

Source: Department of the Army.

Note: Percentages may not total 100 due to rounding.

Appendix II: Selected Data from Service Branches on Processing Time,
Dispositions, and Medical Holdover

Table 7: Navy Processing Times for Disability Cases, Including Only PEB
Processing, Fiscal Year 2001 to 2005
                       Percentage of cases processed in:
          Total Number of Cases    "30 31-60    61-90  91-120 days  >120 days 
                                  days days     days               
FY 2001                                                         
Active duty              4,620     24     41       16         6         13 
Reserve component         379      7      39       19         9         26 
FY2002                                                          
Active duty              3,953     26     43       15         6          9 
Reserve component         413      9      41       24         6         20 
FY2003                                                          
Active duty              3,814     23     39      21          7         10 
Reserve component         436      11     38      24         10         17 
FY2004                                                          
Active duty              4,889     31     35       18         7          9 
Reserve component         543      19     40       17         7         17 
FY2005                                                          
Active duty              4,645     61     24        5         3          5 
Reserve component         555      30     39       12         6         14 

                        Source: Department of the Navy.

      Appendix II: Selected Data from Service Branches on Processing Time,
                       Dispositions, and Medical Holdover

  Table 8: Air Force Processing Times for Disability Cases, Including Only PEB
                      Processing, Fiscal Year 2001 to 2005

                       Percentage of cases processed in:

Total Number of Cases "30 days 31-60 days 61-90 days 91-120 days >120 days

FY2001

                          Active duty 2,376 89 7 3 1 0

                        Reserve component 441 85 9 5 2 0

FY2002

                          Active duty 3,251 86 8 4 2 0

                        Reserve component 535 86 4 5 3 1

FY2003

                          Active duty 3,340 82 5 6 4 3

                        Reserve component 633 77 4 6 6 6

FY2004

                         Active duty 3,525 70 11 7 5 7

                       Reserve component 719 67 8 5 7 13

FY2005

                         Active duty 3,610 55 23 9 5 8

                      Reserve component 758 44 20 12 8 16

                      Source: Department of the Air Force.

      Appendix II: Selected Data from Service Branches on Processing Time,
                       Dispositions, and Medical Holdover

 Table 9: Final Dispositions Made by Navy PEB for Disability Cases, Fiscal Year
                                  2001 to 2005

                       FY2001 FY2002 FY2003 FY2004 FY2005

                             Total Number of Cases

Active duty                         4,620   3,952   3,813   4,889    4,645 
Reserve component                    380     414     436     543       557 
Disposition:                                                       
Fit/Returned to Dutya                                              
Active duty                         1,164    926     820    1,213    1,297 
Reserve component                    176     193     180     200       183 
Separated with Severance Pay                                       
Active duty                         1,998   1,667   1,688   1,991    1,649 
Reserve component                    130     144     130     197       196 
Separated without Benefits                                         
Active duty                          288     225     272     362       269 
Reserve component                        9   11      30      24         26 
Permanent Disability Retirement                                    
Active duty                          130     171     114     141       126 
Reserve component                        5   10       7       9         13 
Temporary Disability Retired List                                  
Active duty                         1,040    963     919    1,182    1,304 
Reserve component                       60   56      89      113       139 

Source: Department of the Navy.

a

Includes "presumed fit" cases.

      Appendix II: Selected Data from Service Branches on Processing Time,
                       Dispositions, and Medical Holdover

Table 10: Final Dispositions Made by Air Force PEB for Disability Cases, Fiscal
                               Year 2001 to 2005

                       FY2001 FY2002 FY2003 FY2004 FY2005

                             Total Number of Cases

Active duty                        2,376    3,251   3,340   3,525    3,610 
Reserve component                   441      535     633     719       758 
Disposition:                                                       
Fit/Returned to Duty                                               
Active duty                        1,406    1,797   1,730   1,492    1,503 
Reserve component                   294      365     427     441       387 
Separated with Severance Pay                                       
Active duty                         311      691     773    1,040    1,273 
Reserve component                    44      40      79      106       156 
Separated without Benefits                                         
Active duty                         101      273     425     429       273 
Reserve component                    5       22      37      49         30 
Permanent Disability Retirement                                    
Active duty                         169      162     144     146       228 
Reserve component                    25      36      32      56         93 
Temporary Disability Retired List                                  
Active duty                         389      328     268     258       333 
Reserve component                    73      72      58      67         92 

                     Source: Departments of the Air Force.

