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United States Government Accountability Office: 


Before the Subcommittee on National Security, Homeland Defense, and 
Foreign Operations, Committee on Oversight and Government Reform, 
House of Representatives: 

For Release on Delivery: 
Expected at 9:30 a.m. EDT:
Wednesday, May 4, 2011: 

Military and Veterans Disability System: 

Worldwide Deployment of Integrated System Warrants Careful Monitoring: 

Statement of Daniel Bertoni, Director: 
Education, Workforce, and Income Security Issues: 


Chairman Chaffetz, Ranking Member Tierney, and Members of the 

I am pleased to be here today to comment on the efforts by the 
Departments of Defense (DOD) and Veterans Affairs (VA) to integrate 
their disability evaluation systems. Wounded warriors unable to 
continue their military service must navigate DOD's and VA's 
disability evaluation systems to be assessed for eligibility for 
disability compensation from the two agencies. GAO and others have 
found problems with these systems, including long delays, duplication 
in DOD and VA processes, confusion among servicemembers, and distrust 
of systems regarded as adversarial by servicemembers and veterans. To 
address these problems, DOD and VA have designed an integrated 
disability evaluation system (IDES), with the goal of expediting the 
delivery of VA benefits to servicemembers. After pilot testing the 
IDES at an increasing number of military treatment facilities (MTF)--
from 3 to 27 sites--DOD and VA are in the process of deploying it 
worldwide. As of March 2011, the IDES has been deployed at 73 MTFs--
representing about 66 percent of all military disability evaluation 
cases--and worldwide deployment is scheduled for completion in 
September 2011. 

My testimony summarizes and updates our December 2010 report on the 
IDES[Footnote 1] and addresses the following points: (1) the results 
of DOD and VA's evaluation of their pilot of the IDES, including 
updated data as of March 2011 from IDES monthly reports, where 
possible; (2) challenges in implementing the piloted system to date; 
and (3) DOD and VA's plans to expand the piloted system and whether 
those plans adequately address potential challenges. A detailed 
explanation of our methodology supporting our prior work (conducted 
between November 2009 and December 2010) can be found in our December 
2010 report. We updated this performance audit from April to May 2011, 
in accordance with generally accepted government auditing standards. 

In summary, DOD and VA concluded that, based on their evaluation of 
the pilot as of February 2010, the pilot had (1) improved 
servicemember satisfaction relative to the existing "legacy" system 
and (2) met their established goal of delivering VA benefits to active 
duty and reserve component servicemembers within 295 and 305 days, 
respectively, on average. However, 1 year after this evaluation, 
average case processing times have increased significantly, such that 
active component servicemembers' cases completed in March 2011 took an 
average of 394 days to complete--99 days more than the 295-day goal. 
In our prior work, we identified several implementation challenges 
that had already contributed to delays in the process. The most 
significant challenge was insufficient staffing by DOD and VA. 
Staffing shortages and process delays were particularly severe at two 
pilot sites we visited where the agencies did not anticipate caseload 
surges. The single exam posed other challenges that contributed to 
delays, such as disagreements between DOD and VA medical staff about 
diagnoses for servicemembers' medical conditions that often required 
further attention, adding time to the process. Pilot sites also 
experienced logistical challenges, such as incorporating VA staff at 
military facilities and housing and managing personnel going through 
the process. DOD and VA were taking or planning to take steps to 
address a number of these challenges. For example, to address staffing 
shortages, VA is developing a contract for additional medical 
examiners, and DOD and VA are requiring local staff to develop written 
contingency plans for handling caseload surges. Given increased 
processing times, the efficacy of these efforts at this time is 
unclear. We recommended additional steps the agencies could take to 
address known challenges--such as establishing a comprehensive 
monitoring plan for identifying problems as they occur in order to 
take remedial actions as early as possible--with which DOD and VA 
generally concurred. 


Under the existing, or "legacy" system, the military's disability 
evaluation process begins at a military treatment facility when a 
physician identifies a condition that may interfere with a 
servicemember's ability to perform his or her duties. On the basis of 
medical examinations and the servicemember's medical records, a 
medical evaluation board (MEB) identifies and documents any conditions 
that may limit a servicemember's ability to serve in the military. The 
servicemember's case is then evaluated by a physical evaluation board 
(PEB) to make a determination of fitness or unfitness for duty. If the 
servicemember is found to be unfit due to medical conditions incurred 
in the line of duty, the PEB assigns the servicemember a combined 
percentage rating for those unfit conditions, and the servicemember is 
discharged. Depending on the overall disability rating and number of 
years of active duty or equivalent service, the servicemember found 
unfit with compensable conditions is entitled to either monthly 
disability retirement benefits or lump sum disability severance pay. 

