WASHINGTON (Army News Service, Jan. 26, 2010) -- Among recommendations to streamline the medical evaluation board process made by an Army-sponsored task force led by retired Gen. Frederick Franks Jr. is the elimination of "dual" disability ratings.
In the past, disability ratings were issued independently by the Army and the Department of Veterans Affairs. The Army's ratings were often much lower than ratings the VA ended up giving wounded, ill and injured Soldiers. This created mistrust and confusion, Franks said in a 42-page report on the MEB and Physical Evaluation Board process.
The Army, by law, could base its disability ratings only on the injury or condition that disqualifies a Soldier from service, while the VA conducts a "full body" diagnosis that often ends up determining higher disability levels.
Franks was asked to research the MEB/PEB process by Army Chief of Staff Gen. George W. Casey Jr., in July 2008. The report contains three strategic recommendations and 43 supporting recommendations in the areas of command emphasis, education & training, policy, and process.
Recommendations stem in part from a survey to wounded warriors and their family members and interviewed experts.
Many of the recommendations require legislation to change existing laws. The report explains that the current Physical Disability Evaluation System is based on a complicated "patchwork" of laws and amendments with some that date back to World War II.
"Certain sections of law are nearly unfathomable in meaning," states an annex to the report, adding that some of the laws were also "inconsistently amended." He recommends creating "a simpler, more transparent, and less adversarial disability evaluation system," but admits this will require a major revision of disability and compensation law.
Franks' study found that many injured Soldiers and their families do not fully understand the complicated MEB/PEB process. As a remedy, he recommends extensive education beginning with basic combat training.
The report recommends immediately beginning MEB/PEB training in pre-command and leader courses at all levels in both officer and NCO schools. It also recommends accelerating an effort started late last year at Fort Leavenworth, Kan., to collect and analyze lessons from the healing and rehabilitation process of wounded warriors.
Franks recommends a "national dialogue" to inform veterans of their rights and benefits. He says this dialogue should be completed through an inter-agency working group comprising the VA, Department of Defense, sister services, members of Congress, staffers, legal experts and veterans' and military service organizations.
"What is the duty of our nation to these selfless and courageous Americans as they return to duty or go into a workplace much changed from the one that created the current PDES'" Franks asked in his report.
Franks and his task force interviewed experts on PDES not only from the Army, but from other services and allied nations. They reviewed all the work and research already done to simplify the disability system. In their first meeting, the task force was briefed about the current Disability Evaluation System, or DES Pilot program that has three features:
Aca,!Ac A single, comprehensive medical examination
Aca,!Ac A single-source VA disability rating
Aca,!Ac Enhanced case-management methods
The DES pilot program is conducted by the VA and defense department and has been implemented at several Army installations including the Walter Reed Army Medical Center, Wash, D.C.; Fort Meade, Md.; Fort Belvoir, Va.; Fort Carson, Colo.; Fort Drum, N.Y.; Fort Stewart, Ga.; Forts Richardson and Wainwright, Alaska; Brooke Army Medical Center, Texas; and Fort Polk, La. During 2010, the DES Pilot program is being expanded to Fort Lewis, Wash.; Fort Riley, Kan.; Fort Hood, Texas; Fort Benning, Ga.; and Fort Bragg, N.C.
The pilot program aims to help injured and ill servicemembers get faster access to TRICARE and other healthcare and VA benefits by developing a single medical examination used by both DoD and VA, with a single-source disability evaluation done by VA and accepted by DoD.
Franks' study essentially recommends extending the pilot to the entire Army and incorporating the features into a revamped disability system. He recommends that one comprehensive examination be used by the Army to determine whether a Soldier continues on active duty and by VA to determine disability levels.
Almost 60 percent of injured and ill Soldiers from specialist to sergeant first class want to stay in the service, according to results of the survey that Franks' task force and West Point administered to almost 1,200 Soldiers and their family members.
Franks said he found no reason to question the organization of the Army's new Warrior Transition Units. His survey found that 86 percent of WTU Soldiers were satisfied with the level of care provided by their physician. But the survey found that WTU staff members thought Soldiers and family members understood the MEB/PEB process better than they actually do. It also found that family members usually did not feel well informed or trust the current system, even when Soldiers did.
Franks is a Vietnam amputee who stayed in the service with a prosthetic leg, went on to earn four stars and command the VII Corps in Desert Storm and then the U.S. Army Training and Doctrine Command. He applauded that more wounded warriors are staying on active duty and said he strongly recommends "changing the Army culture" to encourage more wounded Soldiers to stay in uniform.
In his report, Franks recommends that senior commanders show more interest in the MEB/PEB process to get wounded, ill and injured Soldiers the attention and resources they deserve.
Imbedded in his recommendations is a strategy that calls for a "paradigm shift" from the current system that focuses on disability and compensation, to one that focuses on ability and future productivity. Done without any loss of entitlements, it would require increased emphasis on rehabilitation and transition.
The new system would promote resilience, self-reliance, re-education and employment; regardless if the Soldier returns to duty or moves on to civilian life.
Franks makes several other recommendations regarding policy changes, including designing performance measures to track Soldier satisfaction. He said the only current measure of performance is how long the board process takes, and feedback is needed in other areas.
His report also recommends:
Aca,!Ac continuing automation of MEB/PEB boards to speed up the process and make it transparent or smoother to Soldiers.
Aca,!Ac appointing an "employment czar" to help Soldiers transitioning out of the Army find jobs.
Aca,!Ac revamping lump-sum Army transition payments to provide a greater payout than the current severance formula.
Aca,!Ac increasing VA compensation by quality-of-life and transition payments.
After reading the report, Casey wrote in a letter to the other service chiefs that Franks "accomplished ground-breaking and transformational work."
"Leading an effort to expand the Warrior Ethos to wounded, ill and injured Soldiers was an honor," Franks said. "I saw it as a continuation of a promise I made to my fellow wounded warriors long ago."
This month, Franks has been asked by the Army chief of staff to conduct a further review of the Army's existing MEB/PEB processes for Army Reserve and National Guard Soldiers.
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