Appendix II: Selected Data from Service Branches on Processing Time,
Dispositions, and Medical Holdover

Table 11: Number of Army Reserve Component Members Entering Medical
Holdover by Year, Calendar Years 2001 to 2005

                          Year of Entry Number Entered

                                    2001 175

                                    2002 560

                                   2003 7,865

                                   2004 9,850

                                   2005 8,729

                                  TOTAL 27,181

                        Source: Department of the Army.

Appendix III: Compilation of Differences in Regulations Governing the Military
Disability Evaluation System

Aspect              Army                 Navy           Air Force          
Line of Duty                                            
Determinations                                          
1. Time frames for  Time limits are      No stated      Time limits for    
processing for      placed on each       policy         completing LOD     
active component    participant in the                  determinations are 
members             process.                            placed on each     
                                                           participant in the 
                                                           process.           
2. Time frames for  Time limits are      No stated      Line of duty       
processing for      placed on each       policy         determinations     
reserve component   participant in the                  must be completed  
members             process.                            "promptly".        
3. Required for     Requireda Unit       Requireda Line Always required    
reserve component   commander If line of commander MEB  Commander e If     
members 4.          duty determination   reviews case   necessary for      
Responsible for     is required by       records to     adjudication, the  
doing line of duty  regulations and is   ensure line of MEB/PEB will       
determination 5.    not in the case      duty           request a missing  
MEB/PEB options for file, the case will  determination  LOD be             
missing or          be returned to the   is done. Under accomplished and   
incomplete line of  MTF for completion   some           incomplete LODs to 
duty determinations of LOD process. PEB  circumstances, be completed.      
                       does not have the    cascan be      
                       authority to make    forwarded      
                       LOD determinations.  without one.   

MEB

1. Means of           Physician, unit Physician, unit   Physician and/or
referral to MEB            commander,                   unit 
                    higher command, or   commander, or     commander with
                            the                            
                   Military Occupational higher command.   physician input.
                   Specialty/Medical                       
                   Retention Board                         
                   (MMRB). b                               
2. Composition            Two or more Minimum of two    Three physicians.
                          physicians. If                   
                   MEB contains a mental physicians. When  When adjudicating
                     condition, one must adjudicating      mental
                                    be a mental            
                        psychiatrist. If incapacitation,   incapacitation,
                       dental condition, three             one  
                           one must be a required, one     must be a
                           dentist. When must              
                    adjudicating mental  be a              psychiatrist.
                                         psychiatrist.     
                   incapacitation, three                   
                                required                   
(one must be psychiatrist). 3. Type of process Informal process in which
at MEB members pass Formal process in
                       least two        files among             which board   
                       physicians                               meets to      
                       compile                                  
                       and evaluate a   themselves and          discuss the   
                       service                                  case.         
                       member's medical review them             
                            history and                         
                          his or her    independently.          
                       current medical                          
                       status.                                  
4. MEB has option                                                          
to place member on  Yes              Yes                     No
limited dutyc                                                

Appendix III: Compilation of Differences in Regulations Governing the
Military Disability Evaluation System

                           Aspect Army Navy Air Force

5. Service member can appeal MEB Yes Service member has option of       No 
decision                             submitting a written rebuttal or   
                                                    addendum.              
                                        Physician must address the service 
                                        member's specific issues.          
PEBLOs                                                                  

1. Command with             Medical      Medical and PEB  Medical          
responsibility for PEBLO                                  
                                  Primarily Primarily        Primarily        
2. Training                   on-the-job on-the-job       on-the-job       
                                   training                  
                                and annual  training, plus   training, PEBLO  
                               conference.                   
                                               quarterly and Guide, and       
                                                      annual planned          
                                            training.        annual training. 

3. Point in process PEBLO begins         MEB Regulations indicate this MEB 
counseling service member                    is done upon referral of  
                                                MEB.                      
                                                However, Navy officials   
                                                interviewed               
                                                         said it was done 
                                                      after the PEB       
                                                        decision.         
PEB                                                                    
1. Overall PEB process                                                 