In addition to receiving disability benefits from DOD, veterans with 
service-connected disabilities may receive compensation from VA for 
lost earnings capacity. VA's disability compensation claims process 
starts when a veteran submits a claim listing the medical conditions 
that he or she believes are service-connected. In contrast to DOD's 
disability evaluation system, which evaluates only medical conditions 
affecting servicemembers' fitness for duty, VA evaluates all medical 
conditions claimed by the veteran, whether or not they were previously 
evaluated in DOD's disability evaluation process. For each claimed 
condition, VA must determine if there is credible evidence to support 
the veteran's contention of a service connection. Such evidence may 
include the veteran's military service records and treatment records 
from VA medical facilities and private medical service providers. 
Also, if necessary for reaching a decision on a claim, VA arranges for 
the veteran to receive a medical examination. Medical examiners are 
clinicians (including physicians, nurse practitioners, or physician 
assistants) certified to perform the exams under VA's Compensation and 
Pension program. Once a claim has all of the necessary evidence, a VA 
rating specialist determines whether the claimant is eligible for 
benefits. If so, the rating specialist assigns a percentage rating. If 
VA finds that a veteran has one or more service-connected disabilities 
with a combined rating of at least 10 percent, the agency will pay 
monthly compensation. 

In November 2007, DOD and VA began piloting the IDES. The IDES merges 
DOD and VA processes, so that servicemembers begin their VA disability 
claim while they undergo their DOD disability evaluation, rather than 
sequentially, making it possible for them to receive VA disability 
benefits shortly after leaving military service. Specifically, the 

* Merges DOD and VA's separate exam processes into a single exam 
process conducted to VA standards. This single exam (which may involve 
more than one medical examination, for example, by different 
specialists), in conjunction with the servicemembers' medical records, 
is used by military service PEBs to make a determination of 
servicemembers' fitness for continued military service, and by VA as 
evidence of service-connected disabilities. The exam may be performed 
by medical staff working for VA, DOD, or a private provider contracted 
with either agency. 

* Consolidates DOD and VA's separate rating phases into one VA rating 
phase. If the PEB has determined that a servicemember is unfit for 
duty, VA rating specialists prepare two ratings--one for the 
conditions that DOD determined made a servicemember unfit for duty, 
which DOD uses to provide military disability benefits, and the other 
for all service-connected disabilities, which VA uses to determine VA 
disability benefits. 

* Provides VA case managers to perform outreach and nonclinical case 
management and explain VA results and processes to servicemembers. 

Pilot Evaluation Results Were Promising, but Degree of Improvement was 
Unknown, and Timeliness Has Since Worsened: 

In August 2010, DOD and VA officials issued an interim report to 
Congress summarizing the results of their evaluation of the IDES pilot 
as of early 2010 and indicating overall positive results. In that 
report, the agencies concluded that, as of February 2010, 
servicemembers who went through the IDES pilot were more satisfied 
than those who went through the legacy system, and that the IDES 
process met the agencies' goals of delivering VA benefits to active 
duty servicemembers within 295 days and to reserve component 
servicemembers within 305 days. Furthermore, they concluded that the 
IDES pilot has achieved a faster processing time than the legacy 
system, which they estimated to be 540 days. 

Although DOD and VA's evaluation results indicated promise for the 
IDES, the extent to which they represented an improvement over the 
legacy system could not be known because of limitations in the legacy 
data. DOD and VA's estimate of 540 days for the legacy system was 
based on a small, nonrepresentative sample of cases. Officials planned 
to use a broader sample of legacy cases to compare against pilot cases 
with respect to processing times and appeal rates; however 
inconsistencies in how military services tracked information and 
missing VA information (i.e., on the date VA benefits were delivered) 
for legacy cases, precluded such comparisons. 

