Under the direction of the Senior Oversight Committee, DOD and VA are  piloting a joint disability evaluation system to improve the timeliness and  resource use of DOD’s and VA’s separate disability evaluation systems. Begun in November 2007, the pilot involves cases at three Washington,  D.C.-area military treatment facilities, including Walter Reed Army Medical  Center. Army Has Taken Steps to Help Servicemembers Undergoing Disability Evaluation, but Faces Challenges

The Army has taken a number of steps to help servicemembers navigate  the disability evaluation process through additional supports and  streamlining efforts, such as expanding support to servicemembers by  hiring more board liaisons and legal personnel. The Army faces challenges in demonstrating an impact on  servicemember satisfaction, in part because the Army has not yet  implemented a satisfaction survey that adequately targets and queries  servicemembers who are undergoing disability evaluation. Army Has Increased Staffing for Servicemembers Undergoing Disability Evaluation, but Struggles to Meet Its Internal Goals

As part of the AMAP, the Army established staffing goals for staff who are  key to helping servicemembers navigate the disability evaluation process. Although the Army generally meets DOD’s timeliness goal for the PEBs to  process cases, it has had less success in meeting timeliness goals for the  MEBs. The Army faces particular challenges in meeting timeliness goals for  completing reservists’ MEBs and PEBs. According to Army officials, disability case  processing for reservists is treated the same as that for active component  servicemembers, but reservist cases may take longer due, in part, to the  challenge of obtaining complete personnel and medical documents. The Army has taken steps to streamline processes to help servicemembers  better navigate the disability evaluation system. Servicemembers  we spoke with at each facility we visited said they found the medical  language in the written summary of their medical conditions confusing. Despite its potential benefits, in part due to staffing and  resource constraints, the Army has not adopted this practice at all  locations. Furthermore, DOD and VA  have yet to resolve several challenges to expanding the joint process on a  large scale if the pilot is deemed successful. One set of metrics to be used for evaluating the pilot is servicemember and  stakeholder satisfaction, and DOD and VA are in the process of developing  and administering several surveys to measure their satisfaction; however,  much work remains. DOD and VA Are Identifying, but Have Yet to Resolve, Key Challenges Associated with Expanding the Joint Process

As the pilot progresses, DOD and VA are collecting information that could  be used to identify resource needs and implementation challenges if they  decide to implement the pilot process on a large scale. To further reduce servicemember confusion about and distrust of the  disability evaluation process, the Army should explore more widespread  implementation of promising practices for:    ensuring that servicemembers understand their rights to and are aware  of the availability of legal counsel during the disability evaluation  process, such as having legal counsel present at in-briefings where  feasible; and improving each servicemember’s understanding and acceptance of the  written summary of medical conditions that underlies his or her  disability evaluation, such as affording servicemembers an opportunity  to review the summary with the physician who prepared it before the  summary is finalized. Such plans should  include criteria for determining how much improvement should be  achieved under the pilot on various performance measures—such as  decision timeliness and servicemember satisfaction—to merit  implementing the joint process throughout DOD and VA.
To ensure that pilot evaluation and any large-scale implementation of the  joint disability process is done successfully, DOD and VA should sustain  collaborative executive focus on the pilot and retain knowledgeable staff  by, for example, continuing the agencies’ joint Senior Oversight  Committee or transferring the responsibilities to an equally staffed  structure with the same level of executive commitment. Key contributors to this report are listed in appendix V.

Appendix I: Objectives, Scope, and Methodology

The objectives of our review were to examine (1) recent actions taken by  the Department of the Army to help ill and injured servicemembers  navigate its disability evaluation process and (2) the status, plans, and  challenges of the Department of Defense (DOD) and the Department of  Veterans Affairs’ (VA) efforts to pilot and implement a joint disability  evaluation system.
Why GAO Did This Study

In February 2007, a series of articles in The Washington Post about conditions at Walter Reed Army Medical Center highlighted problems in the military's disability evaluation system. Subsequently, the Department of the Army, Department of Defense (DOD), and Department of Veterans Affairs (VA) undertook initiatives to address concerns with the disability evaluation process. In 2007, the Army took steps to streamline its process, and DOD and VA began piloting a joint evaluation system to address systemic concerns about timeliness and the potential inefficiency of having separate disability evaluation systems. GAO was asked to examine (1) recent actions by the Army to help servicemembers navigate its disability evaluation process and (2) the status, plans, and challenges of DOD and VA's efforts to pilot and implement a joint disability evaluation system. GAO interviewed Army, DOD, and VA officials; visited Army treatment facilities; and reviewed data from these sources.

What GAO Found

The Army has taken a number of steps to help servicemembers navigate the disability evaluation process through additional support mechanisms and streamlining efforts, but faces challenges in meeting internal goals and demonstrating impact. Most significantly, the Army has begun hiring more staff to facilitate the process for servicemembers, such as legal personnel, and setting staffing goals for key positions, such as for board liaisons and physicians. However, the Army has not met its internal staffing goals for board liaisons and physicians, and continues to face shortages in legal personnel. The Army has also struggled to meet timeliness goals for case processing and has even experienced negative trends over the last year, despite streamlining initiatives. Furthermore, the Army faces particular challenges in meeting timeliness goals for completing reservists' evaluations, due in part to the challenge of obtaining complete personnel and medical documents from nonmilitary sources. Besides staffing initiatives, the Army has also taken steps to help servicemembers better understand and navigate the process. However, we found that these efforts varied by location, and that many servicemembers we spoke with were unaware of the availability of expert legal counsel. To increase transparency of the disability process, one location we visited afforded servicemembers the opportunity to have the written summary of their medical conditions explained to them, but not all Army locations have adopted this practice. In general, the Army faces challenges in demonstrating that its efforts to date have had an overall positive impact on servicemembers' satisfaction, because it has not implemented a survey that adequately targets and queries servicemembers who are undergoing disability evaluations. Under direction from the agencies' joint Senior Oversight Committee, DOD and VA moved quickly to design and pilot a joint disability evaluation process, but gaps remain in their plans to evaluate the pilot and potentially implement a joint process on a larger scale. DOD and VA have established a comprehensive mechanism for measuring key aspects of the pilot. However, they have not yet decided on criteria for determining whether the joint process is worthy of widespread implementation. In addition, although DOD and VA are in the process of developing surveys to measure servicemember and stakeholder satisfaction, sufficient comparative data on servicemember satisfaction may not be available when the pilot is scheduled to end. DOD and VA are also in the process of tracking challenges that have arisen in implementing the pilot, but they have not yet resolved several challenges associated with expanding the joint process if the pilot is deemed successful. Such challenges include determining who will perform the single physical examination when a VA medical center is not nearby. Beyond these concerns, DOD and VA may ultimately need to prepare for challenges that come with implementing large-scale system changes--such as those envisioned by the pilot. These challenges include sustaining management attention to ensure that the changes are implemented well and are producing the intended results. However, the Senior Oversight Committee's planned January 2009 end raises questions about whether management attention will be maintained over the long term.