a. Number of PEBs     Three, plus       One               One              
nationwide            "mobile PEB"d                       
b. Reserve component                                                       
board member required Yes               Yes               Yes
on for                                                    
reserve component                                         
cases                                                     
c. Active component                                                        
board member required No stated policy  No stated policy  Yes
on case                                                   
for active component                                      
cases                                                     
2. Informal PEB                                           
a. Composition        At least three    Three members     Three members    
                         members                             
b. Amount of time     Ten calendar days Fifteen calendar  Three duty days  
service member has to                                     
concur/nonconcur with                   days              
findings                                                  
c. Informal PEB can                                                        
reconsider findings   Yes               Yes               Yes
under some                                                
circumstances                                             
3. Formal PEB                                             
a. Composition        At least three    Three members     Three members    
                         members                             
b. Members of                                             Normally will    
informal and formal   Normally will be  No stated policy  not be           
PEB can be the                                            
same for a case                                           
c. Amount of time     Minimum of three                    Up to three duty 
given to a service    workings          A "reasonable                 days 
member to prepare                                         
for the formal PEB    days.             period".          after arrival at 
                                                                       formal 
                                                             PEB.e            
d. When service       At conclusion of  Two to three                       
member is notified of proceedings.      weeks             At conclusion of
Formal PEB                                                
decision                                after             proceedings.     
                                           proceedings.      

Appendix III: Compilation of Differences in Regulations Governing the
Military Disability Evaluation System

Aspect                  Army              Navy             Air Force       
e. Amount of time       Ten calendar days Fifteen calendar  Service member 
service member has to        from receipt                              has 
concur/nonconcur with   of findings       days from            24 hours to 
findings                letter.           receipt of             concur or 
                                             findings letter. nonconcur with  
                                                              the             
                                                              findings. If    
                                                              service         
                                                              member does not 
                                                              concur he has   
                                                              10 duty days to 
                                                              submit a        
                                                              rebuttal if     
                                                              desired.f       
f. Formal PEB can                                                          
reconsider findings     Yes               No               No
under some                                                 
circumstances                                              
Appeals                                                    
1. Appeal opportunities Army Physical     Petition for     Secretary of    
beyond the formal PEB   Disability        Relief to        the Air         
                           Agency            the Secretary of Force Personnel 
                                             the              
                                             Navy Council of  Council         
                                             Review Boards    

        Army Physical Disability      Board for the       Air Force Board for 
        Appeal Boardg                 Correction of Naval the Correction of   
                                      Records             Military Records    
        Army Board for the Correction                     
        of Military Records                               

Source: GAO analysis, review of relevant regulations and interviews with
military officials.

a

"Required" includes a general authority that includes reserve members.

b

The Military Occupational Specialty/Medical Retention Board (MMRB) is an
administrative board that evaluates the ability of a service member with a
permanent profile of 3 or 4 (which indicates a physical limitation) to
meet the responsibilities of his military occupational specialty in a
worldwide field environment.

Limited duty is a temporary period in which a service member's
responsibilities are restricted.

d

The "mobile PEB" is a group of three adjudicators who travel and provide
additional manpower to the PEBs when needed.

e

An Air Force official stated that members can begin their preparations
once they non-concur with the informal PEB findings and request a formal
PEB.

f

A February 2006 policy revision allows the formal PEB president to approve
written requests for additional time to allow the member to obtain medical
documentation or consult with legal counsel.

g Applicable only to cases in which Army Physical Disability Agency
revises the PEB findings as part of a quality or mandatory review and the
soldier does not concur with the revised finding.

Appendix III: Compilation of Differences in Regulations Governing the
Military Disability Evaluation System

                   Disability Evaluation Related Regulations

Federal Code

38 CFR Part 4: Veterans Affairs Schedule for Rating Disabilities

Department of Defense

DODD 1332.18 "Separation or Retirement for Physical Disability" DODI
1332.38 "Physical Disability Evaluation" DODI 1332.39 "Application of the
Veterans Administration Schedule for Rating Disabilities"

Army

AR 40-400 "Patient Administration" AR 40-501 "Standards of Medical
Fitness" AR 600-8-4 "Line of Duty Policy, Procedures, and Investigations"
AR 600-60 "Physical Performance Evaluation System" AR 635-40 "Physical
Evaluation for Retention, Retirement, or Separation"

Navy

SECNAV 1850.4E "Department of the Navy Disability Evaluation Manual"
JAGINST 5800.7D "Manual of the Judge Advocate General" NAVMED P-117
"Manual of the Medical Department"

Air Force

AFI 36-2910 "Line of Duty (Misconduct) Determinations" AFI 36-3212
"Physical Evaluation for Retention, Retirement and Separation" AFI 41-210
"Patient Administration Functions" AFI 44-157 "Medical Evaluation Boards
and Continued Military Service" AFI 48-123 "Medical Examination and
Standards"

Appendix IV: Characteristics of Army Service Members Entering the DES

    Table 12: Occupational Codes for Services Members in Military Disability
                 Evaluation System, Calendar Years 2001 to 2005