While our review of DOD and VA's data and reports generally confirmed 
DOD and VA's findings as of early 2010, we found that not all of the 
service branches were achieving the same results, case processing 
times increased between February and August 2010, and other agency 
goals are not being met. Since our December report, processing times 
have worsened further and the agencies have adjusted some goals 

* Servicemember satisfaction: Our reviews of the survey data as of 
early 2010[Footnote 2] indicated that, on average, servicemembers in 
the IDES pilot had higher satisfaction levels than those who went 
through the legacy process. However, Air Force members--who 
represented a small proportion (7 percent) of pilot cases--were less 
satisfied. Currently, DOD and VA have an 80-percent IDES satisfaction 
goal, which has not been met. For example, 67 percent of 
servicemembers surveyed in March 2011 were satisfied with the IDES. 
Satisfaction by service ranged from 54 percent for the Marine Corps to 
72 percent for the Army.[Footnote 3] 

* Average case processing times: Although the agencies were generally 
meeting their 295-day and 305-day timeliness goals through February 
2010, the average case processing time for active duty servicemembers 
increased from 274 to 296 days between February and August 
2010.[Footnote 4] Among the military service branches, only the Army 
was meeting the agencies' timeliness goals as of August, while average 
processing times for each of the other services exceeded 330 days. 
Since August 2010, timeliness has worsened significantly. For example, 
active component cases completed in March 2011 took an average of 394 
days--99 days over the 295-day target. By service, averages ranged 
from 367 days for the Army to 455 days for the Marine Corps. 
Meanwhile, Reserve cases took an average of 383 days, 78 days more 
than the 305-day target, while Guard cases took an average of 354 
days, 49 days more than the target.[Footnote 5] 

* Goals to process 80 percent of cases in targeted time frames: DOD 
and VA had indicated in their planning documents that they had goals 
to deliver VA benefits to 80 percent of servicemembers within the 295-
day (active component) and 305-day (reserve component) targets. For 
both active and reserve component cases at the time of our review, 
about 60 percent were meeting the targeted time frames. DOD and VA 
have since lowered their goals for cases completed on time, from 80 
percent to 50 percent. Based on monthly data for 6 months through 
March 2011, the new, lower goal was not met during any month for 
active component cases. For completed Reserve cases, the lower goal 
was met during one of the 6 months and for Guard cases, it was met in 
2 months. The strongest performance was in October 2010 when 63 
percent of Reserve cases were processed within the 305-day target. 

Pilot Sites Experienced Several Challenges: 

Based on our prior work, we found that--as DOD and VA tested the IDES 
at different facilities and added cases to the pilot--they encountered 
several challenges that led to delays in certain phases of the process. 

* Staffing: Most significantly, most of the sites we visited reported 
experiencing staffing shortages and related delays to some extent, in 
part due to workloads exceeding the agencies' initial estimates. The 
IDES involves several different types of staff across several 
different DOD and VA offices, some of which have specific caseload 
ratios set by the agencies, and we learned about insufficient staff in 
many key positions.[Footnote 6] With regard to VA positions, officials 
cited shortages in examiners for the single exam, rating staff, and 
case managers. With regard to DOD positions, officials cited shortages 
of physicians who serve on the MEBs, PEB adjudicators, and DOD case 
managers. In addition to shortages cited at pilot sites, DOD data 
indicated that 19 of the 27 pilot sites did not meet DOD's caseload 
target of 30 cases per manager.[Footnote 7] Local DOD and VA officials 
attributed staffing shortages to higher than anticipated caseloads and 
difficulty finding qualified staff, particularly physicians, in rural 
areas. These staffing shortages contributed to delays in the IDES 

Two of the sites we visited--Fort Carson and Fort Stewart--were 
particularly challenged to provide staff in response to surges in 
caseload that occurred when Army units were preparing to deploy to 
combat zones. Through the Army's predeployment medical assessment 
process, large numbers of servicemembers were determined to be unable 
to deploy due to a medical condition and were referred to the IDES 
within a short period of time, overwhelming the staff. These two sites 
were unable to quickly increase staffing levels, particularly of 
examiners. As a result, at Fort Carson, it took 140 days on average to 
complete the single exam for active duty servicemembers, as of August 
2010--much longer than the agencies' goal to complete the exams in 45 
days. More recently, Fort Carson was still struggling to meet goals, 
as of March 2011. For example, about half of Fort Carson's active 
component cases (558 of 1033 cases) were in the MEB phase, and the 
average number of days spent in the MEB phase by active component 
cases completed in March 2011 was 197 days, compared to a goal of 35 

