Military Disability Retirement:

Closer Monitoring Would Improve the Temporary Retirement Process

GAO-09-289: Published: Apr 13, 2009. Publicly Released: Apr 13, 2009.

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Service members found unfit for duty due to a service-related illness or injury may be eligible for military disability retirement. When their disability is not stable, however, they may be placed on the military's Temporary Disability Retired List (TDRL) and granted temporary benefits for as long as 5 years. GAO was asked to respond to concerns about TDRL caseloads, management, and impact on servicemembers. To address these concerns, we analyzed TDRL data; interviewed military officials; reviewed laws, regulations, and other relevant documents; and conducted 12 focus groups with temporary retirees. This report examines (1) recent trends in the TDRL caseload size, (2) recent trends in the characteristics of those placed on the TDRL, (3) disability retirement outcomes for TDRL placements, (4) the adequacy of TDRL management, and (5) the adequacy of information provided to TDRL retirees.

TDRL caseloads within the Department of Defense (DOD) grew by 43 percent, from 9,983 in fiscal year 2003 to 14,285 in fiscal year 2007. Growth in caseloads could be attributable to a combination of increases in the number of cases going through the military's disability evaluation system, higher TDRL placement rates, and low numbers of cases removed from the TDRL relative to new cases added to the list. DOD-wide, servicemembers placed on the TDRL in each calendar year from 2000 through 2007 varied little with respect to their military status, years of service, and disabilities. In each of these years, most TDRL placements had been active duty personnel, although the small proportion who had been reservists grew considerably. Most TDRL placements in each year also had fewer than 20 years of service and, over time, their average years of service declined. The disabilities most prevalent among TDRL placements were musculoskeletal, mental, or neurological in nature. Among those with mental and neurological disabilities, the incidence of post traumatic stress disorder and conditions related to traumatic brain injury increased substantially across the services. Although the experiences of temporary disability retirees varied, some outcomes were more common than others. DOD-wide, very few who were placed on the list between calendar years 2000 and 2003 returned to military service. Further, about half received a final determination within 3 years and, of those who ultimately received permanent disability benefits, 73 percent had final disability ratings that were no different than their initial ratings. Finally, only 7 percent of TDRL placements, DOD-wide, received a final disability rating that qualified them for permanent disability payment amounts higher than their TDRL payments. DOD and the services do not effectively manage key aspects of the TDRL process. The military does not systematically examine physical evaluation board (PEB) stability decisions for accuracy and consistency or routinely compile information on TDRL outcomes to better inform its assessments of stability. According to TDRL administrative staff, ensuring that medical reexaminations are done in TDRL cases at least once every 18 months is often a challenge. However, the military does not monitor the extent to which this requirement is met. Moreover, there is limited use of nonmilitary physicians to perform reexaminations, which could reduce burdens on medical treatment facilities. Finally, military procedures do not ensure consistent enforcement of TDRL rules. Information about the TDRL that the services provide is not always clear or complete and can be difficult to access. PEB findings forms provided to temporary retirees do not fully explain why service members are placed on the list or what is required of them. Temporary retirees reported that counseling related to PEB decisions was inconsistent and lacking in followthrough. Information from military pamphlets, brochures, fact sheets, and Web sites is often incomplete or difficult to find. Temporary retirees participating in our focus groups expressed considerable confusion about and dissatisfaction with their limited access to information and points of contact.

Matter for Congressional Consideration

  1. Status: Closed - Not Implemented

    Comments: As of July 2013, Congress has not considered whether to shorten the 5-year TDRL timeframe.

    Matter: Given the low number of temporary retirees who return to the military, the high proportion who eventually become eligible to receive permanent military disability retirement benefits, and the added cost to the military of administering TDRL cases, the Congress may wish to consider shortening the current 5-year maximum tenure on the TDRL.