Active duty Reserve Component Total Enlisted Occupation Codes Frequency
Percent Frequency Percent Frequency Percent

10 Infantry, Gun Crews, and Seamanship Specialists 7,112

11 Electronic Equipment Repairers 2,029 12 Communications and Intelligence
Specialists 3,673

13 Health Care Specialists 2,930

14 Other Technical and Allied Specialists 945 15 Functional Support and

Administration 4,749

16 Electrical/Mechanical Equipment Repairers 4,539 17 - Crafts Workers 649
18 Service and Supply Handlers 4,872 19 Non-Occupational 281

21.2 1,330 14.4 8,442 19.8 6.1 210 2.3 2,239 5.2 11.0 361 4,034 3.9 9.4
8.8 534 5.8 3,464 8.1 2.8 222 1,167 2.4 2.7 14.2 1,826 6,575 19.8 15.4
13.6 1,084 5,623 11.8 13.2 1.9 557 6.1 1,206 2.8 14.5 2,447 26.6 7,319
17.1 0.8 17 0.2 298 0.7

Officer Occupation Codes

21 General Officers and Executives, N.E.C. 0 22 Tactical Operations
Officers 535

23 Intelligence Officers 136 24 Engineering and Maintenance Officers 247

25 Scientists and Professionals 81 26 Health Care Officers 424 27
Administrators 115 28 Supply, Procurement and Allied

Officers 163 29 Non-Occupational 19

0.0 2 2 0.0 0.0 1.6 151 1.6 686 1.6 0.4 39 0.4 175 0.4 0.7 66 313 0.7 0.7
0.2 43 0.5 124 0.3 1.3 131 1.4 555 1.3 0.3 94 1.0 209 0.5 0.5 94 257 1.0
0.6 0.1 6 0.1 25 0.1

Total 33,499 78.4 9,214 21.6 42,713 100

 Source: Based on conversion of military occupational specialty codes into DOD
                          standard occupational codes.

     Appendix IV: Characteristics of Army Service Members Entering the DES

    Table 13: Rank Groups by Component for Services Members in the Military
                 Disability System, Calendar Years 2001 to 2005

Active duty Reserve Component Total Rank group Frequency Percent Frequency
Percent Frequency Percent

Junior. Enlisted 22,460 66.8 3,771 40.7 26,231 (E1-E4)

Non-Commissioned Officer (E5-E9) 9,403 28.0 4,862 52.4 14,265

Company grade officer 1,018 3.0 205 2.2 1,223 (01-03)

        Field grade and general officer (04-010) 447 1.3 311 3.4 758 1.8

Warrant officer 302 0.9 128 1.4 430 1.0 (W01-CW5)

Total 33,630 74.8 9,277 21.6 42,907

                        Source: Department of the Army.

Appendix V: Disability Evaluation Outcomes for Army Active Duty and Reserve
Component Members for 2001 to 2005

Table 14: Descriptive Statistics on Disability Evaluation Outcomes for
Active Duty and Reserve Component Members in the Army, Calendar Years 2001
to 2005

                                    Permanent                 Temporary       
               Fit w/out Separation disability      pay      disability 
Year         benefits            retirement Sev  erance retired list Total
Active duty                                                          
2001           504       526           642       4,541      165      6,378 
2002           462       541           517       4,866      246      6,632 
2003           366       555           435       4,390      427      6,173 
2004           407       666           362       5,495     1,050     7,980 
2005           445       506           209       4,468      837      6,465 
Reserve                                                              
Component                                                            
2001            105       24           87            311       20      547 
2002            141       73           112           370       32      728 
2003            223      472           126           796       91    1,708 
2004            328      782           177          2,345      439   4,071 
2005            248      338           102          1,220      315   2,223 

                   Source: GAO analysis of Army PDCAPS data.

Table 15: Descriptive Statistics on Disability Evaluation Outcomes for
Active Duty and Reserve Component Members in the Army, Calendar Years 2001
to 2005

                               Permanent                  Temporary     
                  Separation   disability                 disability    
Year      Fit     w/out        retirement Severance    retired list  Total 
                   benefits                  pay                        
Active                                                               
duty                                                                 
2001      7.9           8.2          10.1         71.2      2.6        100 