* Exam summaries: Issues related to the completeness and clarity of 
single exam summaries were an additional cause of delays in the VA 
rating phase of the IDES process. Officials from VA rating offices 
said that some exam summaries did not contain information necessary to 
determine a rating. As a result, VA rating office staff must ask the 
examiner to clarify these summaries and, in some cases, redo the exam. 
VA officials attributed the problems with exam summaries to several 
factors, including the complexity of IDES pilot cases, the volume of 
exams, and examiners not receiving records of servicemembers' medical 
history in time. The extent to which insufficient exam summaries 
caused delays in the IDES process is unknown because DOD and VA's case 
tracking system for the IDES does not track whether an exam summary 
has to be returned to the examiner or whether it has been resolved. 

* Medical diagnoses: While the single exam in the IDES eliminates 
duplicative exams performed by DOD and VA in the legacy system, it 
raises the potential for there to be disagreements about diagnoses of 
servicemembers' conditions. For example, officials at Army pilot sites 
informed us about cases in which a DOD physician had treated members 
for mental disorders, such as major depression. However, when the 
members went to see the VA examiners for their single exam, the 
examiners diagnosed them with posttraumatic stress disorder (PTSD). 
Officials told us that attempting to resolve such differences added 
time to the process and sometimes led to disagreements between DOD's 
PEBs and VA's rating offices about what the rating should be for 
purposes of determining DOD disability benefits. Although the Army 
developed guidance to help resolve diagnostic differences, other 
services have not.[Footnote 8] 

Moreover, PEB officials we spoke with noted that there is no guidance 
on how disagreements about servicemembers' ratings between DOD and VA 
should be resolved beyond the PEBs informally requesting that the VA 
rating office reconsider the case. While DOD and VA officials cited 
several potential causes for diagnostic disagreements, the number of 
cases with disagreements about diagnoses and the extent to which they 
have increased processing time are unknown because the agencies' case 
tracking system does not track when a case has had such disagreements. 
[Footnote 9] 

* Logistical challenges integrating VA staff at military treatment 
facilities: DOD and VA officials at some pilot sites we visited said 
that they experienced logistical challenges integrating VA staff at 
the military facilities. At a few sites, it took time for VA staff to 
receive common access cards needed to access the military facilities 
and to use the facilities' computer systems, and for VA physicians to 
be credentialed. DOD and VA staff also noted several difficulties 
using the agencies' multiple information technology (IT) systems to 
process cases, including redundant data entry and a lack of 
integration between systems. 

* Housing and other challenges posed by extended time in the military 
disability evaluation process: Although many DOD and VA officials we 
interviewed at central offices and pilot sites felt that the IDES 
process expedited the delivery of VA benefits to servicemembers, 
several also indicated that it may increase the amount of time 
servicemembers are in the military's disability evaluation process. 
Therefore, some DOD officials noted that servicemembers must be cared 
for, managed, and housed for a longer period. The military services 
may move some servicemembers to temporary medical units or to special 
medical units such as Warrior Transition Units in the Army or Wounded 
Warrior Regiments in the Marine Corps, but at a few pilot sites we 
visited, these units were either full or members in the IDES did not 
meet their admission criteria. In addition, officials at two sites 
said that members who are not gainfully employed by their units and 
left idle are more likely to be discharged due to misconduct and 
forfeit their disability benefits. However, DOD officials also noted 
that servicemembers benefit from continuing to receive their salaries 
and benefits while their case undergoes scrutiny by two agencies, 
though some also acknowledged that these additional salaries and 
benefits create costs for DOD. 

Deployment Plans Address Many, but not All, Challenges: 

DOD and VA are deploying the IDES to military facilities worldwide on 
an ambitious timetable--expecting deployment to be completed at a 
total of about 140 sites by the end of fiscal year 2011. As of March 
2011, the IDES was operating at 73 sites, covering about 66 percent of 
all military disability evaluation cases. 