Recommendations for Executive Action

  1. Status: Closed - Implemented

    Comments: DOD reported that the Military Departments have addressed the recommendation in multiple ways. DOD revised policy stipulates that Military Departments will base determinations regarding the stability of unfitting conditions upon the VA rating authority input. In addition, the Army uses past quality review findings to guide training efforts and job aid development for medical evaluation board examiners and physical evaluation board adjudicators. The Army also reviewed all cases that came to the agency for mandatory review for appropriateness of the TDRL decisions. The Department of the Navy case reviewers use previous condition/diagnosis based outcome data to determine whether a member is likely to remain stable for rating purposes during the TDRL period. Finally, when Air Force case reviewers review cases, each case although unique in attributes, is recognized for its link to other like cases in terms of the decision making process.

    Recommendation: To ensure that TDRL placement and retention decisions are appropriate and consistent, the Secretary of Defense should direct the Secretaries of the Air Force, Army, and Navy to better inform their decisions about whether or not to place or retain someone on the TDRL by taking into account data from past TDRL cases on outcomes for particular types of disabilities.

    Agency Affected: Department of Defense

  2. Status: Closed - Implemented

    Comments: DOD reported that its Disability Evaluation System (DES) Pilot, implemented world-wide in 2010, would include a TDRL process requiring all Military Departments to use a central database tracking system to monitor their TDRL populations. The policy stipulates that Military Departments base TDRL determinations regarding the stability of unfitting conditions on the VA rating authority's input. The policy aligns VA and DOD processes. DOD also ordered a study of TDRL cases to assess variations in ratings and time to final disposition by service branch, and medical condition, which suggested areas of further research regarding potentially shortening the length of time individuals spend on the TDRL, or if repeated evaluations are necessary, and if specific medical conditions are likely to change in severity over time. This effort helps identify areas for further study.

    Recommendation: To ensure that TDRL placement and retention decisions are appropriate and consistent, the Secretary of Defense should systematically review the appropriateness and consistency of each service's PEB decisions regarding the stability of disabilities.

    Agency Affected: Department of Defense

  3. Status: Closed - Not Implemented

    Comments: In its 2011 follow-up, DOD reported that all military departments utilize tracking spreadsheets and/or an automated system to contact service member to avoid exceeding the 18-month re-examination deadline. However, this status was unchanged from what the team observed at the time the recommendation was made, and did not address the recommendation that DOD direct the services to track and periodically report on timeliness or medical reexaminations.

    Recommendation: To ensure that TDRL reexaminations occur at least once every 18 months, the Secretary of Defense should direct each service to track and periodically report on the timeliness of medical reexaminations in TDRL cases.

    Agency Affected: Department of Defense

  4. Status: Closed - Implemented

    Comments: In 2011, DOD reported that all military departments utilize tracking spreadsheets and/or an automated system to contact service member to avoid exceeding the 18-month re-examination deadline. This effort was already in effect when we made this recommendation in 2009. However, DOD subsequently issued DTM-11-015, which directed the services to initiate the reexamination process no later than 16 months after placement on the TDRL. Initiating the process 2 months before the mandatory 18 months should help ensure better timeliness of re-examinations across services.

    Recommendation: To ensure that TDRL reexaminations occur at least once every 18 months, the Secretary of Defense should develop DOD-wide standards and goals for the timeliness of TDRL reexaminations.

    Agency Affected: Department of Defense

  5. Status: Closed - Not Implemented

    Comments: In its 2011 follow-up, DOD reported that all military departments utilize tracking spreadsheets and/or an automated system to contact service members, to avoid exceeding the 18-month re-examination deadline. However, this status was unchanged from what the team observed at the time the recommendation was made, and did not address the recommendation that DOD establish a clearer policy specifying how the services should enforce requirements for TDRL retirees. Although DOD updated DOD Instruction No. 1332.38 on April 10, 2013, no changes were made to "TDRL Management" (Part 6), which would have addressed this recommendation.

    Recommendation: To ensure that TDRL reexaminations occur at least once every 18 months, the Secretary of Defense should establish a clearer policy specifying how the services should enforce the requirements that temporary retirees submit to periodic reexaminations and notify TDRL administrators when they have a change of address.