2002         7         8.2           7.8       73.4       3.7          100 
2003       5.9          9             7        71.1       6.9          100 
2004       5.1         8.3           4.5       68.9       13.2         100 
2005       6.9         7.8           3.2       69.1       12.9         100 
Reserve                                     
Component                                   
2001      19.2      4.4           15.9         56.9       3.7          100 
2002      19.4       10           15.4         50.8       4.4          100 
2003      13.1      27.6           7.4         46.6       5.3          100 
2004       8.1      19.2           4.3         57.6       10.8         100 
2005      11.2      15.2           4.6         54.9       14.2         100 
                  Source: GAO analysis of Army 
                  PDCAPS data.                 
                  DRAFT                        
                  Page 50                      GAO-06-362 Military Disability
                                                                       System

Appendix VI: Comments from the Department of Defense

Appendix VI: Comments from the Department of Defense

Appendix VI: Comments from the Department of Defense

Appendix VII: GAO Contact and Staff Acknowledgments

Robert E. Robertson (202) 512-7215 or [email protected]

GAO Contact

Staff Acknowledgments

In addition to the contact named above, Clarita A. Mrena, Assistant
Director; and Anna M. Kelley made major contributions to this report. In
addition, Jason Barnosky, Melinda Cordero, Erin Godtland, and Scott
Heacock served as team members; Lynn Milan, Anna Maria Ortiz, Doug Sloane,
Mitch Karpman, and Wil Holloway provided guidance and assistance with
design and analysis; Rachel Valliere advised on report preparation; and
Roger Thomas provided legal advice.

Related GAO Products

Veterans' Disability Benefits: Claims Processing Challenges and
Opportunities for Improvements. GAO-06-283T. Washington, D.C.: December 7,
2005.

Military Personnel: Top Management Attention Is Needed to Address
Long-standing Problems with Determining Medical and Physical Fitness of
the Reserve Force. GAO-06-105. Washington, D.C.: October 27, 2005.

Military Personnel: DOD Needs to Improve the Transparency and Reassess the
Reasonableness, Appropriateness, Affordability, and Sustainability of Its
Military Compensation System. GAO-05-798. Washington, D.C.: July 19, 2005.

Federal Disability Assistance: Wide Array of Programs Needs to be Examined
in Light of 21st Century Challenges. GAO-05-626. Washington, D.C.: June 2,
2005.

Veterans' Disability Benefits: Claims Processing Problems Persist and
Major Performance Improvements May Be Difficult. GAO-05-749T. Washington,
D.C.: May 26, 2005.

21st Century Challenges: Reexamining the Base of the Federal Government.
GAO-05-325SP Washington, D.C.: March 4, 2005.

Military Pay: Gaps in Pay and Benefits Create Financial Hardships for
Injured Army National Guard and Reserve Soldiers. GAO-05-125 and related
testimony GAO-05-322T. Washington, D.C.: February 17, 2005.

High-Risk Series: An Update. GAO-05-207. Washington, D.C.: January 1,
2005.

SSA's Disability Programs: Improvements Could Increase the Usefulness of
Electronic Data for Program Oversight. GAO-05-100R. Washington, D.C.:
December 10, 2004.

Veterans Benefits: VA Needs Plan for Assessing Consistency of Decisions.
GAO-05-99. Washington, D.C.: November 19, 2004 and related testimony
GAO-06-120T.

Military Personnel: DOD Needs to Address Long-term Reserve Force
Availability and Related Mobilization and Demobilization Issues.
GAO-04-1031. Washington, D.C.: September 15, 2004.

Page 55 GAO-06-362 Military Disability System Related GAO Products

Social Security Administration: More Effort Needed to Assess Consistency
of Disability Decisions. GAO-04-656. Washington, D.C.: July 2, 2004.

SSA Disability Decision Making: Additional Steps Needed to Ensure Accuracy
and Fairness of Decisions at the Hearing Level. GAO-04-14. Washington,
D.C.: November 12, 2003.

Defense Health Care: Army Needs to Assess the Health Status of All
Early-Deploying Reservists. GAO-03-437. April 15, 2003 and related
testimony GAO-03-997T Washington, D.C.: July 9, 2003.

Veterans' Benefits: Quality Assurance for Disability Claims and Appeals
Processing Can Be Further Improved. GAO-02-806. August 16, 2002 and
related testimony GAO-05-655T. Washington, D.C.: May 5, 2005.

Defense Health Care: Disability Programs Need Improvement and Face
Challenges. GAO-02-73. Washington, D.C.: October 12, 2001.

DOD Disability: Overview of Compensation Program for Service Members Unfit
for Duty. GAO-01-622. Washington, D.C.: April 27, 2001.

Disability Benefits: Selected Data on Military and VA Recipients.
GAO/HRD-92-106. Washington, D.C.: August 13, 1992.

(130501)

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