In preparing for IDES expansion militarywide, DOD and VA had many 
efforts under way to address challenges experienced at the 27 pilot 
sites. For example, the agencies completed a significant revision of 
their site assessment matrix--a checklist used by local DOD and VA 
officials to ascertain their readiness to begin the pilot--to address 
areas where prior IDES sites had experienced challenges. In addition, 
local senior-level DOD and VA officials will be expected to sign the 
site assessment matrix to certify that a site is ready for IDES 
implementation. This differs from the pilot phase where, according to 
DOD and VA officials, some sites implemented the IDES without having 
been fully prepared. 

Through the new site assessment matrix and other initiatives, DOD and 
VA planned to address several of the challenges identified in the 
pilot phase. 

* Ensuring sufficient staff: With regard to VA staff, VA planned to 
increase the number of examiners by awarding a new contract through 
which sites can acquire additional examiners. To increase rating 
staff, VA filled vacant rating specialist positions and anticipates 
hiring a small number of additional staff. With regard to DOD staff, 
Air Force and Navy officials told us they added adjudicators for their 
PEBs or planned to do so. Both DOD and VA indicated they plan to 
increase their numbers of case managers. Meanwhile, sites are being 
asked in the assessment matrix to provide longer and more detailed 
histories of their caseloads, as opposed to the 1-year history that 
DOD and VA had based their staffing decisions on during the pilot 
phase. The matrix also asks sites to anticipate any surges in 
caseloads and to provide a written contingency plan for dealing with 

* Ensuring the sufficiency of single exams: VA has been revising its 
exam templates to better ensure that examiners include the information 
needed for a VA disability rating decision and to enable them to 
complete their exam reports in less time. VA is also examining whether 
it can add capabilities to the IDES case tracking system that would 
enable staff to identify where problems with exams have occurred and 
track the progress of their resolution. 

* Ensuring adequate logistics at IDES sites: The site assessment 
matrix asks sites whether they have the logistical arrangements needed 
to implement the IDES. In terms of information technology, DOD and VA 
were developing a general memorandum of agreement intended to enable 
DOD and VA staff access to each other's IT systems. DOD officials also 
said that they are developing two new IT solutions--one intended to 
help military treatment facilities better manage their cases, another 
intended to reduce multiple data entry. 

However, in some areas, DOD and VA's efforts to prepare for IDES 
expansion did not fully address some challenges or are not yet 
complete. For these areas, we recommended additional action that the 
agencies could take, with which the agencies generally concurred. 

* Ensuring sufficient DOD MEB physician staffing: DOD does not yet 
have strategies or plans to address potential shortages of physicians 
to serve on MEBs. For example, the site assessment matrix does not 
include a question about the sufficiency of military providers to 
handle expected numbers of MEB cases at the site, or ask sites to 
identify strategies for ensuring sufficient MEB physicians if there is 
a caseload surge or staff turnover. We recommended that, prior to 
implementing IDES at MTFs, DOD direct military services to conduct 
thorough assessments of the adequacy of military physician staffing 
for completing MEB determinations and develop contingency plans to 
address potential shortfalls, e.g. due to staff turnover or caseload 

* Ensuring sufficient housing and organizational oversight for IDES 
participants: Although the site assessment matrix asks sites whether 
they will have sufficient temporary housing available for 
servicemembers going through the IDES, the matrix requires only a yes 
or no response and does not ensure that sites will have conducted a 
thorough review of their housing capacity. In addition, the site 
assessment matrix does not address plans for ensuring that IDES 
participants are gainfully employed or sufficiently supported by their 
organizational units. We recommended that prior to implementing the 
IDES at MTFs, DOD ensure thorough assessments are conducted on the 
availability of housing for servicemembers and on the capacity of 
organizational units to absorb servicemembers undergoing the 
disability evaluation; alternative housing options are identified when 
sites lack adequate capacity; and plans are in place for ensuring that 
servicemembers are appropriately and constructively engaged. 

* Addressing differences in diagnoses: According to agency officials, 
DOD is currently developing guidance on how staff should address 
differences in diagnoses. However, since the new guidance and 
procedures are still being developed, we cannot determine whether they 
will aid in resolving discrepancies or disagreements. Significantly, 
DOD and VA do not have a mechanism for tracking when and where 
disagreements about diagnoses and ratings occur and, consequently, may 
not be able to determine whether the guidance sufficiently addresses 
the discrepancies. Therefore, we recommended that DOD and VA conduct a 
study to assess the prevalence and causes of such disagreements and 
establish a mechanism to continuously monitor diagnostic 
disagreements. VA has since indicated it plans to conduct such a study 
and make a determination by July 2011 regarding what, if any, 
mechanisms are needed. 