    Agency Affected: Department of Defense

  6. Status: Closed - Implemented

    Comments: On December 19, 2011, DOD issued DTM-11-015, which outlines procedures for its Integrated Disability Evaluation System (IDES): a joint DOD-Veterans Affairs (VA) process for determining whether wounded, ill or injured service members are fit for continued military services and for determining appropriate benefits for those who are separated or retired for a service-connected disability. The DTM specifies that the VA will schedule and conduct TDRL rexaminations when the relevant military department has determined that the available medical evidence is not sufficient to conduct the TDRL re-evaluation without a new physical examination.

    Recommendation: To ensure that TDRL reexaminations occur at least once every 18 months, the Secretary of Defense should expand the use of nonmilitary physicians for conducting TDRL reexaminations, in accordance with DOD guidance.

    Agency Affected: Department of Defense

  7. Status: Closed - Implemented

    Comments: In 2010, DOD reported that it would work with the military departments to reduce or eliminate instances where a service member exceeds 5 years on the TDRL, and would pursue legislative change to replace the language "permanent and stable" with the concept/phrase of "maximum medical improvement," in an effort to address variances in the TDRL process due to differences in interpretation, and to defer more clearly to how conditions are assessed by medical caregivers. No progress was identified on either of these proposed actions. However, DOD issued DTM-11-015, which outlines clear goals for the timeliness of required steps in processing TDRL cases, and reiterates that "No service member may remain on the TDRL for more than 5 years." It further notes that disposition of these cases rests with the respective military departments.

    Recommendation: To prevent unnecessary delays in permanent disability determinations for temporary retirees and gaps in the receipt of disability benefits they are entitled to, the Secretary of Defense should direct the services to ensure that temporary retirees receive a final determination upon expiration of their 5 years on the TDRL, as required by law.

    Agency Affected: Department of Defense

  8. Status: Closed - Not Implemented

    Comments: In 2010, DOD commented that it would strive to ensure that service members placed on the TDRL receive information that provides an explanation of both the TDRL, and the specific medical conditions that led to placement. Although the response also notes procedures that were in place for the services, it did not outline steps taken by DOD or the individual branches to assess the adequacy of the information provided to service members. Specifically, we had found that the initial determination form can be difficult for service members to understand, but there has not been any action taken to evaluate these forms.

    Recommendation: To ensure that temporary retirees receive adequate information to understand why they are placed on the list and the importance of complying with TDRL requirements, the Secretaries of the Air Force, Army, and Navy should assess the adequacy of information they provide regarding the TDRL, including the information contained on their PEB findings forms and other materials, and provided by PEBLOs, and make improvements where needed.

    Agency Affected: Department of Defense

  9. Status: Closed - Implemented

    Comments: In 2010, DOD reported multiple service-level efforts to provide information regarding the TDRL to service members. We note that, except for the Air Force, the military departments have taken steps to make contact information easily available to TDRL retirees. Specifically, the Marine Corps' Wounded Warrior Regiment has a 24-hour Call Center; the Army's TDRL brochure includes a list of three TDRL contact numbers; and the Navy Web site offers a full page of TDRL and other contacts for service members.

    Recommendation: To ensure that temporary retirees receive adequate information to understand why they are placed on the list and the importance of complying with TDRL requirements, the Secretaries of the Air Force, Army, and Navy should take steps to encourage ongoing contact between temporary retirees and TDRL administrators by, for example, maintaining a working and easily accessible TDRL administrative telephone hotline for temporary retirees.

    Agency Affected: Department of Defense

  10. Status: Closed - Implemented

    Comments: The Navy has made significant improvements with regard to access to Web-based information about the TDRL for service members. Specifically, the Navy Web site has much more detailed information on TDRL than was previously available, including when reexaminations should occur, consequences of not completing them, and who to contact if one has not been scheduled. It is also easily accessible by a simple Google search. The Marine Corps has established a Wounded Warrior Regiment Web site that provides a comprehensive fact sheet and contact information for those placed on the TDRL. The Army continues to provide easy access to TDRL information online.

    Recommendation: To ensure that temporary retirees receive adequate information to understand why they are placed on the list and the importance of complying with TDRL requirements, the Secretaries of the Air Force, Army, and Navy should improve access to Web-based information about the TDRL.

    Agency Affected: Department of Defense

 

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