Further, despite regular reporting of data on caseloads, processing 
times, and servicemember satisfaction, and preparation of an annual 
report on challenges in the IDES, we determined that DOD and VA did 
not have a systemwide monitoring mechanism to help ensure that steps 
they took to address challenges are sufficient and to identify 
problems in a more timely basis. For example, they did not collect 
data centrally on staffing levels at each site relative to caseload. 
As a result, DOD and VA may be delayed in taking corrective action 
since it takes time to assess what types of staff are needed at a site 
and to hire or reassign staff. DOD and VA also lacked mechanisms or 
forums for systematically sharing information on challenges, as well 
as best practices between and among sites. For example, DOD and VA 
have not established a process for local sites to systematically 
report challenges to DOD and VA management and for lessons learned to 
be systematically shared systemwide. During the pilot phase, VA 
surveyed pilot sites on a monthly basis about challenges they faced in 
completing single exams. Such a practice has the potential to provide 
useful feedback if extended to other IDES challenges. 

To identify challenges as they arise in all DOD and VA facilities and 
offices involved in the IDES and thereby enable early remedial action, 
we recommended that DOD and VA develop a systemwide monitoring 
mechanism. This system could include continuous collection and 
analysis of data on DOD and VA staffing levels, sufficiency of exam 
summaries, and diagnostic disagreements; monitoring of available data 
on caseloads and case processing time by individual VA rating office 
and PEB; and a formal mechanism for agency officials at local DOD and 
VA facilities to communicate challenges and best practices to DOD and 
VA headquarters. VA noted several steps it plans to take to improve 
its monitoring of IDES workloads, site performance and challenges--
some targeted to be implemented by July 2011--which we have not 

Concluding Observations: 

By merging two duplicative disability evaluation systems, the IDES has 
shown promise for expediting the delivery of VA benefits to 
servicemembers leaving the military due to a disability. However, we 
identified significant challenges at pilot sites that require careful 
management attention and oversight. We noted a number of steps that 
DOD and VA were undertaking or planned to undertake that may mitigate 
these challenges. However, the agencies' deployment schedule is 
ambitious in light of substantial management challenges and additional 
evidence of deteriorating case processing times. As such, it is 
unclear whether these steps will be sufficiently timely or effective 
to support militarywide deployment. Deployment time frame 
notwithstanding, we continue to believe that the success or failure of 
the IDES will depend on DOD and VA's ability to quickly and 
effectively address resource needs and resolve challenges as they 
arise, not only at the initiation of the transition to IDES, but also 
on an ongoing, long-term basis. We continue to believe that DOD and VA 
cannot achieve this without a robust mechanism for routinely 
monitoring staffing and other risk factors. 

Chairman Chaffetz and Ranking Member Tierney, this concludes my 
prepared statement. I would be pleased to respond to any questions 
that you or other Members of the Subcommittee may have at this time. 

GAO Contact and Staff Acknowledgment: 

For further information about this testimony, please contact Daniel 
Bertoni at (202) 512-7215 or Contact points for our 
Offices of Congressional Relations and Public Affairs may be found on 
the last page of this testimony. In addition to the individual named 
above, key contributors to this testimony include Michele Grgich, Greg 
Whitney, and Daniel Concepcion. Key advisors included Bonnie Anderson, 
Mark Bird, Sheila McCoy, Patricia Owens, Roger Thomas, Walter Vance, 
and Randall Williamson. 

[End of section] 

Related GAO Products: 

Military and Veterans Disability System: Pilot Has Achieved Some 
Goals, but Further Planning and Monitoring Needed. [hyperlink,]. Washington, D.C.: December 6, 

Military and Veterans Disability System: Preliminary Observations on 
Evaluation and Planned Expansion of DOD/VA Pilot. [hyperlink,]. Washington, D.C.: November 
18, 2010. 

Veterans' Disability Benefits: Further Evaluation of Ongoing 
Initiatives Could Help Identify Effective Approaches for Improving 
Claims Processing. [hyperlink,]. Washington, D.C.: January 29, 

Recovering Servicemembers: DOD and VA Have Jointly Developed the 
Majority of Required Policies but Challenges Remain. [hyperlink,]. Washington, D.C.: July 8, 

Recovering Servicemembers: DOD and VA Have Made Progress to Jointly 
Develop Required Policies but Additional Challenges Remain. 
[hyperlink,]. Washington, 
D.C.: April 29, 2009. 

Military Disability System: Increased Supports for Servicemembers and 
Better Pilot Planning Could Improve the Disability Evaluation Process. 
[hyperlink,]. Washington, 
D.C.: September 24, 2008. 

DOD and VA: Preliminary Observations on Efforts to Improve Care 
Management and Disability Evaluations for Servicemembers. [hyperlink,]. Washington, D.C.: February 
27, 2008. 

DOD and VA: Preliminary Observations on Efforts to Improve Health Care 
and Disability Evaluations for Returning Servicemembers. [hyperlink,] Washington, D.C.: September 
26, 2007. 

Military Disability System: Improved Oversight Needed to Ensure 
Consistent and Timely Outcomes for Reserve and Active Duty Service 
Members. [hyperlink,]. 
Washington, D.C.: March 31, 2006. 

[End of section] 


[1] GAO, Military and Veterans Disability System: Pilot Has Achieved 
Some Goals, but Further Planning and Monitoring Needed, [hyperlink,] (Washington, D.C.: Dec. 6, 
2010). See also GAO, Military and Veterans Disability System: 
Preliminary Observations on Evaluation and Planned Expansion of DOD/VA 
Pilot, [hyperlink,] 
(Washington, D.C.: Nov. 18, 2010). 

[2] We reviewed the agencies' survey methodology and generally found 
their survey design and conclusions to be sound. 

[3] IDES monthly reports present participant satisfaction percentages 
as averages of three surveys during the IDES --MEB phase, PEB phase, 
and Transition phase (completion of PEB phase through discharge from 
service). Previous reports, which were weekly, provided separate data 
for each phase. Thus, we were unable to determine the extent to which 
satisfaction has improved or declined. 

[4] We reviewed the reliability of the case data upon which the 
agencies based their analyses and generally found these data to be 
sufficiently reliable for purposes of these analyses. Our data 
reliability assessment included interviews regarding internal 
controls, electronic testing, and a trace-to-file process, where we 
matched a small number of randomly sampled case file dates against the 
dates that had been entered into the Veterans Tracking Application, 
the case tracking system for the IDES. For the trace-to-file process, 
the overall accuracy rate was 84 percent, and all but one date was 70 
percent accurate or better and deemed sufficiently reliable for 
reporting purposes. 

[5] The IDES monthly report now separates "Guard" (Army and Air Force 
Guard) cases from other reserve component cases for the purpose of 
reporting case processing times and do not provide an overall reserve 
component average processing time. 

[6] For the IDES pilot, the agencies have set targets for both DOD and 
VA case managers to handle no more than 30 cases at a time. However, 
DOD's guidance for the general disability evaluation system sets the 
target at a maximum of 20 cases per case manager, and agency documents 
related to planning for IDES expansion indicate that DOD is striving 
for a 1:20 caseload target for DOD case managers in the IDES. The Army 
has established a caseload target for MEB physicians of 120 
servicemembers per physician. The Navy and Air Force have not 
established caseload targets for their physicians; their MEB 
determinations are prepared by physicians who perform other 
responsibilities, such as clinical treatment or supervision. 

[7] Data were not available nationally to determine the extent to 
which sites are meeting the Army's target of 120 servicemembers per 
MEB physician or VA's target of 30 cases per VA case manager. 

[8] To address such processing delays, the Army issued guidance in 
February 2010 stating that MEB physicians should review all of the 
medical records (including the results of the single exam) and 
determine whether to revise their diagnoses. If after doing so, the 
MEB physician maintains that his or her original diagnosis is 
accurate, he or she should write a memorandum summarizing the basis of 
the decision, and the PEB should accept the MEB's diagnosis. 

[9] DOD and VA officials attributed disagreements about diagnoses to 
several factors, including the agencies identifying conditions for 
different purposes in the disability evaluation system, servicemembers 
being more willing to disclose all of their medical conditions to VA 
than to DOD since VA can compensate for all of the conditions, and VA 
examiners not receiving or not reviewing the servicemembers' medical 
records prior to the exam, making them unaware of the conditions for 
which the members had been previously diagnosed and treated. 

[End of section] 

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